Search

Objectives To investigate stent deformation by torsional stress after implantation at the ostium of a model coronary artery. Background Little is known about coronary stent deformation, especially the association between stent design and deformation at the coronary ostium. Recent reports have suggested that mechanical factors are important for stent restenosis. Methods A coronary ostium model was constructed and three different stents (Express 2 , Cypher, and Tsunami, n =5 each) were implanted at the aorto-ostial junction. Differences of stent deformation were assessed after exposure to torsional stress. Intravascular ultrasound was used to measure the luminal area along each stent. Then the extent and pattern of plastic deformation were compared between the three stent types. Results The Express 2 stents and Cypher stents both showed significant deformation ( P P =.045, respectively) adjacent to the ostium, whereas only a minimal decrease of luminal area was observed with the Tsunami stent. In the central and distal parts of each stent, the decrease of luminal area was minimal and no differences were noted among the three types. Sudden fracture of a Cypher stent strut occurred during the experiment. Conclusion Differences of structural characteristics influence permanent plastic deformation at sites where continuous stress occurs, such as the coronary ostium. A more elastic design may show better resistance to such stress.

Aims/hypothesis: The extent of coronary atherosclerosis is significantly more advanced in symptomatic type 1 diabetes patients than in symptomatic non-diabetic patients. Whether this difference exists between asymptomatic individuals with diabetes and controls is not documented. In vivo imaging techniques allow quantification of the difference at a preclinical stage. Methods: The degree of coronary atherosclerosis in early onset type 1 diabetes patients without symptoms of cardiovascular disease was compared with that of age- and sex-matched controls. Intracoronary ultrasound (IVUS) examinations were performed to determine the degree of atherosclerosis. The mean age of the patients was 43 years (35–58), they had a mean duration of disease of 30 (23–39) years and the diagnosis of type 1 diabetes was made at a mean age of 12.5 years. The controls were people with transplanted hearts; donors were sex- and age-matched and had a mean age of 43 (35–58) years. Results: The degree of subclinical coronary atherosclerosis was significantly more severe in type 1 diabetes patients than in controls. This was the case for all parameters measured. The mean plaque area was ≥ 40% in 71% (54/76) of diabetic arteries as opposed to 33% (25/76) of arteries from controls (p2 in type 1 diabetes and 12.1±4.3 mm2 in controls (p Conclusions/interpretation: Asymptomatic individuals with type 1 diabetes have significantly more advanced sub-clinical coronary atherosclerosis than controls. Coronary atherosclerosis in type 1 diabetes develops at an early age.

OBJECTIVE The efficacy of coronary stenting of aorto-ostial atherosclerotic lesions is still unclear. We investigated the frequency and mechanism of stent restenosis at this particular lesion. METHODS Fifty-five consecutive patients with 64 native aorto-ostial lesions in the right coronary artery (RCA, n = 38) and the left main trunk (LM, n = 26) were treated by conventional stenting. Determinants of angiographic restenosis were established. The mechanism of stent restenosis was evaluated using post-stenting and follow-up intravascular ultrasound (IVUS) findings. RESULTS Restenosis was more frequent in the RCA than in the LM (50% compared with 19%, P < 0.03) and determinants included diabetes mellitus (63% compared with 21%, P < 0.03), calcium deposition (58% compared with 5%, P < 0.003), smaller stent cross-sectional area (SA) (as demonstrated by post-stenting IVUS studies, 8.1 +/- 1.4 mm compared with 10.2 +/- 2.2 mm, P < 0.01), larger plaque burden (64 +/- 6% compared with 57 +/- 8%, P < 0.03) and less circular expansion at the aorto-coronary junction. Serial IVUS examination was performed in 11 patients with restenosis of the right coronary ostium. The mean reduction in the SA was 21% at the aorto-coronary junction (6.4 +/- 1.9 mm, P < 0.003), whereas the SA at the distal edge was unchanged. Thirty-three per cent of late luminal loss was due to chronic stent recoil. CONCLUSION These findings suggest that stenosis of the right coronary ostium is a high-risk lesion for stent restenosis. In addition to excessive intimal growth, chronic stent recoil might be an important etiologic factor at this particular location.

We describe a case of Stanford type B acute aortic dissection causing visceral ischemia. An aortogram showed an hourglass-like narrowing of the true lumen at the diaphragm with a 60 mm Hg pressure gradient. Placement of a self-expanding metallic Z-stent under intravascular ultrasound guidance restored blood flow to the viscera.

