Distal Coronary Artery Segments Research Articles

Body mass index – from the position of assessment of the condition of patients with ischemic heart disease

Purpose: comparative analysis of clinical, laboratory and angiographic parameters in patients with coronary artery disease, depending on the level of body mass index (BMI).Material and Methods: 71 patients with coronary artery disease were examined. All underwent general clinical laboratory functional studies and coronary angiography with stenting of the coronary arteries. Depending on the level of BMI, 2 groups of patients were identified: 1 gr. – 36 patients with BMI < 30 kg/m2 and 2 gr. – 35 patients with BMI ³ 30 kg/m2.Results: an increase in BMI was associated with young age and female sex, but fewer acute forms of coronary artery disease. The level of BMI ³ 30 kg/m2 was characterized by greater comorbidity, with AH being more frequent among comorbidities; diabetes; diseases of the gastroduodenal zone GDZ (p < 0,05); COPD and past history of Covid-19. In addition, among patients with a BMI ³ 30 kg/m2, the incidence of complex ventricular cardiac arrhythmias was 4 times higher than in patients with a BMI < 30 kg/m2. In patients with BMI ³ 30 kg/m2, the average amount of medications taken per day was 0,8 less than in the comparison group. The most frequently taken groups of drugs (in addition to BAB and ASA drugs) among patients in group 2 were: calcium antagonists AK; sartans and hypoglycemic drugs, and among patients of group 1 – ACE inhibitors; statins; thienopyridines and antiarrhythmics. 8,5% of the surveyed were NOT adherent to drug treatment, while among patients in group 1 – 13,9% and in group 2 – 2,8% of respondents. An increase in BMI according to ECG data was characterized by an increase in heart rate and a greater predisposition to ventricular arrhythmia, and according to echocardiography, by a thickening of the LV walls and a decrease in its systolic function. Angiographically, higher BMI values were not a criterion for the complexity of vascular lesions. Nevertheless, the length of the atherosclerotic lesion in the respondents in group 2 was greater than in group 1 (p > 0,05). In patients with BMI ³ 30 kg/m2, lesions of the distal segments of the main coronary arteries were recorded comparatively more often, with type B stenosis prevailing in the PNA basin (60,0%); in the RCA basin – type A (31,6%) and type B (47,4%) stenoses.Conclusion: there are still many controversial points in the assessment of the relationship between excess weight and cardiovascular pathology. Nevertheless, the significance of the BMI indicator has its prerogatives in this direction, especially in primary health care at the first contact with a patient.

Feasibility analysis on reducing iodine delivery rate of coronary CT angiography with 100 kVp to 60% of 120 kVp standard

Objective: To investigate the feasibility of reducing the iodine delivery rate (IDR) of coronary CT angiography(CCTA)with 100 kVp to 60% of 120 kVp standard. Methods: A total of 205 patients (105 males and 100 females, aged from 23 to 87 years) underwent CCTA due to suspected coronary artery disease in Department of Radiology of Peking University Third Hospital from February to July 2022 were enrolled. Those patients were divided into five subgroups according to their body weight: <50 kg, 50 to 59 kg, 60 to 69 kg, 70 to 79 kg and ≥ 80 kg, respectively. All the cases were scanned with 100 kVp tube voltage and combined with mixed iterative reconstruction technology KARL 3D. The IDR injection protocol was set to 60% of the 120 kVp IDR standard (10% lower than the guideline), and the IDR of each group was 0.9, 1.0, 1.1, 1.3 and 1.4 gI/s, respectively. The CT attenuations (CT value) and noise (SD value) of the aortic root, proximal left anterior descending branch and the distal segments of the right coronary artery, the signal-to-noise ratio (SNR) and contrast noise ratio (CNR) of proximal left anterior descending branch and the distal segments of the right coronary artery, the whole subjective image quality scores of the coronary artery, and effective dose (ED) of CCTA in the five groups were compared. The One-way ANOVA or Kruskal-walls test was used for statistical analysis. Results: There was no significant difference in CT attenuations and noise of aortic root, proximal left anterior descending and the distal segments of the right coronary artery, SNR and CNR of proximal left anterior descending branch and the distal segments of the right coronary artery, and subjective image quality scores among the five groups (all P>0.05). The difference of the dosage of contrast medium and ED among the five groups were statistically significant (all P<0.05). The dosage of contrast medium in the five groups were 30, 34, 38, 43 and 48 ml, and the ED in the five groups was 2.24 (1.88, 2.56), 2.62 (2.24, 3.17), 2.70 (2.48, 3.20), 4.13 (3.85, 4.40) and 4.44 (4.01, 5.02) mSv, respectively. Conclusion: It is feasible to reduce the IDR injection protocol of coronary CT angiography with 100 kVp to 60% of the standard injection protocol with 120 kVp, which is worthy of promotion.

