Coronary Blood Flow In Patients Research Articles

The role of microvascular obstruction and intramyocardial hemorrhage in reperfusion injury to the heart

Microvascular obstruction (MVO) of coronary arteries promotes an increase in mortality and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Intramyocardial hemorrhage (IMH) is observed in 41–50 % of patients with ST-segment elevation myocardial infarction and PCI and is accompanied by inflammation. There is evidence that microthrombi are not involved in the development of MVO, which is associated with infarct size, the duration of ischemia, and myocardial edema. However, there is no conclusive evidence that the latter plays an important role in the development of MVO. There is evidence that platelets, inflammation, Ca2+ overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. The role of endothelial cell dysfunction in MVO formation in patients with AMI and PCI remains under question. It is unclear whether nitric oxide production is decreased in patients with MVO. It was obtained only indirect evidence on the involvement of inflammation in the development of MVO. The role of reactive oxygen species, necroptosis and pyroptosis in the pathogenesis of MVO is also not studied. The participation of thromboxane A2, vasopressin, and prostacyclin in the formation of MVO is unknown. It was not obtained conclusive evidence on the involvement of coronary artery spasm in the development of MVO. Dual antiplatelet therapy improves the efficacy of PCI in prevention of MVO. It is unknown whether epinephrine or L-type Ca2+-channel blockers improves coronary blood flow in patients with MVO.

Production of angiogenesis mediators and the structure of the vascular wall in the heart in ischemic cardiomyopathy

Background. In the pathogenesis of ischemic cardiomyopathy (ICMP), angiopoiesis remains unexplored.The aim. To describe the vasculature of the heart and the imbalance of angiogenesis mediators in the coronary circulation in association with the number of endothelial progenitor cells (EPC) and desquamated endothelial cells (DEC) in the blood of patients with coronary heart disease (CHD), suffering and not suffering from ICMP.Methods. Fifty-two patients with CHD (30 patients with ICMP, 22 patients without ICMP), 15 healthy donors were examined. The content of EPC (CD14+CD34+VEGFR2+) in the blood from the cubital vein and DEC (CD45–CD146+) in the blood from the coronary sinus and the cubital vein was determined by flow cytometry. The concentrations of VEGF-A (vascular endothelial growth factor A), PDGF (platelet-derived growth factor), and SDF-1 (stromal cell-derived factor 1) in blood plasma were recorded using immunofluorescence assay; the angiopoietin-2, MMP-9 (matrix metallopeptidase 9) were recorded using enzyme immunoassay. In myocardial biopsies the specific area of vessels and the expression of αSMA (smooth muscle alpha-actin) were determined by morphometric and immunohistochemical methods.Results. In the peripheral blood of patients with CHD, regardless of the presence of ICMP, the DEC content exceeded the physiological level, and the VEGF-A, PDGF, angiopoietin-2, and MMP-9 corresponded to the norm. In CHD patients without cardiomyopathy, there was an excess of SDF-1 and EPC in the blood from the cubital vein, and in ICMP, their physiological significance was noted. In the coronary blood flow in patients with CHD without cardiomyopathy, an increase in the concentration of PDGF was found, which was not determined in patients with ICMP, who had an increased content of DEC, angiopoietin-2 and MMP-9. The specific area of the vessels in the patients of the two groups was comparable; the expression of αSMA in ICMP was 6.2 times lower than in patients with CHD without cardiomyopathy.Conclusion. The development of ICMP is accompanied by impaired maturation of vessels in the myocardium, associated with the absence of a compensatory reaction of activation of cellular and humoral factors of angiogenesis.

Ultra-High-Resolution Electrocardiography Enables Earlier Detection of Transmural and Subendocardial Myocardial Ischemia Compared to Conventional Electrocardiography.

