Robert Jung

CABG Mortality is Not Influenced by Prior PCI in Low Risk Patients

An increasing number of patients referred for coronary artery bypass grafting (CABG) have had prior percutaneous coronary intervention (PCI). We sought to determine whether a relationship exists between increased postoperative mortality and morbidity following CABG procedure in patients with prior PCI.

Myocardial damage size assessment in the zone of infarction for indicating rescue percutaneous coronary intervention

BACKGROUND The most important predictors of subsequent patients outcome after acute myocardial infarction (AIM) are infarct size, left ventricular ejection fraction, left ventricular volumes and presence and extent of residual myocardial ischemia. All of these variables can be directly determined through scintigraphic approaches. The presence and extent of myocardial ischemia are strong pre dictors for fatal and nonfatal cardiac events and improve risk statification beyound the information gleaned from clinical variables. CASE REPORT We presented a case of 66-years-old male with myocardial infarction of anteroseptal localization. Myocardial perfusion imaging (MPI) detected a large zone of residual ischemia (culprit lesion) within infarction zone. It has an important role in risk stratification after myocardial infarction, and indicates subsequent therapeutic decision making, in this case rescue percutaneous coronary intervention (PCI). After PCI we followed the therapy effect by MPI, and we found practically normal perfusion with minimal zone of defect perfusion in the apex. CONCLUSION Myocardial perfusion imaging has an important role in the initial evaluation and risk stratification of patients surviving myocardial infarction. It also plays a major role in guiding subsequent therapeutic decision making, and in monitoring the benefits of these therapeutic measures.

Miopericarditis: Diagnostic dilemmas in relation to acute myocardial infarction

Introduction. Miopericarditis with clinical presentation of chest pain, electrocardiographic changes and positive cardio specific enzymes is often a differential diagnostic dilemma in relation to acute myocardial infarction. Literature data are very scarce and only case reports or small series of patients can be found in the literature so each case is a significant contribution to this issue. Case report. A 19-year-old patient was admitted to the intensive care unit, with chest pain, electrocardiographic signs of suspected myocardial lesion and highly positive cardio specific enzymes. Since echocardiography revealed segmental hypocinesia of the left ventricle, urgent coronary angiography was done, which diagnosed normal luminogram of coronary arteries. Having received the adequate therapy, the patient was subjectively asymptomatic, hemodynamically stable, sub-febrile at the beginning of hospitalization. Two weeks after admission, the patient was discharged in good condition with diagnosis of myopericarditis. Conclusion. This case shows that it is sometimes difficult to differentiate acute miopericarditis from acute myocardial infarction only according to anamnesis, clinical, electrocardiographic sings and echocardiography.

Myocardial Perfusion Imaging in Diagnosis of Culprit Lesion in Patients Undergoing Elective Percutaneous Coronary Intervention

Myocardial perfusion imaging (MPI) was developed in the 1970s and has been used increasingly in clinical cardiology since the 1980s (Underwood et al., 2004). Technical developments that have fuelled this recent increases are single-photon emission computed tomography (SPECT) imaging, pharmacological stress and ECG-gated SPECT imaging. MPI comprises the only widely available method of assessing myocardial perfusion directly and many previously published reports support its evidence in the diagnosis of myocardial ischemia and necrosis. Moreover, the prognostic value of this method for patients’ risk stratification has already been extensively reported, with an incremental prognostic value after clinical assessment, exercise electrocardiography and even above coronary angiography. Thus, MPI is an established imaging technique that is already an integral part of the management of coronary artery disease (CAD) (diagnosis, prognostication, selection for revascularization and assessment of acute coronary syndromes) and is included in a number of professional guidelines. (1, 2) In the past two decades, a great body of literature has established the use of nuclear imaging for risk stratification in patients with known or suspected CAD. Risk stratification is of crucial importance for the practice of contemporary medicine. Extending the paradigm of noninvasive cardiac testing beyond the detection of disease is especially important, may risk assessment permits patients who are identified as being at a high risk for subsequent cardiac events should receive aggressive management, possibly including cardiac catheterization for potential revascularization procedures that may improve their outcome. Conversely, the management focus in patients with low future event rate should be shifted toward risk factor modification and aggressive medical therapy, reserving invasive procedures for

Wall stress in ischemic heart disease

Introduction Wall stress or wall tension is a conception derived from physics (Laplaces law) and represents the systolic force or work per surface unit. It is the systolic force made by myocardial tissues. Stress increase indicates enlargement of the left ventricle or increase of intracavitary pressure. Material and methods This investigation included 170 subjects; control group consisted of 50 patients (pts) with normal coronary angiographic finding without valvular anomalies and the examination group included 120 pts with coronary disease. Transthoracic echocardiography was performed in the left lateral position using computerized Hewlett Packard Sonos 1000 apparatus. Invasive hemodynamic procedure was performed using General Electrics CGR 300. Meridional and equatorial systolic and diastolic stress were calculated according to Grossman formula. Results The meridional end-diastolic equatorial stress was 18.55(12.12 dyn/cm2 x 10³ in the control group, while in coronary patients it was 28.15±13.42 dyn/cm2 x 10³. In healthy persons the meridional end-systolic stress established by echocardiography was 190.37±23.15 dyn/cm2 x 10³, while in coronary patients 203.82±17.88 dyn/cm2 x 10³. End-diastolic equatorial stress was 34.32±17.18 dyn/cm2 x 10³ in the control group and 46.13(17.82 dyn/cm2 x 10³ in coronary patients. Systolic equatorial stress in the control group was 357.42(32.15 dyn/cm2 x 10³ and in coronary patients 385.34(35.72 dyn/cm2 x 10³. The same parameters determined by invasive hemodynamic procedure were slightly higher, but without statistical significance in relation to the values determined by echocardiography (P>0.05). Conclusion Values equatorial and particulary meridional stress were higher in coronary patients in relations to healthy persons, but without significant difference. The correlation coefficients of all investigated parameters established by noninvasive 2D echocardiography and invasive hemodynamic procedure were in one domain of medium high values. meridional stress increases in coronary patients equatorial in hypertensive patients or valvular anomalies with severe myocardial hypertrophy. In regard to high correlation between these two techniques, echocardiography may be considered a highly reliable method in evaluation of wall tension.