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The present study investigated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) without iodine re-injection immediately after primary percutaneous coronary intervention (PCI) for predicting future cardiovascular events after acute myocardial infarction (AMI). We performed a prospective study in which 263 consecutive patients with first AMI successfully treated with primary PCI were enrolled. Sixty-four-slice MDCT without the re-injection of contrast medium was performed immediately after PCI. Myocardial DE was considered to be transmural when involving myocardial thickness ≥ 75% (Group A; n = 104), subendocardial (

BackgroundDrug-eluting stent-induced vasospastic angina (DES-VSA) has emerged as a novel complication in the modern era of percutaneous coronary intervention (PCI). Although beta blockers (BBs) are generally recommended for coronary heart disease, they may promote incidence of DES-VSA. This study aimed to compare the effects of calcium channel blockers (CCBs) perceived to be protective against DES-VSA and BBs on subsequent coronary events after second-generation drug-eluting stent implantation.MethodsIn this multicentre prospective, randomised study, 52 patients with coronary artery disease who underwent PCI for a single-vessel lesion with everolimus-eluting stent placement were randomised into post-stenting BB (N=26) and CCB (N=26) groups and followed for 24 months to detect any major cardiovascular events (MACE). A positive result on acetylcholine provocation testing during diagnostic coronary angiography (CAG) at 9 months was the primary endpoint for equivalence. MACE included all-cause death, non-fatal myocardial infarction, unstable angina, cerebrovascular disease or coronary revascularisation for stable coronary artery disease after index PCI.ResultsAt 9 months, 42 patients (80.8%) underwent diagnostic coronary angiography and acetylcholine provocation testing. Among them, seven patients in each group were diagnosed with definite vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0 (−0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In detail, coronary revascularisation for stable coronary artery disease was the predominant endpoint that contributed to the greater proportion of MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03).ConclusionsThe incidence of acetylcholine-induced coronary artery spasms did not differ between patients receiving BBs or CCBs at 9 months after PCI. However, a higher incidence of 2-year MACE was observed in the CCB group, suggesting the importance of BB administration.Trial registration numberThis study was registered at the Japanese University Hospital Medical Information Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial; UMIN000008321, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009536).

We evaluated the effects of an alpha-glucosidase inhibitor, voglibose, on cardiovascular events in patients with a previous myocardial infarction (MI) and impaired glucose tolerance (IGT). This prospective, randomized, open, blinded-endpoint study was conducted in 112 hospitals and clinics in Japan in 3000 subjects with both previous MI and IGT receiving voglibose (0.6 mg/day, n = 424) or no drugs (n = 435) for 2 years. The Data and Safety Monitoring Board (DSMB) recommended discontinuation of the study in June 2012 after an interim analysis when the outcomes of 859 subjects were obtained. The primary endpoint was cardiovascular events including cardiovascular death, nonfatal MI, nonfatal unstable angina, nonfatal stroke, and percutaneous coronary intervention/coronary artery bypass graft. Secondary endpoints included individual components of the primary endpoint in addition to all-cause mortality and hospitalization due to heart failure. The age, ratio of males, and HbA1C were 65 vs. 65 years, 86 vs. 87%, and 5.6 vs. 5.5% in the groups with and without voglibose, respectively. Voglibose improved IGT; however, Kaplan–Meier analysis showed no significant between-group difference with respect to cardiovascular events [12.5% with voglibose vs. 10.1% without voglibose for the primary endpoint (95% confidence interval, 0.82–1.86)]; there were no significant differences in secondary endpoints. Although voglibose effectively treated IGT, no additional benefits for cardiovascular events in patients with previous MI and IGT were observed. Voglibose may not be a contributing therapy to the secondary prevention in patients with MI and IGT. Clinicaltrials.gov number: NCT00212017

