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Objective: The objective of this study was to evaluate right ventricular systolic and diastolic functions with the use of conventional and tissue Doppler echocardiography in patients with slow coronary flow (SCF)., Methods and Results: Patients who were detected to have SCF but otherwise normal epicardial coronary arteries between October 2010 and July 2011 were included in our study. The control group was selected from the patients with normal coronary arteries but no SCF. All patients underwent echocardiography to evaluate left and right cardiac functions with conventional methods and tissue Doppler imaging. The study consisted of 86 patients [59 (68.6%) males, mean age: 54 +/- 10 years) with SCF. Sixty-six subjects [42 (63.6%) males, mean age: 55 +/- 8 years] with normal coronary arteries without SCF constituted the control group.Tissue Doppler findings of left ventricular systolic and diastolic functions were significantly disturbed in the SCF group (myocardial performance index: 0.37+/- 0.02 vs. 0.28 +/- 0.02, P<0.001; E/A ratio: 0.9 +/-0.1 vs. 1.1 0.1, P < 0.001). However, when the right ventricular functions were considered, no significant difference was observed between the 2 groups (myocardial performance index: 0.25 +/- 0.10 vs. 0.25 +/- 0.10, P = 0.9; E/A ratio: 0.50 +/- 0.06 vs. 0.50 +/- 0.08, P= 0.3; TAPSE: 26.2 +/- 2.2 vs. 25.9 +/- 2.2, P = 0.6)., Conclusions: Preserved right ventricular diastolic and systolic functions in contrast to the impaired left ventricular functions in patients with SCF was the main finding of our study. The exact mechanisms of this new finding should be investigated by further studies.

Objective: Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli. There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis., Methods and Results: We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sex-matched control group having dilated cardiomyopathy without left ventricular thrombosis. We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 +/- 0.8 vs. 8.7 +/- 0.6, p < 0.001)., Conclusions: Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment.

Complications related to percutaneous placement of intra-aortic balloon pump counterpulsation are still high despite major refinements in catheter design and techniques. One hundred and forty-eight patients in whom intra-aortic balloon pumping was inserted were classified into two groups on the basis of the insertion technique. Group I included 103 patients in whom the conventional percutaneous insertion was used. A sheathless insertion technique was used in group II (n = 45). The overall complication rate was 16.6% (25 of 150), in which lower limb ischaemia was the most common complication. The limb ischaemia was noted in 12 patients (11.5%) in group I and 4 patients (8.9%) in group II (statistically not significant). Peripheral vascular disease, diabetes mellitus and female gender were found to be significant predictors of limb ischaemia (p = 0.01, p = 0.02 and p = 0.03, respectively). In conclusion, sheathless insertion of intra-aortic balloon pump catheters does not reduce the incidence of limb ischaemia.