Immediate elastic recoil during coronary angioplasty: incidence and predictors

Background: Percutaneous coronary angioplasty remains one of the most commonly applied techniques in the management of coronary artery disease in patients with suitable coronary anatomy. However, one of the factors that limit its effectiveness is the occurrence of elastic recoil immediately after dilatation

Aim: To assess the incidence and magnitude of elastic recoil that occurs immediately after coronary angioplasty and to detect the clinical and angiographic predictors of this process

Patients and Methods: Forty ischemic heart patients who were scheduled for percutaneous transluminal coronary angioplasty [PTCA] with clinical diagnosis of stable angina, unstable angina or prior myocardial infarction [MI].Their ages ranged between 31-76 years; with a mean age of 49.47+/- 11.89 years. Thirty-six [90%] were males and four [10%] were female. Qualitative and quantitative coronary angiographic evaluation before, during, and after PTCA were done for all patients included in this study to detect the occurrence of elastic recoil, its magnitude, and its predictors

Results: All patients showed different degrees of elastic recoil; with an average of 0.56+/-0.43 mm. Elastic recoil was responsible for a mean cumulative loss of 18.84 +/- 14.19 and of theoretically achievable gain immediately after balloon deflation. The following factors were found to have a positive correlation with the increased incidence and degree of recoil: balloon over sizing, lesion calcification, and eccentricity of lesion. However, elastic recoil was not influenced by age, sex, coronary risk factors or the patient's clinical diagnosis [stable angina, unstable angina old MI]

Conclusion: Elastic recoil was extremely common and caused loss of nearly 20% of the potential gain obtained during maximal balloon inflation. The present study identified the predictors of this unwanted event: the use of an oversized balloon for dilatation, lesion calcification, and lesion eccentricity

Assessment of wall motion abnormalities by tissue Doppler in patients with myocardial infarction

Background: Doppler Tissue Imaging [DTI] is a non invasive ultrasound technique, which allows measuring velocities at any point of the ventricular wall during the cardiac cycle

Objective: To evaluate the clinical feasibility of DTI as a new method for detection and quantification of regional wall motion abnormalities [WMA] in patients with old myocardial infarction [MI]

Patients: Forty patients with old MI who had angiographically-documented significant stenotic lesions in the infarct-related artery and WMA in the infracted area were evaluated in addition to twenty healthy subjects as a control group

Methods: Regional wall motion of each of the anterior and inferior wall segments of the left ventricle was assessed by conventional two-dimensional [2-D] echocardiography and pulsed wave DTI. The later includes the measurement of Peak Myocardial Velocity [PMV] and Myocardial Velocity Gradient [MVG]

Results: The peak MV and MVG in the studied myocardial segments of control subjects ranged between 4 to 15 cm/s and 1 to 3.85 cms-1 respectively. In patients group, myocardial segment supplied by diseased coronary vessel in the infracted area were found to have highly significant reduction in both MV and MVG compared to the same segment in control subjects [p<0.001].The sensitivity for detection of WMA was markedly improved by DTI studies [92.5% for MV and 100% for MVG versus 52.5% for 2-D echo] with retaining the high specificity inherited by conventional echocardiography

Conclusion: Compared to conventional 2-D echocardiography, pulsed wave DTI is an accurate, highly sensitive non-invasive method to detect and quantify regional WMA induced by coronary artery disease. It is almost as accurate as contrast ventriculography in this regard, so it may be the best imaging technique for detection of WMA at rest and with different cardiovascular stresses

Impact of doppler tissue imaging in the assessment of regional wall motion abnormalities in patients with old myocardial infarction

