A randomized trial comparing left distal radial versus femoral approach for coronary artery bypass graft angiography: a pilot study.

BACKGROUND: Left distal transradial angiography (ldTRA) is a new technique for radial coronary angiography and may be an alternative to conventional transfemoral angiography (TFA) in patients who had previously undergone coronary artery bypass graft (CABG) surgery. In this study we compared ldTRA with TFA in patients who had undergone CABG surgery in terms of procedural details. METHODS: Fifty-seven consecutive patients with history of previous CABG among 459 patients who were admitted to coronary angiography unit (elective and acute coronary syndromes) in our center between October 2019 and February 2020 were included in the study. Consecutive patients were randomized to ldTRA (34 patients) and TFA (23 patients) group. The difference in total procedure times was defined as primary endpoint. The difference in sheat times, fluoroscopy times, contrast volume used and radiation exposure were designated as secondary endpoints. Post angiographic complications were compared between two groups. RESULTS: Out of 34 patients, successful distal radial access was obtained in 25 patients (74%). Baseline demographics, contrast use and radiation exposure were similar between groups. Sheath times in ldTRA was significantly longer (P<0.001), but total procedure times were not different (18.4±7.8 vs. 14.6±6.1, P=0.07). Non-standard angiographic equipment usage was significantly higher in ldTRA procedures (80% vs. 13%, P<0.001). There was no major bleeding in neither of groups, and three minor bleedings in FA group (0% vs.13%, P=0.10). CONCLUSIONS: ldTRA in patients with a palpable pulse and successful access might be used successfully for angiography in patient with previous CABG even early in an operator's experience.

The relationship between presystolic wave and subclinical left ventricular dysfunction in asymptomatic hypertensive patients.

BACKGROUND: The main aim of the current study was to investigate the association between presystolic wave (PSW) and subclinical left ventricular (LV) dysfunction. PATIENTS AND METHODS: A total of 139 patients admitted to the cardiology outpatient clinic with hypertension were consecutively enrolled. The patient population included 79 men and 60 women. The presence of a PSW on the left ventricular outflow tract flow was evaluated in all patients. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived myocardial performance index (MPI) of at least 0.5 in the absence of impaired left ventricular ejection fraction (<50%) as evaluated by transthoracic echocardiography. RESULTS: The mean age of the patients was 52±10. Patients with PSW had higher MPI (0.44±0.13 vs. 0.37±0.09, P<0.001), left ventricular mass (LVM) (176±45 vs.142±33, P<0.001), and LVM index values (92±23 vs. 76±17, P<0.001) compared with those without PSW. Patients with PSW had a higher prevalence of subclinical LV dysfunction (29 vs. 3.4%, P: 0.008) and LV hypertrophy (22 vs. 2%, P: 0.011). There was a significant correlation with PSW velocity and age (r=0.22, P: 0.04), LVM (r=0.24, P: 0.021), late diastolic mitral annular velocity (r=0.25, P: 0.018), and an inverse correlation with the Em : Am ratio (r=-0.34, P: 0.001). Binary logistic regression analysis indicated the presence of PSW (95% confidence interval 1.3-8.031, odds ratio 3.2, P: 0.012) as an independent determinant of abnormal MPI. CONCLUSION: Assessment of presystolic wave on echocardiography was an independent predictor of subclinical LV dysfunction in patients with hypertension. Attention to the PSW on echocardiography examination might help to identify hypertension patients who could be at risk for developing overt heart failure that has a prognostic impact.

Predictive value of echocardiography-derived arterial compliance for increased arterial stiffness in hypertensive patients.

OBJECTIVE: Increased arterial stiffness is a predictor of cardiovascular events. The cardio-ankle vascular index (CAVI) is a measure of arterial stiffness. The stroke volume (SV) to pulse pressure (PP) ratio is an estimate of arterial compliance (AC). The main purpose of this study was to investigate the association between echocardiography-derived AC and arterial stiffness. METHODS: One hundred and forty asymptomatic hypertensive patients were enrolled consecutively. AC was calculated as SV/PP and adjusted to body surface area to calculate the SV/PP index (SV/PPi). Arterial stiffness was assessed by a VaSera-1000 CAVI instrument. RESULTS: There was statistically significant negative correlation between SV/PPi and CAVI (r=-0.402; P<0.001). Multivariate binary logistic regression analysis demonstrated SV/PPi as an independent predictor of increased CAVI (CAVI≥9) (95% confidence interval: 0.001-0.147; P<0.001). There were lower SV/PPi values in abnormal CAVI groups (CAVI≥9) than normal and borderline CAVI (CAVI<9) (0.68±0.23 vs. 0.93±0.27; P<0.001). Analysis using the receiver operating characteristic curve has demonstrated that SV/PPi of 0.61 ml/m/mmHg constitutes the cut-off value for the presence of abnormal CAVI with 89% sensitivity and 53% specificity (area under the curve: 0.771, 95% confidence interval 0.674-0.868). CONCLUSION: Assessment of AC during echocardiography examination may provide predictive information of increased arterial stiffness in asymptomatic hypertensive patients.

Coronary artery calcification score is increased in patients with isolated coronary artery ectasia.

PURPOSE: Coronary artery calcification (CAC) is an indicator of coronary atherosclerosis and is associated with future adverse cardiac events. Isolated coronary artery ectasia (CAE) is defined as localized or diffuse dilation of the coronary arteries without coronary stenosis. The aim of this study was to assess the relationship between CAC and isolated CAE. METHODS: Thirty-four patients with isolated CAE and 50 controls subjects, with normal coronary arteries, were enrolled in the study. Baseline demographic features and atherosclerosis risk factors were similar in both groups. RESULTS: Patients with CAE had higher total CAC than control subjects (84±111 vs. 33.5±103.5; p<0.001). There was also a significant correlation between per-segment CAC and ectatic segment length (r=0.32; p=0.01) but no correlation with diameter (r=0.09; p=0.5). CONCLUSION: Patients with isolated CAE had higher CAC than control subjects, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE. Patients with isolated CAE may have increased cardiovascular risk and should receive appropriate risk stratification and relevant medical treatment.

Relationship between Duke Treadmill Score and coronary artery lesion complexity.

PURPOSE: The purpose of this study was to investigate the relationship between the Duke Treadmil Score (DTS) and coronary artery disease (CAD) complexity in patients with suspected coronary artery disease (CAD). METHODS: Sixty five patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed and Syntax score (SxScore), a marker of CAD complexity, was determined. The relationship between DTC and SxScore then evaluated. RESULTS: There was a strong negative correlation between DTS and SxScore (r = - 0.91, p < 0.001). In addition, patients with higher and intermediate risk as evaluated by DTS had increased SxScore compare to those that were low risk (23 ± 6, 6 ± 5 and 0 ± 0 respectively). CONCLUSIONS: A strong negative correlation was seen between DTS and coronary lesion complexity. By assessing DTS important information about coronary artery lesion complexity can be obtained before invasive coronary angiography.

Blood cyst of tricuspid valve: an incidental finding in a patient with ventricular septal defect.

Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endothelium and filled with blood. They appear to be benign lesions and should be removed if they cause problems. We present the case of a mobile tricuspid valve blood cyst that was incidentally found in a patient evaluated for systolic heart murmur. Systolic murmur was found to originate from a muscular-type ventricular septal defect of no haemodynamic significance. The lack of echocardiographic evidence of tricuspid valvular dysfunction and indication for repair of co-existent ventricular septal defect suggested a benign course and, therefore, we monitored the patient safely by echocardiography.