Coronary Artery Occlusion Research Articles

Prognostic Impact of Target Vessel in Chronic Total Occlusions: A Population-Based Cohort Study

Successful percutaneous coronary intervention (PCI) of chronic total occluded (CTO) coronary arteries in the left anterior descending artery (LAD) is associated with better outcome than unsuccessful PCI. Randomized data have not found invasive treatment of non-CTO LAD lesion to be associated with better outcome. This study aimed to investigate the prognostic impact of CTO revascularization stratified on target treated vessel compared with non-CTO LAD PCI. The hypothesis was that successful PCI of LAD CTO and non-LAD CTO, and unsuccessful non-LAD CTO was associated with the same prognosis as non-CTO LAD lesions, while unsuccessful LAD CTO patients was associated with a poorer prognosis. The study was a population-based cohort study, including consecutive patients undergoing PCI from 2009 to 2019 in the Central Denmark Region. Patients with acute myocardial infarction (MI) within 30 days were excluded. CTO patients were stratified by occluded vessel and procedural success. The primary endpoint was long-term all-cause mortality and was calculated as a hazard ratio (HR) with 95% confidence interval (CI). Secondary endpoints were MI and target vessel revascularization (TVR). In total 21,141 patients were screened, 4,518 had non-CTO LAD PCI, and 1,475 had CTO PCI. Median [IQR] follow-up was 5.8[3.6;8.8] years. In the successful CTO groups the adjusted risk for all-cause mortality was equal to non-CTO LAD patients (LAD CTO HR (95% CI): 1.14 (0.90;1.44), non-LAD CTO: 1.09 (0.95;1.27). Unsuccessful LAD CTO patients had higher risk than non-CTO LAD patients whereas unsuccessful non-LAD CTO had not (unsuccessful LAD: 1.88 (1.33;2.65), unsuccessful non-LAD: 1.26 (0.97;1.63)). In conclusion, successful LAD and non-LAD CTO PCI had same prognosis as non-CTO LAD PCI, while only unsuccessful LAD CTO PCI had a poorer prognosis. LAD CTO patients are a high-risk population, and dedicated CTO trials are needed to confirm this finding and establish guideline recommendations.

Peptides are cardioprotective drugs of the future. Oxytocin

The widespread introduction of percutaneous coronary intervention (PCI) in the treatment of acute myocardial infarction (AMI) caused a significant reduction in the mortality rate from AMI in developed countries. However, over the past 10 years, there was no significant reduction in in-hospital mortality from AMI. It is clear that there is an urgent need to develop novel drugs that could effectively prevent reperfusion injury of the heart after successful recanalization of the infarct-related coronary artery. Enzyme-resistant peptide agonists of the oxytocin receptor could become a prototype for the creation of such drugs. It was shown oxytocin could selectively prevent cardiac reperfusion injury. The cardioprotective effect of oxytocin in coronary artery occlusion and myocardial reperfusion is distinguished by a decrease in infarct size, an improvement in cardiac contractility, and a decrease in the incidence of ventricular arrhythmias. In addition, oxytocin inhibits apoptosis and pyroptosis of cardiomyocytes in hypoxia/reoxygenation. It has been established that kinases, NO-synthase, and guanylyl cyclase are involved in an oxytocininduced increase in cardiac resistance to ischemia / reperfusion.

Predicting coronary artery occlusion risk from noninvasive images by combining CFD-FSI, cGAN and CNN

Wall Shear Stress (WSS) is one of the most important parameters used in cardiovascular fluid mechanics, and it provides a lot of information like the risk level caused by any vascular occlusion. Since WSS cannot be measured directly and other available relevant methods have issues like low resolution, uncertainty and high cost, this study proposes a novel method by combining computational fluid dynamics (CFD), fluid-structure interaction (FSI), conditional generative adversarial network (cGAN) and convolutional neural network (CNN) to predict coronary artery occlusion risk using only noninvasive images accurately and rapidly. First, a cGAN model called WSSGAN was developed to predict the WSS contours on the vessel wall by training and testing the model based on the calculated WSS contours using coupling CFD-FSI simulations. Then, an 11-layer CNN was used to classify the WSS contours into three grades of occlusions, i.e. low risk, medium risk and high risk. To verify the proposed method for predicting the coronary artery occlusion risk in a real case, the patient’s Magnetic Resonance Imaging (MRI) images were converted into a 3D geometry for use in the WASSGAN model. Then, the predicted WSS contours by the WSSGAN were entered into the CNN model to classify the occlusion grade.