The sensitivity of exercise ECG is marginally sufficient for the detection of mild reduction of coronary blood flow in patients with early coronary atherosclerosis. Here, we describe the application of a new technique of ECG registration/analysis-ultra-high-resolution ECG (UHR ECG)-for early detection of myocardial ischemia (MIS). The utility of UHR ECG vs. conventional ECG (C ECG) was tested in anesthetized rats and pigs. Transmural MIS was induced in rats by the ligation of the left coronary artery (CA). In pigs, subendocardial ischemia of a variable extent was produced by stepwise inflation of a balloon within the right CA, causing a 25-100% reduction of its lumen. In rats, a reduction in power spectral density (PSD) in the high-frequency (HF) channel of UHR ECG was registered at 60 s after ischemia (power 0.81 ± 0.14 vs. 1.25 ± 0.12 mW at baseline, p < 0.01). This was not accompanied by any ST segment elevation on C ECG. In pigs, PSD in the HF channel of UHR ECG was significantly decreased at a 25% reduction of CA lumen, while the ST segment on C ECG remained unchanged. In conclusion, UHR ECG enabled earlier detection of transmural MIS compared to C ECG. PSD in the HF channel of UHR ECG demonstrated greater sensitivity in the settings of subendocardial ischemia.

Effect of sodium-glucose co-transporter-2 inhibitors on coronary blood flow in patients with type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is known to be associated with endothelial dysfunction (ED). Reducing ED can attenuate the occurrence of cardiovascular diseases. One of the indicators of ED is decreased coronary blood flow (CBF). Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) are known to directly improve ED in both euglycemic and hyperglycemic conditions and have been shown to decrease the incidence of major cardiovascular events. We aimed to investigate whether SGLT-2is improves CBF in patients with T2DM, who have angiographically normal or nearly normal coronary arteries. In this single-center retrospective study, all patients who underwent coronary angiography between January 2017 and September 2022 were screened. We designed the study by dividing the patients into two groups - those who used conventional antidiabetic medications (CAM) together with SGLT-2is (patients using an SGLT-2 inhibitor for at least 3 months) and those who used only conventional antidiabetic medications. Of the 18,205 patients who underwent coronary angiography, 5,040 patients had T2DM. After exclusion, 288 patients were divided into two groups - those who used CAM together with SGLT-2is and those who used only CAM. CBF was assessed by thrombolysis in myocardial infarction (TIMI) frame counting. Two hundred eighty-eight patients who had T2DM and met the inclusion criteria were included in our study. The patients were divided into two groups - those who used CAM together with SGLT-2is (n = 75) and those who used only CAM (n = 213). The median age in the group that used CAM together with SGLT-2is was 55 (51-64), where 52 (69.3%) patients were female. The mean TIMI frame count (TFC) was 23.5 in the group using CAM + SGLT-2is and 27.5 in the group using only CAM. In the multivariable linear regression analysis, the mean TFC was significantly lower in the group using CAM together with SGLT-2is compared to the group using only CAM [β-coefficient = -12.766, 95% Cl: -5.304; -3.887, p < 0.001]. Moreover, there was a statistically significant correlation between an increase in BMI and hemoglobin with an increase in the mean TFC [β-coefficient = 3.018, 95% Cl 0.037-0.175, p = 0.003 and β-coefficient = 2.316, 95% Cl 0.033-0.405, p = 0.021, respectively]. We have demonstrated that the use of SGLT-2is improves coronary artery blood flow in patients with T2DM who have normal or nearly normal coronary angiography.

Prognostic value of changes in coronary blood flow in patients with preserved ejection fraction