We describe a case of isolated right ventricular infarction that has rarely been diagnosed antemortem. Electrocardiogram showed ST segment elevation in left precordial chest, right precordial chest, and inferior leads, which mimicked those of anterior and inferior left ventricular infarction. Coronary angiography revealed that culprit lesion was totally occluded right coronary artery. Infarcted artery was nondominant right coronary artery with branches supplying only right ventricular wall. Restoration of coronary blood flow was obtained by primary stenting and resulted in prompt ST segment normalization in all leads. Despite extensive right ventricular wall motion abnormality, subsequent right ventricular dysfunction was not observed.

OBJECTIVESThe purpose of this study was to examine the relationship between the pattern of coronary blood flow velocity immediately after successful primary stenting and the recovery of left ventricular (LV) wall motion in patients with acute myocardial infarction (AMI).BACKGROUNDIt is difficult to predict the recovery of LV wall motion immediately after direct angioplasty in AMI. Recent reports indicate that dysfunctional coronary microcirculation is an important determinant of prognosis for AMI patients after successful reperfusion.METHODSWe measured left anterior descending coronary flow velocity variables using a Doppler guide wire immediately after successful primary stenting in 31 patients with their first anterior AMI. The patients were divided into two groups: those with and those without early systolic reverse flow (ESRF). Changes in LV regional wall motion (RWM) and ejection fraction (EF) at admission and at discharge were compared between the two groups. Coronary flow velocity variables immediately after primary stenting were compared with changes in left ventriculographic indexes.RESULTSThe change in RWM was significantly greater in the non-ESRF group than it was in the ESRF group (0.9 ± 0.7 vs. −0.1 ± 0.3 standard deviation/chord, respectively, p < 0.001). The change in EF was also significantly greater in the non-ESRF group than it was in the ESRF group (10 ± 10 vs. 1 ± 6%, respectively, p < 0.05). In the non-ESRF group (diastolic to systolic velocity ratio [DSVR]

To evaluate coronary flow dynamics after direct angioplasty and to define the determinants of flow-velocity variables in the infarct artery, we measured coronary flow velocity in 36 infarct arteries and 64 normal coronary arteries by using a Doppler guide wire. Flow-velocity variables in the infarct arteries did not return to normal even after successful direct angioplasty, and phasic coronary flow in infarct arteries varied considerably. Normal phasic flow was calculated as the ratio of diastolic to systolic flow ratio (DSVR) of greater than or equal to mean DSVR - 1 SD in normal coronary arteries. Infarct-related arteries were divided into two groups: normal DSVR (n = 28) and low DSVR (n = 8). Reduced diastolic peak velocity with a relative preservation of systolic velocity contributed to a low DSVR flow. Angiographic slow flow and late recanalization were significantly related to low DSVR flow. Thus the extent of disturbed microcirculation can be evaluated by assessing phasic flow after direct angioplasty for acute infarction.

A comparison of aspiration catheters that have been approved for real-world use was carried out in vitro.Myocardial damage occurs during therapeutic aspiration of thrombus. The relative efficiency of aspiration may be important in this regard.Using saline and human clot, nine aspiration catheters were compared Thrombuster III(R)N (6 Fr and 7 Fr), ZEEK (6 Fr), Rebirth (7 Fr), Eliminate (6 Fr and 7 Fr), Pronto (6 Fr), and Export(R) (6 Fr and 7 Fr). Tracking was assessed from the resistance required to pass the catheter through a vessel model. Pushability was determined from the difference between the load at the hand piece and tip of the catheter during advancement through the vessel model.The Thrombuster III(R)N (6 Fr and 7 Fr) showed significantly better aspiration performance, although the ranking order of the catheters was not the same for saline and clot. The Thrombuster III(R)N also showed the best tracking with low resistance and was the easiest catheter to advance, as evaluated based on pushability.In the present in vitro evaluation system, the Thrombuster III(R)N performed better than other catheters.

