An Early Onset of Myocardial Infarction Patient with Syphilis and Familial Hypercholesterolemia / 罕见病研究

Syphilis may affect the cardiovascular system, in which coronary arteries are less commonly involved. Familial hypercholesterolemia (FH) is an autosomal dominant inherited disease with elevated low-density lipoprotein-cholesterol (LDL-C) levels due to impaired LDL-C clearance. We report a young male patient with syphilis and FH. The clinical manifestations were acute myocardial infarction and high LDL-C levels. Coronary angiography and intracoronary imaging showed multiple aneurysmal ectasia and stenosis. A drug-eluting stent was implemented when recurrent restenosis occurred after two percutaneous coronary drug-eluting balloon angioplasties.

Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India

The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients

Cardiac allograft vasculopathy after heart transplantation: summary of a single-center long-term follow-up experience in Fuwai Hospital / 器官移植

Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.

Effect of lipoprotein / 中南大学学报(医学版)

OBJECTIVES@#To analyze the effect of hyperlipoproteinemia (α) on immediate expansion after coronary stent implantation guided by intravascular ultrasound (IVUS).@*METHODS@#A total of 160 patients (175 lesions) with coronary heart disease diagnosed by coronary artery angiography, who were performed percutaneous intervention guided by IVUS in the Department of Cardiology, Third Xiangya Hospital, Central South University, were enrolled retrospectively.According to the concentration of lipoproteina, the patients were divided into 2 groups: a hyperlipoproteinemia (α) group and a control group. Cardiac ejection fraction was measured with echocardiography. Logistic regression was used to analyze the influential factors for hyperlipoproteinemia (α). The target vessel was examined by IVUS to analyze the immediate expansion effect of hyperlipoproteinemia (α) after stent implantation.@*RESULTS@#The mean stent expansion index, lesion length, stent number, stent symmetry index and posterior balloon diameter were (94.73±18.9)%, (52.92±29.1) mm, (2.11±0.85), (83.62±13.07)%, and (9.46±2.00) mm in the hyperlipoproteinemia (α) group, respectively. Compared with the control group, there were significantly difference (all @*CONCLUSIONS@#Hyperlipoproteinemia (α) appears to be a predictor of stent underexpansion, and the decreased creatinine clearance rate is an independent risk factor for hyperlipoproteinemia (α).

Clinical Outcome of Intravascular Ultrasound Guided Left Main Coronary Intervention

ntroduction: Intravascular ultrasound is a new imaging modality that facilitate the process of coronary intervention. The angiographic evaluation of left main lesions significance is always questionable, IVUSdetect the significance, guide the procedure and some studies proves a benefit in mortality.Objectives:To investigate whether intravascular ultrasound IVUS guided Left Main coronary intervention could improve clinical outcomes compared with angiographic-guided Left main coronary PCI.Patientsand Methods:This controlled study was carried out between June 2017 and June 2019, in Tanta university Hospital and San Donato Hospital, Milan, 83 patients eligible to Left Main coronary intervention divided into two groups, IVUS-guided group (n=19) and angiographic-guided group(n=64). The occurrence of major adverse cardiac events(MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded 6 and18Months of follow-up Results:The IVUS-guided group had a lower rate of 18-months MACE than the control group. The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group. The incidence of TLR after 6 months was not different between both groups (1 cases in IVUS group (5.3%), 6 cases in angiography group (9.4%) (P value 0.686) while the incidence of TLR after 18 months was significantly different between both groups (1 cases in IVUS group (5.3%), 17 cases in angiography group(26.6%) (Pvalue 0.048), However, there were no differences in death, myocardial infarction, stent thrombosis and number of patients treated with CABG in the 2 groups.Conclusion:The present study demonstrates that IVUS-guided LM angioplasty can improve 18 -months MACE events especially the incidence of target lesion revascularization

Definite stent thrombosis among Malaysian population: predictors and insights of mechanisms from intracoronary imaging