BACKGROUND: The measurement of the left ventricular ejection fraction during at echocardiographic study evaluates global contractility. A decrease in this parameter indicates a poor prognosis. However, in the range of normal values, the left ventricular ejection fraction loses prognostic significance. This category of patients requires the development of other prognostic methods.&#x0D; AIM: To explore the effect of changes in coronary blood flow parameters measured using dopplerography in patients with preserved left ventricular ejection fraction in predicting adverse outcomes over the next year.&#x0D; MATERIALS AND METHODS: The prospective study included patients referred for echocardiography in 20192020 followed up at the Saint Petersburg Research Center of Cardiology Medika. The inclusion criterion was age over 18 years. A decrease in left ventricular ejection fraction of less than 53% was an exclusion critrion. In addition to standard echocardiography, dopplerography has been used to study the velocity parameters of blood flow in the coronary arteries. The observation period was 1 year.&#x0D; RESULTS: The control group included 453 patients. During the year of observation, 89 cases of spontaneous adverse events (death / myocardial infarction / progressive heart failure) occurred, including 19 deaths. The patients who died were older (76.6 8.6 vs. 59.3 15.5 years; р 0.000001), with lower global longitudinal function (13.8 4.3% vs. 18.3 3.6%, р 0.000001), with a large volume index of the left atrium (54.6 15.5 vs. 36.5 13.1 ml/m2; р 0.000000), high pressure in the pulmonary artery (39 14.7 vs. 29.5 8.1 mmHg; р 0.000000), high left ventricular myocardial mass index (108.7 37.2 vs. 88,1 24.1 g/m2, р 0.000000) and impaired diastolic function [the ratio of blood flow velocity through the mitral valve in the first (early) phase of left ventricular filling and the average velocity of the mitral valve fibrous ring 13.6 7.1 vs. 9.4 4.4; р 0.000000]. The blood flow velocity in the anterior interventricular artery was significantly higher (78.0 39.0 vs. 50.0 25.4 cm/s, р 0.000007). Only age and flow velocity in anterior interventricular artery were independent predictors of death / myocardial infarction (р 0.004).&#x0D; CONCLUSIONS: Velocity parameters in the anterior interventricular artery are a significant predictor of short-term spontaneous events, including death, in patients with preserved ejection fraction.

Comprehensive analysis of clinical and paraclinical parameters of coronary blood flow in patients with acute types of coronary artery disease and type 2 diabetes

Aim. To study clinical and paraclinical parameters and lesions of the coronary bed in patients with acute types of coronary artery disease (CAD) and type 2 diabetes (T2D).Material and methods. The study included 102 patients of both sexes with acute CAD. Patients were analyzed in two following groups: the first (mean age, 56,6±0,96 years, men/women 34/16) consisted of 50 patients with acute coronary syndrome (ACS) and type 2 diabetes, the second (mean age, 58,7±1,01 years, men/women 37/15) — 52 patients without T2D. Along with the assessment of behavioral and biological risk factors for CVD, clinical and hemodynamic parameters and the results of coronary angiography were analyzed.Results. In patients with ACS and T2D, the duration of T2D was 5,6±3,7 years. Somatic comorbidities were registered in 74% in the first group, and in 53,8% in the second. According to echocardiography, in the group of people with ACS and T2D, the left ventricular ejection fraction was lower, and the mean pulmonary artery pressure was higher compared to the group without T2D. Stenosis of the distal coronary artery third in patients with T2D occurred in 78% of cases, and in patients without T2D — in 42%; the differences were significant (p&lt;0,001). Diffuse CAD also prevailed in the first group and amounted to 58%, and in the second — 27%. The SYNTAX score was higher in patients with T2D compared with the group of people without T2D — 29,2 and 22%, respectively (p&lt;0,001).Conclusion. In patients with ACS and T2D, the prevalence of pulmonary hypertension and left ventricular systolic dysfunction was revealed. The features of the coronary flow in patients with T2D with ACS were predominantly the distal type of lesion, as well as an increased risk of angioplasty complications, assessed using the SYNTAX score.

Relationship between coronary blood flow and improvement of cardiac function after catheter ablation for persistent atrial fibrillation.

The relationship between coronary blood flow during atrial fibrillation (AF) and improvement of cardiac function after catheter ablation (CA) for persistent AF (PeAF) is not prominent; this study was conducted to evaluate this relationship. This was a retrospective case-control study. Eighty-five patients with PeAF (resting heart rate < 100bpm) and heart failure with reduced ejection fraction (left ventricular ejection fraction (LVEF) < 40%) who had undergone coronary angiography within 1week before CA were included. All patients could maintain a sinus rhythm for > 6months after CA. The primary outcome was improvement of cardiac function with an LVEF cutoff value of > 50% during sinus rhythm 6months after CA. In the LVEF improvement group (N = 57), patients were younger, with a higher baseline diastolic blood pressure and lower baseline brain natriuretic peptide level than the no LVEF improvement group (N = 28). Heart rate at baseline and 6months after CA and AF duration did not differ between the two groups. Thrombolysis in myocardial infarction frame count parameters was significantly higher in the LVEF improvement (P < 0.001) than in the no LVEF improvement group. Multivariate logistic regression analysis revealed mean thrombolysis in myocardial infarction frame count as an independent factor for LVEF improvement (odds ratio, 1.72 (95% confidence interval 1.17-2.54); P = 0.006). Coronary blood flow in patients with PeAF is strongly associated with improved left ventricular systolic function after the restoration of sinus rhythm by CA for PeAF and heart failure with reduced ejection fraction.

