Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India.

The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients.

Health related quality of life among Rheumatic Fever and Rheumatic Heart Disease patients in India.

BACKGROUND: Measurement of health-related quality of life (HRQOL) of people with chronic illnesses has become extremely important as the mortality rates associated with such illnesses have decreased and survival rates have increased. Thereby, such measurements not only provide insights into physical, mental and social dimensions of patient's health, but also allow monitoring of the results of interventions, complementing the traditional methods based on morbidity and mortality. OBJECTIVE: The present study was conducted to describe the HRQOL of patients suffering from Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD), and to identify socio-demographic and clinical factors as predictors of HRQOL. METHODOLOGY: A cross-sectional study was conducted to assess the HRQOL among 702 RF and RHD patients using EuroQol 5-dimensions 5-levels instrument (EQ-5D-5L), EuroQol Visual Analogue Scale and Time Trade off method. Mean EQ-5D-5L quality of life scores were calculated using EQ5D index value calculator across different stages of RF and RHD. Proportions of patients reporting problems in different attributes of EQ-5D-5L were calculated. The impact of socio-economic determinants on HRQOL was assessed. RESULTS: The mean EQ-5D-5L utility scores among RF, RHD and RHD with Congestive heart failure patients (CHF) were estimated as 0.952 [95% Confidence Interval (CI): 0.929-0.975], 0.820 [95% CI: 0.799-0.842] and 0.800 [95% CI: 0.772-0.829] respectively. The most frequently reported problem among RF/RHD patients was pain/discomfort (33.8%) followed by difficulty in performing usual activities (23.9%) patients, mobility (22.7%) and anxiety/depression (22%). Patients with an annual income of less than 50,000 Indian National Rupees (INR) reported the highest EQ-5D-5L score of 0.872, followed by those in the income group of more than INR 200,000 (0.835), INR 50,000-100,000 (0.832) and INR 100,000-200,000 (0.828). Better HRQOL was reported by RHD patients (including RHD with CHF) who underwent balloon valvotomy (0.806) as compared to valve replacement surgery (0.645). CONCLUSION: RF and RHD significantly impact the HRQOL of patients. Interventions aiming to improve HRQOL of RF/RHD patients should focus upon ameliorating pain and implementation of secondary prevention strategies for reducing the progression from ARF to RHD and prevention of RHD-related complications.

Rotatripsy: synergistic effects of complementary technologies: a case report.

BACKGROUND: Percutaneous coronary intervention (PCI) to calcified coronary lesions (CCLs) remains one of the most complex procedures. Latest modality to modify calcium, intravascular lithotripsy (IVL), has shown good safety and efficacy in preliminary research. However, it may be associated with acute complications, and as standalone therapy, is not sufficient for all CCLs. CASE SUMMARY: Eighty-two-year-old man, known case of coronary artery disease and multiple comorbidities, presented with worsening angina of 1 month duration. Coronary angiography revealed heavily calcified triple vessel disease with critical distal left main (LM) involvement. Owing to high surgical risk, he was offered intravascular ultrasound (IVUS) guided PCI with intra-aortic balloon support. While the diffuse, circumferential calcified lesions in LM and left anterior descending (LAD) artery were modified with rotablation (RA) followed by IVL with 3.5 and 3.0 mm balloons; ostial-proximal lesion in left circumflex (LCX) artery was treated with 3.0 mm IVL balloon as a standalone therapy. During second cycle of shockwave therapy in LCX, the 3.0 mm IVL balloon ruptured with type C dissection extending upto LM ostium which required emergent LM bifurcation stenting. We had a good angiographic result which was confirmed with IVUS. DISCUSSION: ntravascular lithotripsy and RA are complementary technologies in treating CCLs. Rotablation with a relatively small-sized burr is safe and can favourably modify superficial calcium which helps in smooth delivery of IVL balloon and ensures safe shockwave therapy, if required. Unselected upfront use of IVL without intravascular imaging may be associated with complications as described in this case.

Modified double guiding catheter 'Ping Pong' technique to treat large coronary perforation: a case report.