@#Introduction: Stent thrombosis (ST) is an uncommon, but significant complication following angioplasty. We aimed to examine the predictors, clinical outcomes and mechanism of definite ST cases among patients who underwent percutaneous coronary intervention (PCI). Methods: This was a retrospective observational registry of 14,935 patients from the year 2011 till 2015. Clinical characteristics, clinical outcome and intracoronary imaging data were recorded in all the patients. The SPSS Statistic version 24 was used for statistical analysis. The Cox regression hazard model was used to report calculate the hazard ratio (HR) with a 95% confidence interval (95%CI). Independent predictors of ST were identified by univariate logistic regression analysis. Variables that showed a statistically significant effect in univariate analyses were entered in a multivariate Cox proportional hazards model. A p-value<0.05 was regarded as significant. Results: The incidence of definite ST was 0.25% (37 out of 14935 patients). 75% of ST group patients presented with ST elevation myocardial infarction (75% vs. 19.8%, p<0.01). There was higher mortality among patients with ST when compared to the group without ST (Hazard Ratio, HR=10.69, 95%CI: 1.13, 100). Two independent predictors of ST were 1) previous history of acute myocardial infarction (HR=2.36, 95%CI: 1.19, 4.70) and 2) PCI in the context of acute coronary syndrome when compared to elective PCI (HR=37, 95%CI: 15.7, 91.5). Examination of 19 ST cases with intracoronary imaging identified nine cases (47%) of underexpanded stents and five cases (26%) of malopposition of stents. Conclusions: ST is associated with high mortality. PCI in acute coronary syndrome setting and a previous history of acute myocardial infarction were significant predictors for ST. Intracoronary imaging identified stent underexpansion and malopposition as common reasons for ST. In cases where the risk of ST is high, the use of intracoronary imaging guided PCI is recommended.

Influence of intravascular ultrasound on the prognosis of patients after rotational atherectomy / 医学研究生学报

ObjectiveThe development of new endovascular imaging techniques has optimized surgical treatment strategies. In this paper, we investigated the effect of rotational atherectomy (RA) guided by intravascular ultrasound (IVUS) on long-term postoperative follow-ups.MethodsClinical data of 211 patients who underwent RA in the Department of Cardiology, Nanjing Drum Tower Hospital from November 2011 to December 2018 were retrospectively analyzed, and they were divided into IVUS Group (116 patients) and Non-IVUS Group (95 patients) according to whether they underwent the guidance of intravascular ultrasound or not. Basic information of all patients, coronary artery lesions and details of operation and other clinical data were collected. The long-term prognosis of the patients was collected and compared by telephone or outpatient follow-ups.ResultsThe head diameter, average stent diameter and total hospitalization expenses of the IVUS Group were significantly higher than those of the Non-IVUS Group, and the differences were statistically significant [(1.53±0.19) mm vs (1.46±0.14) mm, P=0.001; (3.09±0.48) mm vs (2.87±0.30) mm, P0.05). Multivariate COX regression analysis showed that the cardiogenic mortality was significantly reduced in the IVUS Group (HR=0.10, 95%CI: 0.02~0.63, P=0.014), but there was no statistically significant difference between the two groups in the incidence of all-cause death and long-term MACE (P>0.05).ConclusionCompared with the Non-IVUS Group, IVUS-guided RA can significantly reduce the incidence of long-term cardiogenic death and total hospitalization expenses.

Influence of intravascular ultrasound on the prognosis of patients after rotational atherectomy / 医学研究生学报

ObjectiveThe development of new endovascular imaging techniques has optimized surgical treatment strategies. In this paper, we investigated the effect of rotational atherectomy (RA) guided by intravascular ultrasound (IVUS) on long-term postoperative follow-ups.MethodsClinical data of 211 patients who underwent RA in the Department of Cardiology, Nanjing Drum Tower Hospital from November 2011 to December 2018 were retrospectively analyzed, and they were divided into IVUS Group (116 patients) and Non-IVUS Group (95 patients) according to whether they underwent the guidance of intravascular ultrasound or not. Basic information of all patients, coronary artery lesions and details of operation and other clinical data were collected. The long-term prognosis of the patients was collected and compared by telephone or outpatient follow-ups.ResultsThe head diameter, average stent diameter and total hospitalization expenses of the IVUS Group were significantly higher than those of the Non-IVUS Group, and the differences were statistically significant [(1.53±0.19) mm vs (1.46±0.14) mm, P=0.001; (3.09±0.48) mm vs (2.87±0.30) mm, P0.05). Multivariate COX regression analysis showed that the cardiogenic mortality was significantly reduced in the IVUS Group (HR=0.10, 95%CI: 0.02~0.63, P=0.014), but there was no statistically significant difference between the two groups in the incidence of all-cause death and long-term MACE (P>0.05).ConclusionCompared with the Non-IVUS Group, IVUS-guided RA can significantly reduce the incidence of long-term cardiogenic death and total hospitalization expenses.

