Coronary Artery Size Research Articles

Comparison of the Diameters of the Major Epicardial Coronary Arteries by Angiogram in Asian-Indians Versus European Americans

Coronary artery disease (CAD) rates are higher in Asian-Indians than in Caucasians. CAD occurs at an earlier age in this group, with about a quarter of all myocardial infarctions occurring under the age of 40. Previous reports have suggested smaller coronary artery size in Asian-Indians as a major cause for increased CAD in this population. This study sought to evaluate the size of normal "atheroma-free" segments of the epicardial coronary arteries in Asian-Indians and Caucasians aged ≤40 years undergoing coronary artery intervention in other diseased segments. A total of 69 consecutive patients (41 whites, 28 Asian-Indians) aged ≤40 years were evaluated. Angiograms were analyzed using standard quality control analysis software with digital acquisition. The arteries measured were the left main, left anterior descending, left circumflex, and the right coronary artery. Conventional risk factors, including hypertension, smoking, and diabetes, that could influence coronary size were also assessed. The coronary arteries of Asian-Indian patients showed significantly smaller values in the mean diameters of the left main (2.96 mm vs 4.04 mm, p = 0.0004), left anterior descending (2.48 mm vs 3.24 mm, p = 0.0005), left circumflex (2.52 mm vs 3.06 mm, p = 0.00002), and right coronary artery (2.71 mm vs 3.65 mm, p = 0.0008) as compared with Caucasians. Even after correction for body surface area, a statistically significant difference remained in coronary artery diameters. In conclusion, statistically significant difference in the mean diameter size even after correction for body surface area in Asian-Indians has implications for predisposition to atherosclerosis, and more challenging performance of procedures such as coronary artery bypass grafting, stent implantation, or atherectomy.

Coronary artery dimensions in normal Indians

BackgroundDiameter of coronary artery is an important predictor of outcome after percutaneous coronary interventions and coronary artery bypass graft surgery. There is very limited data available about coronary artery dimensions in an Indian population. AimsTo study the normal dimensions of the coronary artery segments in Indians without coronary artery disease by using quantitative coronary angiography and also to compare the dimensions in Indians with Western. Material and method229 patients who have undergone coronary angiography with entirely normal coronary angiogram were included in our study. ResultsThis study showed the diameter of vessels in males and females when taken together the left main was larger in size followed by proximal LAD, proximal RCA & proximal LCX respectively (4.08±0.44mm, 3.27±0.23mm, 3.20±0.37mm, 2.97±0.37mm).When the vessel diameter was indexed to body surface area there was no statistical difference between male and female (p value>0.05). The computed value of proximal coronary artery diameter unadjusted for individual body surface area, when compared to Caucasians showed that Caucasians have larger coronary artery dimensions than Indians. But when the proximal vessel diameter was indexed to body surface area there was no statistical significant difference between Indians and Caucasians (p value>0.05). ConclusionsWe found that coronary artery size when indexed to body surface area is not statistically different in Indian males and females and compared to Caucasians. However with a smaller body habitus Indians have smaller coronary arteries.

Does populational difference influence the size of adult human coronary arteries

Introduction: Many articles have measured the coronary artery size and compared with similar studies to verify the differences between populations. This study also compares its finding with other identical studies with an attempt to integrate them to evaluate earlier conclusions made on population differences. Materials and Methods: Normal coronary angiograms from the preexisting database of patients who underwent cardiac catheterization were analyzed for their sizes using catheter tip as calibrating object. Results: The measurements of left main coronary artery, left anterior descending artery, circumflex artery (CX), and right coronary artery (RCA) were 2.53 ± 0.26 mm, 1.86 ± 0.19 mm, 1.77 ± 0.27 mm, and 1.80 ± 0.22 mm, respectively, after being adjusted to body surface area. Coronary vessel sizes were compared between Indians, Nepalese, and the Caucasians. The RCA was significantly larger in the Indians as compared to Nepalese and Caucasians whereas Nepalese left anterior descending and CX arteries were significantly larger than both Indians and Caucasians while the left main artery was significantly larger among Nepalese than Indians. Conclusion: After evaluating our findings with various other similar studies, this study concludes that coronary artery diameter varies with populations.

Endothelial cells respond to the direction of mechanical stimuli through SMAD signaling to regulate coronary artery size.