The state of platelet and plasma hemostasis as a predictor of coronary blood flow in patients with acute myocardial infarction.

Aim To study the relationship of the platelet function and plasma homeostasis with the blood flow in the infarct-related artery (IRA) and with the course of acute myocardial infarction (AMI).Material and methods This study included 93 patients with AMI (75 patients with ST-elevation AMI and 18 patients without ST segment elevation). 63 patients had TIMI 0-1 blood flow in the IRA and 30 patients had TIMI 2-3. Rotational thromboelastometry, impedance aggregometry, the endothelium-dependent vasodilation (EDVD) test, and the thrombodynamics test were performed for all patients. The primary clinical endpoint included the totality of in-hospital complications of AMI, and the secondary endpoint included the totality of out-of-hospital complications of AMI. Major bleedings (BARC 3-5) and minor bleedings (BARC 1-2) were evaluated separately.Results Patients with IRA TIMI 0-1 flow were characterized by a shorter blood clotting time (BCT), larger thrombus size and density, more intense platelet aggregation induced by arachidonic acid and ADP, and lower values of the EDVD test. It was found that the parameters of platelet aggregation induced by arachidonic acid (AUC Asa) in combination with BCT allowed assessment of the severity of IRA blood flow disorder (sensitivity 76 %, specificity 71 %) in patients with AMI, regardless of the presence of ST segment elevation on the ECG. In addition, the incidence of the primary endpoint was greater in patients with IRA TIMI 0-1 flow (41.3% and 16.7%, respectively; p=0.015). In patients with TIMI 2-3 flow in the long-term period of the disease, the incidence of minor bleedings was significantly higher (8.5% and 30.4 %, respectively; p=0.045).Conclusion Compared to patients with preserved blood flow, patients with AMI and IRA TIMI 0-1 flow are characterized by endothelial dysfunction and more intense processes of thrombogenesis and platelet aggregation. It has been shown for the first time that the combination of two simple criteria for assessing hemostasis (AUC Asa; BCT) allows assessment of the degree of IRA blood flow disorder in patients with AMI.

Epidemiology of Post-Infarction Ventricular Septal Rupture in Patients Undergoing Surgical Repair at Different Times from the Development of Acute Myocardial Infarction

Introduction. The article is dedicated to the epidemiological aspects of the mechanical complication of acute myocardial infarction (AMI), particularly post-infarction ventricular septal rupture (VSR), problematic issues of its etiology and localization. Mortality of such patients is determined by rapid development of hemodynamic disorders and their severity, unpredictable clinical course, and the difficulty of early diagnosis. In addition, the high mortality rate of patients, especially when correcting the ventricular septal defect at the early stages after AMI, leaves open the question of the tactics of surgical treatment. The influence of certain risk factors of ischemic heart disease (IHD) on the development of post-infarction VSR is also considered. The aim. To study the epidemic features of post-infarction VSR in patients with different terms of surgical intervention after the development of AMI. Materials and methods. This study presents a retrospective analysis of 90 patients with coronary artery disease complicated by post-infarction VSR, who underwent surgical intervention for the period 2002-2019. The ages of hospitalized patients with post-infarction VSR ranged from 29 to 81 years. All the patients were divided into 3 groups depending on the time interval from AMI to surgical intervention. Results and discussion. It was found that post-infarction VSR is more common in men in the age range of 45-74 years after the manifestation of the first transmural AMI. More than a half of post-infarction VSR cases (56.7%) are associated with anterior localization of the ruptures in consequence of anterior AMI. Since the leading role in the treatment of AMI belongs to percutaneous coronary interventions (PCI), we analyzed the use of various reperfusion techniques to restore coronary blood flow in patients with post-infarction VSR. The analysis suggests that there are no statistically significant differences between the studied groups of patients with post-infarction VSR who underwent myocardial reperfusion (p = 0.103). Conclusions. The presence of chronic renal failure (CRF) in patients in the early post-infarction period can complicate the course of post-infarction VSR and affect perihospital mortality. The absence or untimeliness of myocardial reperfusion increases the risk of developing this complication of AMI. The ambiguous prognosis of treatment of post-infarction VSR makes a serious problem for clinicians.

