Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease.

Assessment of left ventricular (LV) diastolic filling pressure provides important information on the hemodynamic status in the general population. The aim of our study was to investigate the reliability of tissue Doppler imaging (TDI) in estimating left ventricular filling pressure in patients with coronary artery disease (CAD). We prospectively studied 32 consecutive CAD-patients, mean age 64 +/- 12 years, in sinus rhythm. All patients underwent cardiac catheterization and echocardiography within the same hour. Catheterization investigated pre-A-wave pressure (preA) and LV ejection fraction (LVEF). Echocardiographic LVEF was calculated using wall motion indexes (WMI) with segmental division of LV wall. The following Doppler parameters were assessed: (1) PW Doppler signals from the mitral inflow (E), (2) PW TDI of the mitral annulus (E'), thus allowing to obtain the mitral inflow to annulus ratio (E/E'). The best correlation between invasive and echocardiographic LVEF was observed using WMI (r = 0.91). The correlations between preA and E, E', and E/E' were significant (r = 0.36, r = 0.38, and r = 0.60, respectively). In patients with LVEF >50%, no correlation between E/E' and preA was found (r = 0.18, P = 0.44), whereas with LVEF <50%, this correlation was strong (r = 0.76, P < 0.001). In patients with myocardial infarction, the correlation between E/E' and preA was significant whatever the localization of myocardial infarction (r > 0.71, P < 0.05). ROC curve analysis identified an E/E'>9 to be the best cut-off value related to preA > 15 mmHg. We conclude that the mitral inflow-to-annulus ratio is a reliable method in CAD patients and allows determination of LV filling pressure when LVEF <50%.

Acute and six-month clinical outcome after Helistent stent implantation in coronary arteries: results of the French Helistent multicenter registry.

The purpose of our study was to determine the feasibility, safety, and efficacy of the new tubular (Helistent) stent (Hexacath, France) in patients with coronary artery disease. Patients were prospectively included in a multicenter French registry: acute results and 6-month target lesion revascularization rate were assessed. A total of 628 stents were implanted in 527 patients (616 lesions). Mean age was 64 +/- 11 years. Predilatation was performed in 77% of cases. The stent was successfully deployed in 99.4% of attempted lesions. Three patients died during the hospital stay and 10 patients developed myocardial infarction. Angiographic stent thrombosis rate was 1.1%. There was no need for urgent cardiac surgery during hospital stay. Six-month clinical follow-up was obtained in 95% of patients; target lesion revascularization rate was 8.3%. Eight patients (1.6%) (extracardiac death in three patients) died and three patients (0.6%) developed myocardial infarction. In conclusion, the Helistent stent appears safe and effective in minimizing acute complications of elective coronary interventions. Six-month major cardiac events were rare and clinical restenosis was low (< 10%).