Yu Arita

Impact of Heterogeneity of Human Peripheral Blood Monocyte Subsets on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction

OBJECTIVES We examined whether distinct monocyte subsets contribute in specific ways to myocardial salvage in patients with acute myocardial infarction (AMI). BACKGROUND Recent studies have shown that monocytes in human peripheral blood are heterogeneous. METHODS We studied 36 patients with primary AMI. Peripheral blood sampling was performed 1, 2, 3, 4, 5, 8, and 12 days after AMI onset. Two monocyte subsets (CD14(+)CD16(-) and CD14(+)CD16(+)) were measured by flow cytometry. The extent of myocardial salvage 7 days after AMI was evaluated by cardiovascular magnetic resonance imaging as the difference between myocardium at risk (T2-weighted hyperintense lesion) and myocardial necrosis (delayed gadolinium enhancement). Cardiovascular magnetic resonance imaging was also performed 6 months after AMI. RESULTS Circulating CD14(+)CD16(-) and CD14(+)CD16(+) monocytes increased in AMI patients, peaking on days 3 and 5 after onset, respectively. Importantly, the peak levels of CD14(+)CD16(-) monocytes, but not those of CD14(+)CD16(+) monocytes, were significantly negatively associated with the extent of myocardial salvage. We also found that the peak levels of CD14(+)CD16(-) monocytes, but not those of CD14(+)CD16(+) monocytes, were negatively correlated with recovery of left ventricular ejection fraction 6 months after infarction. CONCLUSIONS The peak levels of CD14(+)CD16(-) monocytes affect both the extent of myocardial salvage and the recovery of left ventricular function after AMI, indicating that the manipulation of monocyte heterogeneity could be a novel therapeutic target for salvaging ischemic damage.

Electrocardiographic strain and endomyocardial radial strain in hypertensive patients

BACKGROUND Electrocardiographic strain pattern (ECGS) is a well-recognized marker of the presence and severity of anatomic left ventricular hypertrophy (LVH) and also has been associated with adverse prognosis in hypertensive patients. Left ventricular (LV) endomyocardial radial strain (Endo-RS) is predominant in systolic LV wall thickening compared with epimyocardial radial strain (Epi-RS) in a normal heart. However, it remains unclear whether the ratio of Endo-RS to Epi-RS alters in hypertensive patients, especially in those with ECGS. METHODS Endo-RS and Epi-RS in 9 non-hypertensive subjects (Group A), 26 hypertensive subjects without ECGS (Group B), and 16 hypertensive subjects with ECGS (Group C) were assessed by a tissue tracking system. RESULTS Relative wall thickness, LV mass index, and voltage of SV1+RV5 were significantly greater in Group C than in both Groups A and B. Although no significant difference was seen in Epi-RS among the 3 groups, Endo-RS and the ratio of Endo-RS to Epi-RS (Endo/Epi-RS) in Group C were significantly lower than those in the other two groups. Multiple logistic regression analysis revealed that the only factor which significantly correlated with Endo/Epi-RS in the first tertile (<1.6) was the presence of ECGS (OR=9.28, p=0.01). CONCLUSIONS The appearance of ECGS significantly correlated with not only the development of LV hypertrophy but also with the attenuation of Endo-RS.

Usefulness of rescue ultrasound guidance for transradial cardiac catheterization

INTRODUCTION AND OBJECTIVES Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization. METHODS We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n = 280) and the ultrasound guidance (UG) available group (n = 312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators. RESULTS Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p = 0.62). Although the procedural time in the UG group was longer than that in the PT group (303 s vs. 357 s, p < 0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p < 0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24-6.31, p = 0.01). CONCLUSIONS Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization.

Safety and efficacy outcomes of second-generation everolimus-eluting stents in octogenarians compared to non-octogenarians ☆

BACKGROUND In patients ≥80 years of age, the use of second-generation cobalt-chromium everolimus-eluting stents (CoCr-EES) versus bare-metal stents has been shown to reduce myocardial infarction (MI) and target vessel revascularization (TVR) rates, without an increase in bleeding. However, safety and efficacy of CoCr-EES in octogenarians compared to younger populations are less certain. We aimed to compare the clinical outcomes between octogenarian and non-octogenarian patients undergoing percutaneous coronary intervention (PCI) with CoCr-EES. METHODS We retrospectively analyzed 186 patients treated with CoCr-EES; 54 octogenarians (63 lesions) and 132 non-octogenarians (152 lesions). The primary endpoint was a 1-year composite of all-cause death, MI, TVR, cerebrovascular accident (CVA), or major bleeding. Stent thrombosis (ST) was also evaluated. RESULTS Radial approach was used in 70.4% of octogenarians versus 80.3% of non-octogenarians (p = 0.18). Rates of dual antiplatelet therapy at 1 year were 90.7% for octogenarians and 90.9% for non-octogenarians (p = 1.00). The primary endpoint occurred in 14.8% of octogenarians and 11.4% of non-octogenarians (p = 0.52). There were no significant differences with respect to the rates of 1-year all-cause death (7.4% vs. 3.8%, p = 0.30), MI (1.9% vs. 1.5%, p = 1.00), TVR (3.7% vs. 5.3%, p = 0.65), CVA (1.9% vs. 2.3%, p = 1.00), and definite/probable ST (1.9% vs. 1.5%, p = 1.00) between the 2 groups. Major bleeding was observed in only 1 of octogenarians. Multivariate analysis demonstrated that chronic kidney disease and intravascular ultrasound use were the only independent predictors of the primary endpoint. CONCLUSIONS According to our series, 1-year safety and efficacy outcomes of CoCr-EES PCI in octogenarians were comparable to those in non-octogenarians. SUMMARY We compared the clinical outcomes between octogenarian and non-octogenarian patients treated with second-generation cobalt-chromium everolimus-eluting stents (CoCr-EES). In our series, 1-year safety and efficacy outcomes of CoCr-EES percutaneous coronary intervention in octogenarians were similar to those in younger counterparts.

P-84 ECG Strain Pattern is Related to Endo/Epimyocardial Radial Strain Ratio and Coronary Flow Velocity Reserve in Hypertensive Patients

P-82 Relation Between Functional Stenosis and Tissue Characterization of Moderate Coronary Plaque with Patients of Stable Coronary Heart Disease Shinichiro Tanaka, Toshiyuki Noda, Tomonori Segawa, Shintaro Abe, Reiko Matsuoka, Yoshiaki Goto, Tomoko Hirose, Takashi Katou, Tai Kojima, Shunichiro Warita, Takeshi Hirose, Makoto Iwama, Koji Ono, Haruki Takahashi, Sachiro Watanabe. Department of Cardiology, Gifu Prefectural General Medical Center, Japan