How mechanotransduction intersects with chemical and transcriptional factors to shape organogenesis is an important question in developmental biology. This is particularly relevant to the cardiovascular system, which uses mechanical signals from flowing blood to stimulate cytoskeletal and transcriptional responses that form a highly efficient vascular network. Using this system, artery size and structure are tightly regulated, but the underlying mechanisms are poorly understood. Here, we demonstrate that deletion of Smad4 increased the diameter of coronary arteries during mouse embryonic development, a phenotype that followed the initiation of blood flow. At the same time, the BMP signal transducers SMAD1/5/8 were activated in developing coronary arteries. In a culture model of blood flow-induced shear stress, human coronary artery endothelial cells failed to align when either BMPs were inhibited or SMAD4 was depleted. In contrast to control cells, SMAD4-deficient cells did not migrate against the direction of shear stress and increased proliferation rates specifically under flow. Similar alterations were seen in coronary arteries in vivo Thus, endothelial cells perceive the direction of blood flow and respond through SMAD signaling to regulate artery size.

Urban legend or real fact: Coronary artery size varies with demographics.

OBJECTIVE:This study aimed to determine the relationship between the diameter of coronary artery stents and age, gender, diabetes mellitus (DM), left ventricular ejection fraction (LVEF), renal dysfunction, and the clinical presentation of myocardial ischemia in the cohort of patients with implanted stents in coronary arteries with severe stenotic lesions.METHODS:This study included 2256 patients (mean age, 59.3±10.9 years; men, 62%) who underwent percutaneous coronary intervention (PCI). The clinical status of the patients at presentation was subcategorized as follows: ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, unstable angina pectoris, and stable angina pectoris. The diameters, without any type or brand differentiation, were divided into two groups as follows: Group I, which included 2.5- and 2.75-mm-diameter stents, and Group II, which included ≥3-mm-diameter stents.RESULTS:The type of procedure, including primary PCI, early invasive strategy, and elective stenting, was not found to be a significant factor affecting the diameter of coronary artery stents. Univariate and multivariate analyses revealed a relationship between the diameter of coronary artery stents and age, gender, DM, and LVEF.CONCLUSION:This study demonstrated that the diameter of coronary artery stents was independently associated with gender, age, a history of DM, and moderate-to-severe systolic left ventricular dysfunction.

ANTI-ATHEROSCLEROTIC AND LIPID LOWERING EFFECTS OF CINNAMOMUM VERUM IN CHOLESTEROL-FED RABBITS

Objective: The present study was designed to investigate the antihyperlipidemic and anti-atherosclerotic activity of 70% methanolic crude extract of Cinnamomum verum bark in high cholesterol-fed diet rabbits.Methods: C. verum extract was administered at a dose level of 200 mg/kg and 300 mg/kg (p. o) daily for 120 d to cholesterol-fed rabbits. Lipid profile in serum and histological changes in heart and aorta were investigated. The statistical analysis was carried out by student’s ‘t’test.Results: Plant extract showed a significant decrease in the levels of serum total cholesterol, triglycerides, phospholipids, LDL, VLDL (P ≤ 0.001) in a dose-dependent manner in treated animals. HDL ratio improved overwhelmingly as well as the marked decline was also noticed in the atherogenic index after administration with C. verum extract. Histopathological examinations demonstrated less cholesterol deposits in the aorta and significant increase in lumen size of coronary arteries of high cholesterol diet animals given C. verum compared to the high cholesterol diet animals not given C. verum supplement.Conclusion: The phytochemical analysis of methanol extracts indicated a strong presence of alkaloids, flavonoids, tannins, phenols, saponins and fatty acids may be responsible for the significant hypolipidaemic as well as antiatherosclerotic activity. Our study exhibited that the methanol extract of C. verum bark is a potent hypolipidaemic agent and decreased cholesterol deposition in the aorta and plaque formation process in the coronary artery of high cholesterol diet animals.

