Tomoyori Nakatogawa

Reliability of resolution of ST-segment elevation after coronary reperfusion in predicting myocardial salvage in anterior wall acute myocardial infarction

Resolution of ST-segment elevation (ST resolution) after reperfusion therapy has been shown to correlate with improved left ventricular (LV) function in patients with acute myocardial infarction (AMI). However, not all patients with ST resolution have preserved LV function. We evaluated the clinical significance of ST resolution in 129 patients with anterior wall AMI who underwent successful coronary recanalization within 6 hours after symptom onset by studying the relation to myocardial blush grade, another angiographic marker of myocardial reperfusion. A reduction of > or =50% in ST-segment elevation after recanalization was defined as ST resolution. Ninety-eight patients had ST resolution and 31 patients did not. Patients with ST resolution were subdivided into 2 groups according to myocardial blush grade after recanalization: 67 patients with blush grade 2 or 3, and 31 with blush grade 0 or 1. The QRS score after recanalization was higher (5.9 +/- 1.9 vs 3.4 +/- 2.0, p <0.01) and predischarge LV ejection fraction was lower (39 +/- 8% vs 57 +/- 9%, p <0.01) in patients with blush grade 0 or 1 than in those with blush grade 2 or 3. However, the QRS score after recanalization and the predischarge LV ejection fraction were similar in patients who had ST resolution with blush grade 0 or 1 and in those without ST resolution. Our findings suggest that ST resolution after recanalization does not consistently predict myocardial salvage in patients with anterior AMI.

Intracoronary Ultrasound Diagnosis of an Aortic Dissection Causing Anterior Acute Myocardial Infarction

A 63-year-old woman with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to her back. The ECG (Figure 1A) showed marked ST-segment elevation in leads I, aVL, and V1-V6 and ST-segment depression in leads II, III, and aVF, suggesting acute anterior myocardial infarction. An emergency coronary angiogram demonstrated a long tight lesion of 99% stenosis (Figure 1B) in the left anterior descending coronary artery (LAD), just after the bifurcation of the left circumflex artery (LCx). …

IMPACT OF LIPID-LOWERING THERAPY ON CORONARY PLAQUE COMPOSITION IN PATIENTS WITH STABLE AND UNSTABLE ANGINA EVALUATED BY INTRAVASCULAR ULTRASOUND WITH VIRTUAL HISTOLOGY; FINDINGS FROM THE SUBANALYSES OF THE TRUTH STUDY

Background: Previous trials have shown that lipid-lowering therapy can improve clinical outcomes and achieve regression of coronary plaques. The TRUTH study, a prospective, open-label, randomized multicenter trial, was designed to evaluate the effect of statins on coronary plaque composition in patients with anigina pectoris by using intravascular ultrasound with Virtual Histology(VH-IVUS) in Japan. The aim of this subanalysis was to examine the effects of statins on coronary plaques in patients with unstable angina.

P-212: Long-term effects of medical therapy on autonomic control of heart rate in patients with congestive heart failure with or without hypertension

Since reduced heart rate variability (HRV) is known to be a predictor of prognosis of congestive heart failure, we examined long-term effects of conventional medical therapy on HRV in 314 patients with congestive heart failure (6261 years, NYHA classification 1 to 4), consisting with dilated cardiomyopathy, coronary artery disease, or hypertensive heart disease. Patients were randomly assigned to beta-blocker, angiotensin converting enzyme (ACE) inhibitor, dihydropyridine derivatives, diltiazem, nitrate, or these combinations with or without digitalis and furosemide therapy. 48 patients were treated only by life style modification (LIFE). 24-hour ECG recordings were repeated before and after the therapy (mean duration: 76 weeks), and HF (0.15-0.4 Hz), TF(0.004-1 Hz) and LF (0.04-0.15 Hz) /HF ratio of HRV were calculated by maximum entropy method. Both HF and TF were significantly (p ,0.01) deceased in LIFE while those in beta-blocker were significantly (p ,0.01) increased. None of the interval changes in the rest of therapy groups was significant. Although none of the baseline values between groups before therapy was significant, both HF and TF were significantly (p ,0.01) lower after therapy in dihydropyridine and nitrate groups than those in beta-blocker group. However, when dihydropyridine and nitrate were used as a combination drug with ACE inhibitor or beta-blocker, these differences vanished. In conclusion, long-term beta-blocker therapy only improves autonomic control of heart rate in patients with heart failure. Furthermore, dihydropyridine or nitrate may be useful only when these drugs were used as combination drug with ACE inhibitor or beta-blocker.