Bipolar radiofrequency ablation of refractory ventricular arrhythmias: results from a multicentre network.

Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC. Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%). These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.

Uncommon culprit artery leading to atypical de winter electrocardiographic changes: a case report

BackgroundA subset of patients with acute coronary artery occlusion requiring emergency revascularization, does not present with the typical ECG features of ST-segment elevation myocardial infarction (STEMI).Timely identification of these atypical presentations is crucial.Case presentationThis report describes a 55-year-old male patient who was admitted to the emergency department with chest pain. The electrocardiogram (ECG) recorded atypical de Winter electrocardiographic changes and their evolution.ResultsCoronary angiography confirmed the occlusion of the second diagonal branch (D2). The patient’s condition improved after D2 balloon angioplasty.ConclusionDe Winter electrocardiographic changes can also be observed in D2 occlusions and may present with milder manifestations. Timely recognition of these changes holds significant clinical value.

Kugel's Artery in Coronary Computed Tomography Angiography in a Patient with Left Main Subtotal Stenosis.

The artery of Kugel is defined as a rare anatomical variant of the coronary arteries. It consists of an anastomotic connection between the branches of the right coronary artery (RCA) and the left circumflex artery (LCx). In patients with coronary artery occlusion, the presence of this connection bypassing the area of the occluded vessel may be a factor that prevents significant necrosis of a specific area of the myocardium. Most cases are detected by invasive coronary angiography. We present images from coronary computed tomography angiography (CCTA), which documented the existence of Kugel's artery in a 67-year-old patient with subtotal stenosis of the left main artery. The presented images clearly indicate that CCTA can visualize the existing rescue collateral circulation in patients with significant coronary artery disease.

Exosomal miRNAs Differentiate Chronic Total Occlusion from Acute Myocardial Infarction.

Although coronary artery occlusion can have a negative effect on the myocardium, chronic total occlusion (CTO) exhibits different clinical features from those of acute myocardial infarction (AMI). In this study, we identify the differential associations of exosomal miRNAs with CTO and AMI. Exosomes were isolated from the plasma obtained from coronary arteries of patients undergoing percutaneous coronary intervention to treat CTO (n = 29) and AMI (n = 24), followed by small RNA sequencing, target gene predictions, and functional enrichment analyses. Promising miRNA markers were validated using real-time PCR in 35 CTO, 35 AMI, and 10 normal subjects. A total of 205 miRNAs were detected in all subjects, and 20 and 12 miRNAs were upregulated and downregulated in CTO compared to AMI patients, respectively (|fold change| > 4, FDR q < 0.05). The target genes of miRNAs that were higher in CTO patients were associated with "regulation of cell cycle phase transition", "cell growth", and "apoptosis". The target genes of miRNAs that were lower in CTO patients were enriched in terms such as "muscle cell differentiation", "response to oxygen levels", and "artery morphogenesis". On qRT-PCR analysis, the expression levels of miR-9-5p and miR-127-3p were significantly different between CTO and AMI patients. The miRNA expression levels accurately distinguished CTO from AMI patients with 79% specificity and 97% sensitivity. The miRNA contents of plasma exosomes were significantly different between CTO and AMI patients. The miRNAs may play important roles in CTO and AMI.

Borneol promotes berberine-induced cardioprotection in a rat model of myocardial ischemia/reperfusion injury via inhibiting P-glycoprotein expression

Berberine is reported to protect the heart against ischemia/reperfusion (I/R) injury, although efficacy is limited by low bioavailability. This study aims to determine whether borneol, a classic guiding drug, can enhance the cardioprotection induced by berberine and to clarify the underlying mechanisms involving P-glycoprotein (P-gp) in the heart. Adult male Sprague Dawley rats were gavaged with berberine (200 mg/kg) with or without borneol (100 mg/kg) for 7 consecutive days. A rat model of myocardial I/R injury was established by 30 min left coronary artery occlusion followed with 120 min reperfusion. The arrhythmia score, cardiac enzyme content, and myocardial infarct size were determined following reperfusion. Heart tissues were collected for Western blot and immunofluorescence analyses to measure the protein expression levels of Bcl-2, Bax, and P-gp. The results showed that administration of berberine protected the heart against I/R injury, as demonstrated by lower arrhythmia scores, serum cTnI contents, myocardial infarct size, and cardiomyocytes apoptosis. Moreover, borneol substantially enhanced the cardioprotective effects of berberine. Western blot and immunofluorescence analyses showed that both berberine and I/R injury did not alter P-gp expression in heart. In contrast, borneol combined with berberine significantly reduced P-gp levels by 43.4% (P = 0.0240). Interestingly, treatment with borneol alone decreased P-gp levels, but did not protect against myocardial I/R injury. These findings suggest that borneol, as an adjuvant drug, improved the cardioprotective effects of berberine by inhibiting P-gp expression in heart. Borneol combined with berberine administration provides a new strategy to protect the heart against I/R injury.