The Relation of Angiographic-Based Coronary Artery Diameters with Gender and Traditional Cardiovascular Risk Factors in Patients with Normal or Mild CAD

Background: Several physiological and pathological processes aect the diameter of coronary arteries. It seems that the patholog- ical increase or decrease in the size of coronary arteries is associated with cardiovascular events. Objectives: The aim of this study is to determine the relationship between the diameter of coronary arteries, gender, and traditional cardiovascular risk factors. Methods: In this cross-sectional study, we enrolled 96 patients who underwent coronary angiography at our tertiary research cen- ter. The patients' demographic data, cardiovascular risk factors, and coronary artery diameters were recorded using a digital sliding caliper. Results: Out of 96 patients with a mean age of 56.3 9.8 years, 62 (64.6%) were female. Among cardiovascular risk factors dyslipi- demia was the most prevalent (55 patients or 57.3%) followed by hypertension (45 patients or 46.9%) and smoking (17 patients or 17.7%). The means of the right coronary artery (RCA), left main coronary artery (LMCA), left anterior descending (LAD) and left cir- cumflex (LCX) diameters were 3.27 0.7 mm, 4.35 0.7 mm, 3.5 0.6 mm and 3 0.7 mm, respectively. The female and participants and participants with diabetes had smaller coronary arteries: these dierences have become statistically significant for LMCA and LAD in both groups (in women, the p value for LMCA and LAD were 0.04 and 0.02, respectively, and in those with diabetics, the p value for LMCA and LAD were 0.02 and 0.04, respectively). Conclusions: In our study, female participants and participants with diabetes have smaller coronary arteries. No statistically sig- nificant relationships were found between traditional coronary risk factors and the diameters of coronary arteries.

The Clinical Value of High-Intensity Signals on the Coronary Atherosclerotic Plaques: Noncontrast T1-Weighted Magnetic Resonance Imaging

Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.

Normal Proximal Coronary Artery Diameters in Adults from India as Assessed by Computed Tomography Angiography.

The normative data of coronary artery size among Indians are sparse. It is often essential to know the coronary dimensions especially during interventions such as stenting to choose the appropriate size of the stent and to decide the very need for stenting. In current practice it is the luminal angiography which is most widely employed to assess the coronary artery size. However, luminal angiography is not very accurate in estimating the epicardial coronary artery size as it does not take into account the mural thickness of the arterial wall. Hence it is prudent to assess coronary artery size by other methods such as Computed Tomography (CT) coronary angiography, quantitative coronary angiogram, Magnetic Resonanace (MR) angiogram, etc. In this study we chose computed tomography as it demonstrates mural thickness along with lumen of the vessels and hence measures the diameter more accurately. To establish normative data for diameters of the proximal coronary artery segments during life by using MDCT in a cohort of individuals without any structural heart disease. Between October 2012 and April 2013, 168 consecutive patients who did not have any structural heart disease underwent CT coronary angiography for evaluation of Coronary Artery Disease (CAD) with atypical symptoms with low pretest probability. Patients who were found to have no coronary artery disease on CT-CAG were recruited in this study. The baseline clinical status and demographic data were obtained from the hospital records. In our study we found that the mean indexed diameter to BSA among females for LMCA 2.32±0.12mm, LAD 1.95±0.15mm, LCX 1.73±0.20mm and RCA 1.84±0.22mm. For males the values were LMCA 2.33±0.13mm, LAD 1.94±0.16mm, LCX 1.74±0.21mm, and RCA 1.79±0.20mm. These values are comparable to other studies. We attempted to establish normative data for normal proximal coronary artery dimensions among South Indian population. Coronary artery dimensions in Indians (in-dexed to BSA) for proximal major epicardial coronary arteries are similar to that reported in the West.

Coronary artery dimensions: Iranian population versus Indo-Asians and Caucasians

The dimensions of the coronary arteries have been shown to vary among ethnic groups. There are no data available regarding the normal size of coronary arteries in Iranians. This study aimed to investigate normal coronary artery dimensions in a Northwestern Iranian population and to compare it with pooled data of Indo-Asians and Caucasians in previous studies. The study included 200 adults with suspected coronary disease who were referred for elective coronary angiography between June 2012 and March 2013 and were found to have normal epicardial flow in the coronary arteries. Quantitative coronary angiography was carried out on the longest atheroma-free part of the proximal segment of each coronary artery in all patients. Two Indo-Asian and Caucasian groups were selected and pooled for comparison with the available reports on individuals without coronary artery disease. The mean diameters of the left main coronary artery, proximal left anterior descending artery, proximal left circumflex, and proximal right coronary artery were 4.58 ± 0.80, 3.69 ± 0.64, 3.37 ± 0.73, and 3.47 ± 0.68 mm, respectively. The dimensions of the proximal part of the left main coronary artery and right coronary artery were significantly greater in the Northwestern Iranian population compared to the pooled Caucasian group. This difference was maintained even after correction for body surface area. Our data indicate larger coronary diameters in the Iranian population compared to Caucasians or South-Asians. Hence the high prevalence of coronary artery disease in Iran cannot be explained by coronary dimensions.

