Transient Regional Wall Motion Abnormalities Research Articles

Development of a small animal model replicating core characteristics of takotsubo syndrome in humans.

Adequate animal models are necessary to understand human conditions, such as takotsubo syndrome (TS) characterized by the heart's transient regional wall motion abnormalities. This study aims to develop a reproducible, low-mortality TS model that closely mimics the human condition and addresses the limitations of existing models. We conducted six experiments using 309 Sprague Dawley rats, each approximately 300 g and aged 7-8 weeks. Initially, we replicated an established model using intraperitoneal isoprenaline injections. Subsequent experiments varied the doses and infusion durations of intravenous isoprenaline and assessed the effects of sex, strain, and breeder on the development of reversible akinetic segments. High-resolution echocardiography monitored the regional wall motion over 30 days to correlate with histological changes. Increasing the isoprenaline dose and the infusion time significantly enhanced akinesia (P < 0.01), resulting in pronounced apical ballooning observed in three-dimensional imaging. Akinesia peaked at 6 h post-infusion, with recovery observed at 24 h; most rats recovered from akinetic segments within 48-72 h. Optimizing the mode of administration, dose, and duration achieved a TS-like phenotype in 90% of cases, with a 16.7% mortality rate. Histological examinations confirmed that myocardial injury occurred, independent of apical ballooning. This study presents a refined TS model that reliably replicates the syndrome's key features, including morphological and electrocardiographic changes, demonstrating its transient nature with high fidelity and reduced mortality. The model's reproducibility, evidenced by consistent results across trials, suggests its potential for broader application pending further validation.

Diabetic ketoacidosis induced Takotsubo cardiomyopathy: A case report

Takotsubo cardiomyopathy (TC) is a syndrome of transient regional wall motion abnormalities of the left ventricle causing an apical ballooning pattern. This condition can be triggered by intense emotional or physical stress. In the past, many case reports showed cases of diabetic ketoacidosis induced Takotsubo cardiomyopathy who presented with initial ST segment elevation ECG at the present to the hospital simultaneously with the ongoing stress. In this paper, we report a case of Takotsubo cardiomyopathy whose ST segment changed 2 days after the resolution of diabetic ketoacidosis.

643 THE HEART WAS MADE TO BE BROKEN: RECURRENT TAKOTSUBO SYNDROME IN AMYOTROPHIC LATERAL SCLEROSIS

Abstract Takotsubo syndrome (TTS) is a rare cardiac disease, characterized by transient regional wall motion abnormalities without evidence of obstructive coronary artery stenoses, mainly triggered by emotion or physical stressors. Reverse Takotsubo syndrome (rTTS), an atypical variant with basal segments involvement, is frequently associated with neurological disorders, including patients with amyotrophic lateral sclerosis (ALS). We reported the case of a 54 years old woman who experienced two consecutive episodes of TTS with different wall motion patterns, complicated by a recurrent episode and arrhythmic events. A Caucasian woman, affected by ALS, was hospitalized in our department due to anemia and recurrent episodes of hematochezia. Following a week of relative clinical stability, the patient experienced acute deterioration with generalized malaise and worsening dyspnea. CT scan excluded pulmonary causes, whereas EKG (ST segment depression in the lower and lateral leads), blood test (increase in high-sensitive cardiac troponins) and TTE (severe impairment of LVEF, with akinesia of basal segments) revealed a cardiac etiology. Coronary angiography and left ventriculography were performed, documenting a wall motion pattern consistent with rTTS. After an initial management in intensive care unit, clinical stability was obtained with a complete recovery of left ventricular systolic function. The patient was discharged but one month later, due to bacterial pneumonia, she was readmitted in our ward and antibiotic therapy was started. Two days later an acute deterioration of clinical status occurred, characterized by dyspnea, altered state of consciousness and marked hypotension. TTE revealed a severe left ventricular systolic dysfunction with apical akinesia and preserved contractility of basal segments, so a diagnosis of typical TTS was made. Three weeks later the clinical scenario became more complicated due to advanced atrioventricular block, with phases of atrioventricular dissociation and ventricular escape-rhythm. Therefore, in light of the increased risk of infectious complications, she underwent implantation of a leadless pacemaker (PMK). This clinical case represents the first report of recurrent episodes of TTS, one of which as rTTS, in a patient affected by ALS. It is worth noting that the first episode of TTS had atypical clinical presentation (dyspnea without chest pain), the EKG showed diffuse ST-segment depression (totally different from classical TTS typical electrocardiographic alterations), and TTE confirmed a different phenotype of segment involvement (unsurprisingly InterTAK Diagnostic Score was low). TTS recurrence is an extremely rare event, even if in this case there were two well defined triggers such as anemia and pneumonia. On the other hand it is reasonable to think that non-use of BBs after the first episode may have contributed to the occurrence of the next event, affecting different segments compared to the previous episode. Furthermore, advanced atrioventricular (AV) block represents a rare complication of TTS, most probably due to catecholamine stress or increased vagal tone, often requiring PMK implantation. In conclusion TTS represents an important frequent cardiac complication in patients affected by ALS, often still underdiagnosed. Therefore clinicians must keep their guard up with TTS, especially in the cases with atypical clinical presentation.