Rol del ultrasonido intravascular en el diagnóstico de la disección coronaria espontánea / Role of intravascular ultrasound in the diagnosis of spontaneous coronary artery dissection / Papel da ultrassonografia intravascular no diagnóstico da dissecção espontânea das coronárias

Resumen: El diagnóstico de disección coronaria espontánea como causa de síndrome coronario agudo ha aumentado desde el surgimiento de las técnicas de imagen intracoronaria. Aún así, continúa siendo una entidad subdiagnosticada. La evidencia en relación con el tratamiento es escasa, pero la conducta conservadora ha demostrado resultados favorables en pacientes seleccionados. Presentamos el caso de una paciente de 55 años en la que se diagnostica infarto de miocardio sin elevación del ST. En la cineangiocoronariografía se sospecha como mecanismo causal la disección coronaria espontánea, lo cual se confirma mediante ultrasonido intravascular. Se optó por un tratamiento conservador con buena evolución.

Summary: The diagnosis of spontaneous coronary artery dissection as a cause of acute coronary syndrome has increased since the arise of intravascular imaging techniques. However, it still remains an underdiagnosed entity. Evidence related to its management is scarce, but conservative strategies have shown favorable outcomes in selected patients. We present the case of a 55-year-old female patient who is diagnosed with a non-ST segment elevation myocardial infarction. Spontaneous coronary artery dissection is suspected in the coronary angiography and then confirmed by intravascular ultrasound. Conservative management was selected, with favorable clinical outcomes.

Resumo: O diagnóstico de dissecção coronariana espontânea como causa da síndrome coronariana aguda aumentou com o surgimento das técnicas de imagem intracoronariana. Apesar disso é uma entidade subdiagnosticada. A evidência sobre o tratamento é escassa, mas o tratamento conservador mostrou resultados favoráveis em pacientes selecionados. Apresentamos o caso de um paciente de 55 anos com diagnóstico de infarto do miocárdio sem supradesnivelamento do segmento ST. Suspeita-se de dissecção coronariana espontânea na angiografia, confirmada por ultrassonografia intravascular. Se optou por tratamento conservador com boa evolução.

Optical coherence tomography versus intravascular ultrasound in patients with myocardial infarction: a diagnostic performance study of pre-percutaneous coronary interventions

Accurate coronary measurements are important in guiding percutaneous coronary intervention. Intravascular ultrasound is a widely accepted diagnostic modality for coronary measurement before percutaneous coronary intervention. The spatial resolution of optical coherence tomography is 10 times larger than that of intravascular ultrasound. The objective of the study was to compare quantitative and qualitative parameters of frequency domain optical coherence tomography (FDOCT) with those of intravascular ultrasound and coronary angiography in patients with acute myocardial infarction. Diagnostic parameters of coronary angiography, intravascular ultrasound, and FDOCT of 250 patients with coronary artery disease who required admission diagnosis were included in the analyses. Minimum lumen diameter detected by FDOCT was larger than that detected by quantitative coronary angiography (2.11±0.1 vs 1.89±0.09 mm, P<0.0001, q=34.67) but smaller than that detected by intravascular ultrasound (2.11±0.1 vs 2.19±0.11 mm, P<0.0001, q=12.61). Minimum lumen area detected by FDOCT was smaller than that detected by intravascular ultrasound (3.41±0.01 vs 3.69±0.01 mm2, P<0.0001). FDOCT detected higher numbers of thrombus, tissue protrusion, dissection, and incomplete stent apposition than those detected by intravascular ultrasound (P<0.0001 for all). More accurate and sensitive results of the coronary lumen can be detected by FDOCT than coronary angiography and intravascular ultrasound (level of evidence: III).

