Left Anterior Descending Artery Stenosis Research Articles

Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

Diagnostic Performance of a Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography System With Low-Dose Technetium-99m as Assessed by Fractional Flow Reserve.

Although stress single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride (CZT) camera facilitates radiation dose reduction, only a few studies have evaluated its diagnostic accuracy in Japanese patients by applying fractional flow reserve (FFR) measurements. We prospectively evaluated 102 consecutive patients with suspected or known coronary artery disease with a low-dose stress/rest protocol ((99m)Tc radiotracer 185/370 MBq) using CZT SPECT. Within 3 months, coronary angiography was performed and a significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or as a lesion of <90% and ≥ 50% stenosis with FFR ≤0.80. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 86%, 75%, and 82% for left anterior descending artery stenosis, 76%, 81%, and 79% for left circumflex artery stenosis, and 87%, 92%, and 90% for right coronary artery stenosis. When limited to 92 intermediate stenotic lesions in which FFR was measured, stress SPECT showed 77% sensitivity, 91% specificity, and 84% accuracy, whereas the diagnostic value decreased to 52% sensitivity, 68% specificity, and 58% accuracy based only on visual estimation of ≥75% diameter narrowing. CZT SPECT demonstrated a good diagnostic yield in detecting hemodynamically significant coronary stenoses as assessed by FFR, even when using a low-dose (99m)Tc protocol with an effective dose ≤5 mSv. (Circ J 2016; 80: 1217-1224).

Mincocycline-Induced Discoloration of the Aorta.

A 64-year-old woman with known aortic insufficiency presented to our hospital with dyspnoea on exertion and chest pain. These symptoms had become progressively worse over several months. Her past medical history was otherwise notable for rheumatoid arthritis, treated with minocycline 100 mg PO BID and prednisone, as well as atrial fibrillation. She had started minocycline approximately 9 years prior to surgery and stopped it 6 months prior to surgery. Echocardiography showed severe aortic insufficiency and a decline in left ventricular ejection fraction from 60% 9 months prior to 50%. Coronary angiography was unremarkable apart from a 50% left anterior descending artery stenosis. She was referred for open aortic valve replacement and coronary artery bypass graft. During surgery, aortotomy revealed a slate-gray discoloration of the ascending aorta (Figure 1A). Further exploration showed that this discoloration did not involve the valve leaflets. The remainder of the procedure and her postoperative course were relatively unremarkable, and she was discharged on postoperative day 8. Pathological examination of the operative specimen confirmed minocyline-associated pigmentation (Figure 1B). Minocycline is a broad-spectrum tetracycline antibiotic that is frequently used for the treatment of acne vulgaris and other infections. The drug is also recognized as a disease-modifying antirheumatic drug, and it is occasionally used for other inflammatory conditions. Prolonged use of minocycline can lead to slate-gray discoloration of skin and other tissues including the cardiac valves and coronary vessels [1, 2]. This is caused by deposition of degradation products of minocycline, which are chelated to iron and melanin. In this present article, we describe a case of minocycline-induced discoloration of the ascending aorta.

Cardiovascular molecular imaging: Expanding the paradigms and parameters

Cardiovascular molecular imaging: Expanding the paradigms and parameters

PP-027 A Patient Presented with Acute Inferior Myocardial Infarction and Left Anterior Descending Artery Stenosis and Thrombus Formation

