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While mitral stenosis of rheumatic origin has been effectively treated percutaneously for more than 20 years, transcatheter treatment of mitral (MR) and tricuspid (TR) regurgitation appears as a contemporary unmet clinical need. The advent of new transcatheter therapies offers several treatment options for elderly and frail patients at high surgical risk. MitraClip is now consolidated as a therapy for functional MR in selected patients. Transcatheter mitral valve replacement is a promising alternative to transcatheter repair, for both functional and degenerative forms. However, further developments and new evidence are needed. Transcatheter treatment of the tricuspid valve has arrived late compared to similar technologies that have been developed for the aortic and mitral valve, and is currently in its infancy. This is likely due, in part, to the previously underreported impact of TR on patient outcomes. Edge-to-edge repair is the most advanced transcatheter solution in development. Data on annuloplasty and tricuspid valve replacement are limited and more evidence is needed. The future looks promising for transcatheter mitral and tricuspid valve therapies, although their place in clinical practice has yet to be clearly defined.

OBJECTIVE--It is still controversial whether sirolimus-eluting stem (SES) and paclitaxel-eluting stent (PES) are equally effective in patients with diabetes. In these patients, multiple individual variables may be responsible for neointimal [...]

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Transcatheter aortic valve replacement (TAVR) is the gold standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. This procedure has also been used in patients with previous mitral valve (MV) prostheses, with contrasting outcomes reported. The aim of this study is to describe procedural and early outcomes of patients with previous MV prostheses undergoing TAVR.

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high contrast volumes, which can be particularly deleterious in patients with chronic kidney disease (CKD). We aimed to study the outcomes of CTO PCI in subjects with vs without CKD, and the impact of contrast-induced acute kidney injury (CI-AKI).

The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) programme was designed to assess the comparative safety and effectiveness of radial versus femoral access and of bivalirudin versus unfractionated heparin with optional glycoprotein IIb/IIIa inhibitors in patients with the whole spectrum of acute coronary syndrome undergoing invasive management. Here we describe the prespecified final 1-year outcomes of the entire programme.

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ABSTRACTBackground:To assess early and mid-term efficacy of transcatheter aortic valve replacement (TAVR) using the new-generation CoreValve Evolut R (Medtronic Inc., Galway, Ireland).Methods:This is a prospective, single-center study. All consecutive patients undergoing TAVR with 23-, 26-, 29-, 34-mm Evolut R valve were included. In a secondary analysis, patients undergoing Evolut R implantation were compared using the propensity score method with a historical cohort of patients who underwent CoreValve implantation in our institution.Results:From March 2015 to September 2017, a total of 320 patients with a median age of 81.1 years (IQR 77–84) and mean STS score of 4.9 ± 3.1% were treated. Device success was obtained in 300 patients (93.8%). Effective recapture and repositioning of the valve due to initial suboptimal deployment was accomplished in 40 patients (12.5%). Post-TAVR transthoracic echocardiogram showed a reduction in mean gradient from 49.1 ± 18.2 mmHg to 7.6 ± 0.4 mmHg (p < 0.001). Moderate paravalvular regurgitation (PVR) was observed in 4.2% patients. No patient had severe PVR. At 30-day, all-cause and cardiovascular mortality rates were 2.2% and 1.9%, respectively; disabling stroke occurred in 5 patients (1.6%). Life-threatening and major bleeding occurred in 16 (5.0%) and 42 (13.1%) patients, respectively. Pacemaker implantation rate was 12.6%. Compared with the CoreValve, Evolut R use was associated with higher device success (92.8% vs. 79.7%, p < 0.001) and lower rates of moderate or severe PVR (2.1% vs. 14.4%, p < 0.001), minor vascular complications (4.9% vs. 14.5%, p < 0.001), and pacemaker implantation (13.5% vs. 21.0%, p = 0.026).Conclusion:In this prospective, single-center study, TAVR using the new-generation self-expanding Evolut R system, was associated with high device success rate, excellent hemodynamics, and low early complications rates.

