Abnormal regional left ventricular systolic and diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention: clinical significance of post-ischemic diastolic stunning.

OBJECTIVES: This study was designed to characterize both regional left ventricular (LV) systolic and diastolic function after percutaneous coronary intervention by using strain imaging (SI) derived from 2-dimensional speckle-tracking echocardiography. BACKGROUND: Ischemic insult after coronary occlusion affects not only regional LV systolic but also diastolic function. METHODS: Regional LV transverse peak strain and strain changes during the first one-third of diastole duration (strain imaging diastolic index [SI-DI]) were monitored in at-risk segments after percutaneous coronary intervention in 30 patients with coronary artery disease. The segments were divided into proximal and distal. Strain data in the at-risk segments were compared with values derived from remote nonischemic segments. RESULTS: Coronary occlusion induced a marked reduction in the systolic strain in both proximal and distal at-risk segments (from 36.9 +/- 6.0% to 12.0 +/- 3.9% and from 31.9 +/- 5.6% to 6.2 +/- 3.3%, respectively, p < 0.0001). Concomitantly, SI-DI values decreased (from 76.6 +/- 5.3% to -21.2 +/- 9.1% and from 72.5 +/- 5.9% to -48.7 +/- 20.8%, respectively, p < 0.0001). Upon reperfusion, systolic deformation parameters returned to near-normal pre-occlusion values. However, SI-DI values in the both proximal and distal at-risk segments decreased (43.2 +/- 9.5%, p < 0.01, and -17.3 +/- 11.1%, p < 0.0001, respectively) 30 min after reperfusion and were still lower (51.5 +/- 9.9%, p < 0.01) in the distal at-risk segment 24 h after reperfusion. CONCLUSIONS: SI analysis provides detailed mechanical characterization of regions with myocardial ischemic insult and can demonstrate post-ischemic diastolic stunning despite complete systolic functional recovery after reperfusion.

Bosentan improved syncope in a hemodialysis patient with pulmonary hypertension and mild aortic stenosis.

Pulmonary arterial hypertension (PAH), caused by collagen diseases, Eisenmenger syndrome or of idiopathic etiology, generally has a poor prognosis. Recently, bosentan, a dual endothelin receptor antagonist, has become available for treating PAH. This report describes a bosentan-effective case of combined PAH, hemodialysis and mild aortic stenosis. A 71-year-old woman on hemodialysis was referred to our hospital because of repetitive syncope. Although neurological examinations revealed no etiological diseases, echocardiography and cardiac catheterization showed PAH and mild aortic valve stenosis. Bosentan abolished syncope with improvement of hemodynamic parameters. This report suggests bosentan was clinically useful in a hemodialysis patient with pulmonary hypertension and mild aortic valve stenosis.

Successful thromboendarterectomy for severe chronic thromboembolic pulmonary hypertension caused by primary antiphospholipid syndrome.

Pulmonary hypertension is one of the lethal complications in the antiphospholipid syndrome due to chronic recurrence of embolism or thrombosis. We experienced a 19-year-old man suffering from severe chronic thromboembolic pulmonary hypertension (CTEPH) caused by primary antiphospholipid syndrome. According to the guideline, pulmonary thromboendarterectomy was decided on after combined therapy with warfarin, beraprost and oxygen inhalation had not been effective enough to improve severe CTEPH. By an operation, the mean pressure of the pulmonary artery was decreased from 50 mmHg to 16 mmHg, while his New York Heart Association (NYHA) functional class classification significantly improved from class III to class I. We concluded that pulmonary thromboendarterectomy could dramatically improve hemodynamic indices, NYHA functional status and quality of life in patients with CTEPH.