A Patient Presented with Acute Inferior Myocardial Infarction and Left Anterior Descending Artery Stenosis and Thrombus Formation. Cengiz Ozturk, Mustafa Aparci, Ali Osman Yildirim, Sait Demirkol, Murat Unlu, Zekeriya Arslan, Sevket Balta, Mustafa Demir, Turgay Celik, Atila Iyisoy. Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey; Department of Cardiology, Kasimpasa Military Hospital, Istanbul, Turkey; Department of Cardiology, Mevki Military Hospital, Ankara, Turkey. Acute inferior myocardial infarction is characterized infarction of inferior wall of left ventricle that is territory of right or circumflex coronary artery, frequently occurs with abrupt obstruction of any else of these arteries. We report a case of inferior myocardial infarction that diagnosed clinically and electrocardiographically but angiographically no any culprit lesion in right or circumflex coronary artery but serious lesion and thrombus without complete obstruction in proximal left anterior descending artery. A 38 years old man without previous cardiac history and risk factories is admitted to our coronary care unit with typical chest pain last as 20 minutes as in last 24 hours. The patient feels chest discomfort during moderate exercise last a month. Physical examination revealed blood pressure and heart rate were 117/70mmHg and 80/beat per minute. Heart sounds were normal with no any murmur. Respiratory sounds were normal. His ECG revealed sinus rhythm, ST segment elevation and pathological Q wave in lead 2,3 and aVF and posterior leads (figure1). Echocardiographic findings included left ventricular ejection fraction %60, left ventricular apical hypokinesia and left ventricular diastolic dysfunction (grade 1). Laboratory findings revealed maximum troponin I:0,684 ng/ml, maximum CKMB:54U/l and other routine biochemical parameters were normal. The patient was taken to catheter laboratory for coronary angiography and PCI. In coronary angiography, right and circumflex coronary artery were normal but there is serious stenosis and thrombus formation in the proximal of left anterior decsending artery(figure2). We decided to perform intravascular ultrasonography to evaluate the degree of lesion severity. Intravascular ultrasonography showed serious stenosis and thrombus (figure3). The patient was referred to cardiovascular surgery for coronary artery bypass grafting. Acute STEMI is a condition required emergency revascularization. Our case confirms clinically acute inferior myocardial infarction. We performed coronary angiography but we did not see any culprit lesion in right or circumflex coronary artery and their branches. However, there is severly stenosis and hazy view in proximal segment of left anterior descending artery. Because of inflamatory markers are normal, miyocarditis is low probability. Both echocardiographically left ventricle apical hypokinesia and seriously stenosis and thrombus (see figure 2-3) in the proximal segment of LAD was associated acute coronary syndrome. We referred the patients to cardiovascular surgery for CABG.

CRT-111 Prevalence and Prognostic Value of Wellens’ Sign in Patients with Non-ST Elevation Myocardial Infarction

Deeply inverted or biphasic T-waves in anterior leads, so-called Wellens’ sign, has been considered to represent impending ischemia in left anterior descending (LAD) territory. However, this electrocardiographic pattern may be observed in patients without a critical stenosis in LAD artery. We

Right ventricular stress-induced perfusion defects and late gadolinium enhancement in coronary artery disease.

The assessment of right ventricular (RV) perfusion defects has remained challenging during vasodilator stress perfusion with cardiovascular magnetic resonance (CMR). The significance of RV signal abnormalities during vasodilator stress perfusion and late gadolinium-enhanced CMR is yet uncertain. Among 61 individuals who underwent adenosine CMR stress testing before cardiac catheterization, we assessed the severity of coronary artery stenoses, mortality, the presence of stress and rest perfusion defects, as well as the presence of late gadolinium enhancement (LGE). Right ventricular stress-induced perfusion defects were positively associated with left anterior descending artery and proximal right coronary artery stenoses but were negatively associated with left circumflex artery stenoses. The presence of RVLGE was associated with mortality, but 77% of those with RVLGE also had left ventricular LGE. Proximal right coronary artery and left anterior descending artery stenoses are positively associated, whereas left circumflex artery stenoses are negatively associated with RV stress-induced perfusion defects. Right ventricular LGE was associated with mortality, but further study is needed to determine whether this is independent of left ventricular LGE.

TCT-107 Drug Eluting Stents Versus Coronary Artery Bypass Graft surgery for Isolated Proximal Left Anterior Descending Artery Stenosis: A Meta-analysis

TCT-107 Drug Eluting Stents Versus Coronary Artery Bypass Graft surgery for Isolated Proximal Left Anterior Descending Artery Stenosis: A Meta-analysis

Imaging Challenges in Secondary Mitral Regurgitation

Chronic secondary mitral regurgitation (SMR) is a complex entity that is often clinically underappreciated.1 It complicates either ischemic heart disease or dilated cardiomyopathy; its prevalence varies among series but may reach ≤50% in patients with heart failure.2 When present, SMR may exhibit a broad range of severity and confers an adverse prognosis, which is worse with increasing severity of mitral regurgitation (MR).3,4 The management of SMR poses a unique set of challenges, based partly on the complexity of the valve disorder and the still-evolving adoption of the optimal therapeutic approach.5 Noninvasive imaging and, in particular, echocardiography, plays a critical role for the initial and longitudinal assessment, for individual risk stratification and outcome prediction, and for guiding intervention in patients with chronic SMR.6 SMR develops because of a combination of mitral leaflet tethering secondary to left ventricular (LV) dilatation/deformation with papillary displacement/discoordination, annular dilatation/dysfunction, insufficient LV-generated closing forces attributable to reduction of LV contractility, and global LV/papillary muscle dyssynchrony.1,5 Tethering of the mitral leaflets is the principal lesion of SMR and results in restriction of systolic leaflet motion, namely type IIIb of Carpentier’s classification. SMR does not typically occur in global LV dysfunction without tethering. However, once tethering occurs, leaflet closure is further impaired by LV dysfunction because there is decreased force opposing tethering.6–9 The key event in the pathogenesis of SMR is the distortion of normal LV geometry—regional and global LV remodeling—with subsequent apical and lateral displacement of papillary muscles, which, in turn, draws the chordae tendineae away from the line of coaptation.7,8 The extent of LV systolic dysfunction and dilatation is weakly correlated to the degree of SMR unless accompanied by geometric distortion in the region of the papillary muscles.1,9 …