Aslanger's pattern with acute lesion in the left coronary system: A case report

Acute Coronary Syndrome (ACS) is characterized by the suspicion or confirmation of acute ischemia or acute myocardial infarction (MI). The presence of ST segment elevation (STE) consists in the main criterion for indication of immediate reperfusion therapy due to acute coronary occlusion, although significant part of the acute coronary occlusion cases do not fit the ST-segment elevation myocardial infarction (STEMI) criteria.A case report of a 50 year-old male presenting typical anginal pain, whose electrocardiogram (EKG) presented Aslanger's pattern. The patient had severe lesion of the left anterior descending artery (ADA) and chronic occlusion of the right coronary artery on cardiac catheterization, with important collateral flow from branches of the left coronary artery to the right coronary artery.The dichotomy between STEMI and Non-ST segment elevation myocardial infarction (NSTEMI) must be contested, owing to the evidence that one third of the NSTEMI patients presents a total coronary occlusion. There are other electrocardiographic patterns which must be considered to diagnose ACS. Our case report outlines a different clinical presentation of Aslanger pattern, that shows a ADA acute occlusion, instead of the lesion being in the right coronary system.There is evidence that, in addition to the STEMI vs NSTEMI criteria, the Aslanger pattern and other electrocardiographic patterns characterize occlusive ACS. Recognizing those patterns in clinical practice is essential to improve the diagnosis and early treatment of patients with ACS.

Ascending aortic aneurysm after acute aortic dissection in a case with systemic lupus erythematosus

A 50-year-old woman with systemic lupus erythematosus and a history of aortic arch replacement surgery for Stanford type A aortic dissection experienced a reoccurrence of an ascending aortic aneurysm and coronary artery occlusion. Computed tomography revealed that the aneurysm was compressing the superior vena cava and right atrium. The patient underwent urgent surgery to repair the aneurysm. This case highlights that aortic aneurysms can reoccur even after total arch replacement in systemic lupus erythematosus patients.

Assessment of Severity of ST-Elevation Myocardial Infarction Using Neutrophil-to-Lymphocyte Ratio and Its Correlation With Thrombolysis in Myocardial Infarction Risk Score.

Introduction ST-segment elevation myocardial infarction (STEMI) is an acute presentation of myocardial infarction (MI). It is caused by the complete occlusion of coronary arteries by a thrombus secondary to atherosclerotic plaque formation within these vessels. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a seven-item scale used to categorize patients based on risk and to predict mortality in acute MI patients. The neutrophil-to-lymphocyte ratio (NLR) is an independent assessor of prognosis in cardiovascular diseases; it holds a pivotal role in inflammation and atherosclerotic plaque formation. Methodology A hospital-based cross-sectional study was undertaken among 76 patients who had acute MI, out of which 50 patients who had STEMI were included and 26 patients were excluded (13 patients had non-ST-segment elevation myocardial infarction (NSTEMI), four patients had unstable angina, nine patients had arrhythmias). After detailed clinical and laboratory evaluation, NLR was calculated for all 50 patients, and they were distributed into low NLR, intermediate NLR and high NLR groups based on the ratio. Patients then underwent coronary angiography, and their TIMI-STEMI score was calculated and compared with their NLR score. Using SPSS software (IBM Corp., Armonk, NY, USA), the collected data was statistically analyzed. Results Fifty patients with acute coronary syndrome (ACS) based on their NLR were distributed into three categories: Category A with low NLR of <1.7 (n=2), Category B with intermediate NLR of 1.7-3 (n=10), and Category C with high NLR of >3 (n=38). In this study, there were more male patients (two in Category A, six in Category B, 28 in Category C), mean age group was 55 +/- 10 (one in Category A, five in Category B, 32 in Category C), the most common presentation was chest pain (two in Category A, nine in Category B, 37 in Category C), the most common risk factor was smoking (two in Category A, six in Category B, 15 in Category C), the angiographic TIMI-STEMI score was calculated and two, six, and two patients in Category A, Category B, Category C respectively had a low score of <4, four and 36 patients in Category B and C respectively had a high score of >4, and there was a significant correlation between high NLR and high TIMI-STEMI score (P = 0.001). Conclusion This study infers that a simple bedside parameter like the NLR, which is easily available and affordable, can predict the outcome in STEMI patients and stands on par with conventional angiographic scores.