433 The Clinical Significance Of The Change In FFRCTFrom The Proximal To Distal Coronary Artery Segment In Patients With Non-obstructive Coronary Artery Disease

Introduction: Fractional flow reserve derived from coronary computed tomography angiography (FFRCT) shows a progressive decline from the proximal to distal coronary artery segments in all normal vessels. However, significant decline is associated with obstructive coronary artery disease (CAD). The study objective is to investigate the association of coronary artery plaque features with a significant decline in FFRCT in patients with non-obstructive CAD on coronary computerized tomography angiography (CCTA).

Distal coronary artery abnormalities in Kawasaki disease: experience on CT coronary angiography in 176 children.

Precise evaluation of coronary artery abnormalities (CAAs) in Kawasaki disease (KD) is essential. The aim of this study is to determine role of CT coronary angiography (CTCA) for detection of CAAs in distal segments of coronary arteries in patients with KD. CTCA findings of KD patients with distal coronary artery involvement were compared with those on transthoracic echocardiography (TTE) during the period 2013-21. Among 176 patients with KD who underwent CTCA (128-Slice Dual Source scanner), 23 (13.06%) had distal CAAs (right coronary-15/23; left anterior descending-14/23; left circumflex-4/23 patients). CTCA identified 60 aneurysms-37 proximal (36 fusiform; 1 saccular) and 23 distal (17 fusiform; 6 saccular); 11 patients with proximal aneurysms had distal contiguous extension; 9 patients showed non-contiguous aneurysms in both proximal and distal segments; 4 patients showed distal segment aneurysms in absence of proximal involvement of same coronary artery; 4 patients had isolated distal CAAs. On TTE, only 40 aneurysms could be identified. Further, distal CAAs could not be identified on TTE. CTCA also identified complications (thrombosis, mural calcification and stenosis) that were missed on TTE. CAAs can, at times, occur in distal segments in isolation and also in association with, or extension of, proximal CAAs. CTCA demonstrates CAAs in distal segments of coronary arteries, including branches, in a significant number of children with KD-these cannot be detected on TTE. CTCA may therefore be considered as a complimentary imaging modality in children with KD who have CAAs on TTE.

Influence of Contrast Agent Injection Scheme Customized by Dual-Source CT Based on Automatic Tube Voltage Technology on Image Quality and Radiation Dose of Coronary Artery Imaging.

ObjectiveTo explore the influence of a contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology on coronary imaging image quality and radiation dose.MethodsA total of 205 patients who underwent coronary CT angiography (CCTA) in our hospital from June 2021 to September 2021 were selected. 105 patients in the control group who underwent routine scanning according to body mass (BMI) and 100 patients in the observation group who set tube voltage and contrast agent dosage according to automatic tube voltage selection technology. CT values of the aortic root (AO); left anterior descending (LAD) branch; proximal, middle, and distal segments of the right coronary artery (RCA); and proximal and distal segments of left circumflex (LCX) branch were measured. We calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the image. Image quality scoring and effective dose (ED) calculation were carried out.ResultsThere was no significant difference in the CT value, SNR value, and CNR value of each part of the artery between the two groups (P > 0.05). Image quality scores of the control group and the observation group were 1.28 ± 0.25 and 1.25 ± 0.23, respectively, and there was no significant difference in scores (P > 0.05). In the control group, the dosage of comparator was 43.81 ± 6.74 ml, and the ED was 4.92 ± 1.26 mSv. The dosage of contrast agent in the observation group was 34.23 ± 6.39 ml, and ED was 3.05 ± 0.94 mSv. The dosage of contrast agent and ED in the observation group were lower than those in the control group (P < 0.05).ConclusionThe contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology can meet the clinical requirements of coronary image quality, reduce the radiation dose and contrast agent consumption, and help doctors choose a more accurate and reasonable examination scheme, which has certain clinical application value.