Abstract 13870: Ventricular Fibrillation Arrest in a 27-Year-Old Woman Due to Takotsubo Cardiomyopathy

Introduction: Sudden cardiac death in young patients may be due to coronary artery disease, primary electrical disease, cardiomyopathy, or congenital anomalies. We explore potential causes for sudden cardiac arrest in a young patient. Case Description: A 27-year-old woman was found unconscious. Initial rhythm showed ventricular fibrillation. Cardiopulmonary resuscitation was done for 5 minutes before return of spontaneous circulation. ECG showed ST elevations in aVL, V4, and V5. She was admitted for therapeutic temperature management. Troponin peaked at 1.86 ng/mL on the evening of arrival. Transthoracic echocardiography (TTE) demonstrated hypokinesis of the mid to distal septum, anterior wall, and apex (Figure 1). Repeat TTE 3 days later showed resolution of the wall motion abnormalities. She reported marijuana use and a domestic dispute with her significant other the night prior. Coronary CT angiography showed calcium score of 0 with normal coronary anatomy, no significant coronary artery stenosis, and incidental finding of bilateral pulmonary artery filling defects. Lower limb venous duplex was unremarkable. Therapeutic dose of enoxaparin was started. Cardiac MRI showed no myocardial infarction, scar, or infiltrative disease. An electrophysiology study revealed adequate QT shortening during epinephrine infusion and no inducible ventricular arrhythmias. Genetic testing was unremarkable. She was discharged with a wearable defibrillator before ultimately receiving a subcutaneous implantable cardioverter-defibrillator. Discussion: The presentation of transient regional wall motion abnormalities, with ST-segment elevations and negative ischemic workup, is highly suggestive of Takotsubo cardiomyopathy, mid-ventricular variant. Marijuana use is a risk factor, and the domestic dispute is a potential emotional trigger. This case highlights Takotsubo cardiomyopathy as a possible cause of sudden cardiac arrest in young patients.

Recurrent Post-Cardioversion Takotsubo Syndrome

Takotsubo syndrome (TTS) is characterised by transient regional wall motion abnormalities of the left or right ventricles often associated with new ECG changes (including ST-segment elevations, ST-segment depressions, T-wave inversions and QTc prolongation) in the absence of a culprit atherosclerotic artery which could explain the ventricular dysfunction. In this article we present an unusual case of recurrent TTS following electrical cardioversion in a 61 year old female patient who was admitted to our unit.

78-Year-Old Woman With Intermittent Chest Pain and Palpitations

78-Year-Old Woman With Intermittent Chest Pain and Palpitations

Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit - a retrospective study.

Takotsubo syndrome (TS) is an acute cardiac condition that is often triggered by critical illness but that has rarely been studied in the intensive care unit (ICU) setting. The aim of this study was to (i) estimate the incidence of TS in a hemodynamically unstable ICU-population; (ii) identify predictors of TS in this population; (iii) study the impact of TS on prognosis and course of hospitalization. Medical records from all patients admitted to our general ICU from 2012 to 2015 were analyzed. TS was defined as having transient regional wall motion abnormalities (RWMA) with a typical pattern not attributable to a history of coronary artery disease or acute coronary syndromes. Out of 6470 patients admitted to the ICU, echocardiography due to hemodynamic instability was performed in 1051 patients; 467 had LV dysfunction and 59 fulfilled TS criteria. Patients with TS had higher SAPS 3 scores on admission than patients with normal LV function. Septic shock, cardiac arrest, cerebral mass lesion, female sex and low pH were independently associated with TS on admission. Patients with TS needed more ICU resources measured by higher NEMS scores and longer ICU-stay. Crude mortality was higher in TS patients (32%) vs the ICU-population (20%, P = 0.020), but there were no differences in a SAPS 3 adjusted analysis. TS was not an uncommon cause of LV dysfunction in hemodynamically unstable ICU-patients. Furthermore, TS was associated with a more complex disease. TS is a complication to take in consideration in the critically ill.