P226 EMPAGLIFLOZIN IS ABLE TO REDUCE COLLAGEN DEPOSITION IMPROVING HEART FUNCTION IN MYOCARDIAL INFARCTED RATS

Cardiovascular diseases, particularly Acute Myocardial Infarction (AMI), are the leading cause of death worldwide. Studies show that empagliflozin improves cardiac function and outcomes in patients with heart failure. This study hypothesizes that different doses of empagliflozin (3 mg/kg and 10 mg/kg) affect collagen deposition and cardiac function differently. Male Wistar rats were divided into four groups: control (Ctrl), infarcted (AMI), infarcted treated with empagliflozin 3 mg/kg (AMI+EMPA3), and infarcted treated with empagliflozin 10 mg/kg (AMI+EMPA10). Infarcted groups underwent left coronary artery occlusion. Treated groups received empagliflozin for 14 days via oral gavage. Echocardiographic evaluation was followed by euthanasia and tissue collection. Collagen deposition was assessed histologically and stained with picrosirius red, with area calculations done. Data were analyzed using the 1-way ANOVA test. Echocardiographic results showed an improvement in diastolic function index (E’/A’) in the AMI+EMPA10 group (1.654 ± 0.3) in relation to the Ctrl (0.98 ± 0.5), AMI (0.58 ± 0.1) and AMI+EMPA3 (1.02 ± 0.4). Systolic function, measured by ejection fraction, was reduced in AMI (30.14 ± 9.7%) and AMI+EMPA3 (33.68 ± 13.2%) compared to Ctrl (77.09 ± 8.1%). The AMI+EMPA10 group showed improved ejection fraction (50.69 ± 14.5%). Fractional area change showed similar patterns (Ctrl: 61.18 ± 5.7; AMI: 23.94 ± 5.7%; AMI+EMPA3: 27.39 ± 7.2%; AMI+EMPA10: 38.46 ± 7.1%). Histology revealed no difference in total left ventricle area among groups, but collagen area was increased in AMI (81.30 ± 16.2 mm2) and AMI+EMPA3 (86.64 ± 15.3 mm2) compared to Ctrl (62.89 ± 16.2 mm2), but not in AMI+EMPA10 (77.68 ± 8.5 mm2). In conclusion, empagliflozin treatment improved left ventricular diastolic and systolic function dose-dependently and reduced collagen deposition in infarcted rats. Supported by: CNPq 312962/2020-7

Effect of Fibroblast Growth Factor-21 Molecule on Coronary CollateralDevelopment.

Collateral arteries provide an alternative source to the myocardium resulting from ischemia due to occlusive coronary artery disease and may help preserve myocardial function in the case of coronary artery disease (CAD). Although collateral development is so important, its pathophysiology has not been fully elucidated. Till now, no study has investigated the relationship between Fibroblast growth factor-21(FGF-21) and coronary collateral. This study aims to investigate the pathophysiology of coronary collateral development. In our study, which we planned as a case-control, 60 consecutive patients with ≥90 stenosis in at least one large coronary artery as a result of coronary angiography (CAG) and 30 patients with normal coronary angiography were included in the study cross-sectional. Demographic, echocardiographic and laboratory data were recorded. Coronary collateral circulation was evaluated using the Rentrop-Cohen method. FGF-21 levels were measured in all individuals. In the analysis, no significant difference was observed between the two groups in basic biochemical parameters other than HDL (p>0.05 for all). FGF-21 level was statistically significantly higher in the patient group compared to the control group (p: 0.003). Also, the FGF-21 level was found to be statistically significantly higher in the good collateral circulation group than the poor (p:0.006). Univariate and multivariate logistic regression analysis was performed to predict the presence of collateral. We found that FGF-21(p=0.006), and C-reactive protein (p=0.020) predicted the presence of collateral independently. Collateral formation and cardiac prognosis are closely related. Our study is the first to investigate the relationship between collateral formation and FGF-21. Our study showed that the FGF-21 level is an independent predictor of collateral formation. In addition, there was a significant difference between bad and good collateral formation regarding FGF-21 levels.