C27. CATASTROPHIC EVENT IN PERCUTANEOUS CORONARY INTERVENTION PROCEDURE: TYPE III LEFT MAIN CORONARY ARTERY DISSECTION

Abstract Percutaneous coronary intervention (PCI) is an invasive revascularization method to improve coronary blood flow in patients with CHD. A male patient, 61 years old, came to the cardiac clinic at Sanglah General Hospital, complaining intermittent chest pain since one month earlier. Coronary angiography found a stenosis of 70% in the ostium left anterior descending coronary artery (LAD), 80-90% in the proximal to distal LAD and 70-80% in the ostium to the proximal right coronary artery (RCA).The patient was diagnosed with coronary artery disease 2 vessel disease (CAD 2VD) and was then prepared for the PCI procedure on LAD. The 6F Optitorque TIG catheter was then replaced with a 3.5/6F BL guide catheter to the LMCA ostium. Angiographic evaluation at the time of re-canulation revealed aortic dissection at the LMCA to the ascending aorta (type III) and cessation of blood flow to the LAD. The patient then complained of severe chest pain accompanied by shock. Wiring to distal LAD was performed quickly afterward using a 0.014”/180 cm Runtrough NS Floppy, followed by a 2.0 x 15 mm balloon inflation on the LMCA ostium to the proximal LAD. Then, double wiring was performed to the LCx using 0.014 "/ 180 cm Runtrough NS Floppy wire to maintain coronary patency. At last, the a 3.5 x 12 mm Drug Eluting Stent (DES) on the LMCA to proximal to the LAD. Despite stenting at the dissection site, the patient fell into shock, developed a malignant arrhythmia and subsequently had cardiac arrest.

C27. CATASTROPHIC EVENT IN PERCUTANEOUS CORONARY INTERVENTION PROCEDURE: TYPE III LEFT MAIN CORONARY ARTERY DISSECTION

Abstract Percutaneous coronary intervention (PCI) is an invasive revascularization method to improve coronary blood flow in patients with CHD. A male patient, 61 years old, came to the cardiac clinic at Sanglah General Hospital, complaining intermittent chest pain since one month earlier. Coronary angiography found a stenosis of 70% in the ostium left anterior descending coronary artery (LAD), 80-90% in the proximal to distal LAD and 70-80% in the ostium to the proximal right coronary artery (RCA).The patient was diagnosed with coronary artery disease 2 vessel disease (CAD 2VD) and was then prepared for the PCI procedure on LAD. The 6F Optitorque TIG catheter was then replaced with a 3.5/6F BL guide catheter to the LMCA ostium. Angiographic evaluation at the time of re-canulation revealed aortic dissection at the LMCA to the ascending aorta (type III) and cessation of blood flow to the LAD. The patient then complained of severe chest pain accompanied by shock. Wiring to distal LAD was performed quickly afterward using a 0.014”/180 cm Runtrough NS Floppy, followed by a 2.0 x 15 mm balloon inflation on the LMCA ostium to the proximal LAD. Then, double wiring was performed to the LCx using 0.014 "/ 180 cm Runtrough NS Floppy wire to maintain coronary patency. At last, the a 3.5 x 12 mm Drug Eluting Stent (DES) on the LMCA to proximal to the LAD. Despite stenting at the dissection site, the patient fell into shock, developed a malignant arrhythmia and subsequently had cardiac arrest.