Importance of guiding catheter disengagement during measurement of fractional flow reserve in patients with an isolated proximal left anterior descending artery stenosis.

To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis. Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa1 , Pd1 , FFReng ), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa2 , Pd2 , FFRdis ). The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFReng was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFRdis ) after 38 ± 6 sec of guiding catheter disengagement. The mean ΔFFR (FFReng - FFRdis ) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pabaseline - FFRdis vs. Pd/Pabaseline - FFReng , 0.15 ± 0.05 vs. 0.10 ± 0.04, P < 0.0001). Before guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy. During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy.

Evaluation of the relation between fractional flow reserve and midterm graft patency in CABG patients

Objectives: The severity of the stenosis in left anterior descending artery might be misdiagnosed in coronary angiography. Fractional flow reserve is an important tool in such patient group in order to determine the modality of the treatment; medical, percutaneous intervention or surgical revascularization. We proposed to evaluate the midterm outcome of patients with moderate left anterior descending artery stenosis, who under- went surgical revascularization with regard to fractional flow rate studies. Materials and Methods: Eleven patients were identified who were operated between 2005 and 2007. The mean age was 54.2 ±6.88 (range between 44 and 66). Our study group was composed of patients with mod- erate (50-60%) left anterior descending artery stenosis in whom a left anterior descending thoracic artery-left anterior descending artery anastomosis had been performed with the decision for surgical revascularization given with regard to fractional flow rate values. The symptomatic patients were evaluated with conventional angiography or three dimensional computed tomography, whereas asymptomatic patients were evaluated with Doppler ultrasonography. Results: All the patients had been operated under cardiopulmonary bypass with cross clamping of the aorta. The left anterior descending thoracic artery-left anterior descending artery anastomosis had been performed in all cases. Any mortality was not encountered. All the patients were evaluated within a mean interval of 2.4 years after the surgical revascularization. Five of the patients (45.5%) had left anterior descending thoracic artery flow, whereas 6 of the patients (54.5%) did not. Three dimensional computed tomography was per - formed in 5 of the asymptomatic patients, which demonstrated the 'string sign' of the left internal thoracic artery conduit as well as a left anterior descending artery without any significant stenotic lesion. The midterm (2-4 years) patency of left internal thoracic artery graft was found to be 54.5%. Conclusions: Our study demonstrates that when the patients with moderate left anterior descending artery stenosis undergo bypass surgery with regard to fractional flow rate measurement, graft stenosis might be en - countered in the follow up. This patient group may not be suitable for surgical revascularization.

Save or sacrifice the internal mammary pedicle during anterior mediastinotomy?

Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.

Coronary stenting using a 6 French diagnostic catheter: A case report

Guiding catheters have larger lumen diameter as compared to the same size diagnostic catheters, and thus provide adequate arterial blood flow and good visualization of the artery during percutaneous coronary intervention. However, feasibility of percutaneous coronary intervention via diagnostic catheters has been demonstrated in a few studies. This case reports the use of a 6 French diagnostic catheter for both the coronary angiography as well as coronary stenting in a 52-year-old male patient with critical mid left anterior descending artery stenosis on December, 2012. DOI: http://dx.doi.org/10.3126/jaim.v2i2.8781 Journal of Advances in Internal Medicine 2013;02(02):71-73

Non-invasively assessed coronary flow reserve stratifies outcomes in patients with intermediate left main coronary artery stenosis

