value of pulse-wave doppler tissue imaging during dobutamine stress echocardiography in detection of right coronary artery narrowing

The importance of right ventricalar function in acute and chronic cardiac affection is well established. Is to assess the value of pulse wave Doppler tissue imaging [PWTDI] during dobutamine stress echocardiography in detection of right coronary artery narrowing. 40 subjects were divided into two groups according to the presence [patient group] or absence [control group] of significant > 70% isolated right coronary artery narrowing proved by coronary angiography. All patients studied had right coronary artery dominance, they were subjected to the following: complete history taking and thorough clinical examination, 12 leads resting surface electrocardiography, resting standard echo Doppler study, coronary angiography, doubtamine-atropine stress echocardiography with pluse-wave Doppler tissue sampling. There was no statistically significant difference between the two groups as regard to early [E] and late diastolic [A] velocity in cm/sec by pulse wave tissue Doppler at rest, low dose and high dose dobutamine. p > 0.05. Regarding the ejection phase velocity in cm/sec. [EJ] by pulse-wave Doppler tissue there was no statistically significant difference between the control and the patient groups at rest and low dose dobutamine p > 0.05., however at higdose dubutamine there was a highly statistically significant difference [p < 0.01] and it was found that a progressive increase of the ejection phase velocity [EJ], expressed by a more than 25% increase from 10 microg/kg/min [low dose] to peak dobutamine stress was predictive of normal or insignificantly narrowed right coronary artery [RCA]. Whereas a blunted increase, expressed by < 25% increase of velocity, was predictive of a significantly narrowed RCA. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of pulse-wave Doppler tissue sampling in detection of right coronary artery narrowing was 80%, 75%, 79.2%, 76.9% and 78% respectively. Analysis of the right ventricular wall was accessible using the pulsed wave tissue Doppler sampling in all cases while visual assessment was not. Pulsed wave tissue Doppler sampling is a valuable tool to detect right coronary artery narrowing when combined with dobuta-mine-atropine stress echocardiography

Comparison of stenting with minimally invasive bypass surgery for high grade stenosis of the proximal left anterior descending coronary artery: six months follow up of randomized study

High grade stenosis of the proximal left anterior descending coronary artery [LAD] in patients with single-vessel disease is associated with a significantly worse prognosis than lesions at any other location. To compare the merits of stenting with minimally invasive coronary artery bypass [MICAB] surgery for high grade stenosis of isolated proximal LAD. One hundred patients with isolated high grade lesion [stenosis] >75% of laminal diameter in the proximal LAD were included. The patients were classified into two groups: Group A included 50 patients in whom successful stenting was performed. Group B included 50 patients in whom successful MICAB was performed. In group A the mean percentage of stenosis was significantly reduced to 10.48 +/- 4.112. After stenting, non of the patients died, 2Q wave infarction, 2 non Q wave infarction and 1 required coronary bypass surgery, 1 stroke, 3 LAD dissection, 5 angina pectoris, 3 needed revascu-larization, 4 vascular complications and 4 needed blood transfusion. In group B, after surgery 1 patient had Q wave infarction, 1 non Q wave infarction, 2 patients needed necessary sternotomy because of an intramyocardial segment of the LAD, 3 angina pectoris, 2 needed revascularization, 2 vascular complications, 2 needed blood transfusion, 2 developed AF and 2 chest wall hernias. The mean duration of lCU stay after surgery was 2.62 +/- 1.086 days as compared to 1.8 +/- 1.591 days after stenting [p < 0.05], the mean duration of hospitalization after surgery was 8.64 +/- 3.186 days as compared to 2.34 +/- 2.471 days after stenting [p < 0.01], Follow-up was complete for all patients except two patients in each group [2 patients died in group B while in group A one patients traveled and other was excluded, eleven asymptomatic patients refused repeated cardiac catheterization after stenting, as did 13 patients after surgery. No statistically significant difference was found between both groups as regard to positive exercise stress test [p > 0.05]. After stenting, the angina class improved 79.2% were free of angina. After surgery, the mean angina class improved, 91.6% of patients were free of angina. After six months of follow up, in-stent restenosis was detected in 11 patients [29.7%] and subgroup analysis showed a restenosis rate 15.4 for type B lesion and 46.2% for type C lesion. The recurrence of stenosis was more in type C and B than type A in stenting group. In surgical group, 3 patients [8.6%] had stenosis > 50% of the luminal diameter at the anatomic region, and subgroup analysis showed a restenosis rate of 3.6% for type B lesions and 21.4% for type C lesions. The recurrence of stenosis was more in type C and B than type A in surgical group. Secondary end points were 56% in group A vs 26% in group B. Stenting and minimally invasive bypass surgery are safe and effective treatment options for high grade lesions in the proximal LAD; MICAB requires longer hospitalization, more cost but has better an-giographic outcome while stenting has higher target vessel revascularization and secondary adverse cardiac event than MICAB