Doppler Tissue Imaging [DTI] is an emerging non-invasive ultrasound technique, which allows measuring velocities at any point of the ventricular wall during the cardiac cycle.To evaluate the clinical feasibility of DTI as a new method for detection and quantification of regional Wall Motion Abnormalities [WMA] in patients with old Myocardial Infarction [MI].Fourty patients with old MI who had angiographically-documented significant stenotic lesion in the infarct-related artery and WMA in the infarcted area were evaluated in addition to twenty healthy subjects[control group].Regional wall motion of each of the anterior and inferior wall segments of the left ventricle was assessed by conventional 2-D echocardiography and pulsed wave DTI. The later includes the measurement of Peak Myocardial Velocity [PMV] and Myocardial Velocity Gradient [MVG].The peak MV and MVG in the studied myocardial segments of control subjects ranged between 4 to 15 cm/s and 1 to 3.85 cms.[-l] respectively. In patients group, Myocardial segments supplied by diseased coronary vessel in the infarcted area were found to have highly significant reduction of both MV and MVG compared to the same segments in control subjects [p<0.001]. The sensitivity for detection of WMA was markedly improved by DTI studies [92.5% for MV and 100% for MVG versus 52.5% for 2-D echo] with retaining the high specificity inherited by conventional echocardiography .Compared to conventional 2-D echo, pulsed wave DTI is an accurate, highly sensitive non-invasive method to detect and quantify regional WMA induced by coronary artery disease. It is almost as accurate as contrast ventriculography in this regard, so it may be the best imaging technique for detection of WMA at rest and with different cardiovascular stresses

Feasibility and accuracy of acoustic quantification and color kinesis in assesment of regional and global systolic left ventricular function in patient with coronary artery disease

The analysis of segmental wall motion using two-dimentional [2-D] echocardioglaphy is subjective with inter-obsever variability.Color kinesis is new technique providing color-encoded map of endocardial motion. We evaluated the accuracy of Acoustic Quantification [AQ] and 2-D for assessment of global and regional LV systolic function compared with LV angiography as a reference method. Forty ischemic heart patients who underwent coronary angiography were included in this study in addition to 10 healthy control subjects. Control subjects and patients were evaluated by 2-D, AQ and color kinesis echocardiography. Coronary Angiography and LV angiography were done for ischemic heart patients. Regional wall motion pattern [normal, hypokinesis, Akinesis, dyskinesis as well as EF were determined. Accuracy of AQ color kinesis and 2-D were evaluated and compared to LV angiography. LVEF measured by 2-D and color kinesis were closely correlated with that estimated from contrast LV angiography ventriculography[r= 0.95 and r= 0.97 respectively]. Color kinesis compared to 2-D, enhance the accuracy of EF measurements.In control subjects there was a very close agreement of 2-D and color kinesis as regard the pattern of regional wall motion. In patients group, color kinesis was significantly better than 2-D on the definition of normal versus abnormal segments [95.2% of segments correctly evaluated by color kinesis versus 86.1% by 2-D, p < 0.05]. Color kinesis is a new echocardiographic technique that provide more accurate semiquantitative assessment of regional wall motion abnormalities. Additionally, AQ is a convenient method for better measurement of EF

Incidence and predictors of immediate elastic recoil after percutaneous translumenal coronary angioplasty

To assess the incidence and magnitude of elastic recoil that occurs immediately after coronary angioplasty and to detect the clinical and angiographic predictors of this process. Forty ischaemic heart patients who were scheduled for PTCA: with clinical diagnosis of stable angina, unstable angina or prior myocardial infarction [MI Their ages ranged 31-76 years; with mean age 49.47 +/- 11.89 years. Thirty-six [90%]were males and four [10%]were female Qualitative and Quantitative coronary angiographic evaluation before, during, and immediately after PTCA were done for all patients included in this study to detect the occurrence of elastic recoil, its magnitude, and its predictors. All patients showed different degrees of elastic recoil; with an average of 0.56 +/- 0.43 mm. Elastic recoil was responsible for a mean cumulative loss of 18.48 +/- 14.19% of the theoretically achievable gain immediately after balloon deflation. The following factors were found to have a positive correlation with the increased incidence and degree of recoil: bal loon over sizing, lesion calcification, and eccentricity of lesion. However, elastic recoil was not influenced by age, sex, coronary risk factors or the patient's clinical diagnosis [stable angina, unstable angina or old MI]. Elastic recoil was extremely common and caused loss of nearly 20% of the potential gain obtained during maximal balloon inflation. The present study identified the predictors of this unwanted event: the use of an oversized balloon for dilatation, lesion calcification and lesion eccentricity