We aimed to investigate the procedural and long-term outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients who had undergone previous coronary artery bypass grafting (CABG) vs those who had not, and to evaluate the role of the Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom (RECHARGE) score in predicting acute and long-term outcomes.

AbstractObjectives:We compared the outcome of anaemic patients undergoing transcatheter (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic valve stenosis.Methods:Anaemic patients (haemoglobin <13.0 g/dL in men and <12.0 g/dL in women) undergoing TAVI and SAVR from the OBSERVANT study were the subjects of this analysis.Results:Preoperative anaemia was an independent predictor of 3-year mortality after either TAVI (HR 1.37, 95% CI 1.12–1.68) and SAVR (HR 1.63, 95% CI 1.37–1.99). Propensity score matching resulted in 302 pairs with similar characteristics. Patients undergoing SAVR had similar 30-d mortality (3.6% versus 3.3%, p = .81) and stroke (1.3% versus 2.0%, p = .53) compared with TAVI. The rates of pacemaker implantation (18.6% versus 3.0%, p < .001), major vascular damage (5.7% versus 0.4%, p < .001) and mild-to-severe paravalvular regurgitation (47.4% versus 9.3%, p < .001) were higher after TAVI, whereas acute kidney injury (50.7% versus 27.9%, p < .001) and blood transfusion (70.0% versus 38.6%, p < .001) were more frequent after SAVR. At 3-year, survival was 74.0% after SAVR and 66.3% after TAVI, respectively (p = .065), and freedom from MACCE was 67.6% after SAVR and 58.7% after TAVI, respectively (p = .049).Conclusions:These results suggest that TAVI is not superior to SAVR in patients with anaemia.

Prediabetes is associated with subclinical cardiac changes associated with heart failure development.

BackgroundPercutaneous edge-to-edge mitral valve repair (PMVR) recently emerged as an effective treatment modality for patients with severe mitral regurgitation (MR). Length of postprocedural hospital stay may represent a modifiable cost associated with percutaneous treatment. We looked at feasibility, predictors and safety of early discharge (ED), defined as hospital discharge within 72 hours, in patients undergoing PMVR.Methods and resultsConsecutive patients treated with MitraClip from October 2008 to December 2015 were analysed. Primary outcomes of interest were cardiovascular and non-cardiovascular mortality, rehospitalisation for heart failure and major adverse events at 30 days and 90 days. A total of 269 patients were included. Of these, 115 patients were early discharged (ED group). Rates of ED increased from 25.9% for the biennium 2008–2009 to 59.1% in 2014–2015 (p<0.001 for trend). In a penalised logistic regression model, male gender (OR=2.13, 95% CI 1.17 to 3.95) and procedural year (OR=2.13, 95% CI 1.51 to 3.11) were associated with higher probability of ED. Conversely, atrial fibrillation (OR=0.48, 95% CI 0.27 to 0.85), any Mitral Valve Academic Research Consortium bleeding (OR=0.07, 95% CI 0.01 to 0.60), log-transformed N-terminal pro-brain natriuretic peptide levels (OR=0.79, 95% CI 0.63 to 0.99) and postimplant MR grade (OR=0.60, 95% CI 0.37 to 0.94) conferred a lower likelihood of ED. In propensity score-weighted analyses, overall survival, freedom from heart failure and major adverse events at 30 days and 90 days were not different in ED and non-ED groups (all weighted log-rank p value>0.05).ConclusionsIn selected patients undergoing PMVR, ED may be feasible and safe.

