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Biomedical subjects

E Verna

Publications and source records attributed to E Verna.

At least 19 recordsLinked to original sources
PubMed2005

Therapeutic endoscopic retrograde cholangiopancreatography without fluoroscopy in four critically ill patients using wire-guided intraductal ultrasound.

Emergent endoscopic retrograde cholangiopancreatography cannot be performed at the bedside in critically ill patients in an intensive care unit because of the requirement for fluoroscopy. Moving such patients to a safe location where fluoroscopy is available can pose practical problems, and can lead to delayed intervention, which may adversely affect the outcome. We report the use of intraductal ultrasound to facilitate therapeutic biliary interventions in four critically ill patients in an intensive care unit. Cannulation was performed endoscopically at the bedside using a sphincterotome and a guide wire. Intraductal ultrasound, rather than fluoroscopy, was then used to confirm the location of the wire within the common bile duct prior to performing endoscopic sphincterotomy or stent placement. This technique was successful in all four patients.

Aged↗
PubMed2005

Intraductal ultrasound for the evaluation of patients with biliary strictures and no abdominal mass on computed tomography.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic procedure of choice in patients with biliary strictures and no culprit mass lesion on abdominal imaging, but it is limited in its diagnostic accuracy. The aim of this prospective study was to determine the value of intraductal ultrasound (IDUS) in distinguishing between benign and malignant biliary strictures in this clinical setting. PATIENTS AND METHODS: Sixty-one patients with painless jaundice and no mass lesion on abdominal computed tomography, who were found to have a biliary stricture at ERCP, underwent IDUS with a high-frequency (20-MHz) wire-guided probe. Histopathological confirmation or clinical follow-up was used to establish the final diagnosis. The diagnostic performances of IDUS, ERCP, and IDUS plus ERCP in the identification of malignant strictures were evaluated. RESULTS: Forty-three patients had malignant strictures and 18 had benign strictures. ERCP produced 25 false-negative diagnoses, 22 of which were identified as malignant by IDUS. IDUS provided seven false-negative and three false-positive diagnoses. The proportion of patients with malignant strictures who tested positive with IDUS was 2.06 times that of ERCP (95 % CI, 1.37 - 3.10; 83.3 % vs. 40.5 %, P = 0.0004). When used in conjunction, IDUS increased the accuracy of ERCP from 58 % to 90 %. Patients with operable lesions on IDUS and no contraindication to surgery underwent resection; most patients with pancreatic parenchymal invasion on IDUS underwent EUS, which identified a pancreatic mass in more than 50 % of cases. Patients with negative IDUS and a low clinical suspicion for malignancy were treated endoscopically, while a more aggressive work-up was performed in all patients with high pretest probability, regardless of the IDUS results. CONCLUSIONS: IDUS is a valuable adjunct to ERCP in the characterization of biliary strictures in patients who present with painless jaundice in the absence of a culprit mass on abdominal imaging.

Adenocarcinoma↗
PubMed2001

Intracoronary Doppler- and quantitative coronary angiography-derived predictors of major adverse cardiac events after stent implantation.

BACKGROUND: Distal coronary flow velocity reserve (CVR) is significantly improved after a successful balloon angioplasty (PTCA). Furthermore, a postinterventional CVR >2.5 and a percent diameter stenosis (%DS) </=35% are predictive for a low incidence of major adverse cardiac events (MACE) at 6 months of 16%. Similar results are lacking for coronary stenting. METHODS AND RESULTS: In 150 patients, baseline and hyperemic coronary flow velocities were recorded with a Doppler guidewire distal to the target lesion and in an unobstructed reference artery before and after PTCA, after stenting, and at 6 months. Distal CVR and relative CVR (CVR(rel)) were calculated. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of CVR, CVR(rel), %DS, and minimal lumen diameter separately and in combination to predict MACE at 6 months. After stenting, CVR (2.96+/-0.87 versus 2.40+/-0.7; P:=0.001), CVR(rel) (1.02+/-0.24 versus 0.81+/-0.24; P:=0.001), and minimal lumen diameter (2.98+/-0.56 versus 2.11+/-0.74 mm; P:=0.001) were significantly higher than after PTCA. Thirty-three patients developed MACE. A postinterventional CVR(rel)>0.88 was the best single predictor of MACE, with an incidence of 6.8%, whereas the combination of a CVR(rel)>0.88 and a %DS </=11.2% predicted an incidence of MACE of 1.5%. CONCLUSIONS: Measurement of CVR(rel) and %DS after stent implantation are best suitable to predict MACE at 6 months.

Aged↗
PubMed2001

The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study. Doppler Endpoints Balloon Angioplasty Trial Europe.

BACKGROUND: There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting. METHODS AND RESULTS: A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve ( 2.5 (46% vs 23% and 36% vs 16%, respectively; P<0.05) due to a trend towards restenosis (29% vs 16%; P=0.15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity. CONCLUSIONS: Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2.5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.

Adult↗
PubMed2001

[Evolution of the catheterization laboratory: new instruments and imaging techniques].