Abstract 132: Methylprednisolone Pulse Therapy for Kawasaki Disease with Symptomatic Myocarditis

Purpose: Kawasaki disease (KD) is an acute febrile illness of infants and young children that is characterized by a systemic vasculitis, especially involving the coronary arteries. Although, sometimes, subclinical myocarditis is combined in KD, symptomatic myocarditis is extremely uncommon. We report a 7 year old boy who developed hypotension and decreased left ventricular systolic function (EF 40%) in the acute phase of KD. Case: A 7 year old boy (height 115 cm, body weight 20 kg) was admitted because of 2 days of persistent fever and left cervical lymphadenopathy (white blood cell count 17,870 /mm 3 , C reactive protein 23.6 mg/dL). Conjunctiva injection and lip redness developed on the 4th day of illness, and hypotension and tachycardia (SBP 59/DBP 29 mmHg, HR 153/bpm) were combined. The echocardiography revealed a decreased ejection fraction (EF) (40%) without chamber dilatation and normal coronary artery size (LM 1.9mm, z score=-1.3, RCA 2.3mm, z score=0.4). The level of N terminal pro BNP was 28,000 pg/mL. With a diagnosis of KD with myocarditis, he was initially treated with inotropics and intravenous immunoglobulin (2 g/kg). Without clinical improvement in spite of initial treatment, A change of coronary arterial size (LM 2.9mm, z score=1.2, RCA 3.1mm, z score=2.3) was developed and decreased LV systolic function (EF 45%) and fever were persisted. Then, he was given 3 daily pulses of intravenous methylprednisolone followed by tapering doses of oral prednisolone. He showed prompt clinical recovery after pulse therapy of intravenous methylprednisolone (SBP 95/DBP 49 mmHg, HR 98/bpm). Although EF was improved (59%), coronary arterial dilatation was progressed (LM 3.4mm, z score=2.4 RCA 5.5mm, z score=7.9). Conclusions: The present case serves to highlight the fact that methylprednisolone should be considered as the priority in children with KD who have symptomatic myocarditis during the acute stage.

Abstract O.68: Corticosteroid Pulse Therapy for Acute Kawasaki Disease: Consideration for the Long-Term Prognosis of Coronary Artery Lesions

Background: The use of corticosteroids as treatment for Kawasaki disease (KD) patients is still controversial. And the effects of corticosteroids on coronary artery lesions (CALs) development and later vascular remodeling are also unclear. The purpose of this study was to compare the long term prognosis of KD with CALs between corticosteroid administration patients and no corticosteroid using patients. Methods: Five hundred sixty nine patients with KD were studied at Kurume University Hospital from 1996 to 2004. Clinical records of 66 patients (46 males, 20 females) with CALs were reviewed. The median age at diagnosis was 1.5 (range 0.2 - 13.2) years and median follow-up period was 8.9 (range 0.1 - 16.4) years. Coronary artery sizes were measured by body surface area (BSA) adjusted z-score to using echocardiography. CALs were defined as coronary artery z-score > 2.5, and CAL regressions were defined as z-score < 2.5. Results: Sixty four patients were treated with intravenous immunoglobulin (IVIG), and 51 (79.7%) patients were unresponsive to the initial IVIG treatment. Twenty seven (40.9%) patients were received corticosteroid pulse therapy in the acute phase. The maximum CAL z-score in the acute phase, there were not significant differences between corticosteroid administration patients and no corticosteroid using patients (5.1 ± 2.2 vs. 4.9 ± 2.3, p = 0.277). The CAL z-score at the end of this study period, there were not significant differences between two groups (2.1 ± 2.0 vs. 2.3 ± 2.3, p = 0.432). The ratio of CAL regression in the study period (33.3% vs. 46.2%), the mean interval between the onset of KD and CAA regression (0.6 ± 0.5 vs. 0.8 ± 0.5 years, p = 0.209), and the ratio of coronary artery stenosis or occlusion (14.8% vs. 15.4%), there were not significant differences between two groups. Conclusion: Corticosteroid pulse therapy for KD patients may not be worsened CALs in the acute phase and long-term after the onset.