The impact of hydrostatic pressure on the result of physiological measurements in various coronary segments

Abstract Background The effect of hydrostatic pressure on physiological intracoronary measurements is usually ignored in the daily clinical practice. Purpose To investigate the effect of resting Pd/Pa (distal/aortic pressure) and FFR (fractional flow reserve) adjustment based on the calculation of hydrostatic pressure gradient between the coronary orifice and the pressure wire sensor. Methods 41 FFR measurements (between 0.7 and 0.9) were selected. The difference in height of the orifice and the sensor was defined in cm on the basis of 3D coronary reconstruction. The resting Pd/Pa and FFR were adjusted by subtracting the pressure gradient from the distal pressure. Measurements were also performed from 2D lateral projections for each coronary segment visible (n=305). Results In case of the left anterior descending artery (LAD), each segment was located higher (proximal: –13.69±5.4; middle: –46.13±6.1; distal: –56.80±7.7 mm), whereas for the circumflex (CX), lower (proximal: 14.98±8.3; distal: 28.04±6.3 mm) compared to the orifice. In case of the right coronary artery (RCA), the distance from the orifice was much less (proximal: –6.39±2.9; middle: –6.86±7.0; distal: 17.95±6.6 mm). The posterolateral (PL) and posterior descending (PD) branches of the distal RCA were located lower than the orifice (PL: 29.65±6.1; PD: 17.53±6.6 mm). The effect of these distances on pressure ratios at 100 Hgmm aortic pressure was between −0.044 and 0.023. After correction, values of 11 and 5 patients (27% and 12%) stepped the 0.92 Pd/Pa and 0.80 FFR cut-off values, respectively. There was a strong correlation between the 3D and 2D methods (r=0.98; p&amp;lt;0.001). Conclusion The clinical implementation of hydrostatic pressure calculation should be considered during intracoronary pressure measurements. A correction for this parameter may become crucial in case of borderline significant coronary artery stenosis, especially in distal coronary artery segments. Effect of hydrostatic pressure on FFR Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Άron Üveges was supported by the EFOP-3.6.2-16-2017-00006 project. The project is co-financed by the European Union and the European Social Fund.

Parametry morfologiczne tętnic obwodowych w ocenie ryzyka sercowo-naczyniowego

Introduction. The aim of the study was to test the hypothesis that ultrasound measurements of common carotid artery (CCAd) and brachial artery (BAd) diameters represent markers of higher coronary artery disease risk (CAD, defined as ≥ 50% reduction in diameter of at least one large coronary artery segment). Materials and methods. Seventy-one patients (pts) evaluated for suspected stable CAD (23.9% women, age 61.5 ± 7.5) underwent ultrasound measurements of averaged diameters of both common carotid arteries and the brachial artery diameter of dominant arm. Clinical protocol included also: standard medical examination, assessment of biochemical parameters, resting electrocardiography, treadmill exercise test and transthoracic echocardiography. Diagnosis was established using quantitative coronary angiography measurements and calculation of Gensini Score (GS). Results. Angiographic CAD was present in 43 (60.5%) patients. Average CCAd was larger in CAD group (7.97 ± 0.96 mm vs. 7.37 ± 0.67 mm, p = 0.0052), similar to BAd (5.06 ± 0.65 vs. 4.68 ± 0.75, p = 0.03), respectively. The peripheral arterial diameters correlated with values of GS index, more pronounced for CCAd ( ρ = 0.35, p = 0.0023) than for BAd ( ρ = 0.24, p = 0.0368). CCAd significantly more positively correlated with the distal coronary artery segments values of the GS index ( ρ = 0.35, p = 0.0024), whereas the diameter of BA with the proximal segments values of GS index ( ρ = 0.239, p = 0.045). CCA and BD diameters indexed to body surface area (BSA) showed a strong trend toward larger average diameters in CAD patients: CCAd/BSA index: 4.06 ± 0.46 mm/m 2 vs. 3.85 ± 0.56 mm/m 2 , p = 0.087, BAd/BSA index: 2.57 ± 0.29 mm/m 2 vs. 2.42 ± 0.35 mm/m 2 , p = 0.057. Gensini score significantly correlated with CCAd/BSA index ( ρ = 0.24, p = 0.043) with a strong trend of positive correlation between GS index and BAd/BSA index ( ρ = 0.21, p = 0.076). Conclusions. The diameters of common carotid arteries and the brachial artery of dominant arm are greater in CAD pts. Peripheral arteries ultrasound may complement classic diagnostic pathway of stable coronary artery disease.