Aim: Whether high platelet reactivity (HPR) immediately after diagnostic angiography is associated with worse coronary reperfusion prior to and after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is unknown. This study aimed to assess the impact of P2Y12-mediated HPR on angiographic outcomes in patients with STEMI undergoing PPCI.Methods: STEMI patients undergoing PPCI and pretreated with a P2Y12receptor antagonist underwent platelet function testing with the VerifyNow™ assay at the time of angiography. Light transmission aggregometry (LTA) was performed in a subgroup. HPR was defined according to expert consensus definitions. Pre-PCI coronary patency, thrombotic burden and indices of impaired post-PCI reperfusion were compared between HPR and non-HPR patients.Results: Among 164 patients, the prevalence of VerifyNow™-derived HPR was 71.3% at a median (interquartile range (IQR)) of 55 (40–75) minutes after a P2Y12inhibitor loading dose. Compared with non-HPR patients, those with HPR had significantly lower rates of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grades 2 or 3 (51.1% vs. 32.5%, p?=?0.04), higher rates of thrombus score (TS) grade 3/4 (29.8% vs. 52.1%, p?=?0.015) and 4 (14.9% vs. 32.5%, p?=?0.037) and lower median (IQR) corrected TIMI frame count (cTFC; 23.2 (15.8–32.5) vs. 26.0 (21.0–35.0), p?=?0.02), respectively. These findings were consistent using LTA-based data. HPR and TS grade 4 were predictors of higher cTFC.Conclusions: In patients with STEMI undergoing PPCI pretreated with P2Y12receptor inhibitors, pre-PPCI HPR was found to be associated with lower pre-PCI coronary patency, higher thrombotic burden and a worse index of post-PCI coronary reperfusion.

Background: There is conflicting evidence regarding the benefit of an early invasive strategy vs. a conservative strategy in women with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: We searched English-language studies on MEDLINE and the Cochrane Database of Systematic Reviews from 2000 to December 2015. Results from major available studies and meta-analysis comparing outcomes of an early invasive strategy vs. a conservative strategy or medical therapy vs. revascularization in women with NSTE-ACS were considered. Results: Available data on the comparative effectiveness and safety of different management strategies in NSTE-ACS women derive from observational registries and pre-specified gender sub-analyses of randomized trials comparing early routine invasive with a selective invasive strategy. While some post-hoc analysis of randomized trials showed that an early invasive strategy did not reduce the risk of future events among women, in contrast to its beneficial effect in men, others showed similar benefits of a routine early invasive vs. a conservative strategy in men and women. Several important differences between these trials may explain the lack of benefits from a routine invasive strategy compared with a conservative strategy. Overall evidence showed better outcomes with a routine invasive strategy, especially for women at higher risk and those with positive biomarkers. Differently, women with negative biomarkers and those at lower risk appeared to benefit most from a conservative approach. Conclusion: The benefit of an early invasive strategy is restricted to women at higher risk. Further research is warranted to define the optimal management of women with NSTE-ACS.

Aims: To evaluate the impact of bivalirudin versus heparin on efficacy and safety outcomes of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) and to explore the impact of differential use (bailout vs. routine) of glycoprotein IIb/IIIa inhibitors (GPI).Methods and Results: Five randomized controlled trials encompassing 10,350 patients were included. Primary efficacy and safety endpoints were all-cause death and major bleeding, respectively. All-cause death at 30 days did not significantly differ with bivalirudin compared to heparin (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.74–1.28; P=0.84). Major bleeding was significantly reduced by bivalirudin compared to heparin (OR 0.58, 95% CI 0.40–0.85; P=0.005). Bivalirudin use was associated with non-significantly different rates of 30-day definite stent thrombosis (ST) (OR 1.71, 95% CI 0.84–3.49; P=0.14), albeit with higher rates of acute ST (OR 3.55, 95% CI 1.67–7.56; P=0.001) and non-significantly different rates of subacute ST (OR 0.86, 95% CI 0.46–1.61; P=0.64). There were non-significant differences in the 30-day rates of reinfarction (OR 1.47, 95% CI 0.94–2.30; P=0.10) and cardiovascular death (OR 0.76, 95% CI 0.56–1.02; P=0.07). There were no significant interactions between bailout versus routine GPI use in the heparin arm for any of the safety or efficacy outcomes (all Pinteraction>0.10).Conclusions: Bivalirudin compared with heparin was associated with comparable 30-day rates of mortality with reduced major bleeding, at the price of an increased risk of acute ST, with non-significant differences in the overall 30-day rates of ST and reinfarction. Intended use of GPI in the heparin arm did not significantly modify the treatment effects of bivalirudin. Given the important differences between trials, as well as evolution in technique and adjunct pharmacotherapy, further randomized trials are warranted to discriminate whether there are substantial safety and efficacy differences between these agents during primary PCI in STEMI.