Neurogenic stress cardiomyopathy associated with subarachnoid hemorrhage.

Cardiac manifestations are recognized complications of subarachnoid hemorrhage. Neurogenic stress cardiomyopathy is one complication that is seen in acute subarachnoid hemorrhage. It can present as transient diffuse left ventricular dysfunction or as transient regional wall motion abnormalities. It occurs more frequently with neurologically severe-grade subarachnoid hemorrhage and is associated with increased morbidity and poor clinical outcomes. Managing this subset of patients is challenging. Early identification followed by a multidisciplinary team approach can potentially improve outcomes.

Takotsubo cardiomyopathy after bisoprolol withdrawal and open appendectomy

Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome characterized by transient regional wall motion abnormalities of the left ventricular apex or midventricle. Patients often present with chest pain or dyspnea, ST-segment elevation, and minor elevation of cardiac enzyme levels. TTC has been associated with severe emotional or physical stress such as severe burns, spinal cord injury, subarachnoid hemorrhage, multiple traumas, and surgery. We report a case of TTC in a 45-year-old woman who had undergone appendectomy 2days before presenting to our institution.

Allergic myocardial infarction

Allergic myocardial infarction

Evaluation of Non‐ST Segment Elevation Acute Chest Pain Syndromes with a Novel Low‐Profile Continuous Imaging Ultrasound Transducer

This investigation was designed to test the hypothesis that continuous cardiac imaging using an ultrasound transducer developed in our laboratory (ContiScan) is superior to electrocardiogram (ECG) monitoring in the diagnosis of coronary artery disease (CAD) in patients with acute non-ST segment elevation chest pain syndromes. Seventy patients with intermediate to high probability of CAD who presented with typical anginal chest pain and no evidence of ST segment elevation on the ECG were studied. The 2.5-MHz transducer is spherical in its distal part mounted in an external housing to permit steering in 360 degrees. The transducer was placed at the left sternal border to image the left ventricular short-axis view and recorded on video tape at baseline, during and after episodes of chest pain. Two ECG leads were continuously monitored. The presence of CAD was confirmed by coronary arteriography or nuclear or echocardiographic stress testing. Twenty-four patients had regional wall motion abnormalities (RWMA) on their initial echo which were unchanged during the period of monitoring. All had evidence of CAD. Twenty-eight patients had transient RWMA. All had evidence of CAD. Eighteen patients had normal wall motion throughout the monitoring period, 14 of these had no evidence of CAD, and four had evidence of CAD. These four patients did not have chest pain during monitoring. The sensitivity, specificity, and accuracy of echocardiographic monitoring for diagnosing non-ST elevation myocardial infarction was 88%, 100%, and 91% respectively. The sensitivity, specificity, and accuracy of the ECG for diagnosis of CAD were 31%, 100%, and 52%, respectively. Echocardiography was superior to ECG (P < 0.001). The data indicate that continuous cardiac imaging is superior to ECG monitoring for the diagnosis of CAD in patients presenting with acute non-ST segment elevation chest pain syndromes. This technique could be a useful adjunct to ECG monitoring for myocardial ischemia in the acute care setting.

Takotsubo cardiomyopathy in a patient with pulmonary embolism

Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient regional wall motion abnormalities of the left ventricular apex or midventricle. Patients often present with chest pain or dyspnoea, ST-segment elevation, and minor elevations of cardiac enzyme levels. Takotsubo cardiomyopathy has been associated with severe emotional or physical stress such as severe burns, spinal cord injury, subarachnoid haemorrhage, and multiple traumas. We report a case of takotsubo cardiomyopathy in a 79-year-old woman with pulmonary embolism. Although pulmonary embolism has been listed as a potential cause of takotsubo cardiomyopathy, this is the first case reported with this association.