The impact of hydrostatic pressure on the result of physiological measurements in various coronary segments

The effect of hydrostatic pressure on physiological intracoronary measurements is usually ignored in the daily clinical practice. Our aim was to investigate this effect on Pd/Pa (distal/aortic pressure) and FFR (fractional flow reserve). 41 FFR measurements between 0.7 and 0.9 were selected. The difference in the height of the orifice and that of the sensor was defined in mm on the basis of 3D coronary reconstruction. Resting Pd/Pa and FFR were adjusted by subtracting the hydrostatic pressure gradient from the distal pressure. Height measurements were also performed from 2D lateral projections for each coronary segment (n = 305). In case of the LAD, each segment was located higher (proximal: − 13.69 ± 5.4; mid: − 46.13 ± 6.1; distal: − 56.80 ± 7.7 mm), whereas for the CX, each segment was lower (proximal: 14.98 ± 8.3; distal: 28.04 ± 6.3 mm) compared to the orifice. In case of the RCA, the distances from the orifice were much less (proximal: − 6.39 ± 2.9; mid: − 6.86 ± 7.0; distal: 17.95 ± 6.6 mm). The effect of these distances on pressure ratios at 100 Hgmm aortic pressure was between − 0.044 and 0.023. The correction for height differences changed the interpretation of the measurement (negative/positive result) in 5 (12%) and 11 (27%) cases for the FFR (cut-off value at 0.80) and the resting Pd/Pa (cut-off value at 0.92), respectively. The clinical implementation of hydrostatic pressure calculation should be considered during intracoronary pressure measurements. A correction for this parameter may become crucial in case of a borderline significant coronary artery stenosis, especially in distal coronary artery segments.

The Impact of the Right Coronary Artery Geometric Parameters on Hemodynamic Performance.

Coronary artery geometry can have a significant impact in the hemodynamic behavior of coronary blood flow, influencing atherosclerotic plaque formation. The present work focuses on, through a statistical study, the connection between several geometric parameters of the right coronary artery-ostium cross-sectional area, angles between the common trunk and the side-branches, tortuosity, curvature and cross-sectional area in each side-branch-and their influence on hemodynamic descriptors. Parameters such as low wall shear stress and local disturbed flow, which are associated with atherosclerosis formation, were analysed. Computed tomography images of ten healthy individuals were selected to reconstruct in vivo three-dimensional models of right coronary arteries. Blood flow was simulated through a compliant model with realistic boundary conditions. Calculated hemodynamic descriptors values were correlated with the geometric parameters using the Pearson correlation coefficient (r) and the p value. The strongest correlations were found in the middle and distal segments of the right coronary artery. A decrease in the ostium area promotes a decrease in the WSS magnitude from the proximal to the distal segment (r = 0.82). Very strong correlations (r > 0.90) were achieved between geometric parameters (cross-sectional area, angle, tortuosity) of the right-ventricular branch and the wall shear stress magnitude in the middle and distal segments. Low values of tortuosity, smaller cross-sectional area and higher angle of the right-ventricular branch leads to a hemodynamic behavior more propitious to atherosclerosis formation, within the study cases. The right-ventricular branch seems to have the highest influence in the hemodynamic behavior of the right coronary artery.

Comparative Study between Multislice Computed Tomography Coronary Angiography and Invasive Coronary Angiography in Diagnosis of Mid and Distal Segment Coronary Artery Stenosis

AbstractBackground: Computed Tomography Coronary Angiog-raphy (CCTA) is a promising method for detection and exclu-sion of obstructive coronary artery stenosis. Mid and distal segments of coronary arteries were chosen because they are usually small in caliber especially distal segment (usually less than 1.5mm) and they are affected by cardiac motion on the contrary, the proximal segment is always away from the myocardium and usually larger in diameter so that it can be easily diagnosed by CCTA.Objective: The purpose of this study was to evaluate the added value of CT coronary angiography for detecting Coro-nary Artery Disease (CAD) in mid and distal segment lesions using invasive coronary angiography as a reference standard.Methods: We prospectively evaluated 20 patients who suspected to have CAD and underwent CTA. we assessed mid and distal segment lesions using invasive coronary angiography as a reference standard. We excluded proximal segment lesion, high calcium score (800), arrhythmias, post percutaneous coronary intervention and post coronary artery bypass graft.Results: A total of 20 subjects underwent both CCTA and ICA (60% were females with mean age: 58.1 years). On a patient based model, the sensitivity, specificity, and positive and negative predictive values to detect mid segment lesions were 88.9%, 95.2%, 88.9%, and 95.2% respectively and for distal lesions were 85%, 100%, 100%, 98.1%, respectively. Diagnosis of mid and distal segment lesions by both CT and coronary angiography showed statistically significant strong positive correlation.Conclusion: CT angiography is a reliable tool and has high accuracy for detection of CAD in both mid and distal segment lesions. Importantly, the high NPV (97%) firmly establishes CCTA as an effective noninvasive method to rule out obstructive coronary artery stenosis in patient with mod-erate pre-test probability.

