Left ventricular pseudoaneurysm complicating inferior myocardial infarction: a case report.

Acquired pseudoaneurysm of the left ventricle is a very rare disorder and mostly occurs after large transmural myocardial infarction (MI) with peak creatine phosphokinase-MB levels greater than 150 IU/mL. Patients developing left ventricular (LV) pseudoaneurysm usually present with angina or heart failure symptoms. Although different imaging modalities exist, coronary angiography is the gold standard for diagnosis. Surgery is the treatment of choice for LV pseudoaneurysms detected in the first months after MI. Here we report the case of a 74-year-old woman who presented with a relatively small inferior MI due to right coronary artery occlusion and complicated by LV pseudoaneurysm.

Comparison of intracoronary versus intravenous administration of tirofiban in primary percutaneous coronary intervention.

OBJECTIVE: The purpose of this study was to compare the intravenous bolus dose of tirofiban with intracoronary bolus dose in primary percutaneous coronary intervention (PCI) with regard to in hospital and six months clinical outcomes and peak cardiac enzyme levels. METHODS: We retrospectively examined 84 ST elevation myocardial infarction (STEMI) patients who underwent primary PCI from March 2006 to February 2007. All patients received the systemic bolus dose of tirofiban 10 mcg/kg either via intracoronary (IC) or intravenous (IV) route, followed by a 36 hours of IV infusion at 0.15 mcg/kg/min. Thirty six patients in IC group were compared with 48 patients in IV group in terms of peak cardiac enzyme levels, in-hospital and six months major adverse cardiac events (MACE) rates (death, myocardial infarction and repeat revascularization). Fisher's exact test, Yates Chi-square, unpaired Student's t-test and Mann-Whitney U test were used for statistical analysis. RESULTS: There was no difference in cardiovascular risk profile or cardiac history between two groups. At six months the incidence of MACE was 6.25% in IV group and 11.1% in IC group (p=0.45). Peak cardiac phosphokinase (CPK) levels between IV and IC groups were also statistically non significant (2657+/-2181 U/L in IV group and 2529+/-1929 U/L in IC group) (p=0.92). CONCLUSION: Intracoronary bolus application of tirofiban was not associated with reduction in MACE rates compared to intravenous administration in patients with STEMI who underwent primary PCI. Future prospective trials with higher bolus doses of IC tirofiban should addressed to clarify this issue.

Evaluation of subclinical right ventricular dysfunction in obstructive sleep apnea patients using velocity vector imaging.

BACKGROUND: The aims of this study were to evaluate subclinical regional right ventricular (RV) dysfunction in newly diagnosed obstructive sleep apnea (OSA) patients without systemic and pulmonary arterial (PA) hypertension, and to correlate OSA severity to RV dysfunction, using both velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI). METHODS AND RESULTS: The OSA group consisted of 27 patients and the control group consisted of 26 healthy participants. All participants underwent 24-h ambulatory blood pressure monitoring. Peak systolic myocardial velocities, strain, and strain rate (SR) were determined at the basal and mid segments of the RV free wall by VVI. Additionally, RV myocardial velocities were assessed by pulsed-wave TDI. Patients with OSA had significantly impaired VVI-derived peak systolic myocardial velocities, strain, and SR (P<0.0001 for all). RV isovolumic acceleration (IVA) was the only TDI-derived parameter that was significantly impaired (P<0.0001). RV IVA (r=-0.512, P<0.0001), RV mid free wall strain (r=0.568, P<0.0001) and SR (r=0.519, P<0.0001) revealed the best correlations with apnea hypopnea index (AHI). CONCLUSIONS: Subclinical RV dysfunction is present in OSA patients despite normal systemic and PA pressures. Tissue Doppler-derived RV IVA and VVI-derived RV deformation can accurately recognize and quantify RV function abnormalities in this subgroup of patients.

Treatment of saphenous vein graft lesions with paclitaxel- and sirolimus-eluting stents: comparison of short- and long-term clinical outcomes.