Сlinical and hemodynamic characteristics and coronary blood flow in patients with chronic coronary artery disease and type 2 diabetes

Aim. To assess the features of clinical and hemodynamic characteristics and the severity of coronary involvement in patients with chronic coronary artery disease (CAD) with and without diabetes.Material and methods. The study included 100 patients with stable CAD, which were divided into two groups: group I (mean age, 57,9-1,04 years, male/female 35/14) — 49 patients with CAD and type 2 diabetes, II — (60,2-0,9 years, 34/17) — 51 patients without SD. Along with behavioral and biological risk factors, clinical and hemodynamic characteristics were analyzed. All patients underwent coronary angiography.Results. The presence of diabetes in patients with CAD was associated with abdominal obesity and comorbidity of somatic diseases. Among group I patients, electrocardiographic signs of left ventricular hypertrophy, conduction abnormalities, accompanied by a decrease in the left ventricular ejection fraction, impaired diastolic function, and high mean pulmonary artery pressure were significantly more often detected. In patients with CAD and type 2 diabetes, significant right coronary artery (CA) stenoses were more often recorded (39%), while in patients without diabetes, the anterior descending artery was the most susceptible to atherosclerosis. In group I, stenosis of the distal CA third was detected 1,5 times more often (p&lt;0,001), and their diffuse multivessel lesion prevailed by 28% (73% and 45%, respectively, p&lt;0,005). The average SYNTAX score in patients with and without diabetes was 29,2±0,8 vs 22±0,7, respectively (p&lt;0,0005).Conclusion. In patients with CAD and diabetes, more pronounced atherosclerotic coronary involvement (diffuse multivessel CAD) was revealed, which should be taken into account when planning further treatment. The risk of adverse cardiovascular events will always be present with percutaneous coronary interventions.

Predictors of myocardial reperfusion syndrome: a modern view of the issue and current problems. Part 1: Reperfusion arrhythmias, injury and stunning myocardium (review of literature)

Myocardial reperfusion syndrome is a complex set of pathological processes that occur in the heart muscle due to restoration of coronary blood flow in patients with ST-segment elevation myocardial infarction. Despite the fact that it has been known for a long time, there is still no unequivocal opinion about the predictors, and, accordingly, the risk groups for its occurrence. This prevents predicting the further course of the disease and studying the effectiveness of surgical and therapeutic methods for preventing the consequences of reperfusion in patients with ST-segment elevation myocardial infarction, which in turn significantly worsens the postoperative and long-term prognosis in this group of patients. We used the search engines such as E-lilbrary, Google Scholar and Pubmed to search for studies on this issue. The article presents research data highlighting predictors of myocardial reperfusion syndrome. In addition, the problems of verification of irreversible reperfusion injury and myocardial stunning are described.

Usefulness of excimer laser in acute coronary syndrome with left main coronary artery: a case series.

BackgroundAcute coronary syndrome caused by unprotected left main coronary artery (ACS-ULMCA) occlusion has a high mortality due to the formation of plaques and rich thrombi. Although excimer laser coronary angioplasty (ELCA) is effective in debulking and ablation of plaque burden and rich thrombi, its effectiveness in ACS-ULMCA remains unknown.Case summaryWe conducted percutaneous coronary intervention (PCI) using ELCA for six patients with ACS-ULMCA from February 2016 to May 2019. This case series includes a 65-year-old man who presented with sudden-onset chest pain. Angiography revealed subtotal occlusion of the left main coronary artery (LMCA). The use of a 0.9-mm ELCA catheter advanced from LMCA to the left anterior descending artery markedly improved coronary blood flow, and intravascular ultrasound revealed debulking of the plaque and thrombus. Another 79-year-old man presented with chest pain. Angiography revealed total occlusion of LMCA. Use of a 0.9-mm ELCA catheter improved coronary blood flow. Subsequent kissing balloon technique led to satisfactory results. All cases needed mechanical support (such as intra-aortic balloon pumping or percutaneous cardiopulmonary support) prior to PCI. Five patients survived finally, and one died 34 days after primary PCI.DiscussionAfter stabilizing haemodynamics by mechanical support, ELCA could be a good option to improve coronary blood flow in patients with ACS-ULMCA.