We investigated the relationship between coronary plaque components and small embolic particles during stenting and examined the influence on the coronary microcirculation.In vivo tissue characterization of atherosclerotic plaques was introduced by the Virtual Histology intravascular ultrasound (VH-IVUS) system (Volcano Therapeutics, Inc., Rancho Cordova, California).The study consisted of 44 patients who underwent elective coronary stenting. Plaque characteristics were identified with VH-IVUS, and small embolic particles liberated during stenting were detected as high-intensity transient signals (HITS) with a Doppler guidewire. Coronary flow velocity reserve (CFVR) was also measured before and after stenting.Patients were divided into the tertiles according to the HITS counts: the lowest, HITS5 (n = 16); the middle, 5 to 12 (n = 15); and the highest,12 (n = 13). Dense calcium and necrotic core area identified with VH-IVUS were significantly larger in the highest tertile (lowest vs. middle vs. highest; dense calcium: 0.2 +/- 0.3 mm2 vs. 0.3 +/- 0.6 mm2 vs. 0.8 +/- 0.7 mm2, p = 0.007; necrotic core: 0.5 +/- 0.4 mm2 vs. 0.9 +/- 0.9 mm2 vs. 1.8 +/- 1.0 mm2, p0.001, respectively). Multivariate logistic regression analysis revealed only necrotic core area was an independent predictor of high HITS counts (odds ratio 4.41, p = 0.045). Furthermore, there was a significant negative correlation between the HITS count and CFVR after stenting (r = -0.35, p = 0.017).The necrotic core component identified with VH-IVUS is related to liberation of small embolic particles during coronary stenting, which results in the poorer recovery of CFVR.

Previous studies reported that a coronary flow velocity (FV) pattern with a rapid diastolic deceleration time (DDT) immediately after percutaneous coronary intervention implies advanced microvascular damage in patients who have experienced an acute myocardial infarction (AMI).Using transthoracic echocardiography, we recorded the coronary FV in the left anterior descending coronary artery (LAD) and the FV in the intramyocardial artery 2 days after successful percutaneous coronary intervention in 24 patients who had experienced an anterior AMI. We measured the DDT of the LAD and the intramyocardial artery. DDT of the LAD and the intramyocardial artery was detected in the anteroseptal lesion, the wall motion of which revealed severe hypokinesis or akinesis. We performed echocardiography during both the acute phase and 6 months after the AMI.Patients were divided into two groups (group A: DDT of the LADor = 600 milliseconds [n = 10], group B: DDT of the LADor = 600 milliseconds [n = 14]). DDT of the LAD and the intramyocardial artery was significantly shorter for group A than group B (373 +/- 223 vs 786 +/- 105 milliseconds, P.0001). In the acute phase, there were no significant differences in left ventricular (LV) wall-motion score index (WMSI), LV end-diastolic volume (EDV), or ejection fraction (WMSI: 2.38 +/- 0.24 vs 2.08 +/- 0.58, P = .20; LV EDV: 160 +/- 41 vs 154 +/- 34 mL; ejection fraction: 45 +/- 11 vs 46 +/- 5%). However, WMSI and LV EDV in group A were significantly greater than in group B (WMSI: 2.47 +/- 0.16 vs 1.84 +/- 0.57, P = .01; LV EDV: 198 +/- 28 vs 132 +/- 37 mL, P = .0004) and the ejection fraction in group A was significantly lower than in group B (38 +/- 9 vs 55 +/- 10%, P = .001) during the chronic phase.In patients who had experienced an anterior AMI, we could predict wall-motion recovery of the infarcted area by using the coronary FV of the LAD and FV of the intramyocardial artery.

Background Newly-diagnosed diabetes mellitus (DM) and impaired glucose tolerance are common among patients with acute myocardial infarction (AMI). However, its significance on long-term clinical outcomes in those patients remains unclear. The present study was designed to determine whether such abnormalities after AMI affect long-term clinical outcomes. Methods and Results Two-hundred and seventy-five AMI patients were prospectively enrolled. Eighty-five had diagnosed DM, while the other 190 did not. According to oral glucose tolerance tests at discharge, non-DM patients were divided into 2 groups: 78 patients with normal glucose tolerance and 112 patients with abnormal glucose tolerance. Patients were followed until they reached the primary endpoint: cardiovascular death or unplanned hospitalization due to major adverse cardiovascular events. The median follow-up period was 5.3 years. Kaplan-Meier survival curves for the abnormal glucose tolerance group were poorer than for normal glucose tolerance, and were equivalent to the pre-diagnosed DM group in prognosis (p