Coronary protective effect of the J-Valve during transcatheter aortic valve implantation for patients with aortic stenosis and low coronary artery openings

BackgroundIn recent years, transcatheter aortic valve implantation (TAVI) has become a widely used treatment for low-risk elderly patients. As an alternative to TAVI via the femoral artery, transapical TAVI (TA-TAVI) is a better surgical choice for patients with severe vascular diseases. The J-Valve assists doctors in completing valve implantation easily using its positioning locator device, which prevents the self-leaflet from approaching the sinus wall. This function acts as coronary artery protection to avoid coronary occlusion. However, the clinical prognosis of J-Valve implantation for patients with aortic valve stenosis and low coronary openings is unclear.MethodsA retrospective analysis was performed on 30 patients with aortic stenosis (AS) and coronary openings measuring ≤ 10 mm in height. All patients underwent TA-TAVI with J-Valve implantation. Patients were screened using preoperative computed tomography three-dimensional imaging of the aortic root, and the safety and efficacy of the procedure were evaluated. The collected indexes included patients’ general data, cardiac function, preoperative imaging parameters, intraoperative data and postoperative short-term prognosis.ResultsOf the 30 patients in the study successfully underwent TA-TAVI and J-Valve implantation. Two patients required temporary cardiopulmonary bypass assistance during the operation due to heart failure. The implant success rate was 100%, and there were no deaths within 30 days postoperatively. No patients experienced intraoperative or postoperative coronary artery occlusion. Postoperative echocardiography, physiological state and laboratory test results indicated that all patients recovered well. The electrocardiograms remained normal after TA-TAVI, and heart function improved within 30 days.ConclusionTransapical TAVI with J-Valve implantation is a safe and effective treatment option for patients with AS and a low coronary artery opening. Preoperative coronary artery evaluation and the locators of the J-Valve are crucial in preventing coronary artery occlusion. This treatment regimen provides beneficial outcomes and warrants further multi-centre clinical research in the future.

Genesis of ischemic ST segment changes: A study using precordial bipolar leads and regional vectorcardiograms

BackgroundPrecordial Bipolar Leads (PBLs), Weighted Unipolar Leads (WUL), and Regional Vectorcardiograms (RVCGs) are constructed using the same data recorded by a standard 12‑lead ECG, but they provide additional information not visible in the standard 12‑lead ECG (ECG) tracings. ObjectivesIn previous studies during balloon occlusion of the LAD and RCA, we observed a complete ischemic inversion of the QRS waves, with folding of the loop and ST segment shift. In the present study, we aim to investigate this abnormality using new ECG methods. We hypothesize that utilizing PBL, WUL, and RVCG in patients with ischemia caused by total acute coronary artery occlusion enables the detection of specific abnormalities—such as changes in waveform time/amplitude, the presence of the omega sign, distortion and folding of RVCG loops, and alterations in loop direction in both the transverse and frontal planes—that are not easily discernible with a standard 12‑lead ECG. This enhanced detection aids in understanding the mechanisms underlying electrocardiographic changes and may assist in managing patients when diagnostic uncertainties arise. MethodsThirty-three patients undergoing elective PTCA were studied before and after acute LAD (16 patients) or RCA (17 patients) occlusion, and their data were processed with new methods based on PBLs, WULs, and RVCGs. Results1. In acute ischemia due to occlusion of the LAD and RCA, the most important current of injury occurs in the right to left axis. This axis is underestimated by the standard 12‑lead ECG and only partially complemented by leads V3R and V4R. 2. The two-dimensional presentation detects a new sign (the omega sign), not detectable in the classic ECG, but almost always present in ischemia. It also allows for an accurate identification of the J point. 3. Ischemic R wave peak delay results in distortion and folding of the RVCG loop and causes displacement of the J point and the ST segment. 4. Wave inversion changes the loop direction in the transverse and frontal plane. ConclusionsPrecordial bipolar leads, weighted unipolar leads, and regional vectorcardiograms provide essential information omitted by the standard 12‑lead ECG.