BACKGROUND: Despite improvement in available tools and techniques, procedural complications like coronary perforation can occur during percutaneous coronary intervention (PCI). Severe proximal coronary perforations are usually caused by balloon and vessel size mismatch but can also occur with appropriately sized balloons or stents if the coronary vessel has very eccentric calcification or if there is negative remodelling of the vessel. CASE SUMMARY: A 74-year-old man with a history of type II diabetes mellitus, hypertension, and chronic coronary syndrome (previous PCI 10 years before) presented with unstable angina of 2 weeks of duration. Coronary angiography revealed a patent stent in left anterior descending artery, significant disease in left circumflex artery and diffuse calcified lesion in dominant right coronary artery (RCA). During angioplasty of RCA, the patient developed severe Ellis grade III perforation, which was successfully managed with modified double guiding catheter 'Ping Pong' technique. In this technique, the already engaged 7 French (F) Amplatz Left 1 guide catheter was used to deliver the bulky covered stent in highly tortuous and calcified RCA while a second 6F guide catheter (Judkin Right) introduced through contralateral femoral access was used for introducing the balloon, which initially sealed the perforation and subsequently acted as a distal anchor to provide strong support to deliver the covered stent. CONCLUSION: In a case of severe coronary perforation, modified Ping Pong technique using a small-sized second guide catheter complimentary to the first guide catheter, can be used to deploy bulky covered stent.

Real world perspective of coronary chronic total occlusion in third world countries: A tertiary care centre study from northern India.

OBJECTIVES: The aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India. BACKGROUND: There is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India. METHODS: Retrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI. RESULTS: CTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI. CONCLUSIONS: CTO's are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre.

ROTAVI: simultaneous left main rotablation and transcutaneous aortic valve implantation in calcified coronaries and severe aortic stenosis - a case report.

BACKGROUND: There is a high incidence of calcified coronary artery disease in patients with severe valvular aortic stenosis (AS). With transcutaneous aortic valve replacement (TAVR) as one of the promising options for severe AS in high and intermediate surgical risk patients; we will encounter more and more patients who will require both complex percutaneous coronary intervention (PCI) with rotablation (RA) and TAVR. The timing of PCI in patients undergoing TAVR; however remains indecisive. Due to the complexity of procedures and the risks involved, very few cases of concomitant TAVR and coronary RA have been reported so far. CASE SUMMARY: Seventy-five years old high surgical risk female had severe AS with calcified left main (LM) distal and ostial left anterior descending (LAD) artery lesion. Successful PCI with RA to LM-LAD lesion was done followed by uneventful transfemoral TAVR in the same setting. DISCUSSION: This is probably one of the very few cases reported where PCI to LM with RA and TAVR was done successfully in the same setting. Since the calcified lesion was focal and left ventricular ejection fraction of the patient was normal, we went ahead with PCI without prior balloon dilatation of aortic valve (BAV) which was a deviation from the prior reported cases, where BAV was performed prior to complex PCI to improve the cardiac output. We herein discuss our case and thoughts about concomitant complex PCI and TAVR.

Cost of Treatment of Valvular Heart Disease at a Tertiary Hospital in North India: Policy Implications.