Background Accumulation of lipids within coronary plaques is an important process in disease progression. However, gray-scale intravascular ultrasound images cannot detect plaque lipids effectively. Radiofrequency signal analysis could provide more accurate information on preclinical coronary plaques. Methods We analyzed 29 zones of mild atheroma in human coronary arteries acquired at autopsy. Two histologic groups, i.e., plaques with a lipid core (group L) and plaques without a lipid core (group N), were analyzed by automatic calculation of integrated backscatter. One hundred regions of interest were set on the target zone. Radiofrequency signals from a 50 MHz transducer were digitized at 240 MHz with 12-bit resolution. The intensity of integrated backscatter and its distribution within each plaque were compared between the two groups. Results Although the mean backscatter was similar between the groups, intraplaque variation of backscatter and backscatter in the axial direction were larger in group L than in group N (p = 0.02). Conventional intravascular ultrasound showed extremely low sensitivity for lipid detection, despite a high specificity. In contrast, a cut-off value>32 for the total variance of integrated backscatter identified lipid-containing plaque with a high sensitivity (85%) and specificity (75%). Conclusion Compared with conventional imaging, assessment of the intraplaque distribution of integrated backscatter is more effective for detecting lipid. As coronary atheroma progresses, its composition becomes heterogeneous and multi-layered. This radiofrequency technique can portray complex plaque histology and can detect the early stage of plaque progression.

When performing intravascular ultrasound studies, the backward echo image can show marked attenuation, although there are no calcified deposits and it may be impossible to detect the intraplaque architecture. The pathology underlying this phenomenon was investigated in autopsy specimens. We hypothesize that the mechanism responsible for the attenuation involves micro‐calcification and lipid in unstable plaques causing ultrasonic wave reflection and dispersion.

There are few data regarding acute coronary syndrome (ACS) in young Japanese patients. We examined the risk factors for ACS in young Japanese patients, especially impaired glucose metabolism. From a database of 789 consecutive patients admitted to our hospital with ACS between 2000 and 2005, we compared risk factors of patients divided into two age categories:or =45 years (group Y, n = 41) andor =46 years (group O, n = 748). All patients in group Y were male. Overt diabetes, hypertension, and a family history of ischemic heart disease were not so important to group Y. Higher triglyceride (160.5 +/- 86.0 vs 133.9 +/- 75.2 mg/dl, P = 0.0296) and lower high-density lipoprotein cholesterol (43.9 +/- 12.1 vs 48.7 +/- 13.5 mg/dl, P = 0.027) concentrations were present in group Y. We obtained data concerning insulin resistance in 326 of 789 patients. Although the incidence of impaired glucose tolerance was similar between the groups (31% vs 31%, not significant), a higher homeostasis model assessment insulin resistance index (2.26 +/- 2.03), indicating insulin resistance, was present in group Y. Insulin resistance might be correlated with the development of ACS in the young adult Japanese population.

A 68-year-old male hemodialysis patient presented with severe congestion in his left arm. Left arm venography showed a completely occluded left brachiocephalic vein. We chose a self-expandable stent for treating this vein. However, restenosis occurred once at 8 months and again after six additional months. The cause of the restenosis was considered to be a stent fracture. On the first restenosis, we performed redilation with a balloon; on the second restenosis, we chose stent-in-stent with a balloon-expandable stent. At least 9 months after the stent-in-stent procedure, there has been no edema in his left arm. Therefore, stent-in-stent is one of the useful strategies for stent fracture in central venous obstruction.

Background. In patients with chronic kidney disease (CKD), although strong associations have been observed between malnutrition and atherosclerosis, the relationship between serum albumin concentration and angiographic changes of coronary artery disease (CAD) remains poorly explored. The goal of the present study was, in patients with CKD, to clarify the relationship between the angiographic severity of CAD and serum albumin concentration reflecting either inflammation or nutrition or both. Methods. In this study, 100 end-stage renal disease (ESRD) patients were enrolled, who commenced longterm dialysis therapy at our hospital and underwent coronary angiography within 3 months of the first haemodialysis (HD) session. Mean age was 63±11 years, 20% of the subjects were female and 62% had diabetes. Severity of CAD was evaluated in terms of (i) number of vessels exhibiting CAD (� 75% stenosis) and (ii) Gensini score (GS). Clinical characteristics and laboratory findings were recorded at initiation of longterm HD therapy. We then evaluated a possible association with the presence and degree of CAD. Results. Sixty-four patients exhibited signs of CAD. Forty-one among them (64%) had multivessel disease. On univariate logistic regression analysis, age, diabetes and hypoalbuminaemia were significantly associated with multivessel CAD. Univariate linear regression analysis demonstrated a positive correlation of age and diabetes with GS, and an inverse correlation of BMI and serum albumin level with GS. Stepwise regression analysis showed age and serum albumin level to be independently associated with multivessel CAD and GS. The ROC curves demonstrated best cut-off levels of age and albumin for predicting multivessel CAD to be 70 years and 3.15 g/dl, respectively. Conclusion. Hypoalbuminaemia at the initiation of dialysis is an important predictor of advanced CAD, particularly in male and in diabetic patients. It may reflect mainly a state of inflammation. However, malnutrition as a confounding factor cannot be entirely excluded.

