Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging.

OBJECTIVES: We tested a pre-defined visual interpretation algorithm that combines cardiovascular magnetic resonance (CMR) data from perfusion and infarction imaging for the diagnosis of coronary artery disease (CAD). BACKGROUND: Cardiovascular magnetic resonance can assess both myocardial perfusion and infarction with independent techniques in a single session. METHODS: We prospectively enrolled 100 consecutive patients with suspected CAD scheduled for X-ray coronary angiography. Patients had comprehensive clinical evaluation, including Rose angina questionnaire, 12-lead electrocardiography, C-reactive protein, and calculation of Framingham risk. Cardiovascular magnetic resonance included cine, adenosine-stress and rest perfusion-CMR, and delayed enhancement-CMR (DE-CMR) for infarction imaging. Matched stress-rest perfusion defects in the absence of infarction by DE-CMR were considered artifactual. All patients underwent X-ray angiography within 24 h of CMR. RESULTS: Ninety-two patients had complete CMR examinations. Significant CAD (> or =70% stenosis) was found in 37 patients (40%). The combination of perfusion and DE-CMR had a sensitivity, specificity, and accuracy of 89%, 87%, and 88%, respectively, for CAD diagnosis, compared with 84%, 58%, and 68%, respectively, for perfusion-CMR alone. The combination had higher specificity and accuracy (p < 0.0001), owing to incorporating the exceptionally high specificity (98%) of DE-CMR. Receiver operating characteristic curve analysis demonstrated the combination provided better performance than cine, perfusion, or DE-CMR alone. The accuracy was high in single-vessel and multivessel disease and independent of CAD location. Multivariable analysis including standard clinical parameters demonstrated the combination was the strongest independent CAD predictor. CONCLUSIONS: A combined perfusion and infarction CMR examination with a visual interpretation algorithm can accurately diagnose CAD in the clinical setting. The combination is superior to perfusion-CMR alone.

Extension of the tandem conjugate addition-Dieckmann condensation: the formal synthesis of tetracenomycin A2.

Tandem cuprate addition-Dieckmann condensation is featured in the construction of the polyketide metabolite tetracenomycin A(2). Thus, cyclization substrate 11 was treated with Gilman cuprate Me(2)CuLi to afford anthracene 12. The phenolic acetate protecting group of 12ensured its chemoselective oxidation to reveal terminal quinone 13, which intercepts the previously reported synthesis of tetracenomycin A(2).

Nucleophilic partners in the tandem conjugate addition-Dieckmann condensation reaction: 1. synthesis of 1,2,3-trisubstituted naphthalenes.

The scope and limitations of the tandem conjugate addition-Dieckmann condensation for the construction of 1,2,3-trisubstituted naphthalenes is defined. Viable nucleophilic partners in this methodology include organocuprates, active methylenes, and a variety of heteroatom initiators.

The VB-1 catheter: a novel catheter for peripheral arterial revascularization.

Despite recent advances in catheter-based technologies for peripheral arterial revascularization, adequate guide catheter positioning and support remains a leading procedural challenge. This report describes the adaptation of the Behar Internal Mammary VB-1 catheter for peripheral revascularization procedures in patients with complex anatomy not amendable to other conventional peripheral guide catheters.

The VB-1 catheter: an improved catheter for difficult-to-engage internal mammary artery grafts.

As patients with prior coronary artery bypass grafting age, internal mammary artery grafts are more frequently encountered in the cardiac catheterization laboratory. Angiography and interventions involving these grafts are often difficult, particularly in patients with tortuous subclavian anatomy and/or proximal internal mammary artery origins. We describe a new catheter shape, the Cordis Behar Internal Mammary, VB-1, which allows selective intubations of both right and left internal mammary arteries that are not possible with conventional catheters.

Tandem conjugate cyanide addition-Dieckmann condensation in the synthesis of the ABCD-ring system of lactonamycin.

An efficient synthesis of the ABCD-ring system of lactonamycin (1) is reported in this Letter. The key step is the tandem cyanide conjugate addition-Dieckmann condensation of alkyne 17 to afford a fully functionalized anthracene. Selective reduction of the cyano group with subsequent lactam formation affords the tetracyclic core of lactonamycin 19. [reaction: see text]

Remarkable diastereoselectivity in the addition of allylic and unsaturated diorganozinc reagents to beta-(N,N-dialkylamino)-aldehydes.

1,3-Anti amino alcohols 5(a)-18(a) are obtained with high diastereoselectivity by use of diorganozinc reagents in additions to amino aldehydes 2a and 2b. The corresponding Grignard reagents exhibit low to modest diastereoselectivity. The highly diastereoselective zinc-based method makes available a wide range of 4,4-disubstituted cyclohexenone derivatives containing contiguous stereocenters.

An anomalous left coronary artery originating from the pulmonary artery in a 72-year-old woman: diagnosis by color flow myocardial blush and coronary arteriography.

An anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality often associated with myocardial infarction, congestive heart failure and sudden death. Survival to adulthood in individuals with this coronary anomaly is quite uncommon. Since mortality approaches 90% in infancy with untreated ALCAPA, early recognition and surgical correction are essential. Using both echocardiographic myocardial blush and coronary arteriography, we describe the new diagnosis of uncorrected ALCAPA in a 72-year-old woman and review contemporary methods for the diagnosis and management of this particular coronary anomaly.