Telmisartan, an angiotensin II type 1 receptor blocker, improves coronary microcirculation and insulin resistance among essential hypertensive patients without left ventricular hypertrophy.

Hypertension and insulin resistance are associated with reduced coronary vasodilatory capacity, possibly caused by structural changes in the coronary resistance vessels. The goal of this study was to compare the effect of an angiotensin receptor blocker (ARB) with that of a calcium channel blocker (CCB) on coronary flow reserve and insulin resistance among essential hypertensive patients without left ventricular hypertrophy. A total of 40 consecutive essential hypertensive patients were randomized to daily 40 mg telmisartan or 20 mg nifedipine coat-core treatment. Coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography and blood tests were performed before and after 12 weeks of treatment. At baseline, blood pressure, CFVR, and homeostasis model assessment of insulin resistance (HOMA-IR) were not significantly different between the two groups. At the end of the treatment period, the telmisartan and nifedipine groups exhibited similar declines in blood pressure. CFVR was improved in the telmisartan group (2.4+/-0.4 to 2.9+/-0.4; p<0.01), but there was no difference in the nifedipine group (2.5+/-0.3 to 2.5+/-0.3; n.s.). HOMA-IR was improved in the telmisartan group (3.1+/-1.1 to 1.6+/-0.7; p<0.01), but there was no difference in the nifedipine group (2.8+/-1.1 to 2.4+/-0.7; n.s.). In conclusion, this study demonstrates that antihypertensive therapy with telmisartan, but not nifedipine, has a beneficial effect on coronary microcirculation and insulin resistance among essential hypertensive patients.

Feasibility of a rapid protocol of 1-day single-isotope rest/adenosine stress Tc-99m sestamibi ECG-gated myocardial perfusion imaging.

BACKGROUND: We previously developed a new rapid protocol for single-isotope rest/adenosine stress technetium 99m sestamibi (MIBI) electrocardiography-gated myocardial perfusion imaging examination. The feasibility and limitations of this rapid protocol are unclear. METHODS AND RESULTS: We examined 422 patients who underwent rest acquisition, which eliminates the waiting time, after injection of low-dose MIBI and drinking 400 mL of water. The patients immediately underwent adenosine stress. Stress acquisition was performed 1 hour after injection of high-dose MIBI. The sensitivity and specificity for detecting significant coronary stenoses were 93% and 70%, respectively. The frequency of significant (moderate or severe) inferior wall artifacts on the rest single photon emission computed tomography images among all patients was 16.3%. The frequency of significant artifacts in patients aged 70 years or older was significantly lower than that in patients aged less than 70 years (11.9% vs 26.9%, P = .0001). Multivariate analysis revealed that age less than 70 years and prior myocardial infarction were predictors of significant artifacts on resting images (P < .0001 and P < .05, respectively). CONCLUSIONS: Our rapid protocol for MIBI myocardial perfusion imaging (MPI) provides high-quality images and good patient throughput, and it is effective at reducing the total examination time.

Intravascular ultrasound-guided coronary artery stenting for spontaneous coronary artery dissection in a case of acute myocardial infarction associated with vasospasm in a non-culprit coronary artery during the hospitalization.

We report a case of spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction, which was complicated by vasospastic angina (VA). The patient received intravenous administration of t-PA. Emergency coronary angiography demonstrated narrowing of the left anterior descending artery (LAD) due to SCAD. During hospitalization, the patient suffered chest pain, and ECG showed ST elevation in the inferior leads. Sublingual administration of nitroglycerin provided temporary remission. Coronary stent implantation was performed electively using intravascular ultrasound imaging. This is the first reported case of SCAD associated with vasospasm in a non-culprit coronary artery during the hospitalization.

Anomalous origin of the right coronary artery from the pulmonary artery.

A case of anomalous origin of the right coronary artery from the pulmonary artery in a 73-year-old man is presented. The patient had been suffering from chronic heart failure with mitral and tricuspid regurgitation and atrial fibrillation for two years. Surgical repair was performed successfully, including ligation of the right coronary artery and coronary arterial bypass with a radial artery graft.

Acute effect of atorvastatin on coronary circulation measured by transthoracic Doppler echocardiography in patients without coronary artery disease by angiography.

Thirty-two patients were randomly assigned to treatment with placebo or atorvastatin. The time-averaged peak diastolic velocity (APDV) of the left anterior descending artery without stenosis was measured by transthoracic Doppler echocardiography at rest and under hyperemic conditions before and 1 hour after treatment. APDV increased significantly in the atorvastatin group, at rest and under hyperemic conditions, and coronary flow velocity reserve also increased in the atorvastatin group compared with patients given placebo. Atorvastatin improved the blood flow velocity of the normal coronary artery <1 hour after administration in patients without coronary artery disease by angiography.

Paradoxical peripheral embolism coincident with acute pulmonary thromboembolism.

Paradoxical embolism may occur in patients with acute pulmonary thromboembolism, when patent foramen ovale (PFO) coexists with pulmonary hypertension (right-left shunt). There have been few case reports of paradoxical embolism in peripheral arteries coincident with acute pulmonary thromboembolism. Here, we describe a case of paradoxical peripheral embolism associated with PFO complicated by acute pulmonary thromboembolism. The patient had severe peripheral ischemia due to a massive thrombus and was treated successfully by peripheral thrombectomy, thrombolysis, implantation of a permanent inferior vena cava filter and anticoagulation.