OBJECTIVE: The purpose of this study was to compare treatment of saphenous vein graft (SVG) lesions with paclitaxel-eluting (PES) and sirolimus-eluting stents (SES) in daily practice with regard to short- and long-term clinical outcomes. METHODS: Between August 2002 and September 2006, a total of 71 patients with SVG lesions who were implanted PES or SES with percutaneous coronary intervention in our center were evaluated retrospectively. Forty-six patients with PES (PES group) were compared to twenty-five patients treated with SES (SES group) in terms of in-hospital, 30-day, six-months and 1-year clinical outcomes. Statistical analyses were performed using Chi-Square statistics or Fisher's exact and independent sample t test. Survival analysis was done using Kaplan-Meier method and log-rank test. RESULTS: Baseline clinical characteristics were similar in both groups except for a tendency toward a lower age in the SES group. No statistically significant difference was found between two groups by means of lesion and procedural characteristics. All clinical outcomes at 30-day, 6-month and 1-year after the interventions were similar in both groups. Early stent thrombosis was detected in one patient (2.2%) of PES group (p=0.65). Late stent thrombosis was not observed in both groups. The rate of major adverse cardiac events at 1-year was 8.7% in the PES group and 16% in the SES group (p=0.44). CONCLUSION: Short-and long-term clinical outcomes of PES and SES in the treatment of SVG lesions are similar. The results of our study showed that both drug-eluting stents are effective and safe in real-world patient with diseased SVGs.

Very late thrombosis of paclitaxel-eluting stent.

Drug-eluting stents (DES) have been proven to be effective in reducing restenosis after percutaneous coronary interventions, but they are associated with a risk of late thrombotic occlusion with adverse clinical events. We report a case of an angiographically confirmed paclitaxel-eluting stent (PES) thrombosis which occurred 36 months after successful stent implantation. To the best of our knowledge, this is the most delayed case of PES thrombosis described so far.

The relation between coronary flow rate, plasma endothelin-1 concentrations, and clinical characteristics in patients with normal coronary arteries.

BACKGROUND: Coronary slow flow (CSF) is characterized by delayed opacification of epicardial arteries in the absence of occlusive disease. In the present study, we aimed to investigate the relation between coronary flow rate, plasma endothelin-1 (ET-1) concentrations, and clinical characteristics in patients with normal coronary arteries. METHODS: The study population included 77 patients with angiographically normal coronary arteries who underwent coronary angiography on suspicion of ischemic heart disease due to typical chest pain or ischemic findings on treadmill exercise test or myocardial scintigraphy. Based on the Thrombolysis In Myocardial Infarction frame count (TFC), patients were grouped into those with normal coronary flow and those with slow coronary flow. RESULTS: Forty-eight (61.5%) patients were found to have CSF. Plasma ET-1 concentrations were significantly higher with the presence of CSF (P=.03). There were significant differences between plasma ET-1 concentrations, and mean TFC, TFC for left anterior descending coronary artery (LAD), TFC for left circumflex coronary artery (CX), and TFC for right coronary artery separately in patients with and without CSF (P=.033, P<.001, P<.001, P<.001, and P<.001, respectively). Mean TFC, TFC for LAD, and TFC for CX, and ET-1 concentrations were significantly higher in smokers than in nonsmokers (P<.001, P<.001, P=.004, and P=.033, respectively). However, logistic regression analysis suggested that ET-1 concentration was not an independent determinant of CSF. CONCLUSIONS: Although there is a significant relation between ET-1 concentrations and coronary flow rate, ET-1 concentrations are not sufficient to determine the presence of CSF. Smoking is strongly associated with CSF, TFC, and increased ET-1 concentrations.

[The effects of phase II cardiac rehabilitation programme on patients undergone coronary bypass surgery]. / Koroner baypas geçiren olgularda faz II kardiyak rehabilitasyon programinin etkileri.

OBJECTIVE: To investigate the effects of phase II cardiac rehabilitation in 52 patients undergone coronary artery bypass surgery. METHODS: Gradual walking tests, cardio-pulmonary capacity tests and lipid profile were administered to patients selected for phase II cardiac rehabilitation before and after the programme. Training was started on 12-channel electrocardiogram controlled running bands 3 times a week for 20 min periods for 12 weeks fitting the programme. Low or intermediate level exercise programme was applied to patients. Cleveland Clinic Chronotropic Assessment exercise protocol was used during rehabilitation. RESULTS: As a result of phase II cardiac rehabilitation administered to 52 patients undergone coronary bypass operation, exercise capacity, oxygen consumption, anaerobic threshold, cardiac output mean values (p<0.001) and mean HDL cholesterol level (p<0.05) were found to increase, whereas body mass index, total cholesterol, LDL cholesterol and triglyceride mean levels reduced (p<0.001) significantly. CONCLUSION: In patients who have undergone coronary bypass surgery, phase II cardiac rehabilitation is a very useful programme in improvement of life quality and secondary prevention.