Vasomotor function in rat arteries after ex vivo and intragastric exposure to food-grade titanium dioxide and vegetable carbon particles

BackgroundHumans are continuously exposed to particles in the gastrointestinal tract. Exposure may occur directly through ingestion of particles via food or indirectly by removal of inhaled material from the airways by the mucociliary clearance system. We examined the effects of food-grade particle exposure on vasomotor function and systemic oxidative stress in an ex vivo study and intragastrically exposed rats.MethodsIn an ex vivo study, aorta rings from naïve Sprague-Dawley rats were exposed for 30 min to food-grade TiO2 (E171), benchmark TiO2 (Aeroxide P25), food-grade vegetable carbon (E153) or benchmark carbon black (Printex 90). Subsequently, the vasomotor function was assessed in wire myographs. In an in vivo study, lean Zucker rats were exposed intragastrically once a week for 10 weeks to vehicle, E171 or E153. Doses were comparable to human daily intake. Vasomotor function in the coronary arteries and aorta was assessed using wire myographs. Tetrahydrobiopterin, ascorbate, malondialdehyde and asymmetric dimethylarginine were measured in blood as markers of oxidative stress and vascular function.ResultsDirect exposure of E171 to aorta rings ex vivo increased the acetylcholine-induced vasorelaxation and 5-hydroxytryptamine-induced vasocontraction. E153 only increased acetylcholine-induced vasorelaxation, and Printex 90 increased the 5-hydroxytryptamine-induced vasocontraction, whereas Aeroxide P25 did not affect the vasomotor function. In vivo exposure showed similar results as ex vivo exposure; increased acetylcholine-induced vasorelaxation in coronary artery segments of E153 and E171 exposed rats, whereas E171 exposure altered 5-hydroxytryptamine-induced vasocontraction in distal coronary artery segments. Plasma levels of markers of oxidative stress and vascular function showed no differences between groups.ConclusionGastrointestinal tract exposure to E171 and E153 was associated with modest albeit statistically significant alterations in the vasocontraction and vasorelaxation responses. Direct particle exposure to aorta rings elicited a similar type of response. The vasomotor responses were not related to biomarkers of systemic oxidative stress.

Coronary artery-positive remodeling in current smokers.

This study aims to evaluate the association of the coronary artery-positive remodeling (CAPR) observed on cardiac computed tomography angiography (CCTA) with cigarette smoking. This retrospective case-control study enrolled 178 consecutive patients with CAPR plaque (case group) and 180 consecutive patients with coronary artery plaque, but no positive remodeling (control group). CAPR was evaluated in CCTA images and defined as at least 10% larger vessel diameter at the plaque site compared with a normal reference segment. The average age of this population was 61.8±11.5 years (30.4% women). In the case group, the prevalences of current smokers, former smokers, and nonsmokers were 15.7, 26.4, and 57.9%, respectively. In the control group, the prevalences were 6.1, 20.6, and 73.3%, respectively, which were significantly different from the control group (P=0.002 for all). In a subanalysis of the CAPR location in the CAPR group, CAPR was more prevalent in the proximal than the distal segments of the major coronary arteries. Most of the patients in the case group had only one segment involvement with CAPR (71.35%). Logistic regression analyses showed that a history of current smoking has a significant correlation with CAPR in both unadjusted and adjusted models after controlling for risk factors. Current smokers have a 3.5-fold higher risk of having CAPR compared with nonsmokers (P<0.01). There is a significant independent association between a history of cigarette smoking and CAPR evaluated by CCTA. Current cigarette smokers have a 3.5 times higher risk of having CAPR.

Role of imaging studies in Kawasaki disease.

Kawasaki disease is a medium vessel vasculitis which may be associated with coronary artery abnormalities. Recognition of these abnormalities depends upon various imaging modalities. While two-dimensional echocardiography remains the first line modality to identify coronary artery abnormalities, it is subject to several fallacies and is operator dependent. Computed tomography coronary angiography is rapidly emerging as a useful imaging modality for better characterization of dilatations, ectasia and aneurysms in the mid- and distal segments of coronary arteries. It provides precise details in terms of aneurysm size and morphology. In this review we here described the importance of computed tomography coronary angiography and have also given a brief description of magnetic resonance coronary angiography.