Coronary lesion stenting with aspiration and distal balloon occlusion is more often associated with embolic occlusion of interposed side branches when the branch arises at an angle of/=45 degrees and the artery containing the lesion is large. However, this event is infrequent, often resolving during the procedure and uniformly resolving by 6 months.

Insulin resistance has been implicated as an important initiating factor in coronary atherosclerosis. However, associations between insulin resistance and specific morphologic features of atherosclerotic coronary arteries remain unclear. We ultrasonographically evaluated the morphologic features of atherosclerotic coronary arteries in nondiabetic patients with insulin resistance.Before intervention, 90 patients with 105 culprit lesions underwent intravascular ultrasound examination through which vessel area, lumen area and plaque area were evaluated. Expansive remodeling (lesion vessel area more than 5% greater than at the proximal reference segment) and constrictive remodeling (lesion vessel area more than 5% less than at the distal reference segment) were also evaluated. Insulin resistance was determined by homeostasis model assessment and defined as values above the 75th percentile (that is, 1.71).Insulin-resistant patients numbered 23, while nonresistant patients numbered 67. Culprit lesions in the insulin-resistant group showed larger vessel area (18.16 +/- 6.94 compared with 13.64 +/- 4.28 mm, P = 0.0001) and plaque area (16.64 +/- 6.78 compared with 12.05 +/- 4.12 mm, P = 0.0001) and more frequently showed expansive remodeling (56% compared with 14%, P0.0001) and calcific plaque (33% compared with 12%, P = 0.01). Multivariable logistic regression analysis identified only insulin resistance (odds ratio, 4.9, P = 0.008) as an independent predictor of expansive remodeling.Insulin resistance independently predicted expansive remodeling, underscoring the importance of insulin resistance in coronary atheroscrelosis.

ContextAlthough low levels of high-density lipoprotein cholesterol (HDL-C) increase risk for coronary disease, no data exist regarding potential benefits of administration of HDL-C or an HDL mimetic. ApoA-I Milano is a variant of apolipoprotein A-I identified in individuals in rural Italy who exhibit very low levels of HDL. Infusion of recombinant ApoA-I Milano–phospholipid complexes produces rapid regression of atherosclerosis in animal models.ObjectiveWe assessed the effect of intravenous recombinant ApoA-I Milano/phospholipid complexes (ETC-216) on atheroma burden in patients with acute coronary syndromes (ACS).DesignThe study was a double-blind, randomized, placebo-controlled multicenter pilot trial comparing the effect of ETC-216 or placebo on coronary atheroma burden measured by intravascular ultrasound (IVUS).SettingTen community and tertiary care hospitals in the United States.PatientsBetween November 2001 and March 2003, 123 patients aged 38 to 82 years consented, 57 were randomly assigned, and 47 completed the protocol.InterventionsIn a ratio of 1:2:2, patients received 5 weekly infusions of placebo or ETC-216 at 15 mg/kg or 45 mg/kg. Intravascular ultrasound was performed within 2 weeks following ACS and repeated after 5 weekly treatments.Main Outcome MeasuresThe primary efficacy parameter was the change in percent atheroma volume (follow-up minus baseline) in the combined ETC-216 cohort. Prespecified secondary efficacy measures included the change in total atheroma volume and average maximal atheroma thickness.ResultsThe mean (SD) percent atheroma volume decreased by −1.06% (3.17%) in the combined ETC-216 group (median, −0.81%; 95% confidence interval [CI], −1.53% to −0.34%; P = .02 compared with baseline). In the placebo group, mean (SD) percent atheroma volume increased by 0.14% (3.09%; median, 0.03%; 95% CI, −1.11% to 1.43%; P = .97 compared with baseline). The absolute reduction in atheroma volume in the combined treatment groups was −14.1 mm3 or a 4.2% decrease from baseline (P

