Hyo Seung Ahn

Non-invasively measured aortic wave reflection and pulse pressure amplification are related to the severity of coronary artery disease

BACKGROUND Augmentation index (AIx) and pulse pressure amplification (PPA, here the aortic/brachial pulse pressure ratio) are an age-related emerging risk factor for cardiovascular disease. However, it has not been clearly shown that AIx and PPA predict a high risk of coronary artery disease (CAD). OBJECTIVES The aim of the study was to investigate the association between non-invasively measured aortic wave reflection (AWR) and PPA and CAD. METHODS The study group consisted of 80 patients who were admitted to our institute for elective coronary angiography. We non-invasively measured augmentation pressure (AP), AIx, and PPA using radial applanation tonometry. RESULTS When the extent of CAD was divided by no or minimal CAD, 1- or 2- and 3-vessel disease (VD), there was a significant association between the extent of CAD and AIx and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. In multivariate regression analysis after controlling the traditional risk factors, the odds ratio of having 3VD was significant in patients aged <65 years: 2.15 (1.04-4.44; p=0.039) per 5% increase of AIx and 2.02 (1.15-3.55; p=0.015) per 0.05 increase of PPA, but not in patients aged ≥ 65 years. The severity of CAD expressed as a Gensini score showed a significant correlation with AP, AIx, and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. CONCLUSION Increasing of non-invasively measured AWR and PPA is related to the severity of CAD, particularly in younger patients up to 65 years of age.

Effect of Aspiration Thrombectomy on Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction With an Elevated Neutrophil Count.

Background and Objectives Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. Subjects and Methods Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm3, 5,300-7,600/mm3, and >7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. Results There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. Conclusion A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.

A Case of Primary Cardiac Lymphoma Mimicking Acute Coronary and Aortic Syndrome

Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.

EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION WITH CORONARY EVALUATION SIGNIFICANTLY IMPROVES SURVIVAL OF PATIENTS WITH OUT OF HOSPITAL CARDIAC ARREST

Out-of-hospital cardiac arrest (OHCA) is lethal problem. A large proportion of OHCA is caused by coronary artery disease. The aim of this study is to report the benefit of extracorporeal CPR (ECPR) and aggressive coronary evaluation in patients with witnessed OHCA patients compared to conventional

EFFICACY OF DIRECT STENTING WITHOUT PREDILATION DURING PERCUTANEOUS CORONARY INTERVENTION IN ACUTE MYOCARDIAL INFARCTION- A RANDOMIZED TRIAL EVALUATING MICROVASCULAR DYSFUNCTION WITH INDEX OF MICROCIRCULATORY RESISTANCE

Results: A total of 35 patients were randomized after exclusion of patients not suitable for stenting, Direct stenting strategy was feasible in 16 of patients among the initially randomized 17 pts (DS group) and compared to 19 patients with stenting after balloon predilation (PB group). There were no signiicant differences in age, sex, traditional risk factors, pain-to-treatment time, use of Glycoprotein IIb/IIIa Inhibitor. Infract location was more anterior in PB group (73.7%) than DS group (37.5%). Final TIMI grade 3 low (97.3% vs 78.9 %, p=0.04), inal TMP grade 2 or 3 (76.8% vs 64.2%, p=0.19), and average ST-segment resolution after the procedure (65.3% vs 54.3%, p=0.08), and peak CK-MB level (178 vs. 154 mg/ dL, p=0.25) were comparable between DS and PB group, but showed results favorable to DS group. IMR was signiicantly lower in DS group than PB group (22.6 vs. 32.6 mmHg∙sec, p=0.034). At one month, a cardiac death had occurred in 0 % in the DS group and 5.3 % in the PB group (p = 0.40). Conclusion: The DS without predilation after TA during primary PCI is safe and more effective strategy to improve myocardial perfusion than conventional aspiration thrombectomy. This preliminary report lends the support to the use of DS during the TA of acute STEMI favored by the low cost.