Coronary flow velocity (CFV) pattern with a rapid deceleration time of diastolic flow velocity and small average systolic peak velocity immediately after reperfusion implies poor wall-motion recovery in patients with acute myocardial infarction. Microvascular injury has been demonstrated to progress after coronary reperfusion. The purpose of this study was to assess whether CFV 1 day after reperfusion (day 1) may reflect accurately the degree of myocardial damage.In the left anterior descending coronary artery in 29 patients with anterior acute myocardial infarction, CFV was measured immediately and 1 day after recanalization using transthoracic Doppler echocardiography, respectively. Regional wall motion was estimated as anterior wall-motion score index (AWMSI) by echocardiography before recanalization and 1 month after the onset of acute myocardial infarction.Although significant correlation was observed among deceleration time of diastolic flow velocity, average systolic peak velocity, and average peak velocity immediately after reperfusion and 1-month AWMSI (r = -0.62, P.001; r = -0.61, P.001; and r = -0.55, P.01, respectively), much better correlation was demonstrated between those at day 1 and 1-month AWMSI (r = -0.72, P.0001; r = -0.68, P.0001; and r = -0.60, P.001, respectively). Deceleration time of diastolic flow velocity, average systolic peak velocity, and average peak velocity in poor wall-motion recovery group (1-month AWMSI2.0, n = 14) were significantly smaller (P.01, P.05, and P.05, respectively) at day 1 compared with those immediately after reperfusion.CFV pattern assessed by transthoracic Doppler echocardiography at day 1 provides the degree of myocardial damage much more accurately than that immediately after reperfusion. These results may suggest that myocardial damage progresses after reperfusion.

Paroxysmal atrial fibrillation (PAF) is a common complication of patients with hypertrophic cardiomyopathy, often leading to acute or progressive heart failure and cerebral infarction. We assessed the echocardiographic data of 141 consecutive patients with hypertrophic cardiomyopathy, with and without PAF. In all, 31 patients (22%) had a history of PAF with spontaneous conversion to in sinus rhythm. Left atrial volume and left atrial volume indexed to body surface area were significantly increased for patients with PAF compared with those without PAF. Maximum left atrial volume was the most sensitive and specific parameter for the occurrence of PAF in patients with hypertrophic cardiomyopathy.

Background The measurement of flow velocity (FV) in coronary artery bypass grafts using a Doppler guidewire has provided useful clinical and physiologic information. The recently developed transcutaneous Doppler echocardiography is a noninvasive technique to measure FV and FV reserve (FVR) in the right gastroepiploic artery (GEA) graft. The purpose of this study was to evaluate whether transcutaneous Doppler echocardiography accurately measures FV and FVR in the right GEA graft in a clinical setting. Methods In 33 patients who underwent graft angiography for the assessment of the right GEA graft, FV in the right GEA graft was measured by transcutaneous Doppler echocardiography under the guidance of color flow Doppler imaging at the time of examination using a Doppler guidewire. FV in the midportion of the right GEA graft was measured at baseline and during hyperemic conditions using both transcutaneous Doppler echocardiography and a Doppler guidewire. Results There were excellent correlations between the value of FV obtained by transcutaneous Doppler echocardiography and those obtained with the Doppler guidewire (averaged peak velocity: y=0.95 x + 1.46, r = 0.98, standard error of the estimate [SEE] = 2.94 cm/s; averaged systolic peak velocity: y=0.94 x + 1.18, r = 0.97, SEE=3.15 cm/s; diastolic peak velocity: y=0.97 x + 1.62, r = 0.98, SEE=4.40 cm/s; averaged diastolic peak velocity: y=0.95 x + 1.75, r = 0.98, SEE=3.60 cm/s). The FVR as determined by transcutaneous Doppler echocardiography showed a good correlation with that determined using the Doppler guidewire method (y = 0.90 x + 0.21, r = 0.92, SEE=0.31). Conclusions Transcutaneous Doppler echocardiography proved to be an accurate noninvasive method to measure FV and FVR in the right GEA graft.

Background: Intravenous myocardial contrast echocardiography with harmonic power Doppler imaging is a novel technique for assessing myocardial perfusion. Aims: The aim of this study was to quantitatively assess myocardial perfusion by harmonic power Doppler imaging in patients with a previous myocardial infarction and compare myocardial contrast echocardiography results with myocardial viability evaluated by thallium-201 single-photon emission computed tomography (201Tl-SPECT) and the results of Doppler flow measurement of coronary flow velocity reserve. Methods: Twenty-three patients with anterior myocardial infarction who were scheduled for adenosine stress 201Tl-SPECT underwent myocardial contrast echocardiography with harmonic power Doppler imaging. Harmonic power Doppler imaging was performed at rest and during adenosine infusion (0·15 mg/kg/min) using an intravenous infusion of Levovist. The peak colour pixel intensity ratios of the risk area to the control area were used for quantitative analysis of myocardial perfusion by harmonic power Doppler imaging. Coronary blood flow velocity was measured using Doppler-tipped guidewire in the distal portion of left anterior descending artery and coronary flow velocity reserve was calculated. Results: In patients with myocardial viability assessed by 201Tl-SPECT, pixel intensity ratios both at rest and during hyperaemia were significantly higher compared with those in patients without myocardial viability (at rest: 0·62±0·28 vs 0·37±0·17, P =0·038, during hyperaemia 0·72±0·19 vs 0·40±0·18, P =0.003). Coronary flow velocity reserve was significantly different between two groups (2·35±0·43 vs 1·49±0·53, P