BACKGROUND: Lack of data on the cost of cardiac care is an impediment to evidence-based planning, especially for determining provider payment rates under publically financed health insurance schemes. OBJECTIVE: This study estimates the unit costs of outpatient consultation, hospitalization, intensive care, selected surgical procedures and diagnostics for providing cardiac care for valvular heart disease at a tertiary hospital in India. METHODS: We undertook an economic costing of cardiac care using both patient and health system perspectives. For the health system costs, a bottom-up costing methodology was used. Data on all resources (capital and recurrent) utilized for the delivery of cardiac care services for valvular heart disease for 1 year were collected. Data on out-of-pocket expenditures was collected from 100 cardiac patients who underwent valve replacement and balloon valvotomy procedures. All estimated costs represent the year 2016-2017. RESULTS: The health system cost of an outpatient cardiac consultation was estimated as 182.4 Indian rupees (INR) (US$2.8) and INR334.8 (US$5.2) in the cardiology, and cardio-thoracic and vascular surgery (CTVS) departments, respectively. The cost of hospitalization per bed-day in cardiology, CTVS and the intensive care unit (ICU) was INR1040 (US$16), INR3853 (US$60) and INR12,635 (US$197), respectively. The median out-of-pocket expenditure for valve replacement surgery using mechanical and bio-prosthetic valves was estimated to be INR107,800 (US$1684) and INR154,000 (US$2406), respectively, and for balloon valvotomy was estimated to be INR14,456 (US$367). Overall package cost per mechanical and bio-prosthetic single valve replacement surgery and balloon valvotomy procedure was estimated as INR127,919 (US$1999), INR148,919 (US$2372) and INR14,456 (US$226), respectively. CONCLUSION: Our findings are useful for planning expansion of public sector cardiac care services, developing package rates for publically financed insurance schemes in India and for undertaking research on cost effectiveness of various models of cardiac care.

Evaluation of Endothelial Dysfunction in Idiopathic Dilated Cardiomyopathy Patients.

Background: Endothelial dysfunction has early been characterized in ischemic cardiomyopathy patients. The study was aimed to study evaluation of endothelial dysfunction in idiopathic cardiomyopathy patients (DCM). Methods: Thirty newly diagnosed patients (age >18 years) of DCM were enrolled in the study from cardiology OPD, PGIMER, Chandigarh from January 2011 to June 2012. Age-and sex-matched 30 healthy controls were also enrolled. Idiopathic DCM was diagnosed by presence of left ventricular dilatation and systolic dysfunction (LVEF <40%) on echocardiography in the absence of coronary artery disease, hypertension or valvular disease. All patients underwent echocardiography and coronary arteriography. Flow mediated dilation (FMD) and carotid intima media thickness (IMT) were compared between patients and controls. Results: There was no significant difference in mean IMT between patients (0.73±0.04 mm) and controls (0.747±0.03 mm) (P=0.18). There was significant difference in left IMT in NHYA class (P=0.010). There was significant difference in mean percentage of FMD (patients vs. controls; 4.37% vs. 8.35%; P=0.001) while baseline FMD was different (patients vs. controls; 3.6 mm±0.26 mm vs. 3.72±0.32 mm; P=0.13). There was no significant difference in percentage NMD (P=0.057) and mean NMD (P=0.26) between patients and controls. There was no correlation between FMD and IMT. Conclusion: Endothelial dysfunction occurs in IDC patients. Also, there is a positive correlation with NHYA class; however, IMT is not affected in dilated cardiomyopathy.

Common variants of HMGCR, CETP, APOAI, ABCB1, CYP3A4, and CYP7A1 genes as predictors of lipid-lowering response to atorvastatin therapy.

There is interindividual variation in lipid-lowering response to statins. The objective of this study was to investigate whether common variation in genes involved in lipid and statin metabolism modify the effect of statins on serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol concentration in coronary artery disease (CAD) patients. We studied the association between 18 single-nucleotide polymorphisms (SNPs) in six genes (HMGCR, CETP, APOAI, ABCB1, CYP3A4, CYP7A1) in response to atorvastatin therapy (20 mg/day) in 265 newly diagnosed CAD patients using multivariable adjusted general linear regression. Variant alleles of ABCB1 (-41A/G), HMGCR SNP29 G/T, rs5908A/G, rs12916C/T, and CYP7A1-204A/C polymorphisms were significantly associated with attenuated LDL-C reduction and variant alleles of CETP TaqI, -629C/A, and APOAI PstI polymorphisms were associated with higher increase in high-density lipoprotein-cholesterol. A three-loci interaction model consisting of CYP7A1rs892871AA/APOAIPstIP1P1/HMGCR rs12916CT was a better predictor for LDL-C lowering, when compared with single polymorphisms analysis on statin response. Variant genotypes of APOAI -2500C/T, CETP 405I/V, and ABCB1 3435C/T showed higher risk of myocardial infarction events (p < 0.05) in a 1-year follow-up of CAD patients. These results suggest that SNPs in lipid and statin pathway genes are associated with reduced LDL-C lowering by statins and identify individuals who may be resistant to maximal LDL-C lowering by statins.

