R. Bing

Percutaneous Transcatheter Assessment of the Left Main Coronary Artery: Current Status and Future Directions.

Accurate assessment of the left main coronary artery (LMCA) is critical in determining treatment strategies and delineating revascularization options to improve prognosis. There has been an evolution in invasive techniques that allow detailed assessment of both function and anatomy. As technologies advance, there is an increasing amount of evidence supporting the use of percutaneous coronary intervention for the LMCA. This state-of-the-art paper provides an in-depth exploration of intravascular ultrasound, fractional flow reserve, and optical coherence tomography. A discussion is provided that explores the basis for application of these technologies, the body of evidence for each modality and its use in LMCA assessment, and the potential role in post-PCI optimization in what is a dynamically changing field.

Prevalence of Echocardiography Use in Patients Hospitalized with Confirmed Acute Pulmonary Embolism: A Real-World Observational Multicenter Study

Background Acute pulmonary embolism (PE) carries an increased risk of death. Using transthoracic echocardiography (TTE) to assist diagnosis and risk stratification is recommended in current guidelines. However, its utilization in real-world clinical practice is unknown. We conducted a retrospective observational study to delineate the prevalence of inpatient TTE use following confirmed acute PE, identify predictors for its use and its impact on patient’s outcome. Methods Clinical details of consecutive patients (2000 to 2012) from two tertiary-referral hospitals were retrieved from dedicated PE databases. All-cause and cause-specific mortality was tracked from a state-wide death registry. Results In total, 2306 patients were admitted with confirmed PE, of whom 687 (29.8%) had inpatient TTE (39.3% vs 14.4% between sites, P<0.001). Site to which patient presented, older age, cardiac failure, atrial fibrillation and diabetes were independent predictors for inpatient TTE use, while malignancy was a negative predictor. Overall mortality was 41.4% (mean follow-up 66.5±49.5months). Though inpatient TTE use was not an independent predictor for all-cause or cardiovascular mortality in multivariable analysis, in the inpatient TTE subgroup, right ventricle-right atrial pressure gradient (hazard ratio [HR] 1.02 per-1mmHg increase, 95% confidence interval [CI] 1.01–1.03) and moderate/severe aortic stenosis (HR 2.26, 95% CI 1.20–4.27) independently predicted all-cause mortality. Conclusions Inpatient TTE is used infrequently in real-world clinical settings following acute PE despite its usefulness in risk stratification, prognostication and assessing comorbid cardiac pathologies. Identifying patients that will benefit most from a TTE assessment following an acute PE episode and reducing barriers in accessing TTE should be explored.

Assessment of left main artery stenosis with fractional flow reserve is affected by downstream stenosis in the left anterior descending artery.

Coronary Artery Disease 2015, 26:e35–e37 Assessment of left main artery stenosis with fractional flow reserve is affected by downstream stenosis in the left anterior descending artery Rong Bing, Andy S.C. Yong and William F. Fearon, Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia and Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA Correspondence to Andy S.C. Yong, MBBS, PhD, Department of Cardiology, Level 3 West, Concord Repatriation General Hospital, 1A Hospital Road, Concord, Sydney, NSW 2039, Australia Tel: + 61 2 9767 5000; fax: + 61 2 9767 8395; e-mail: andy.yong@sydney.edu.au

No reflow in ST elevation myocardial infarction: a new way forward?

Cardiology Department, Level 3 West, Concord Repatriation General Hospital, Concord and Department of Medicine, University of Sydney, Sydney, New South Wales, Australia Correspondence to Harry C. Lowe, FRACP, PhD, MBChB, Cardiology Department, Level 3 West, Concord Repatriation General Hospital, Concord 2139, NSW, Australia Tel: + 61 2 9767 5000; fax: + 61 2 9767 8395; e-mail: h.lowe@bigpond.net.au