Study of the clinical value of medical history and clinical manifestation-based protocol for the diagnosis of spontaneous coronary artery dissection using intravascular ultrasound

Objective To investigate the feasibility and clinical value of medical history and clinical manifestation-based protocol(MHCMP) for the diagnosis of spontaneous coronary artery dissection(SCAD) using intravascular ultrasound(IVUS). Methods Based on the MHCMP designed in our centre, intraoperative sequential analysis was performed in patients with acute coronary syndrom and clinical tip of SCAD, SCAD and its classification were defined according to the result of IVUS. Results Of the 37 patients admitted with ACS at the Cardiology Service, 29 patients had SCAD as the cause(78.4%). All the patients underwent coronary angiography and IVUS, of which 9 patiens were type Ⅰ(24.3%), 15 patients were type Ⅱ(40.5%) and 5 patients were type Ⅲ(13.5%). The left anterior descending artery was the most frequently affected (16 patients), followed by the the right coronary artery (7 patients), while 5 patients had dissection of the circumflex artery and 1 patient had dissection of the left main coronary artery. Type Ⅰ (evident arterial wall stain): this was the pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens. Type Ⅱ (diffuse stenosis of varying severity): this angiographic appearance was not well appreciated and was often missed or misdiagnosed. SCAD commonly involved the mid to distal segments of coronary arteries, and could be so extensive that it reached the distal tip. There was an appreciable (often subtle) abrupt change in arterial caliber, with demarcation from normal diameter to diffuse narrowing. This diffuse and usually smooth narrowing could vary in severity from inconspicuous mild stenosis to complete occlusion. Type Ⅲ (mimic atherosclerosis): this appearance was the most challenging to differentiate from atherosclerosis and most likely to be misdiagnosed, while IVUS was helpful for the differential diagnosis. Conclusions MHCMP is able to screen out all kinds of SCAD and guide the treatment decisions making. Key words: Endosonography; Coronary artery disease; Acute coronary syndrome

Effects of neuropeptide Y on coronary artery vasomotion in patients with microvascular angina

BackgroundPatients with microvascular angina (exertional angina, positive exercise tests and normal coronary arteriograms) usually have a reduced coronary blood flow reserve. Neuropeptide Y (NPY) is a potent endogenous vasoconstrictor involved in modulation of coronary vasomotor tone and may play a role in microvascular angina. MethodsWe compared the effects of NPY (0.2–1.0pmol/kg, intracoronary) on the vasomotor response of proximal and distal segments of the coronary arteries in 7 patients with microvascular angina, 9 with chronic stable angina, and 9 control individuals. The coronary response to the administration of ergonovine was also assessed in 9 other patients with microvascular angina. Computerized coronary artery diameter measurements were carried out before (baseline) and after the administration of the vasoactive agents. ResultsMean baseline coronary lumen diameters were similar in control, microvascular angina, and coronary artery disease patients. NPY constricted proximal coronary segments by 8±2%, 5±2% and 6±3% and distal segments by 14±2%, 11±2% and 10±2% in control, microvascular angina, and coronary artery disease patients, respectively (p=NS between groups). In patients with microvascular angina, ergonovine constricted proximal coronary segments by 7±1.5% and distal segments by 12.5±3% (p=NS vs. NPY). During NPY administration four microvascular angina patients developed chest pain, ST segment depression, and a marked lengthening of the contrast medium run off, in the absence of epicardial coronary artery spasm. Control individuals and coronary artery disease patients did not experience chest pain, ST segment shifts, or lengthening of the run off during NPY administration. Ergonovine administration caused chest pain and lengthening of the contrast run-off, in the absence of epicardial coronary artery spasm, in one microvascular angina patient. ConclusionsExogenous NPY causes mild epicardial coronary artery constriction which is similar in patients with non-cardiac chest pain, microvascular angina and coronary artery disease. Myocardial ischemia and marked lengthening of the contrast run off in response to NPY occurred in microvascular angina patients but not in control or coronary artery disease patients. An abnormal constrictor response to NPY at the microcirculation level could be the mechanism underlying the ischemic manifestations observed in patients with microvascular angina. Condensed abstract (table of contents)The vasomotor response of proximal and distal coronary artery segments was studied in twenty five patients: 7 microvascular angina, 9 chronic stable angina, and 9 control subjects. Computerized measurements of coronary diameters were carried out before and after the intracoronary administration of neuropeptide Y (NPY) and ergonovine. Constriction of epicardial arteries in response to NPY was mild and not significantly different in control, microvascular angina and coronary artery disease patients. Ergonovine-induced epicardial coronary artery constriction was similar to that of NPY. However, NPY caused transient myocardial ischemia in patients with microvascular angina (probably through constriction of the small intramyocardial vessels), but not in control subjects or coronary artery disease patients.