The Condition of the Coronary Arteries in Patients with Ischemic Mitral Insufficiency

Secondary (or functional) mitral regurgitation is the result of myocardial dysfunction due to ischemic injury with relatively normal cusps. In patients with ischemic mitral insufficiency, only surgical coronary artery bypass grafting can affect the reverse remodeling of the left ventricle and reduce the degree of mitral regurgitation. One of the main pathogenetic factors for the development of this type of mitral insufficiency is myocardial ischemia. Studying the state of coronary blood flow in patients with ischemic mitral insufficiency is a primary task in the surgical treatment of this pathology.&#x0D; The aim. To study the condition of the coronary arteries in patients with ischemic mitral insufficiency.&#x0D; Material and methods. From January 2015 to December 2019, 194 patients with ischemic mitral insufficiency underwent surgical intervention at the Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine.&#x0D; Results and Discussion. Coronarography revealed haemodynamically significant coronary artery stenosis in 190 (97.9%) patients. In 4 (2.1%) patients there was no hemodynamically significant coronary arteries stenosis. Analysis of the data of selective angiography showed that the majority of patients with ischemic mitral insufficiency had three-vessel disease (75.2%). Occlusion of the left circumflex coronary artery was observed in 33 (17.4%), and sub-occlusive changes were detected in 3 (1.6%) of patients. A completely different lesion pattern is observed for the branches of the right coronary artery. Thus, in 56 (29.4%) cases, occlusion of a particular branch was found on angiogram. Sub-occlusion of the right coronary artery was observed in 15 (7.9%) cases.&#x0D; Conclusions. In patients with ischemic mitral insufficiency, hemodynamically significant stenosis was most often observed in the anterior interventricular artery (81.6%). Comparison of the status of the right coronary artery and circumflex artery showed that the right coronary artery lesions occurred more frequently. The section of the right coronary artery between the outflow of the acute marginal branch and the branching to the posterior interventricular and lateral branches was the most vulnerable site of the coronary bed, where the frequency of occurrence of critical stenosis was 28.4%.

Integrating Patient-Specific Electrocardiogram Signals and Image-Based Computational Fluid Dynamics Method to Analyze Coronary Blood Flow in Patients during Cardiac Arrhythmias

PurposeThe aim of this study was to use the computational fluid dynamics (CFD) method, patient-specific electrocardiogram (ECG) signals, and computed tomography three-dimensional image reconstruction technique to investigate the blood flow in coronary arteries during cardiac arrhythmia.MethodsTwo patients with premature ventricular contraction-type cardiac arrhythmia and one with atrial fibrillation-type cardiac arrhythmia were investigated. The inlet velocity of the coronary artery in simulation was applied with the measured velocity profile of the left ventricular outflow tract (LVOT) from the Doppler echocardiography. The measured patient central aortic blood pressure waveform was employed for the coronary artery outlet in simulation. The no-slip boundary condition was applied to the arterial wall.ResultsFor the patient with irregular cardiac rhythms (Case I), the coronary blood flow rate under the shortened and lengthened cardiac rhythms were 0.66 and 0.96 mL/s, respectively. In Case II, the maximum velocity at the LVOT under a normal heartbeat was found to be 101 cm/s, whereas the average value was 73 cm/s. In Case III, the patient was also diagnosed with a congenital stenosis problem at the myocardial bridge (MCB) at the LAD. The measured blood flow rate at the MCB of the LAD for the three heartbeats in Case III was found to be 0.68, 1.08, and 1.14 mL/s.ConclusionThe integration of patient-specific ECG signals and image-based CFD methods can clearly analyze hemodynamic information for patients during cardiac arrhythmia. The cardiac arrhythmia can reduce the blood flow in the coronary arteries.

ACUTE CORONARY SYNDROME WITH NONOBSTRUCTIVE CORONARY ARTERIES: THE SEVERITY OF CORONARY ATHEROSCLEROSIS AND MYOCARDIAL PERFUSION DISORDERS (PILOT STUDY)