In summary, troglitazone reduces angiographic in-stent restenosis and target lesion revascularization rates after coronary stent implantation using 2.5-mm stents in patients with type 2 DM. Serial IVUS assessment demonstrates that the reduction in neointimal tissue proliferation in the troglitazone group is associated with the angiographic results.

Low-dose dobutamine stress echocardiography (DSE) assesses myocardial viability at the early stage of acute myocardial infarction (AMI), but its assessment is subjective and variable. Recently, automated function imaging (AFI) was shown to determine global longitudinal peak strain (GLPS) based on

Category: 3. Intravascular DiagnosticsPresentation Number: 2520-28Authors: Koichi Tamita, Atsushi Yamamuro, Shuichiro Kaji, Yutaka Furukawa, Junichi Yoshikawa, Nihinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan, Kobe City Medical Center General Hospital, Kobe, Japan Background: Recent studies have shown that the coronary wedge pressure (CWP) is not unlikely to reflect collateral function but to increase with the severity of microvascular dysfunction in patients with acute myocardial infarction (AMI). The aim of this prospective study was to examine whether an elevated CWP may predict the long-term cardiovascular events in patients with AMI.Methods: The study population consisted of 53 consecutive patients with a first anterior AMI successfully treated with primary coronary intervention (PCI). We examined the ratio of mean CWP to mean aortic pressure (CWP/Pa) during a balloon inflation using a pressure guidewire. According to previous reports, we defined an elevated CWP as a CWP/Pa >0.24. Patients were divided into two groups: those without an elevated CWP (n=35; group 1) and those with an elevated CWP (n=18; group 2). We evaluated the association between an elevated CWP and the long-term major adverse cardiovascular event (MACE) rates.Results: The median follow-up period was 5.5 years. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0026). Risk-adjusted data by multivariate analysis showed that an elevated CWP was one of the strongest predictors for long-term MACE (hazard ratio: 3.81; 95% confidence interval, 1.25-11.63; p=0.0189).Conclusion: Among patients with a firtst anterior AMI, an elevated CWP during PCI was associated with increased long-term MACE rates.

BACKGROUND: The noninvasive measurement of coronary flow velocity in the left anterior descending artery (LAD) has recently been realized by using the transthoracic Doppler echocardiography (TTDE). A couple of investigations demonstrated that the diastolic-to-systolic peak velocity ratio (DSVR) by TTDE is a simple and noninvasive method for the detection of severe stenosis in the elective settings. However, the usefulness of DSVR by TTDE in the emergency settings has not been evaluated. OBJECTIVE: The purpose of this study was to assess the clinical feasibility to document the LAD flow by TTDE in emergency patients who complained of chest pain. METHODS: We studied 49 consecutive patients with acute coronary syndrome who were going to undergo emergency coronary angiography (CAG) for the anatomical diagnosis and the facilitated percutaneous coronary intervention (PCI). Prior to CAG, we recorded the LAD flow by TTDE and measured the diastolic peak velocity (DVp), systolic peak velocity (SVp), and their ratio, DSVR (DVp/SVp) of LAD flow. RESULTS: By CAG, the culprit lesions actually resided in the proximal LAD in 36 patients. Among the 36 patients, we detected the Doppler LAD flow in 29. Five out of 7 patients who were unable to detect the LAD flow revealed total occlusions by CAG. DSVR of the LAD is significantly lower in 17 patients who showed severe stenoses (>90%) than those in the rest of 12 patients who did not show such critical stenoses (1.44 +/- 0.16 vs 2.10 +/- 0.26, P < 0.0001). CONCLUSION: In the emergency settings, a noninvasive assessment of the LAD flow by TTDE accurately estimates the critical stenotic lesions of the LAD.

