Viktor Sasi

Five-year experience with transradial coronary angioplasty in ST-segment-elevation myocardial infarction

BACKGROUND AND PURPOSE Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI). METHODS AND MATERIALS The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study. Forty-three patients were excluded from the present study due to cardiogenic shock or rescue PCI. Patients (n=539) were categorized into the TR group (n=167) or the TF group (n=372), and several parameters were evaluated to assess the advantages and drawbacks of TR access: access-site crossover, rate of access-site complications, procedure time, fluoroscopy time, X-ray area dose, major adverse cardiac events (MACE) at 1 month, and consumption of angioplasty equipment. RESULTS In the TR group, the crossover rate to femoral access was 5%, while in the TF group, it was 0.8% (P<.05). There was a significant difference, in both major and minor access-site complications, between the TR group and the TF group (0% vs. 5%, P<.05, and 4% vs. 9%, P<.05, respectively). Consumption of angioplasty equipment proved to be the same for the two groups. The MACE rate was 4% in the TR group and 11% in the TF group (P<.05). CONCLUSIONS Our results suggest that the TR approach is a safe and effective way to treat STEMI; furthermore, site-related complications are less common with this approach.

Serum lipids and cardiac function correlate with nitrotyrosine and MMP activity in coronary artery disease patients

Peroxynitrite‐matrix metalloproteinase (MMP) signalling has been shown to contribute to myocardial ischaemia/reperfusion injury and heart failure and to be influenced by hyperlipidaemia in preclinical models. Therefore, here we investigated the correlation between the markers of peroxynitrite–MMP signalling and hyperlipidaemia in patients with significant coronary stenosis.

Myocardium selective densitometric perfusion assessment after acute myocardial infarction

BACKGROUND Myocardial perfusion is an important prognostic factor after recanalisation in acute myocardial infarction patients. We present a computerized, densitometric measurement method to assess myocardial perfusion on phase-matched digitally subtracted coronary angiograms. METHODS AND MATERIALS Quantitative myocardial perfusion was assessed by the G(max)/T(max) parameter of the time-density curves (TDCs) in infarct-related myocardial regions on X-ray coronary angiograms. Arteries were masked out from regions of measurement. This novel method has been compared with enzymatic infarct size, ST-segment resolution, and ejection fraction after successful revascularization of 62 patients with acute myocardial infarction. RESULTS Significant correlations were found between G(max)/T(max) and enzymatic infarct size (R=-0.445, P<.001), ST-segment resolution (R=0.364, P=.004), and ejection fraction (R=0.278, P=.029). Bland and Altman plot of G(max)/T(max) reveals good interobserver agreement. CONCLUSIONS G(max)/T(max) of the TDC measured in the infarct-related myocardial area is a reliable parameter to assess clinical indicators of myocardial reperfusion. Therefore, results suggest that it could be used to immediately assess the success of recanalisation at the tissue perfusion level during coronary intervention, and as an objective end point in clinical trials of new interventional devices and drugs.

Correlations between myocardium selective videodensitometric perfusion parameters and corrected TIMI frame count in patients with normal epicardial coronary arteries

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Comparison of two visual angiographic perfusion grades in acute myocardial infarction.

Introduction. Prognosis after opening the obstructed coronary artery in acute myocardial infarction (AMI) is influenced by several factors. In routine clinical practice, revascularization is considered to be successful when the restoration of epicardial blood-flow is complete. However, the patent epicardial artery does not always provide functional recovery in the myocardium. There are two visual angiographic grades to assess myocardial perfusion: myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMP). The aim of our study was to compare these two parameters, how they correlate with short-term indicators of myocardial damage. Patients and methods. The two visual grades were assessed along with enzymatic infarct size as creatine kinase release (CK), echocardiographic left ventricular ejection fraction (LVEF), and ST-segment resolution (STR) in 62 patients with acute myocardial infarction and successful revascularization. Results. Better correlation was found with TMP in case of all clinical parameters (CK: R= − 0.687, P<0.001; LVEF: R=0.586, P<0.001; STR: R=0.574, P<0.001). MBG also showed significant correlations with clinical measurements, except for enzymatic infarct size (CK: R=− 0.062, P=0.626; LVEF: R=0.389, P=0.002; STR: R=0.348, P=0.006). Conclusion. Our findings suggest that the clearance of the dye (described by TMP) is more characteristic to myocardial recovery after AMI, than maximal contrast density (described by MBG) in the clinical practice.