ABSTRACTBackground:We sought to appraise the accuracy of non-contrast three-dimensional (3D) magnetic resonance imaging (MRI) in comparison with computed tomography (CT).Methods:This is a single-center prospective study enrolling 48 consecutive patients with severe aortic stenosis screened for transcatheter aortic valve implantation (TAVI), who underwent non-contrast 3D MRI and standard cardiac CT for pre-TAVI aortic annulus assessment. Systolic MRI dimensions were modelled, by adding a corrective factor (+7.5% of the area). Tests of correlation and agreement were performed.Results:The mean subjective MRI image quality was 3.2±0.8. According to CT, 20 patients (43.5%) had severe or massive annular calcifications. Bland–Altman plots and Passing and Bablock regression analysis showed no relevant differences of cross-sectional area measurements for corrected systolic MRI vs. systolic CT measurements (mean bias 0.09 cm2; 95% limits of agreement: -0.48 to 0.67). Higher bias was seen in patients with severe or massive annular calcifications. Disagreement between CT and MRI in terms of transcatheter valve size was reported in 3 patients (6.5%). All of them had severe or massive annular calcifications.Conclusion:In patients referred for TAVI, aortic annulus measurements using corrected systolic MRI compare favorably with those made at CT. Caution should be applied when choosing transcatheter valve size in the presence of severe or massive annular calcification as they reduce the accuracy of MRI measurements.

We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).

Management of carotid artery stenosis is considered an important strategy for stroke prevention. Carotid artery stenting (CAS) has been introduced as an acceptable alternative to surgical carotid endarterectomy (CEA) in the treatment of internal carotid artery (ICA) stenosis.

Antithrombotic prophylaxis is the cornerstone of adjunctive pharmacologic therapy in patients undergoing transcatheter intervention for valvular and structural heart disease. However, drugs and doses of antiplatelet and anticoagulant agents are mostly empiric for these indications and typically administered at the operator’s discretion. This article describes the rationale for antithrombotic management of patients undergoing transcatheter aortic valve implantation, percutaneous mitral valve repair with the Mitraclip system, patent foramen ovale, and atrial septal defect closure, as well as common strategies for managing antiplatelet and anticoagulant therapy in patients with valvular and structural heart disease undergoing transcatheter procedures.

The mainstay of acute ST segment elevation myocardial infarction (STEMI) emergent management consists of reperfusion therapy combined with antithrombotic treatment. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for STEMI. Rescue PCI consists of urgent transfer for PCI of patients with failed fibrinolysis. The pharmacoinvasive strategy consists of administration of fibrinolysis followed by immediate transfer to a PCI-capable hospital for routine early catheterization. This article provides an overview of data and recommendations on primary PCI, rescue PCI, and pharmacoinvasive strategy as well as of the antithrombotic regimens used to support STEMI reperfusion approaches.

Novel oral anticoagulants (NOACs) have been associated with multiple safety benefits compared with vitamin K antagonists in patients with diseases at high thromboembolic potential, including nonvalvular atrial fibrillation. Although these agents have several distinct advantages, they are limited by the lack of a proven antidote, which may represent a major concern in case of life-threatening bleeding. Several different drugs and compounds are currently under investigation as reversing agents of NOACs. This article provides an overview of potential NOACs antidotes, including recent patents of emerging compounds.

Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation.

Successful mitral valve surgical repair, decreasing volume overload, has been shown to provide reverse left ventricular (LV) and/or left atrial remodeling in most patients. Percutaneous mitral valve repair with the MitraClip system (Abbott, Abbott Park, IL) has been associated with favorable clinical outcomes in patients with mitral regurgitation at high risk of surgery. However, specific data on left cardiac chambers reverse remodeling after such procedures are limited.

Whether renal revascularization reduces left ventricular hypertrophy in patients with coronary artery disease is uncertain.

Atherosclerotic renovascular disease is associated with resistant hypertension and chronic kidney disease, although the causal relationship is discussed. To date, the role of renal artery diameter on these pathological conditions was not clearly studied. We aimed to identify the association of reference diameter and minimal luminal renal artery diameter with glomerular filtration rate (GFR) and resistant hypertension in a high cardiovascular risk population.