SummaryA 59-year-old male with an abdominal mass that showed a diffuse large B cell lymphoma underwent extirpation of the tumor and chemotherapy. He subsequently received high-dose chemotherapy containing cyclophosphamide (1.5g/m2/day×2 days), followed by autologous peripheral blood stem cell transplantation. He developed congestive heart failure 5 days after administration of cyclophosphamide. His electrocardiogram showed extremely low voltage with ST segment change and echocardiogram showed diffusely increased left ventricular wall thickness, an increase in myocardial echogenicity, pericardial effusion, and generally decreased systolic function. Congestive heart failure progressed rapidly and he died the following day. Post-mortem examination of the heart revealed myocardial hemorrhage, yellowish brown pericardial effusion, and fibrinous pericarditis. His liver was atrophic and focal necrosis was observed histologically. Cyclophosphamide-induced cardiotoxicity occurred, even though the patient had both shown normal cardiac function before high-dose chemotherapy and had received a lower dose of cyclophosphamide. Concomitant administration of cytarabine might have affected his liver function and there might have been interaction between the drugs.

Background— Although animal studies showed that annular remodeling may be related to the pathogenesis of chronic ischemic mitral regurgitation (CIMR), little was known in humans. A better understanding of the precise 3D geometry of the mitral valvular-ventricular complex in CIMR is needed to devise a better surgical technique. The purpose of the study was to elucidate mitral annular geometry in patients with CIMR using cardiac MRI. Methods and Results— Thirty-eight patients with previous inferior or posterior myocardial infarction were studied. With the 3D reconstruction of the mitral annulus and subvalvular apparatus from a series of longitudinal cine MRIs, end-systolic mitral annulus dimensions and 3D geometry were calculated. Patients were grouped by mitral regurgitation grade using echocardiography (≥2+, n=15 versus ≤1+, n=23). Both septal-lateral and commissure-commissure mitral annular diameters were significantly greater in CIMR(+) patients (35±5 versus 30±4 mm, P =0.005; 46±6 versus 39±4 mm, P P P =0.002), and the annular height to commissural width ratio was significantly lower in CIMR(+) patients (12±3 versus 21±5%; P Conclusions— Patients with CIMR had greater septal-lateral and commissure-commissure mitral annular dimension, larger intertrigonal distance, and flattened saddle shape of mitral annulus. These associated geometric alterations may be important in the pathogenesis of CIMR.

Background Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. Aim To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. Methods Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR). Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. Results Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time ≧ 600 msec, Group B; 10 pts with deceleration time < 600 msec). In acute phase, there were no significant differences in left ventricular end-diastolic volume and ejection fraction (Left ventricular end-diastolic volume 112 ± 33 vs. 146 ± 38 ml, ejection fraction 50 ± 7 vs. 45 ± 9 %; group A vs. B). However, left ventricular end-diastolic volume in Group B was significantly larger than that in Group A (192 ± 39 vs. 114 ± 30 ml, p < 0.01), and ejection fraction in Group B was significantly lower than that in Group A (39 ± 9 vs. 52 ± 7%, p < 0.01) at 6 months. PIR and coronary flow velocity reserve of Group A were higher than Group B (PIR, at rest: 0.668 ± 0.178 vs. 0.248 ± 0.015, p < 0.0001: during hyperemia 0.725 ± 0.194 vs. 0.295 ± 0.107, p < 0.0001; coronary flow velocity reserve, 2.60 ± 0.80 vs. 1.31 ± 0.29, p = 0.0002, respectively). Conclusion The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction.

Background It has been reported that pioglitazone reduces neointimal hyperplasia after balloon-induced vascular injury in an experimental model. Methods To determine whether pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus, we studied 44 stented lesions in 44 patients with diabetes mellitus who underwent successful coronary stent implantation. Study patients were randomized into 2 groups: the pioglitazone group (23 patients with 23 lesions) and the control group (21 patients with 21 lesions). All patients underwent serial quantitative coronary angiography and serial intravascular ultrasound scanning studies. With a motorized pullback system, multiple image slices within the stent were obtained at every 1 mm. The stent area and lumen area were measured, and the neointimal area was calculated. Measurements were averaged over the number of selected image slices. The neointimal index was calculated as the averaged neointimal area divided by the averaged stent area multiplied by 100 (%). Results After 6 months of treatment, angiographic in-stent restenosis (17% vs 43%, respectively, P = .0994) and target lesion revascularization (13% vs 38%, respectively, P = .0835) were less frequent in the pioglitazone group than the control group; however, these differences did not reach significance. The intravascular ultrasound scanning study demonstrated that the neointimal index in the pioglitazone group was significantly smaller than that in the control group (28% ± 9% vs 48% ± 15%, respectively, P Conclusion A serial intravascular ultrasound scanning assessment demonstrated that pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus.