Aim. To study the structural and functional status of coronary blood flow in patients with acute coronary syndrome with nonobstructive coronary arteries using multispiral computed tomography (MSCT) and single photon emission tomography (SPECT) and to compare data of MSCT and invasive coronary angiography (ICA).Material and Methods. This study is a non-randomized, open-label, controlled clinical trial. The study is registered on ClinicalTrials.gov. The inclusion criteria are listed on the site. All patients underwent CT and SPECT.Results. The study included 14 patients with MINOCA; the group comprised predominantly women (n=11, 78.6%); the average age was 61.1±14 years. The risk according to GRACE (Global Registry of Acute Coronary Events) risk score was moderate in 8 patients (57%) and high in 5 patients (35.7%). 85.7% of patients were admitted to hospital within the first six hours from onset of diseases. Three patients (21.4%) received thrombolytic therapy and it was effective in two of them (14%). Risk factors included hypertension (64.2%), dyslipidemia (50%), and burdened history (71.4). According to the results of invasive coronary angiography, intact coronary arteries were detected in 9 patients (64.3%); 5 patients (35.7%) had stenosis up to 50%. Coronary slow-flow phenomenon (TIMI 2) was detected in 11 patients (78.6%) including 8 patients (57.1%) who had coronary slow-flow phenomenon and intact coronary arteries. Severe coronary spasm was registered in 1 patient (7.1%) in the group with ST segment elevation acute coronary syndrome (STE ACS). According to MSCT data, the proportion of patients with intact coronary arteries decreased from 7 (50%) to 5 patients (35.7%) whereas the proportion of patients with nonstenosing atherosclerosis increased from 7 (50%) to 9 patients (64.3%). Twenty six atherosclerotic plaques were detected including eccentric (76%), circular (11.5%), and semi-circular plaques (11.5%). In regard to morphological structure, the atherosclerotic plaques were calcified (59.5%), mostly calcified (7.7%), and soft (29%). Normal myocardial perfusion (Summed Stress Score (SSS) and Summed Rest Score (SRS) &lt;4) was detected in two patients (14.3%); 12 patients (85%) had transitory perfusion defects. The median score values were 7.5 (4; 13) for SSS, 4.7 (1.0; 9.0) for SRS, and 4.7 (3.0; 8.0) for SDS.Conclusion.The introduction of MCTA and SPECT into the algorithm of the examination of patients with acute myocardial infarction and non-obstructive atherosclerosis of the coronary arteries was safe when additionally used during index hospitalization. These approaches provided new information about the structure and function of the coronary arteries. These data provide rationale for further study using a larger group of patients to determine a prognostic significance of detecting the atherosclerotic plaques with the signs of instability in this patient category.

GW29-e1820 Impact of fibrillatory wave amplitude on coronary blood flow in patients with chronic atrial fibrillation

GW29-e1820 Impact of fibrillatory wave amplitude on coronary blood flow in patients with chronic atrial fibrillation

Coronary blood flow in patients with coronary heart disease: interrelations with emotional control and social support

Coronary blood flow in patients with coronary heart disease: interrelations with emotional control and social support

Peripheral revascularization attenuates the exercise pressor reflex and increases coronary exercise hyperemia in peripheral arterial disease.

Peripheral arterial disease (PAD) is associated with augmented blood pressure (BP) and impaired coronary blood flow responses to exercise, which may increase cardiovascular risk. We investigated the effects of leg revascularization on the BP and coronary blood flow responses to exercise in PAD. Seventeen PAD patients (11 men, 66 ± 2 yr) performed single-leg plantar flexion exercise 24 h before and 1 mo following leg revascularization. BP and heart rate (HR) were measured continuously, and rate pressure product (systolic BP × HR) was calculated as an index of myocardial oxygen demand. Coronary blood velocity was obtained by transthoracic Doppler echocardiography in 8/17 subjects. The mean BP response to plantar flexion exercise was attenuated by leg revascularization (pre-revascularization: 15 ± 4 vs. post-revascularization: 7 ± 3 mmHg, P = 0.025). The HR response to plantar flexion was also attenuated following leg revascularization (pre-revascularization: 9 ± 1 vs. post-revascularization: 6 ± 1 beats/min, P = 0.006). The change in coronary blood velocity with exercise was greater at the post-revascularization visit: 4 ± 1 vs. pre-revascularization: -1 ± 2 cm/s ( P = 0.038), even though the change in rate pressure product was not greater following revascularization in these subjects (pre-revascularization: 2,796 ± 871 vs. post-revascularization: 1,766 ± 378 mmHg·beats/min, P = 0.082). These data suggest that leg revascularization alters reflex control of BP, HR, and coronary blood flow in response to exercise in patients with PAD. NEW & NOTEWORTHY We found that peripheral revascularization procedures lowered exercise blood pressure and improved coronary blood flow in patients with peripheral arterial disease.