Association of ACE and FACTOR VII gene variability with the risk of coronary heart disease in north Indian population.

The angiotensin converting enzyme (ACE) is a key factor in the production of angiotensin II and in the degradation of bradykinin. Chronic exposure to high levels of circulating and tissue ACE predispose to vascular wall thickening and atherosclerosis. Factor VII (FACTOR VII) is the first enzyme in the extrinsic pathway of the blood coagulation system and plays a key role in hemostasis; it also contributes to the occurrence of thrombotic events. In this study, we have examined the association of ACE and FACTOR VII gene in coronary heart disease patients (n = 300) and their age-matched controls (n = 300). Genotyping was done by PCR-RFLP method. No significant difference was observed in the distribution of I/D genotypes of ACE between cases and controls. In case of FACTOR VII R353Q polymorphism, there was not much difference in the distribution of alleles. AA genotype had protective effect for CHD (OR 0.56, 95% CI 0.37-0.83, P = 0.001). In case of FACTOR VII VNTR, there was difference in the distribution of alleles, H6 (73.5) and H7 (25.5) in cases, and H6 (70.5) and H7 (30.5) in controls. H6H7 and H7H7 genotypes had a protective effect for CHD with OR 0.27, 95% CI 0.18-0.41, P < 0.001, and OR 0.18, 95% CI 0.09-0.36, P < 0.001. Our study showed D allele of ACE to be associated with marginal risk of CHD, AA genotype of FACTOR VII R353Q and H6H7 and H7H7 genotypes of FACTOR VII VNTR showed protective effect for CHD.

VEGF and IL-4 gene variability and its association with the risk of coronary heart disease in north Indian population.

Vascular endothelial growth factor (VEGF) is a potent angiogenic growth factor that has been shown to play a significant role in neovascularization during inflammation in atherosclerotic plaques, formation of collateral vessels to an area of ischemic myocardium and neovascularization at the edges of a myocardial infarction during its repair. Interleukin-4 (IL-4) has important role in immune cell chemotaxis, formation of endothelial cell adhesion molecules and has numerous anti-inflammatory effects which prevent the complications of atherosclerosis, the primary cause of coronary heart disease (CHD). In this study, we have analyzed the effect of 1154 A/G polymorphism of VEGF and 70 bp VNTR polymorphism of intron 3 in IL-4 genes in coronary heart disease (CHD) patients (n = 300) and their age matched controls (n = 300). To analyze polymorphic alleles, ARMS-PCR and RFLP techniques were used. Multiple logistic regression analysis was carried out with statistical software. GG genotype was associated with a decreased risk of development of CHD (OR 0.22, 95% CI 0.12-0.38, P < 0.001). However, A allele showed an increased risk whereas G allele decreased the risk of CHD with diabetes mellitus, hypertension, chronic mental stress and positive familial history of myocardial infarction (MI)/CHD. GG genotype was found to have protective effect with alcohol intake (OR 0.34, 95% CI 0.14-0.82, P < 0.01) and central obesity (OR 0.15, 95% CI 0.04-0.56, P < 0.001). GG genotype of VEGF has also shown significant association with IL-4 (P2P2 and P1P2) genotypes.

Triple antiplatelet therapy vs. dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: an evidence-based approach to answering a clinical query.