Background: Correct assessment of the significance of left main coronary artery (LMCA) stenosis on the basis of clinical and angiographic information alone often cannot be done reliably and requires assessment of functional significance of lesions observed on coronary angiography. Aim: The aim of this study was to determine the prognostic value of noninvasively measured coronary flow reserve (CFR) in patients with angiographically assessed intermediate or equivocal LMCA stenosis during long-term follow up. Methods: Hundred patients (59±9 years, 80 male) in whom LMCA was assessed by coronary angiography to be ≤50% diameter stenosis; without significant left anterior descending artery stenosis (LAD), were included in this prospective follow-up study. All patients underwent transthoracic Doppler echocardiography measurements of CFR in medial part of LAD after intravenous adenosine administration to assess functional significance of LMCA stenosis. CFR values were calculated as the ratio between hyperemic maximal flow velocity and resting flow velocity. Patients were followed for the mean period of 27±10 months for the occurrence of composite end point including cardiovascular death, myocardial infarction, hospitalization due to unstable angina and clinically guided revascularization. Results: 91 patient completed follow-up. Events occurred in 16. Mean CFR value of 1.80±0.44 for patients having events was significantly lower, compared to those who were free of events where mean CFR value was 2.4±0.44 (p<0.001). During the follow up period (range 1-50 months), 69 patients (95, 8%) with CFR ≥2 remained free of death and major adverse events vs. 6 patients (31,6%) with CFR <2, p<0.001. By Kaplan-Meier method, at 24 months the percent estimated survival free from cardiac related events was 95±3% in patients with CFR ≥2 and 45±11% in patients with CFR <2, p<0.001. Picture Conclusion: In patients with intermediate or equivocal left main coronary artery disease, CFR ≥2 is associated with low event rate and excellent survival. According to our results CFR measured by transthoracic Doppler echocardiography provides reliable and precise, yet non-invasive tool for the assessment of functional severity of LMCA disease that carries significant prognostic information in long-term follow-up.

Adenosine‐induced temporary block to improve accuracy of ostial coronary stent implantation: Adenosine to improve stent implantation accuracy

Implantation of coronary stents should be performed with high precision to ensure optimal clinical results. In some clinical conditions, during the cardiac cycle, significant movement of the predeployed stent may impact its implantation accuracy. We describe a case in which a patient had a short ostial left anterior descending artery stenosis and hyperkinetic left ventricle, resulting in significant movement of the stent inside the vessel lumen during the cardiac cycle. Intracoronary adenosine was used to create temporary heart block to enable accurate stent implantation.

Gender differences in the evaluation of coronary artery disease with a cadmium-zinc telluride camera

Coronary artery disease remains one of the most significant causes of morbidity and mortality among women. The published literature shows the importance of standard single photon emission computed tomography in the evaluation of women with known or suspected ischaemic heart disease, in terms of target intervention and clinical treatment. The purpose of the present study was to ascertain the diagnostic accuracy of cadmium-zinc-telluride (CZT) myocardial perfusion imaging according to gender, within a prospective database of patients with known or suspected coronary artery disease, using coronary angiography as the reference standard. Included in the study were 309 consecutive patients, of whom 248 were men (80 %), with known or suspected coronary artery disease and who had been referred to our laboratory for stress-rest myocardial perfusion imaging. All patients underwent coronary angiography within 30 days. All patients underwent a single-day stress-rest low-dose ultrafast protocol. Fifteen minutes after the end of the stress (dose range 185 to 222 MBq of (99m)Tc-tetrofosmin), all patients underwent the first scan with an acquisition time of 7 min. The rest scan (dose range 370 to 444 MBq of (99m)Tc-tetrofosmin) was acquired from 30 min to 45 min after injection, with an acquisition time of 6 min. Images were visually inspected, and summed stress scores (SSS) and summed rest scores (SRS) were obtained. Image quality was graded "good" or better in more than 90 % of patients. On coronary angiography, left main trunk stenosis, left anterior descending artery stenosis, left circumflex artery stenosis and right coronary artery stenosis were seen in 3, 155 , 142 and 131 patients, respectively. In women, the mean SSS and SRS were 8 ± 5 and 3 ± 1, respectively. Semiquantitative regional and global SSS were good discriminants of coronary artery disease, and the overall area under the receiver operator characteristic (ROC) curve was 0.822 (95 % CI 0.685 - 0.959). The value was comparable to that obtained in men (overall ROC area 0.884, 95 % CI 0.836 - 0.933). A low-dose protocol with a CZT camera can be routinely used in women with known or suspected coronary artery disease without loss of accuracy and with lower radiation exposure of the patients.