Acute pancreatitis mimicking myocardial infarction: evaluation with myocardial contrast echocardiography

Acute pancreatitis has frequently been reported to be associated with transient electrocardiography changes mimicking myocardial infarction despite normal epicardial coronary arteries. Although these reports generally have not included simultaneous assessment of myocardial function, 1 previous report has documented suggestive electrocardiography changes associated with a transient regional wall-motion abnormality but normal epicardial coronary arteries. Although the origin of these findings is poorly understood, suggested mechanisms have included electrolyte abnormalities, a vagally mediated reflex, coronary vasospasm, and myonecrosis as a result of the release of pancreatic proteolytic enzymes. We report a case of acute pancreatitis with electrocardiography changes and a regional wall-motion abnormality despite normal epicardial coronary arteries. Myocardial contrast echocardiography performed in this patient to evaluate the coronary microcirculation allows further insight into the mechanism of these findings.

&lt;b&gt;Dipyridamole Stress Echocardiography and Ultrasonic Myocardial Tissue Characterization in Predicting Myocardial Ischemia, in Comparison With Dipyridamole Stress Tc-99m MIBI SPECT Myocardial Imaging&lt;/b&gt;

The purpose of this study was to validate whether dipyridamole stress ultrasonic tissue characterization with cyclic variation of integrated backscatter (CVIBS) compared with dipyridamole stress echocardiography and dipyridamole stress Tc99m-MIBI SPECT myocardial perfusion scintigraphy could predict myocardial ischemia in patients with chronic coronary artery disease. Twenty patients (16 M, 4 F) who had coronary angiography for stable angina pectoris were included in the study. Mean age was 62 +/- 8 years. The left ventricle was divided into 16 segments. Regional wall motion analysis and CVIBS measurements were obtained from 16 myocardial segments at rest and after dipyridamole (0.84 mg/kg) infusion. After 10 minutes, Tc-99m MIBI (10 mCi) was injected and SPECT myocardial imaging was performed. After 3 hours, 25 mCi Tc-99m MIBI was reinjected and rest images were obtained. A total of 320 ventricular wall segments were evaluated. Two hundred and six ventricular wall segments were supplied by stenotic coronary arteries and 114 segments were supplied by normal coronary arteries. Dipyridamole stress Tc-99m MIBI SPECT studies showed abnormal myocardial perfusion in 176 segments and normal perfusion in 144 segments. Transient regional wall motion abnormality was detected in 116 segments. A significant decrease in CVIBS after dipyridamole stress was detected in 184 segments. The sensitivity and specificity of dipyridamole stress echocardiography, Tc-99m MIBI SPECT, and CVIBS were 56% and 100%, 85% and 92%, and 89% and 100%, respectively, compared with the results from coronary angiography. Dipyridamole stress ultrasonic tissue characterization with CVIBS may provide more sensitive detection of myocardial ischemia than dipyridamole stress echocardiography and may be as valuable as dipyridamole stress myocardial perfusion scintigraphy.

Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Prospective Registry

Background and Objectives:The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI, has recently been reported, particularly in Japan. We pro- spectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. Subjects and Methods:Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were:1 no previous history of cardiac disease, 2 acute onset, 3 a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4 no significant stenosis in the coronary angiogram. Results:The events preceding the condition included:emotional stress (N=7, acute illness (N=5, non-cardiac surgery or medical procedure (N=4 and accident (N=2. Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%. Pulmonary edema was demonstrated in 10 (56%, and cardiogenic shock in 4 (23% of the patients. The peak creatinine kinase MB fraction was 69±136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF was 38±8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51±8%, and regional wall motion was normalized after 30±29 days following onset. Conclusion:We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies. (Korean Circulation J 2002;32(12 :1054-1063

Coronary vasodilation without myocardial erection. Simultaneous haemodynamic, echocardiographic and arteriographic findings during adenosine and dipyridamole infusion.

