Late lumen loss and follow-up percent diameter stenosis at different doses of oral valsartan six months after bare-metal stent implantation in type B2/C coronary lesions.

UNLABELLED: Higher doses of oral valsartan (160-320 mg) seem to reduce in-stent restenosis rate after bare-metal stent implantation. The value of 80, 160 or 320 mg valsartan should be analyzed by late lumen loss and follow-up percent diameter stenosis as surrogate parameters in a total of 60 patients with matched demographic, clinical and angiographic findings and continuous doses of valsartan. In each group 20 patients (14 males, 6 females) with a mean age of 62.1+/-9.1, 64.3+/-8.1 and 62.9+/-11.6 years after implantation of a total of 22, 33 and 27 stents in 21, 25 and 23 lesions were included. Quantitative coronary angiography was performed with an automated contour analysis system; reference diameter, minimum diameter, late lumen loss, follow-up percent diameter stenosis and restenosis rate were determined. RESULTS: In-stent restenosis rate including persistent area was n=5/21 (24%), n=4/25 (16%) and n=2/23 (8.7%) under 80, 160 and 320 mg valsartan. Late lumen loss was 0.79+/-0.49 mm, 0.60+/-0.43 mm and 0.37+/-0.25 mm, respectively, with significant differences between 80 and 320 mg (p<0.001) and 160 and 320 mg (p<0.05). Follow-up percent diameter stenosis was 31.8+/-18.6% under 80 mg, 25.2+/-17.5% under 160 mg and 13.8+/-9.4% with significant differences between 80 mg and 320 mg (p<0.0005) and 160 and 320 mg (p<0.01). CONCLUSIONS: Different doses of oral valsartan over six months after BMS implantation show a linear response with regard to late lumen loss and follow-up percent diameter stenosis.

Early repolarization phenomenon in arrhythmogenic right ventricular dysplasia-cardiomyopathy and sudden cardiac arrest due to ventricular fibrillation.

The case of a 26-year-old male with sudden cardiac arrest due to ventricular fibrillation and the final diagnosis of arrhythmogenic right ventricular dysplasia-cardiomyopathy (ARVD/C) and initial early repolarization phenomenon is presented in detail. An additional analysis of early repolarization in additional 359 patients with ISFC/ESC diagnostic criteria of ARVD/C revealed a frequency within the threshold in healthy volunteers with 3% in isolated lateral leads and 7% in inferolateral leads. The high frequency of electrocardiographic early repolarization limited to inferior leads (22%) is probably due to late depolarization and represents an already reported typical feature of ARVD/C.

Detection of patients with coronary artery disease using cardiac magnetic field mapping at rest.

We studied the use of cardiac magnetic field mapping to detect patients with CAD without subjecting them to stress. Fifty-nine healthy control subjects and 101 patients with CAD without previous MI were included. The optimal positions for detecting CAD were located in the left superior parasternal and in the inferior midsternal area. Values for ST slope, ST shift, T peak amplitude, ST-T integral, and magnetic field map orientation differed significantly between the 2 groups. Three parameters together in a multivariate analysis yielded a sensitivity of 84% and a specificity of 83% in distinguishing patients with CAD from control subjects. We suggest that cardiac magnetic field mapping is a promising technique to identify patients with CAD.

Myocardial viability evaluation using magnetocardiography in patients with coronary artery disease.

OBJECTIVE: Magnetocardiography (MCG) has been used to risk stratify patients in terms of sudden death or to detect ischemia. We evaluated the potential of this technique to assess myocardial viability in coronary artery disease. METHODS: Fifteen patients aged 36-75 (median, 59) years with stable single-vessel disease (> or =70% diameter stenosis) and corresponding regional wall-motion abnormality underwent (1) echocardiography to evaluate wall motion, (2) Tl dipyridamole single-photon emission computed tomography to document perfusion and (3) quantitative F-fluorodeoxyglucose positron emission tomography to assess viability in 16 left-ventricular wall segments. MCG was performed in each patient using a shielded prototype 49-channel low-temperature superconducting quantum interference device (SQUID) system. Multiple time and area parameters were extracted automatically from each baseline-corrected data set. RESULTS: Eleven patients had prior myocardial infarction. In each patient, four to 12 (median, seven) segments were lesion dependent, totalling up to 117 out of 240 segments. A total of 88 segments (75%) were viable and 29 segments (25%) represented scar. Patients were divided into three categories: (a) no scar segments (five patients), (b) scar in one to three segments (six patients) and (c) scar in > or = four segments (four patients). The three MCG parameters with the best selectivity were identified using linear discriminant analysis with forward inclusion (P<0.10). The corresponding Fisher's discriminant functions classified all patients correctly (Wilks' lambda=0.079). CONCLUSION: Selected MCG parameters yielded accurate patient classification with regard to the extension of myocardial scar within the viable tissue in retrospect. These findings indicate that MCG may contribute to the assessment of myocardial viability. Further evaluation in a comprehensive multicenter study is warranted.

Heart rate variability before the onset of ventricular tachycardia: differences between slow and fast arrhythmias.

BACKGROUND: We tested whether or not heart rate variability (HRV) changes can serve as early signs of ventricular tachycardia (VT) and predict slow and fast VT in patients with an implantable cardioverter defibrillator (ICD). METHODS AND RESULTS: We studied the ICD stored 1000 beat-to-beat intervals before the onset of VT (131 episodes) and during a control time without VT (74 series) in 63 chronic heart failure ICD patients. Standard HRV parameters as well as two nonlinear parameters, namely 'Polvar10' from symbolic dynamics and the finite time growth rates 'Fitgra9' were calculated. Comparing the control and the VT series, no linear HRV parameter showed a significant difference. The nonlinear parameters detected a significant increase in short phases with low variability before the onset of VT (for time series with less than 10% ectopy, P<0.05). Subdividing VT into fast (cycle length 270 ms) events, we found that the onset of slow VT was characterized by a significant increase in heart rate, whereas fast VT was triggered during decreased heart rates, compared to the control series. CONCLUSIONS: Our data may permit the development of automatic ICD algorithms based on nonlinear dynamic HRV parameters to predict VT before it starts. Furthermore, they may facilitate improved prevention strategies.