Pulmonary arterial hypertension (PAH) is a rare, but serious condition which, if untreated, is associated with a poor survival. Currently, even if several trials have led to the approval of many drugs for PAH, there is no established cure for this disease. However, approved drugs for PAH have contributed to significantly improve symptoms, exercise capacity, quality of life and survival of these patients. The aim of this review is to overview the standard treatment of PAH and to give some insights about new treatments that are currently under investigation along with the discussion of recent patents.

Introduction:Adjunctive pharmacotherapy is of key importance in determining the outcomes of percutaneous coronary intervention (PCI). In parallel, there has been an increasing body of evidence indicating that the aggressive management of coronary risk factors and changes in lifestyle behavior yield additional positive results in morbidity and mortality reductions. A stream of new data from randomized clinical trials has recently prompted the release of a focused update of the PCI guidelines, endorsing new recommendations on the use of antiplatelet drugs and parenteral anticoagulants.Areas covered:The aim of this manuscript is to provide an up-to-date overview of the current evidence on the use of adjunctive pharmacological therapy in patients undergoing revascularization, with focus on results of recent trials and future directions.Expert opinion:Given the availability of several pharmacological agents with different mechanisms of action, understanding whether a drug should or should not be prescribed, as well as individualizing the pharmacological formula to the patient's need and risk category, is pivotal to balance the safety and efficacy of adjunctive therapies for PCI. Studies on new antiplatelet agents and selective inhibitors of specific coagulation factors are likely to characterize the next years of research on interventional pharmacology.

We investigated the long-term impact of different stent types and diabetes mellitus (DM) in patients undergoing percutaneous coronary intervention (PCI) of bifurcation lesions, based on a large multicenter survey endorsed by the Italian Society of Invasive Cardiology.

Although standard anticoagulation, including heparins and vitamin K antagonists (VKA), is clinically beneficial, several unmet needs remain due to several pharmacokinetic and pharmacodymamic limitations. Selective anticoagulant agents have been developed to overcome the drawbacks associated with both heparins and.VKA. Agents selectively targeting factor Xa, IXa and thrombin are alternative anticoagulants in the most advanced phases of clinical development. Compared to traditional anticoagulants these drugs have the potential to be more effective, safer and easier to use and to provide a more predictable dose response, without need for routine monitoring and dose adjustment. This review will summarize the current status of selective anticoagulant drugs, which are already licensed or being evaluated in advanced phases clinical studies for antithrombotic treatment in non-valvular atrial fibrillation, percutaneous coronary intervention and acute coronary syndromes, focusing on design and results of studies in these specific clinical settings.

Ultrapure poly[bis(trifluoroethoxy)phosphazene] is a novel biocompatible, anti-inflammatory, antithrombogenic polymer which has the potential to cover stent devices without elution of a cell cycle inhibiting drug. The properties of polyphosphazene are likely to extend its use to a broad array of promising applications. This article reviews the features of the polymer and some recent patents related to use of poly[bis(trifluoroethoxy)phosphazene] in coating, its relevance as compared to other polymers, current evidence on pre-clinical and clinical performance, and future perspectives.

Percutaneous coronary intervention has become a mainstay in the treatment of patients with coronary artery disease in recent years. However, restenosis, incomplete revascularization, and progression of disease continue to cause a need for a clinical functional assessment in order to reduce morbidity. Angiographic systematic follow-up should nowadays be considered a valuable approach only to monitor small groups of very high risk patients. Although coronary CT angiography seems able to non-invasively image the coronary artery lumen, but the presence of a stent could limit visualization of coronary morphology. Recurrence of symptoms itself has low sensitivity and specificity for detection of restenosis and myocardial ischemia. Exercise testing may provide useful information on symptoms and functional capacity of the patient; however, it is poorly diagnostic of restenosis and myocardial ischemia with a low level of sensitivity and specificity. Conversely, the significantly increased sensitivity and specificity obtained by stress nuclear, echocardiographic or magnetic resonance imaging provide great advantage for clinical assessment of these patients. Additional advantages of stress imaging are the ability to assess location and extent of myocardial ischemia regardless of symptoms as well as to evaluate patients who are unable to exercise or who have an uninterpretable electrocardiogram. Furthermore, the clear superiority of stress imaging with regard to specificity and predictive value for postrevascularization events makes this functional approach of paramount importance for assessing prognosis of such patients.