The aim of this study was to evaluate simultaneously echocardiographic, haemodynamic and angiographic changes that occur during adenosine and dipyridamole infusion, in patients with one-vessel coronary artery stenosis. This would assess whether deterioration in left ventricular haemodynamics during vasodilator agent infusion is influenced by vasodilation per se, or the development of myocardial ischaemia. We performed adenosine (140 micrograms.kg-1.min-1 over 4 min) and dipyridamole (up to 0.84 mg.kg-1 over 10 min) stress echocardiography tests, together with angiographic and haemodynamic assessment, in 26 patients undergoing elective coronary angioplasty. In 12 of 26 patients, adenosine and dipyridamole tests were repeated 24 h after angioplasty. The criterion for echocardiography test positivity was the appearance of a new transient regional wall motion abnormality. Coronary angiograms were analysed with quantitative coronary arteriography. Adenosine and dipyridamole induced regional dysfunction in 18/26 (69%) and 14/26 (54%) patients before angioplasty, respectively (P = ns). In the echocardiography-positive patients, the percent diameter stenosis was significantly (P < 0.05) tighter stenosis than in the echocardiography-negative patients (adenosine, 66.6 +/- 8.3% vs 58.0 +/- 8.9%; dipyridamole, 69.2 +/- 7.1% vs 57.7 +/- 7.6%). During both tests, left ventricular end-diastolic pressure significantly increased (P < 0.05) in echocardiography-positive patients (adenosine, 9.8 +/- 2.7 mmHg to 13.5 +/- 4.1 mmHg; dipyridamole, 10.1 +/- 2.8 mmHg to 14.1 +/- 4.3 mmHg), but not in echocardiography-negative patients. In the patients who had undergone successful angioplasty (reduction to < 50% diameter stenosis), both adenosine and dipyridamole confirmed the arteriographic success of the procedure (echocardiography negative in all patients). In this group of patients, no significant change was observed in left ventricular end-diastolic pressure during adenosine or dipyridamole infusion. Intravenous infusion of either adenosine or dipyridamole was accompanied by an obvious increase in left ventricular end-diastolic pressure only in patients with induced wall motion abnormalities. Coronary vasodilation per se has no significant effect on left ventricular end-diastolic pressure when no ischaemia is induced, disproving any clinically significant 'erectile' and adverse effects of coronary vasodilation per se.

Dipyridamole myocardial contrast echocardiography in patients with single-vessel coronary artery disease: Perfusion, anatomic, and functional correlates

The aim of this study was to examine whether myocardial contrast echocardiography (MCE) may be used to study regional myocardial blood flow distribution during dipyriamole-induced hyperemia. MCE was performed before and after dipyridamole infusion in 11 patients with a proximal, significant left anterior descending (LAD) coronary artery stenosis. The relation between contrast-derived parameters and the degree of coronary narrowing and the occurrence of transient regional wall motion abnormalities was also investigated. In the territory supplied by left circumflex coronary artery, mean peak contrast intensity increased after dipyridamole from 50 ± 18 to 76 ± 27 IU ( p < 0.001). In contrast, a significant reduction in mean peak intensity was observed after dipyridamole in the LAD territory (from 41 ± 27 to 13 ± 13 IU, p < 0.01). Similar results were obtained with the use of the area under the time-intensity curve. An increase in peak intensity ≥10 IU after dipyridamole administration separated normal regions from those supplied by a significant coronary artery lesion with a sensitivity of 91% and a specificity of 91%. Perfusion abnormalities were always detected by contrast echocardiography when septal motion abnormalities developed and, in five patients they were detected in the absence of clinical, electrocardiographic, and echocardiographic signs of ischemia. A weak correlation was found between both peak intensity and area under the curve and percent coronary diameter stenosis and cross-sectional area. In conclusion, dipyridamole MCE can be used during routine coronary angiography to assess myocardial blood flow distribution in patients with coronary artery disease. The intracoronary injection of contrast agents during dipyridamolestress echocardiography, may provide additional information on the functional significance of coronary lesions, thus helping in prognostic stratification and therapeutic decision making.

Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography.