Transit-Time Flow Measurement as a Predictor of Coronary Bypass Graft Failure at One Year Angiographic Follow-Up

Transit-time flow measurement (TTFM) is a commonly used intraoperative method for evaluation of coronary artery bypass graft (CABG) anastomoses. This study was undertaken to determine whether TTFM can also be used to predict graft patency at one year postsurgery. Three hundred forty-five CABG patients with intraoperative graft flow measurements and one year angiographic follow-up were analyzed. Graft failure was defined as more than 50% stenosis including the "string sign." Logistic regression analysis was used to analyze the risk of graft failure after one year based on graft vessel type, anastomatic configuration, and coronary artery size. Nine hundred eighty-two coronary anastomoses were performed of which 12% had signs of graft failure at one year angiographic follow-up. In internal mammary arteries (IMAs), analysis showed a 4% decrease in graft failure odds for every 1 mL/min increase in TTFM (OR = 0.96, CI = [0.93; 0.99], p = 0.005). ROC analysis showed good discriminative ability for TTFM alone AUC = 69.5% in IMA grafts. For single-vein grafts the decrease in graft failure odds was 2% for every 1 mL/min increase in TTFM (OR = 0.98; CI = [0.97; 1.00], p = 0.059) and AUC of 59.9%. There were no significant relationships between TTFM and graft failure in other graft types or graft configurations. The TTFM method has good discriminative ability for assessing the risk of graft failure in certain graft types within the first year after CABG surgery and is a valuable instrument for intraoperative quality assessment of bypass grafts.

Applied Imagistics of Ischaemic Heart a Survey. From the Epidemiology of Stable Angina In Order to Better Prevent Sudden Cardiac Death

Abstract Coronary computed tomography angiography (CCTA) allows coronary artery visualization and the detection of coronary stenoses. In addition; it has been suggested as a novel, noninvasive modality for coronary atherosclerotic plaque detection, characterization, and quantification. Accurate identification of coronary plaques is challenging, especially for the noncalcified plaques, due to many factors such as the small size of coronary arteries, reconstruction artifacts caused by irregular heartbeats, beam hardening, and partial volume averaging. The development of 16, 32, 64 and the latest 320 row multidetector CT not only increases the spatial and the temporal resolution significantly, but also increases the number of images to be interpreted by radiologists substantially. Radiologists have to visually examine each coronary artery for suspicious stenosis using visualization tools such as multiplanar reformatting (MPR) and curved planar reformatting (CPR) provided by the review workstation in clinical practice

TCT-316 Impact of Coronary Artery Size on Physiologic Microcirculatory Indices: A Volumetric Intravascular Ultrasound Study with Coronary Flow Assessment

Microvascular dysfunction has been associated with increased mortality. However, little is known whether physiologic microcirculatory indices can fundamentally be affected by coronary dimensions. Volumetric IVUS (50 mm length) and physiologic assessment (Fractional Flow Reserve [FFR], Coronary Flow

The relative anatomy of the coronary arterial and venous systems: implications for coronary interventions.

An anatomical understanding of human coronary arterial and venous systems is necessary for device development and therapy applications that utilize these vessels. We investigated the unique use of contrast-CT scans from perfusion-fixed human hearts for three-dimensional visualization and analysis of anatomical features of the coronary systems. The coronary arterial and venous systems of eleven perfusion-fixed human hearts were modeled using contrast-CT and Mimics software. The coronary arteries that coursed near the major coronary veins, how close coronary arteries were to coronary veins, and the size of adjacent coronary arteries were recorded and analyzed. The majority of coronary veins were within 5 mm of a coronary artery somewhere along its length. Interventricular veins elicited the largest occurrence of overlaps. There was significant variability in the percentage of each vein that coursed within 0.5, 1, 2, and 5 mm of a nearby artery. The left marginal veins and anterior interventricular vein had the largest portion of the vein that coursed near a coronary artery. The right coronary artery most often coursed near the middle cardiac vein. The inferior veins of the left ventricle elicited the most variation in adjacent arteries. The left circumflex artery and/or branches of the circumflex artery coursed near the left marginal vein in all cases where there was an artery near the marginal vein. The wide variation of measurements reinforces the importance of a precise understanding of individualized cardiac anatomy in order to provide the highest quality care to cardiac patients.