To determine the comparable safety and efficacy of cutting balloon angioplasty (CBA) and balloon angioplasty (BA) for diffuse in-stent restenosis (ISR).Previous studies have found that diffuse-type ISR predicts recurrence of ISR. The efficacy of CBA in this clinical setting is incompletely documented.One-hundred and seven consecutive diffuse ISR lesions (length10 mm) in 104 patients treated by CBA or BA were retrospectively analyzed. CBA was used in 61 lesions and BA in 46 lesions. Initial success (residual restenosis 30% with no major complications) was achieved in 99% of cases in each group. Follow-up angiography was performed in all patients at 131 93 days. Although the percent diameter stenosis after CBA was lower than after BA (19 12% versus 27 12%; p = 0.001), intravascular ultrasound (IVUS) or other QCA data were similar in the 2 groups. In follow-up angiography, recurrent restenosis rate was not statistically different between CBA (34%) and BA (52%); however, recurrent diffuse ISR was lower in the CBA group (20%) than the BA group (48%; p = 0.01). Lesion length at follow-up in the CBA group was smaller compared to the BA group (15.9 7.3 mm versus 24.2 14.4 mm; p0.05), while lesion length before procedure was similar.CBA for ISR is safe and effective with favorable long-term outcomes. This effect is mainly due to shortening lesion length.

OBJECTIVE Vessel bifurcations are prone to atherosclerotic plaque accumulation. Using volumetric intravascular ultrasound analysis, we investigated atheroma distribution at human coronary bifurcations in vivo. METHODS We analyzed plaque distribution in 49 left anterior descending coronary artery-diagonal and 20 left circumflex coronary artery-obtuse marginal bifurcations with

Thrombotic occlusion in the culprit lesion of acute myocardial infarction was successfully recanalized using a 4.5 Fr thrombectomy catheter (RESCUE), which was also used to normalize the coronary blood flow. The retrieved specimens were white thrombi containing red thrombi and cholesterol crystals, indicating plaque rupture.

Background. Percutaneous balloon angioplasty has become a well-established and routine procedure for coronary revascularization of haemodialysis patients with coronary artery disease. However, the incidence of restenosis after balloon angioplasty is significantly higher in haemodialysis patients than in the general population. We performed a retrospective study comparing balloon angioplasty with coronary stenting in haemodialysis patients. We evaluated the long-term clinical and angiographic outcome after successful percutaneous coronary revascularization in haemodialysis patients. Methods. A total of 103 consecutive haemodialysis patients (123 lesions) underwent procedurally and clinically successful percutaneous revascularization. Patients were treated with three different strategies: (i) balloon angioplasty in 55 patients (69 lesions); (ii) coronary stenting with balloon angioplasty in 23 patients (25 lesions); and (iii) coronary stenting with rotational atherectomy in 25 patients (29 lesions) who had severely calcified stenotic coronaries. Results. The rates of in-hospital mortality were similar in the three groups. The 1-year incidence of overall events and major adverse cardiac events (MACE) were significantly higher in the balloon group than in the stent withuwithout rotational atherectomy groups (75% vs 36 and 28%, P-0.01; 71% vs 32 and 28%, P-0.01). Use of coronary stenting (relative risk s0.006, P-0.001) and the presence of calcified coronary lesion (relative risk s 68.2, P-0.001) were independent predictors of the 1-year MACE-free survival after percutaneous revascularization. The 3-year MACE-free survival rate was significantly lower in the balloon group than in the stent withuwithout rotational atherectomy groups (11% vs 33 and 47%, P-0.005 and P-0.001). Conclusions. This study shows that coronary stenting reduces the incidence of MACE in haemodialysis patients withuwithout calcified coronary lesions. Moreover, coronary stenting reduces the restenosis rate of both complex and restenotic lesions, and rotational atherectomy prior to coronary stenting reduces the restenosis rate of the severely calcified coronary lesions. These results suggest that coronary stenting withuwithout rotational atherectomy has led to an improved long-term outcome in the haemodialysis patients with coronary artery disease.

We describe a case of a 60-year-old man with effort-induced angina pectoris. Coronary angiography showed an aneurysm in the proximal left anterior descending coronary artery. It was unclear whether it was a coronary artery aneurysm or a coronary fistula with an associated aneurysm. Three-dimensional reconstruction images from 16-slice multidetector row computed tomographic (MDCT) angiography showed an aneurysm that drained into the pulmonary artery. Images from 16-slice MDCT coronary angiography can be helpful in understanding complex coronary artery anatomy.

We investigated the safety and limitations of the Doppler guide wire for continuous monitoring of coronary flow velocity outside the catheterization laboratory in 17 patients with acute myocardial infarction. After direct angioplasty, patients were taken to the coronary care unit with the Doppler guide wire positioned within the artery. Flow velocity was continuously monitored. Heparin was titrated to an active clotting time >200 seconds. Clinical outcome and angiographic analyses were evaluated. Flow velocity monitoring was conducted with an 88.2% success rate and lasted for 16 ± 5 hours. Monitoring failed in 2 of the 4 right coronary artery cases. Small amounts of thrombus were seen to adhere to the Doppler guide wire at the end of monitoring. No complications were related to the procedure. No deterioration of angiographic findings was observed. This preliminary study confirmed the safety of the Doppler guide wire for continuous monitoring of coronary flow in patients with acute myocardial infarction.