RESULTS OF BIODEGRADABLE VASCULAR ENDOPROSTHESES IMPLANTATION IN ISCHEMIC HEART DISEASE PATIENTS WITH TYPE 2 DIABETES

Aim. To evaluate efficacy of endovascular treatment in patients with diabetes, operated with biodegradable vascular endoprostheses and everolimus eluting stents. Material and methods. Primarily, 143 patients were selected into the study. Then 125 patients included and randomized to 2 groups. Patients of I group (n=57) underwent implantation biodegradable vascular endoprostheses, and the II group (n=68) — coronary stents eluting everolimus. For the control of biodegradable endoprostheses implantation optical coherent tomography was used, that was performed at the end of intervention and in long-term follow-up by 12 months. Results. Totally, 63 biodegradable vascular endoprostheses implanted to the patients of I group, and 102 everolimus coated stents to II group patients. Mean diameter of implanted endoprostheses in group I was — 2,88±0,06 mm, and in group II — 2,68±0,12 mm (р>0,05). Technical success of intervention was 100% in both groups. Total number of serious cardiovascular complications during in-patient phase was 3,5% and 2,94% in groups, respectively (p>0,05). Long-term results were followed-up in 41 patient from group I and in 52 from group II. In 12 months survival rate was 100%. Prevalence of non-fatal MI among I and II group patients was 4,9% and 3,8%, resp. (p>0,05). The reason was progression of atherosclerotic process in other arteries. Restenosis prevalence that required new intervention on target lesion was 2,4% and 1,9%, resp. (p>0,05). Late thrombosis in long-term follow-up was not marked in both groups. Late loss of intrinsic lumen of the vessel, by the data of optical coherent tomography was 0,14±0,19 mm and 0,12±0,23 mm, respectively, for groups I and II (р>0,05). Conclusion. Biodegradable vascular endoprostheses in CHD patients with diabetes and mostly involvement of middle and distal segments of coronary arteries, showed equal efficacy and safety, with everolimus coated stents, in 12 months after intervention.

Cranioselectivity of Sumatriptan Revisited: Pronounced Contractions to Sumatriptan in Small Human Isolated Coronary Artery

Initial concerns about the coronary side-effect potential of the anti-migraine drug sumatriptan and second-generation triptans initiated cranioselectivity studies using proximal human coronary arteries. However, myocardial ischaemia may originate from both large and small human coronary arteries. We investigated the contractions to sumatriptan in proximal (internal diameter 2-3mm), distal (internal diameter 1,000-1,500μm) and small (internal diameter 500-1,000μm) human epicardial coronary arteries and compared these with contractions in the human middle meningeal artery. Concentration response curves to sumatriptan in human coronary arteries were constructed in the absence or presence of the 5-hydroxytryptamine1B (5-HT1B) receptor antagonist SB224289 and the 5-HT1D receptor antagonist BRL15572. The effect of sumatriptan on increased cyclic adenosine monophosphate (cAMP) levels induced by forskolin in proximal and distal coronary artery segments was investigated using a biochemical assay. Western blotting was used to analyse the 5-HT1B receptor density in the human arteries. Contractions in the proximal human coronary artery were significantly smaller than those in the human meningeal artery, as we showed previously. In contrast, contractions to sumatriptan in distal and small human coronary arteries were not different from those in the human meningeal artery. The 5-HT1B receptor antagonist SB224289, but not the 5-HT1D receptor antagonist BRL15572, inhibited the contraction induced by sumatriptan in the coronary arteries. Moreover, in distal, but not in proximal, coronary arteries, sumatriptan inhibited the increase in cAMP levels induced by forskolin. Contrary to our expectations, the 5-HT1B receptor expression was more pronounced in the proximal human coronary artery than in the distal and small human coronary artery. Based on functional experiments in distal and small human coronary arteries, contractions to sumatriptan are not as cranioselective as previously assumed. However, the vast clinical experience with sumatriptan and other triptans has proven that these drugs are cardiovascularly safe when contraindications are taken into account.