Myocardial density analysis utilizing automated myocardial defect analysis software on resting 320-detector MDCT

Cardiac CT myocardial perfusion is an emerging tool utilizing differences in myocardial density of ischemic compared to normal myocardium. We sought to document the contrast enhanced density profile of myocardial segments subtended by severely stenotic coronary arteries on rest (non stress) cardiac CT imaging, and compare the density with identical segments without ischemic disease. 100 cardiac CT studies were identified resulting in 25 normal patients, 37 with severe left anterior descending artery stenosis, 14 with severe left circumflex artery stenosis, and 24 with severe right coronary artery stenosis. The studies were reviewed on a workstation with dedicated myocardial analysis software. Left anterior descending artery ischemic segments (apical anterior and apical septal) measured 82.2 (±3) and 102 (±3) Hounsfield unit (HU) respectively comparing with non-ischemic segments 89 (±4) and 109 (±4) HU respectively (both P values 0.16). Left circumflex artery segments (basal anterolateral and mid anterolateral) demonstrated 80 (±4) and 76 (±4) HU respectively compared to non-ischemic segments, 89 (±4) and 87 (±4) HU (P value 0.13 and 0.07 respectively). Right coronary artery ischemic segments (basal inferoseptal and basal inferior) measured 104 (±3) and 105 (±3) HU respectively and these compared with non-ischemic segments, 102 (±4) and 105 (±4) HU respectively (P Value 0.69 and 0.94 respectively). Comparison of ischemic myocardial segments with non-ischemic segments demonstrated no significant difference in myocardial density. In prospectively acquired resting 320 multi detector CT, the myocardium subtended by severely stenotic vessels demonstrates no significant density difference compared with those supplied by vessels with no stenosis, confirming that myocardial ischaemia cannot be reliably detected on rest coronary computed tomography angiography by qualitative nor quantitative assessment.

Prediction of Coronary Artery Stenosis at Rest in Patients With Normal Left Ventricular Wall Motion

Noninvasive detection of coronary artery stenosis usually requires a stress test in patients without left ventricular (LV) regional wall motion abnormalities (RWMA). In contrast, abnormal regional LV relaxation caused by ischemia may persist beyond recovery from transient ischemia. The aim of the present study was to determine whether segmental analysis of abnormal regional LV relaxation using the strain imaging diastolic index (SI-DI) at rest could predict coronary artery stenosis in the three major vessels in patients without LV dysfunction or RWMA. We performed 2D speckle tracking echocardiography and coronary angiography in 85 patients without RWMA with suspected coronary artery disease. Patients with LV dysfunction or acute coronary syndrome were excluded. Echocardiographic images of the LV were obtained in the apical 2-, 3-, and 4-chamber views and divided into 6 segments. In each segment, SI-DI derived from transverse strain imaging was determined. Forty-eight patients had significant coronary artery stenosis (≥ 70%). The optimal cutoff values of SI-DI were 60.5% in the mid anteroseptal segment for detecting left anterior descending artery stenosis (sensitivity, 83.3%; specificity, 81.1%), 60.5% in the basal anterolateral segment for detecting left circumflex artery stenosis (sensitivity, 80.9%; specificity, 90.3%), and 61.5% in the basal inferior segment for detecting right coronary artery stenosis (sensitivity, 74.1%; specificity, 77.8%). A segmental analysis of SI-DI at rest predicted coronary artery stenosis in the three major vessels in patients without RWMA. This noninvasive method may be useful for detecting coronary artery stenosis without a stress test.

The Effect of Smoking on Myocardial Performance Index in Middle‐Aged Males after First Acute Myocardial Infarction

Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 48-72 hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 ± 0.15 vs. 0.66 ± 0.14, P = 0.01), and Em/Am values were also higher in smokers (0.84 ± 0.28 vs. 0.75 ± 0.31, P = 0.01). Independent predictors of impaired MPI (≥0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.98-5.83, P = 0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.73-5.91 P = 0.001), and, age (odds ratio 1.12, 95% CI 1.03-1.22, P = 0.01). Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.

RELATIONSHIP BETWEEN SPHINGOMYELINASE, CERAMIDE AND CLINICAL PRESENTATION, EXTENT AND SEVERITY OF ATHEROSCLEROTIC CORONARY ARTERY DISEASE

ObjectivesBackground and objective Matrix metalloproteinases (MMPs) and Tissue Inhibitor of Matrix Metalloproteinases (TIMPs) associated with atherogenesis and plaque rupture. Sphingomyelinase has a potential regulator role in the activation of MMP...