In this paper, we give a simple counter example to the famous Hodgeconjecture.

To predict the recovery of left ventricular regional wall motion after successful direct angioplasty in acute myocardial infarction, we measured coronary flow velocity variables using Doppler guidewire (FloWire) immediately after reperfusion in 22 patients (pts) (14LAD, 8RCA) and compared them with left ventriculographic indices. Average peak velocity (cm/sec; mean ± SD) was 17.6 ± 8.0, average diastolic peak velocity (em/sec; mean ± SD) was 21.7 ± 10.6 and diastolic systolic velocity ratio (DSVR) was 2.1 ± 1.0. Patients were divided into 2 groups based on DSVR (normal DSVR: LAD g 1.7, RCA g 1.4). There were no significant differences between 2 groups in peak CPK, elapsed time and collateral flow grade. Left ventricular ejection fraction (EF) and regional wall motion (RWM) by left ventriculogram on admission and at discharge were compared between normal DSVR group (n = 15; 10LAD, 5RCA) and low DSVR group (n = 7; 4LAD, 3RCA). RWM (SD/chord) Normal DSVR (n = 15) Low DSVR (n = 7) p-value on admission -30 ± 0.7 -25 ± 0.5 NS at discharge -2.0 ± 1.0 -2.0 ± 0.6 NS ΔRWM EF(%) 1.0 ± 0.4 0.5 ± 0.4 l 0.05 on admission 48 ± 13 53 ± 6 NS at discharge 62 ± 11 52 ± 10 NS ΔEF 14 ± 6 -1 ± 9 l 0.05 Conclusions Measurements of coronary flow velocity immediately after direct coronary angioplasty predict the recovery of regional and global left ventricular function in pts with acute myocardial infarction

Objectives. We evaluated the relationship between alterations in coronary flow velocity during the acute phase of acute myocardial infarction (AMI) and the recovery of left ventricular wall motion in patients who underwent successful primary angioplasty. Background. The status of the coronary microcirculation is the major determinant of the prognosis of patients who have had successful reperfusion after AMI. Animal studies have shown that dynamic changes in regional flow are associated with the extent of infarction. Evaluation of alterations in coronary flow velocity in infarcted arteries may provide information about microcirculatory damage. Methods. Flow velocity of the distal anterior descending artery was continuously monitored with the use of a Doppler guide wire immediately after recanalization for 18 ± 4 h in 19 patients who underwent successful primary angioplasty after anterior AMI. Subjects were divided into two groups on the basis of the time course of alterations in average peak velocity (APV). Group D consisted of patients who had progressive decreases in APV through the next day (n = 9), and Group I comprised patients with an increase in APV after a transient decline (n = 10). Ejection fraction (EF) and regional wall motion (RWM) were assessed by left ventriculography performed on admission and at discharge. Results. The APV at the end of monitoring was greater in group I than in group D. In group I, EF and RWM were significantly improved at discharge. The change in EF was greater in group I than in group D (17 ± 9% vs. 4 ± 9%, p = 0.007), as was the change in RWM (0.96 ± 0.23 vs. 0.13 ± 0.36 SD/chord, p Conclusions. The alteration in flow velocity in recanalized infarcted arteries is related to left ventricular recovery. A progressive decrease in velocity after angioplasty implies no reflow, which is associated with a poor recovery of left ventricular function. Reperfusion injury may account in part for this phenomenon.

An initial major adverse cardiac event (MACE) is an important predictor of future cardiovascular events in patients with chronic kidney disease (CKD). We sought to identify factors influencing occurrence of initial MACE in new maintenance hemodialysis patients without previous cardiac symptoms during the predialysis phase of CKD. Among 112 participating patients with no predialysis cardiac history, 57 underwent coronary angiography, whereas the other 55 underwent stress thallium-201 single-photon emission computed tomography within 1 month of beginning hemodialysis to detect asymptomatic coronary artery disease (CAD). In subsequent follow-up for a median of 24 months, subjects experiencing an initial MACE were compared with those who did not have such an event based on several clinical parameters at the end of predialysis phase. Asymptomatic CAD was present in 47 patients (42%), who had a higher cumulative MACE rate, than subjects without CAD (49 vs 3%, P