Prediction by intravascular ultrasound with monocyte to high density lipoprotein-cholesterol ratio of prognosis in patients with intermediate non-left main coronary lesions underwent percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the prediction by intravascular ultrasound (IVUS) with monocyte to high density lipoprotein-cholesterol (HDL-C) ratio (MHR) of 12-month prognosis in patients with intermediate non-left main coronary lesions after percutaneous coronary intervention (PCI). Methods Patients with intermediate non-left main coronary lesions diagnosed by coronary angiography were tested of monocyte counts and HDL-C levels at admission with MHRs calculated. IVUS was used to examine plaque stability in target lesions. Patients were dviided into stable plaque group (n=44) and unstable plaque group (n=140) according to the IVUS results. PCI was then operated in patients with unstable plaque or with minimum lumen area<4 mm2. The major adverse cardiovascular events (MACE) were recorded during the follow-up period of 12 months after PCI. Results MHR was significantly higher in unstable plaque group than that in stable plaque group[(22.6±8.4) vs.(14.1±7.2),P<0.001]. Receiver-operating characteristic (ROC) analysis revealed that an MHR cut-off of 16.05 had 74.2％ sensitivity and 77.0％ specificity for prediction of 12-month MACE after PCI (AUC 0.78, 95％ CI 0.71–0.85, P<0.001). Besides, unstable plaque with MHR over 16.05 was an independent risk factor for 12-month MACE after PCI (adjusted HR 3.26, 95％ CI 2.48–4.14, P=0.020). Conclusions IVUS combined with MHR is a valuable index predicting the prognosiso f patients with intermediate non-left main coronary lesions who underwent PCI.

Short-term outcome of complex coronary lesions treated by excimer laser coronary atherectomy / 中国介入心脏病学杂志

Objective To investigate the feasibility, safety and efficacy of excimer laser coronary atherectomy used in complex lesions, including in-stent restenosis, non-crossable or nonexpandable lesions, heavily calcified lesions without successful wire-exchange and saphenous vein grafts lesions. Methods From Jul 24, 2017 to Aug 24, 2018, 22 cases with 24 lesions were treated with excimer laser coronary atherectomy in Peking University People's Hospital, combined with or without IVUS/OCT, rotational atherectomy or other percutaneous coronary intervention instrument, and with or without stent implantation. Results The procedural success rate was 23/24. There was no complications in all cases. Drug-eluting stents were implanted in 19/24 of lesions. There were no major advent cardiovascular events, including death, acute ST-segment-elevation myocardia and pericardial tamponade recorded. Conclusions Excimer laser coronary atherectomy used in complex lesions is feasible, safe and efficient with satisfactory in-hospital short-term outcome.

Super-resolution construction of intravascular ultrasound images using generative adversarial networks / 南方医科大学学报

The low-resolution ultrasound images have poor visual effects. Herein we propose a method for generating clearer intravascular ultrasound images based on super-resolution reconstruction combined with generative adversarial networks. We used the generative adversarial networks to generate the images by a generator and to estimate the authenticity of the images by a discriminator. Specifically, the low-resolution image was passed through the sub-pixel convolution layer -feature channels to generate -feature maps in the same size, followed by realignment of the corresponding pixels in each feature map into × sub-blocks, which corresponded to the sub-block in a high-resolution image; after amplification, an image with a -time resolution was generated. The generative adversarial networks can obtain a clearer image through continuous optimization. We compared the method (SRGAN) with other methods including Bicubic, super-resolution convolutional network (SRCNN) and efficient sub-pixel convolutional network (ESPCN), and the proposed method resulted in obvious improvements in the peak signal-to-noise ratio (PSNR) by 2.369 dB and in structural similarity index by 1.79% to enhance the diagnostic visual effects of intravascular ultrasound images.

Application of Intravascular Imaging in Forensic Autopsy / 法医学杂志

With the emergence of new technologies and devices including minimally invasive catheters and rotary couplers, the application of imaging technology such as traditional ultrasound and optical coherence tomography （OCT） is gradually expanded. In recent years, intravascular ultrasound （IVUS） and OCT have become increasingly mature as coronary intravascular imaging techniques, and therefore become an important complementary means of coronary angiography. Although studies on feasibility of clinical applications of IVUS and OCT have been confirmed in the evaluation of previous cadaver studies, these techniques have been neglected in forensic autopsy. This paper reviews the application value of IVUS and OCT in forensic autopsy, especially in the adjuvant evaluation of coronary artery disease. Including the characteristics of IVUS and OCT imaging technology, the problems of coronary examination in traditional autopsy and the specific application of new intravascular imaging technology in forensic autopsy.