Microvascular obstruction in patients with non-ST-elevation myocardial infarction: a contrast-enhanced cardiac magnetic resonance study.

The aim of the study was to assess the frequency and predictive factors of microvascular obstruction (MVO) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study included 190 consecutive patients with NSTEMI who underwent percutaneous coronary intervention (PCI) within 24 h after admission and cardiac magnetic resonance (CMR) imaging, 4.1 days after angiography. MVO was defined using the CMR criteria. MVO was detected 26 of 190 patients (13.8%). Patients with MVO had higher peak high-sensitivity troponin T, creatine-kinase and creatine kinase-myocardial band levels and higher proportions of those with baseline thrombolysis in myocardial infarction (TIMI) flow grade 0-1, absence of collateral circulation, post-PCI TIMI flow grade <3, myocardial blush grade <3 and angiographic no-reflow than patients without MVO. Patients with MVO had larger initial area at risk [median (25th-75th percentiles), 23.9% (17.4-33.9%) vs. 16.1% (7.8-27.7%), P = 0.018] and infarct size [11.4% (6.6-19.2%) vs. 1.4% (0-4.7%) of the left ventricle, P < 0.001] than patients without MVO. In multivariable analysis, the culprit lesion localization in the circumflex coronary artery [adjusted odds ratio (OR) 13.71, 95% confidence interval 2.91-64.58, P < 0.001] and the infarct size [adjusted OR 3.37 (1.80-6.29), P < 0.001, for each 5% of the left ventricle] were independently associated with the increased risk for MVO. In patients with NSTEMI undergoing early PCI, the MVO defined by CMR imaging was present in 13.8 % of the patients. The localization of culprit lesion in the circumflex coronary artery and larger infarct size were independently associated with the increased risk for MVO.

Coronary artery size and origin imaging in children: a comparative study of MRI and trans-thoracic echocardiography

Coronary artery size and origin imaging in children: a comparative study of MRI and trans-thoracic echocardiography

Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: A pilot study

Heart rate is a major determinant of myocardial oxygen demand; in ST-segment elevation myocardial infarction (STEMI), patients treated with primary percutaneous intervention (PPCI), heart rate at discharge correlates with mortality. Ivabradine is a pure heart rate-reducing agent that has no effect on blood pressure and contractility, and can reverse left ventricular (LV) remodelling in patients with heart failure. To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI. This paired-cohort study included 124 patients between June 2011 and July 2012. Ivabradine (5mg twice daily) was given promptly after PPCI, along with beta-blockers, to obtain a heart rate<60 beats per minute (ivabradine group). This group was matched with STEMI patients treated in line with current guidelines, including beta-blockers (bisoprolol), according to age, sex, infarct-related coronary artery, ischaemia time and infarct size determined by initial cardiac magnetic resonance imaging (CMR) (control group). Statistical analyses were performed according to an intention-to-continue treatment principle. CMR data at 3 months were available for 122 patients. Heart rate was lower in the ivabradine group than in the control group during the initial CMR (P=0.02) and the follow-up CMR (P=0.006). At the follow-up CMR, there was a smaller increase in LV end-diastolic volume index in the ivabradine group than in the control group (P=0.04). LV end-systolic volume index remained unchanged in the ivabradine group, but increased in the control group (P=0.01). There was a significant improvement in LV ejection fraction in the ivabradine group compared with in the control group (P=0.04). In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy.

Excluding a giant coronary aneurysm by implantation of a covered stent

A 61-year-old gentleman underwent coronary computed tomography (CT) angiography (CCTA) for atypical chest pain, which revealed partially ectatic, diffusely diseased coronary arteries and a giant, eccentric, and partially thrombosed aneurysm in the proximal segment of the right coronary artery (RCA) (size: 7 × 5.5 × 6 cm; Panels A and B , arrows). On invasive angiography, the true size of the aneurysm …