Background: The separation of patients with suspected or known coronary artery disease into low- and high-risk subgroups by means of noninvasive testing is highly relevant in the selection of patients who require further diagnostic or therapeutic investigation. We evaluated whether exercise electrocardiographic variables during exercise testing might be a means of predicting the severity of myocardial ischemia as assessed with myocardial scintigraphy. Methods and Results: We retrospectively reviewed 816 consecutive patients (mean age, 57 ± 10 years) who underwent exercise technetium-99m tetrofosmin single photon emission computed tomography (SPECT) for the assessment of suspected or known coronary artery disease. Eight independent significant predictors of the extent and severity of reversible perfusion defects (ischemic perfusion score), which when integrated in a diagnostic algorithm satisfactorily discriminated patients with no reversible perfusion defects (sensitivity, 75%; specificity, 80%) and patients with severe impaired myocardial perfusion (≥11 ischemic perfusion score; sensitivity, 77%; specificity, 82%), were identified by means of stepwise discriminant analysis. However, patients with mildly to moderately impaired myocardial perfusion (≥1 but &lt;11 ischemic perfusion score) were poorly discriminated (sensitivity, 50%; specificity, 78%). The set of variables that were significant (P &lt; .0001) for prediction included sex, myocardial infarction, exercise angina, the maximal amount of ST segment depression, rate-pressure product threshold criteria, slope of ST segment depression, ST/heart rate index, and peak exercise heart rate. Conclusions: The results of the use of clinical and electrocardiographic exercise variables satisfactorily agrees with the results from scintigraphy only for patients with no reversible perfusion defects and with severely impaired myocardial perfusion. However, it fails as an approach with universal applicability.

Background: Technetium 99m-labeled myocardial agents have been proposed as an alternative to thallium 201. The aim of this study was to assess retrospectively the accuracy of exercise myocardial 99mTc-tetrofosmin scintigraphy with tomographic imaging (SPECT) in a large group population in the evaluation of coronary artery disease. Furthermore we evaluated the relation between the severity of scintigraphic impaired myocardial perfusion and the angiographic coronary artery stenoses in patients without myocardial infarction and with stenosis localized exclusively in the proximal segment of the 3 main coronary arteries. Methods and Results: The study group consisted of 235 consecutive patients, 204 (87%) of whom were men, with a mean age of 57±10 years, and with suspected or known coronary artery disease, who underwent 99mTc-tetrofosmin SPECT and coronary angiography. Furthermore, 61 patients in a low-likelihood group for coronary artery disease were also studied. Significant disease was defined by ≥50% luminal coronary artery stenosis in ≥1 native coronary artery or major branch or in a saphenous vein graft or arterial mammary graft. The overall sensitivity was 95%, specificity was 76%, and predictive accuracy was 95%. The normalcy rate for the lowlikelihood group was 93%. Sensitivity was 71% for the left anterior descending artery, 61% for the left circumflex artery, and 73% for the right coronary artery. Specificity was 94% for the left anterior descending artery, 96% for the left circumflex artery, and 91% for the right coronary artery. Predictive accuracy was 79% for the left anterior descending artery, 78% for the left circumflex artery, and 81% for the right coronary artery. In patients without myocardial infarction linear regression analysis between scintigraphy and angiography showed a significant correlation in patients with severe proximal coronary artery stenosis (r=0.53, P&lt;.002), but not in those with moderate proximal stenosis (r=0.31, P=NS). Conclusion: This study shows that 99mTc-tetrofosmin SPECT is accurate in the detection of coronary artery disease. The relation of the severity of scintigraphic impaired myocardial perfusion and angiographic coronary artery stenosis, however, may differ significantly in patients with proximal stenosis of different severity.