Angiographic and intravascular ultrasound characteristics of coronary artery aneurysmal lesions / 中国介入心脏病学杂志

Objective To analyze the angiographic and intravascular ultrasound(IVUS) characteristics of 65 coronary artery aneurismal lesions and to evaluate the effects of interventional and medical therapy. Methods 65 in-hosptal patients with coronary artery aneurysmal lesions with both quantitive coronary angiography and IVUS data from 10/2007 to 10/2014 were retrospectively analyzed in our center. Aneurysmal lesions were confi rmed as ture coronary artery aneurysms(CAA) (n=32)or false aneurysms(n=33)by IVUS. The angiography and IVUS characteristics in both groups were analyzed. Patients with aneurysmal lesion were provided with interventional or medical therapy according to the severety of stenosis. The major adverse cardiac events(MACE) were observed in these patients for two years. Results LAD and RCA were the most common sites of true CAA lesions(40.6% and 34.4% respectively).Compared with the false aneurysm group, the ture aneurysm group had longer aneurysm[(11.1±5.8)mm vs.(5.9±2.7)mm,P<0.001], more bifurcation vessels(21 cases vs. 8 cases,P=0.001),bigger luminal external elastic membrane[(25.6 ±10.7)mm2vs.(17.7±6.6)mm2,P=0.001],bigger luminal diameters [(6.2±1.5)mm vs.(5.3±1.0)mm,P=0.005]and bigger cross sectional area[(33.5±12.0)mm2vs. (25.8±7.9)mm2, P=0.003]. The false aneurysms group had bigger plaque burdens than the ture aneurysms[(32.4±10.7)% vs.(23.0±9.8)%,P=0.001].The ratios of receiving percutaneous coronary intervention(PCI) and medical therapy were the same in the two groups (P=0.272). The percentage receiving crossover stenting was higher in the false aneurysms group(33.3% vs. 6.2%, P=0.006). There were no cardiac death and acute myocardial infarction in both groups.One subacute in-stent thrombosis happened in the ture aneurysm group. Conclusions IVUS is a good method for diff erentiation of CAA from false coronary aneurysm. Most aneurysms were adjacent to severe stenosis and vessel bifurcation. It implied that maybe the changes of flow hemodynamics were related to the formation of coronary artery aneurysm. Sufficient and long term anti-thrombotic therapy and provisional interventions to aneurysmal unilateral severe stenosis may be a good choice of treatment for CAA.

Multi-vessel intractable coronary spasm development in a patient with aborted sudden cardiac death: a case study with intravascular ultrasound findings / 영남의대학술지

Coronary spasm generally occurs in patients with minimal atherosclerotic plaque lesion, and it has a rather favorable prognosis. However, in some cases, coronary spasm may induce myocardial infarction and even sudden cardiac death (SCD). Here, we report a case in which multi-vessel intractable coronary vasospasm suddenly occurred in a diffuse atherosclerotic lesion after percutaneous coronary intervention (PCI) in a patient with aborted SCD. We identified the characteristics of the spasm portion in intravascular ultrasound (IVUS) images and conducted percutaneous cardiopulmonary bypass support-PCI with stenting as treatment. Intima and media thickening and a large attenuated plaque burden with rupture were identified in IVUS images at the obstructive spasm portion.

A review of recent experience with transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound

Portal vein access has historically been the most technically challenging step in the creation of transjugular intrahepatic portosystemic shunts (TIPSs). The use of intravascular ultrasound (IVUS) for guidance of portal vein access during TIPS creation has garnered much interest in recent years. Recent literature has suggested potential improvements in procedural metrics that may result from use of IVUS for TIPS. This review aims to provide historical context, detail technical advances and describe recent clinical experience with the use of IVUS for TIPS creation.

Research on the relationship between area strain and eccentric index of atherosclerotic plaques by intravascular ultrasonic elastography / 中华超声影像学杂志

Objective To assess the relationships between area strain (AS) and eccentric index (EI) of atherosclerotic plaques as seen by intravascular ultrasonic elastography (IVUSE),and to reveal the effect of EI on the plaques stability.Methods Forty purebred New Zealand rabbits were fed with a high-cholesterol diet;the abdominal aorta endothelium was balloon-injured after 2 weeks;at the end of week 12,2 plaques with moderate echo from each rabbit were chosen for in situ imaging,and 2 consecutive frames near the end-diastole images in situ were used to construct an IVUS elastogram.Results The eccentric plaques showed significantly greater area stain (AS) than the centripetal plaques [4.77(2.92,8.01)% vs 3.27(2.15,4.82)%,P=0.029] with smaller plaque area and plaque burden (P<0.05).The plaque AS was positively correlated with EI (r=0.392,P=0.003).The eccentric plaques showed significantly greater AS in the shoulder than in body [4.98(3.17,8.48)% vs 4.64(2.51,5.92)%,P=0.008].Conclusions The EI is one of influential factors on plaque AS.Eccentric plaques may be more vulnerable than centripetal plaques,especially in the shoulder of eccentric plaques which have greater AS than their body.