AIMS: Outcomes of patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare metal stents (BMS) have not been evaluated separately for specific dual and triple antiplatelet agent use. The purpose of this meta-analysis was to determine whether triple antiplatelet therapy (combination of clopidogrel, aspirin and cilostazol) has any advantage in efficacy compared with standard dual antiplatelet therapy (aspirin and clopidogrel) in patients undergoing PCI. METHODS: Electronic and printed sources were searched till May 2008 for randomized controlled clinical trials (RCTs) of cilostazol in combination with aspirin and clopidogrel. Pooled weighted mean difference (WMD) and pooled odds ratio (OR) with 95% confidence intervals (CIs) were calculated. RESULTS: A total of four RCTs including 1457 patients with a median follow-up period of 6-9 months were included in the analysis. The rates of major adverse cardiac and/or cerebrovascular events (MACE/MACCE), stent thrombosis and bleeding were not significantly different between triple and dual antiplatelet therapy groups. Pooled analysis showed that cilostazol was associated with significantly decreased incidence of in segment restenosis (ISR) (OR 0.51, 95% CI 0.38, 0.68; P < 0.00001), increased minimum luminal diameter (MLD) (WMD 0.16, 95% CI 0.10, 0.22; P < 0.00001) for both DES and BMS and also individually. However, the rates of target vessel revascularization (OR 0.45, 95% CI 0.25, 0.83; P = 0.01 and late lumen loss (pooled WMD 0.14, 95% CI 0.2, 0.07; P = 0.001) were decreased significantly only in the DES group receiving triple therapy. CONCLUSIONS: Cilostazol appears to be effective in reducing the rates of ISR without any significant benefit for MACE/MACCE.

Correlation among soluble markers and severity of disease in non-diabetic subjects with pre-mature coronary artery disease.

Studies are lacking in literature, which demonstrate the cumulative impact of certain soluble markers in predicting the severity of CAD. Serum hsCRP, MMP-9, TIMP-1 and sRAGE levels were measured in non-diabetic 100 angiographically proven CAD patients (Group I) and 40 non-diabetic subjects with coronary risk factors and without any lesions (Group II). Increased levels of serum hsCRP, MMP-9, TIMP-1 and decreased levels of sRAGE were observed in Group I as compared to Group II. Gensini score, a measure for severity of CAD was found to be positively correlated with serum hsCRP, MMP-9, TIMP-1 and negatively with sRAGE. Multivariate analysis revealed serum MMP-9, hsCRP, sRAGE and family history as predictors of severity of CAD with a cumulative sensitivity and specificity of 92% and 82%, respectively. Cumulative impact of these soluble markers, in addition to the established markers will contribute to improve the predictive value for the assessment of disease severity.

Functional genomics of blood cellular LXR-alpha gene in human coronary heart disease.

Recent studies on the liver X receptor-alpha (LXR-alpha) have recognized its crucial protective role in the initiation of a cross-talk between lipid metabolism and inflammation regarded as a prerequisite for the development of atherosclerotic lesions. The present study was directed to explore the functional genomics of LXR-alpha gene within blood mononuclear cells of subjects suffering from coronary heart disease (CHD), revealed a paradoxical relationship between blood cellular LXR-alpha mRNA expression and the severity of coronary occlusion. In order to resolve this apparent paradox, the ligand binding domain of LXR-alpha gene was analyzed. The results of such a study revealed that three critical mutations in the domain comprising of amino acids Asp324, Pro327 and Arg328, were responsible for inability of this domain to interact with its natural ligands leading thereby to deregulation of its effector genes that are known to play crucial role in the cross-talk between lipid peroxidation and inflammation. This phenomenon was in conformity with functional assay of LXR-alpha dependent transcriptional activity within cells derived from normal and CHD subjects. Based upon these results we propose that the mutations in the LXR-alpha gene reported here for the first time not only may be exploited for the diagnosis of CHD in human subjects but also could be used as a marker for exploring the predisposition of human subjects towards CHD.

Prospective follow-up cardiac evaluation of children with Kawasaki disease in Northern India using the Japanese echocardiography criteria.