The aim of this study was to compare the results of dipyridamole-echocardiography test (DET: two-dimensional echo monitoring during dipyridamole infusion up to 0.84 mg/kg over a period of 10 minutes) with both anatomic and physiological parameters of coronary artery disease severity, assessed by computer-assisted quantitative coronary arteriography, and regional coronary flow reserve, measured by [13N]ammonia (13NH3) and dynamic positron emission tomography (PET), respectively. We studied 31 patients with a history of chest pain and neither previous myocardial infarction nor resting wall motion abnormalities. Eighteen patients had single-vessel disease (> 50% stenosis of one major coronary vessel), and 13 had normal coronary arteries. The criterion for DET positivity was the appearance of a new transient regional wall motion abnormality. In patients with a positive DET, two parameters were evaluated: the dipyridamole time (ie, the time from the beginning of drug infusion to the development of obvious dyssynergy) and the wall motion score index (WMSI, a semiquantitative integrated estimation of extent and severity of the stress-induced dyssynergy). WMSI was derived by summation of individual segment scores divided by the number of segments interpreted. Quantification of regional myocardial blood flow was obtained by PET measurements of 13NH3 arterial input function and left ventricular myocardial tissue concentration both at control and after dipyridamole (0.56 mg/kg over 4 minutes). Maximal regional blood flow after dipyridamole in the region supplied by the stenotic vessel was significantly lower in the 11 patients with coronary artery disease and positive DET than in the 7 patients with coronary artery disease and negative DET (1.08 +/- 0.33 versus 1.98 +/- 0.37 mL.min-1.g-1, P < .01). In patients with a positive DET, regional coronary flow reserve correlated well with dipyridamole time (r = .87, P < .01) but not with peak WMSI (r = .25, P = NS). Patients with dipyridamole-induced akinesia or dyskinesia (n = 6) had a greater reduction in regional coronary flow reserve than did those showing hypokinesia (n = 5): 1.38 +/- 0.51 versus 2.17 +/- 0.42, P < .05. Percent area reduction was more severe in patients with DET positivity than in those with DET negativity (93.7 +/- 8.7% versus 77 +/- 10.3%, P < .01), and it correlated with regional coronary flow reserve (r = .64, P < .01) and dipyridamole time (r = -.59, P < .01). In patients with single-vessel disease, DET shows an excellent specificity but a limited sensitivity; in these patients, DET positivity is associated with a physiologically important coronary stenosis. Severity of the anatomic stenosis and impairment in regional flow reserve are greater when the dipyridamole-induced dyssynergy appears earlier during the test. Therefore, a stratification of the anatomo-physiological severity of coronary artery disease can be obtained with DET, based mainly on the temporal allocation of the transient dyssynergy.

Serial analysis of regional left ventricular wall motion by two-dimensional echocardiography in patients with coronary artery enlargement after Kawasaki disease

Objectives. This study was designed to assess the temporal relation between early coronary artery abnormalities and left ventricular function in Kawasaki disease.Background. Although late segmental wall motion abnormalities may be seen in patients with Kawasaki disease who have coronary artery stenosis, the impact of early coronary artery abnormalities is unclear.Methods. Regional left ventricular wall motion was assessed by two-dimensional echocardiography in 18 patients with Kawasaki disease and echocardiographic evidence of coronary artery enlargement at 3 weeks and 3 months and at either 6 or 12 months after the onset of fever. Four patients had a persistent left coronary artery aneurysm, four had regression of their aneurysm, two had persistent left coronary artery ectasia and eight had regression of ectasia. Left ventricular wall motion was assessed by measuring regional area change in parasternal and apical views. After planimetry of an end-systolic and an end-diastolic frame, the ventricle was divided into eight equal segments and the percent area change was calculated, A floating system correcting for translation and rotation was applied. The measoremaents in the patient group were compared with values previously obtained in 55 normal age-matched infants and children.Result. A transient regional wall motion abnormality 3 and 6 months after the onset of fever was discovered in the inferolateral wall of one patient with a persistent left coronary artery aneurysm. One patient with regression of coronary artery ectasia had a persistent wall motion abnormlity in the anterolateral left ventricular wall. There was no correlation between the extent of coronary artery enlargement and the presence or absence of wall motion abnormalities.Conclusions. These early changes are most likely secondary to associated myocarditis rather than coronary artery abnormalties.

High speed rotational coronary atherectomy for patients with diffuse coronary artery disease

High speed rotational coronary atherectomy was undertaken using the Rotabiator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis >1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesicn. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy.The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion ≤1 cm in length, but in only 70% of patients with a lesion >1 cm in length (p < 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction.Follow-up angiography (at a mean interval of 6.2 ± 2.6 months) was performed in 91% of patients and revealed restenosis (>58% narrowing) in 59%. The restenosis rate was 22% for short lesions (≤ cm) and 75% for long lesions (>1 cm) (p < 0.05).In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length. Although short lesions (≤ cm) were treated effectively, longer lesions (>1 cm) were associated with decreased procedural success, increased procedural complications and a higher restenosis rate.