Background— Recently, it was reported that the degree of microvascular injury and left ventricular functional recovery during the chronic period can be predicted after treatment of the infarct-related artery based on the coronary flow velocity (CFV) pattern assessed using a Doppler guidewire. The aim of this prospective study was to examine whether the CFV pattern may predict complications and in-hospital survival after acute myocardial infarction (AMI). Methods and Results— The study population consisted of 169 consecutive patients with a first anterior AMI successfully treated with percutaneous coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. In accordance with previous findings, we defined severe microvascular injury as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascular injury (n=118; group 1) and those with severe microvascular injury (n=51; group 2). All of the patients who had cardiac rupture were in group 2. Congestive heart failure (CHF) was observed more frequently in group 2 than in group 1 (53% versus 8%, P P Conclusions— These findings suggest that the CFV pattern is an accurate predictor of the presence or absence of complications and of in-hospital survival after AMI.

Fractional flow reserve (FFR) has emerged as a lesion-specific index of the functional severity of coronary stenosis in patients with chronic coronary artery disease. As the coronary blood flow in acute myocardial infarction (AMI) patients with microvascular damage is restricted, the pressure drop across the stenosis during hyperemia may be smaller than expected. However, the effects of microvascular dysfunction on FFR in AMI patients remain undetermined. The study comprised 33 AMI patients who underwent coronary stenting within 12 hr of onset, and 15 patients with stable angina pectoris who underwent elective stenting. Assessment of the 48 lesions by means of intravascular ultrasound and pressure measurements after stenting showed that postinterventional FFR was higher in AMI than angina pectoris patients (0.95 +/- 0.04 vs. 0.90 +/- 0.04; P = 0.002), although there were no significant differences in intravascular ultrasound parameters. AMI patients were divided into two subgroups based on their postprocedural Thrombolysis on Myocardial Infarction (TIMI) flow grade (23 patients with TIMI 3 and 10 with TIMI 2). There were no differences in intravascular ultrasound parameters between the AMI subgroups, while FFR was greater in the patients with TIMI 2 than in those with TIMI 3 (0.98 +/- 0.02 vs. 0.93 +/- 0.05; P = 0.017). No significant correlation was found between FFR and intravascular ultrasound parameters in either AMI subgroup, while FFR of more than 0.94 was observed in all TIMI 2 cases independent of residual stenosis severity. We conclude that in patients with marked microvascular dysfunction, FFR may not be reliable for the assessment of coronary lesion severity and may underestimate coronary lesion severity.

Background: Previous studies have reported that acute hyperglycemia at hospital admission is associated with adverse outcomes after acute ST-segment elevation myocardial infarction (STEMI) in patients without diabetes mellitus. Non-invasive assessment of microvascular obstruction (MVO) and interstitial myocardial hemorrhage by cardiovascular magnetic resonance (CMR) provides a specific biomarker of severe ischemia-reperfusion injury. However, the relationship between acute hyperglycemia and hemorrhagic myocardial infarction has not been fully evaluated in STEMI patients without diabetes. The aim of this study was to determine whether acute hyperglycemia was related to the presence of myocardial hemorrhage determined by T2*-CMR in patients with acute STEMI and no previous diabetes. Methods: The study population consisted of 64 consecutive patients with no diagnosis of diabetes and a first STEMI successfully treated with percutaneous coronary intervention (PCI). T2*-CMR performed within 4 days after primary PCI was used to identify the presence of reperfusion hemorrhage and contrast enhancement was used to detect and quantify MVO. Acute hyperglycemia was defined as a blood glucose level of ≥190 mg/dl at admission. We assessed the association between acute hyperglycemia and hemorrhagic myocardial infarction determined by CMR. Results: Acute hyperglycemia was found in 12 patients (19%). Patients with MVO and hemorrhagic myocardial infarction were more frequently observed in patients with acute hyperglycemia compared to those without hyperglycemia (83% vs 58%, p=0.0825; 75% vs 40%, p=0.0281, respectively). Multivariate analysis showed that acute hyperglycemia was an independent predictor of hemorrhagic myocardial infarction (odds ratio 4.43; 95% confidence interval, 1.17-21.8, p=0.0281). Conclusion: Hyperglycemia on admission is related to hemorrhagic myocardial infarction after primary PCI in patients with STEMI and no previous diabetes.

Recent studies have shown that increased accumulation of fat around the heart, i.e. epicardial adipose tissue (EPI) and pericardial adipose tissue (PERI), is associated with cardiovascular disease and metabolic disease. However, which cardiac fat is more appropriate for cardiovascular risk