Preliminary study on non-contrast-enhanced whole-heart coronary magnetic resonance angiography at 3.0 T to evaluate the coronary stenosis

Objective To evaluate the clinical value of non-contrast-enhanced whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T to diagnose coronary artery stenosis. Methods Thirty-three consecutive patients with significant coronary artery stenosis (>50%) on coronary computed tomographic angiography (CCTA) and who were scheduled for coronary angiography (CAG) were recruited for CMRA.CMRA was performed on a 3.0 T scanner with 32-element matrix coil.A non-contrast-enhanced,ECG-triggered,navigator-gated,T2prepared and fatsaturated 3-dimensional GRE sequence was employed.Using beta blockade to reduce the heart rate to less than 80 bpm.The quality at proximal-middle and distal segments of coronary artery between CMRA and CCTA was compared with Wilcoxon rank test.Using CAG as gold standard to evaluate the accuracy of CMRA to detect proximal-middle segments of coronary artery stenosis>50% diagnosed and the agreement between CMRA and CCTA were calculated. Results Among the 33 patients,30 patients successfully finished CMRA.The score at proximal-middle segments of coronary artery evaluated by CMRA and CCTA was similar (CMRA:3.49±0.61,CCTA:3.56±0.55,Z=- Key words: Coronary artery stenosis; Magnetic resonance angiography; Tomography,spiral computed; Coronary angiography

Left Ventricular “Masses” in a Patient With Protein S Deficiency and a Recent Myocardial Infarction: Evidence of Intraventricular Thrombi or a Benign Observation?

A 46-YEAR-OLD, 56 kg, 165 cm man with a history of hypertension, hyperlipidemia, tobacco abuse, transient ischemic attacks, and protein S deficiency was evaluated in a community hospital for acute, severe substernal chest pressure radiating to his left arm, nausea, vomiting, diaphoresis, and dizziness. He denied neurological symptoms. The patient stated that he had not taken any of his prescribed cardiac and anticoagulant medications for three months before admission because he had lost his insurance coverage. An electrocardiogram obtained in the emergency department demonstrated acute inferior wall myocardial ischemia. The laboratory analysis showed that the plasma troponin T concentration was elevated. The patient was taken emergently to the cardiac catheterization laboratory where 3 drug-eluting stents were placed in proximal, mid, and distal segments of the right coronary artery. The distal stent occluded immediately after implantation and could not be reopened with angioplasty, but blood flow was restored using intracoronary administration of tissue plasminogen activator. The patient was also treated with clopidogrel, aspirin, atorvastatin, and metoprolol; he was subsequently discharged after several days in the hospital. Two weeks later, he was readmitted with recurrence of his original symptoms accompanied by nonsustained ventricular tachycardia. He was treated with metoprolol and amiodarone and transferred to the authors’ institution for definitive care. A repeat cardiac catheterization demonstrated that the right coronary artery was occluded; some of its distal branches filled in a retrograde fashion through collaterals from the left coronary circulation. Hemodynamically significant stenoses were present in the left anterior descending and left circumflex coronary arteries. Transthoracic echocardiography revealed severe hypokinesis of the inferior wall and an estimated left ventricular (LV) ejection fraction of 45%. The patient was taken to the operating room for coronary artery bypass graft surgery. After anesthetic induction and endotracheal intubation, a transesophageal echocardiography (TEE) examination was performed that revealed the following images (Figs 1 and 2, Videos 1 and 2). What is the diagnosis? Fig 2Midesophageal 4-chamber TEE image. View Large Image Figure Viewer Download Hi-res image

High-pitch dual-source CT coronary angiography with low volumes of contrast medium

To assess the effect of lower volumes of contrast medium (CM) on image quality in high-pitch dual-source computed tomography coronary angiography (CTCA). One-hundred consecutive patients (body weight 65-85kg, stable heart rate ≤65bpm, cardiac index ≥2.5L/min/m(2)) referred for CTCA were prospectively enrolled. Patients were randomly assigned to one of five groups of different CM volumes (G30, 30mL; G40, 40mL; G50, 50mL; G60, 60mL; G70, 70mL; flow rate 5mL/s each, iodine content 370mg/mL). Attenuation within the proximal and distal coronary artery segments was analysed. Mean attenuation for men and women ranged from 345.0 and 399.1HU in G30 to 478.2 and 571.8HU in G70. Mean attenuation values were higher in groups with higher CM volumes (P < 0.0001) and higher in women than in men (P < 0.0001). The proportions of segments with attenuation of at least 300HU in G30, G40, G50, G60 and G70 were 89%, 95%, 98%, 98% and 99%. CM volume of 30mL in women and 40mL in men proved to be sufficient to guarantee attenuation of at least 300HU. In selected patients high-pitch dual-source CTCA can be performed with CM volumes of 40mL in men or 30mL in women. • High-pitch dual-source coronary angiography is feasible with low contrast media volumes. • Traditional injection rules still apply: higher volumes result in higher enhancement. • The patient's gender is a co-factor determining the level of contrast enhancement. • Volumes can be reduced down to 30-40mL in selected patients.