OBJECTIVES: There is no information available on the follow-up of children with Kawasaki disease (KD) in developing countries. This prospective study was undertaken to evaluate the cardiac abnormalities in a cohort of children with KD from a tertiary care centre in Northern India. METHODS: Twenty children with diagnoses of KD and followed-up for at least 3 months in the Pediatric Rheumatology and Immunology Clinic of the Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh were evaluated between July 2002 to January 2006. Age of onset of disease ranged from 12 months to 10 years. The male: female ratio was 4:1. All patients had received intravenous immunoglobulin (IVIG) administration in the acute stage. Chest radiography showed no abnormalities in the 15 patients in whom it was done. Electrocardiographic abnormalities were seen in 3 patients in the form of T wave inversion in 3, ST segment changes in 2, and prolonged PR interval in 1 patient which normalized on follow-up. The mean time interval between the diagnosis of KD and first follow-up echocardiography was 7.9 +/- 3.5 months (range 4.4-11.4 months), which was repeated at 1 year and 2 years follow-up in patients who had abnormal findings. When we analyzed coronary artery diameters using Japanese Ministry of Health criteria, none of our patients could qualify for a diagnosis of coronary aneurysm. However, 3 had coronary artery diameters more than + 2 SD when the body surface area adjusted coronary dimensions were used. RESULTS: One of our patients also had increased left ventricular dimensions but also had normal ejection fraction and shortening fraction, and there were no regional wall motion abnormalities. Mitral valve was thickened in 2 patients and trivial mitral regurgitation was noticed in 1 patient. Repeat echocardiography done 1 year and 2 years later on follow-up, showed persistence of thickening of the mitral valve leaflet in one of these but there was no regurgitation. None of our patients had evidence of cardiac failure, arrhythmia or myocardial infarction. There was no mortality in this series. Thallium scans were carried out during follow-up on 14 patients in this cohort and 2 patients showed perfusion defects in anterior wall, septum and posterior wall of lateral ventricle. CONCLUSIONS: We conclude that significant myocardial dysfunction and coronary artery changes due to KD were uncommon in our cohort. We speculate that this can be attributed to the IVIG given to the patients during the acute phase of the illness. To the best of our knowledge, this is the first study on detailed cardiac follow-up of children with KD from a developing country.

Comparison of left ventricular functional parameters measured by gated single photon emission tomography and by two-dimensional echocardiography.

The aim of the present study was to evaluate the correlation amongst left ventricular (LV) functional parameters estimated by gated single photon emission tomography (GSPET) and two-dimensional (2D) M-mode, echocardiography (ECHOC). GSPET was performed in a single day stress/rest protocol by using either technetium-99m methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) or technetium-99m tetrofosmin ((99m)Tc-myoview) in 36 consecutive patients, 21 males and 15 females; mean age 57.6+/-11.8 y, range 32-82 y. The various LV parameters studied were: ejection fraction (EF), end systolic volume (ESV), end diastolic volume (EDV), stroke volume (SV) and LV mass (LVM). The GSPET data were reconstructed using an automatic algorithm employing filtered back projection (FBP) and further analyzed by Emory cardiac (EC) toolbox versions EO-00369 and EO-00733 for the quantitative determinations of these parameters. All patients underwent ECHOC within 1-2 h of the post-stress data acquisition of GSPET. Our results showed that the LV volumes and the LVM showed good correlation (r=0.749 to 0.952, P=0.01). These values could thus be used interchangeably. The assessment of these parameters by GSPET therefore does not seem to be affected by the dose of the radioactivity administered as the dose of the (99m)Tc-labeled myocardial agents for acquiring rest study was approximately four times higher than that for the stress study. Our results also showed that the mean +/- SD values of the volumes and the EF of the LV evaluated by the two techniques, differed significantly except significant correlations for ESV, EDV and LVEF were observed between the two methods: r=0.574 to 0.954; 0.347 to 0.952 and 0.516 to 0.876 respectively. On the other hand, a wide disagreement was observed in estimating the LVM by the two techniques. The LVM measurements by 2D ECHOC were approximately double the values estimated by GSPET. Despite the large disagreement, a small correlation (r=0.33, P=0.05) was observed for LVM between the two techniques. In conclusion, although we observed a good correlation for LV volumes and LVM between the GSPET and the ECHOC techniques, yet these two techniques cannot be used interchangeably.

Isolated noncompaction of left ventricle presenting as peripartum cardiomyopathy.

Long term follow-up of the first reported case of isolated noncompaction of left ventricle presenting as peripartum cardiomyopathy is presented.