The choice of a method for restoring coronary blood flow in myocardial infarction with ST segment elevation (literature review)

In the structure of total mortality, cardiovascular diseases are in the first place in the world. The main and most common reason for this is the incidence of myocardial infarction (MI). The basis of the pathogenesis of MI with ST elevation is persistent and complete thrombotic occlusion of the large epicardial branch of the coronary artery, leading to extensive necrosis of the heart muscle with the development of life-threatening complications, including death, the frequency of which is 8–10 %. The prognosis for MI is influenced by the presence of risk factors, complications, hemodynamic status, polymorbidity, as well as tactics for restoring coronary blood flow. To eliminate acute coronary artery occlusion, conservative treatment is used – thrombolytic therapy, surgical – primary percutaneous intervention, thromboextraction, coronary bypass surgery, as well as their combination. Today, there are scattered and isolated studies characterizing the approach to treatment in patients with MI with ST elevation in various diseases and with polymorbid pathology, the relationship with risk factors and laboratory and instrumental data has not been established, among which predictors of rapid response and death in patients with polymorbid pathology for emergency physicians have not been determined. It can be assumed that the chosen optimal patient management tactics in a specific clinical situation, taking into account the above-mentioned factors, will reduce the development of complications and increase the survival rate of patients with MI.

Antioxidative and cardioprotective effects of minocycline in ischemia/reperfusion injury in experimental model of hypertension.

Cardiovascular diseases remains leading cause of death and disabilities. Coronary artery occlusion and consequent ischemia leads to acute myocardial infarction, but restoration of blood flow, paradoxically, provokes further myocardial damage known as reperfusion injury. Minocycline is possessing anti-inflammatory and anti-apoptotic activity, immune-modulating and antioxidative properties besides its primary antibacterial effect. Recently it gained significant interest in preventing cardiac damage especially due to myocardial ischemia/reperfusion injury (MI/RI). The aim of this study was to assess the protective ability of pre-treatment and post-treatment of isolated hearts from healthy and spontaneously hypertensive rats with minocycline, on functional recovery and redox status after MI/RI using Langendorff technique. Using sensor in the left ventricle, the cardiodynamic parameters were recorded and in the samples of the coronary venous effluent oxidative stress biomarkers were analyzed. Minocycline was injected directly into the coronary vessels, in pre-treatment 5min before global ischemia, and in post-treatment during the first 5min of reperfusion. Changes in redox balance induced by minocycline were more prominent in post-treatment fashion of application. Cardioprotective effects of minocycline due to MI/RI are even more significant in hypertensive hearts. Minocycline showed significant cardioprotective effects, which was more pronounced in hypertensive compared to healthy hearts. Reduction of pro-oxidative biomarkers was more prominent in hypertensive hearts compared to the normotensive, especially if it is applied in the form of post-treatment. Minocycline could be important tool in reduction of heart damage induced by MI/RI due to its antioxidative potential, if these results are confirmed by clinical study.

Allergy, infarction, and stress cardiomyopathy: in-depth analysis of a complex clinical case report

Abstract Background Diagnosis of Kounis syndrome, an acute coronary syndrome associated with anaphylactic reactions, is challenging owing to the overlapping symptoms of myocardial ischemia. Takotsubo syndrome (TTS), characterized by stress-induced cardiomyopathy, may share pathophysiological mechanisms with Kounis syndrome and potentially coexist in the same patient. Case Presentation We present a case of a 63-year-old patient who developed an allergic reaction to contrast medium administration, leading to dyspnea and chest pain. Electrocardiography revealed a new-onset left bundle-branch block, and echocardiography indicated wall motion abnormalities with apical ballooning, suggestive of TTS. Coronary angiography displayed a chronic total occlusion of the right coronary artery. Laboratory tests revealed elevated inflammatory markers, supporting the diagnosis of Kounis syndrome and TTS. Conclusion This case highlights the challenges of diagnosing and managing type II Kounis syndrome associated with concurrent TTS. This underscores the need for tailored therapeutic interventions and comprehensive guidelines to address these complex conditions effectively.

Editorial to “Acute occlusion of the left main coronary artery following impedance rise after high‐frequency catheter ablation”: Prepare for a disastrous matter in the EP laboratory

Editorial to “Acute occlusion of the left main coronary artery following impedance rise after high‐frequency catheter ablation”: Prepare for a disastrous matter in the <scp>EP</scp> laboratory

Anterior ST elevation in a patient with RBBB

A 79-year-old male with a history of coronary artery disease presented to the Emergency Department with chest pain. ECG showed RBBB with mild ST elevation and positive T waves in I, aVL and V2. In patients with RBBB lack of ST depression and T wave inversion in the anterior leads could signify ischemia secondary to left anterior descending coronary artery occlusion. However, the patient did not have acute coronary syndrome and the presenting ECG was comparable to an ECG recorded five years earlier.