Multiple coronary fistulas originating from all major coronary arteries.

Coronary fistulas to one of the cardiac chambers are infrequent anomalies and usually are found unexpectedly. Fistulas communicating between coronary artery and left heart chambers are extremely rare, especially those emptying into the left ventricle.We report a case in which all three major coronary arteries emptied into the left ventricle through multiple microfistulas.

Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve.

We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula. With the present case, the importance of functional evaluation of these fistulas is demonstrated.

Validation of videodensitometric myocardial perfusion assessment

IntroductionInvasive methods for assessment of coronary microcirculatory function are time- and instrumentation-consuming tools. Recently, novel computer-assisted videodensitometric methods have been demonstrated to provide quantitative information on myocardial (re)perfusion. The aim of the present prospective study was to evaluate the accuracy of videodensitometry-derived perfusion parameters in patients with stable angina undergoing elective coronary angiography.MethodsThe study comprised 13 patients with borderline epicardial coronary artery stenosis (40–70%). Coronary flow reserve and index of microcirculatory resistance were measured by using an intracoronary pressure and temperature sensor-tipped guidewire. A videodensitometric quantitative parameter of myocardial perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) of the time-density curves in regions of interest on conventional coronary angiograms. Myocardium perfusion reserve was calculated as a ratio of hyperemic and baseline Gmax/Tmax.ResultsAt hyperemia a significant increase in Gmax/Tmax could be observed (p <0.0001). Significant correlations were found between myocardium perfusion reserve and coronary flow reserve (r =0.82, p =0.0008) and between hyperemic Gmax/Tmax and hyperemic index of microcirculatory resistance (r =−0.72, p =0.0058).ConclusionsVideodensitometric Gmax/Tmax assessment seems to be a promising method to assess the myocardial microcirculatory state.

Aortic valve stenosis is associated with reduced myocardial perfusion as assessed by videodensitometry in coronary angiograms

UNLABELLED Aortic valve stenosis may be accompanied by angina despite coronary arteries free of significant stenosis due to microvascular abnormalities. AIMS The aim of the current study was to test whether densitometry-derived myocardial perfusion on coronary angiogram is reduced in patients with aortic valve stenosis. METHODS The study comprised 20 patients with aortic valve stenosis (mean transvalvular gradient: 47.4±15.2 mm Hg) and 30 control subjects without significant epicardial coronary artery stenosis. A quantitative parameter of myocardial perfusion was calculated by the ratio of maximal density (Gmax) and time to reach maximum density (Tmax) on time-density curves in regions of interest of each coronary artery on coronary angiograms. RESULTS Mean three-vessel Gmax/Tmax proved to be significantly lower in patients with aortic valve stenosis compared to control subjects (2.55±1.02 1/sec vs. 3.39±1.09 1/sec, p<0.01). CONCLUSIONS Reduced Gmax/Tmax values indicative of myocardial perfusion abnormalities as measured by densitometry on coronary angiograms could be demonstrated in patients with aortic valve stenosis compared to controls.

Erdheim-Chester's disease of the heart: a diagnostic conundrum and collision with the same mass in the orbit.

Erdheim-Chesters disease is a rare multisystem xanthogranulomatosis, afflicting the skeletal system with the occasional involvement of soft tissues. We delineate an unusual case of a cardiac variant of Erdheim-Chesters disease presenting with pericardial effusion and as a collision with a synchronous orbital manifestation. We describe our diagnostic pathway and propose a novel treatment option involving nonsteroidal anti-inflammatory drugs. The role of cyclo-oxygenase in the disease process and inhibition thereof by NSAIDs is hypothesized and discussed.