The Editorial Board of the Italian Heart Journal Supplement has planned to publish a series of four consecutive papers focusing on new highlights from the cardiac catheterization laboratory, developments of new devices, coronary imaging and physiological measurement. The first paper on cineless digital angiography and new fluoroscopy systems presented in this issue of the Journal has been prepared by Danzi et al. (Brescia). The paper follows the publication of the Vergara's work (Rovereto-TN) on a similar topic presented last year in a Symposium of the Gruppo Italiano di Studi Emodinamici (GISE) at the XXXI ANMCO meeting. The recent development of cineless digital angiography and the increasing interest in new digital fluoroscopic low energy systems represent a significant change in the management of cardiac images and have significant implications in the organization of a new catheterization laboratory. The second paper will focus on the clinical applications of intravascular ultrasound imaging and will be prepared by Di Mario (Milan). Intravascular ultrasound imaging has significantly contributed to the understanding of vascular adaptation to coronary artery disease and mechanisms of percutaneous coronary interventions. This new diagnostic approach is particularly useful in assessing the early stages of disease, evaluating occult atherosclerosis and guiding the strategy of coronary interventions. Unfortunately, the application of intravascular ultrasound imaging in clinical practice remains limited. The third paper prepared by Verna (Varese) will discuss the new techniques for physiological evaluation of coronary artery disease now available in the catheterization laboratory. The use of pressure and Doppler flow-wire in the assessment of functional significance of individual coronary artery stenoses and in the evaluation of the vasodilatory capacity of coronary microcirculation may provide new insights for the clinical decision at the catheterization table. In addition, the application of myocardial contrast echocardiography with new sonicated agents for intracoronary use may represent a novel approach to the direct evaluation of regional myocardial perfusion and microvascular integrity. Intracoronary stenting has become a widely used and accepted technique in percutaneous coronary interventions. The fourth article of this series, prepared by Silva (Milan), will discuss the advantages and limitations of stenting in different clinical settings based on the results of large clinical trials. In spite of the growing number of procedures safely performed in many countries, long-term results of intracoronary stenting may be sometimes disappointing in selected patients. In-stent restenosis still represents a clinical problem limiting long-term outcome. In addition, the increasing use of new antiplatelet agents in combination with most stenting procedures rise some concern about overall cost of interventions. The objective of this editorial program is to give a view of the changing scenario of the catheterization laboratory with the new methods and devices presently available. There may be significant implications and controversial issues of interest also for all clinical cardiologists.

Cardiac Catheterization↗
PubMed2001

[New methods of functional assessment in the catheterization room. Pressure wire, Doppler flow wire and echocontrastomyography].

Although coronary angiography has been used for many years in the evaluation of coronary artery disease the limitations of this technique are well known. The functional significance of individual coronary artery stenoses may not be easily determined particularly in patients with intermediate stenoses, lesions with irregular and complex morphology and in subjects with multivessel diffuse disease and/or prior myocardial infarction. In selected patients, the role of abnormalities of vasomotion and function at the microcirculatory level cannot be assessed with lone coronary angiography. The functional evaluation of the results of percutaneous coronary interventions usually requires adjunctive non-invasive testing. New techniques for physiological evaluation of coronary artery disease are now available in the catheterization laboratory. The intracoronary pressure wires and Doppler flow wires may provide for an accurate evaluation of the functional significance of the individual stenosis and of the vasodilatory capacity of the coronary bed. Disease of the coronary microcirculation and vasomotion abnormalities may be recognized. Several studies have indicated that these techniques may be helpful in the clinical decision-making process. The strategy of deferring or performing percutaneous coronary interventions may be guided by on-line functional evaluation of the target stenosis and the result of interventions may be evaluated. In addition, new imaging modalities such as myocardial contrast echocardiography with new sonicated agents for intracoronary use may represent a novel approach to the direct evaluation of regional myocardial perfusion and microvascular integrity. The application of these techniques is safe, useful and cost-effective. Unfortunately, physiologic evaluation of the coronary artery disease by means of these techniques still remains confined to few catheterization laboratories.

Cardiac Catheterization↗
PubMed2000

Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography. DEBATE study group. Doppler Endpoints Balloon Angioplasty Trial Europe.

AIMS: Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenosis severity. METHODS AND RESULTS: A total of 225 patients with one-vessel disease were studied before PTCA and at 6 months follow-up. Exercise electrocardiography was performed to document presence (n = 157) or absence (n = 138) of an ST segment shift (> or =0.1 mV). Intracoronary blood flow velocity analysis was performed to determine the proximal/distal flow velocity ratio, the distal diastolic/systolic flow velocity ratio and coronary flow velocity reserve. Receiver operator characteristic curves were calculated to assess the predictive value of these variables compared with the exercise test. The distal coronary flow velocity reserve demonstrated the best linear correlation for both percentage diameter stenosis and minimum lumen diameter (r = 0.67 and r = 0.66; P<0.01), compared to the diastolic/systolic flow velocity ratio (r = 0.19 and r = 0.14; P<0.01) and the proximal/distal flow velocity ratio (r = 0.03 and r = 0.07; not significant). The areas under the curve were 0. 84+/-0.02; 0.82+/-0.03 and 0.83+/-0.03 for diameter stenosis, minimum lumen diameter and coronary flow velocity reserve, respectively. Logistic regression analysis revealed that the percentage diameter stenosis or minimum lumen diameter and coronary flow velocity reserve were independent predictors for the result of stress testing. CONCLUSIONS: The distal coronary flow velocity reserve is the best intracoronary Doppler parameter for evaluation of coronary narrowings. Angiographical estimates of coronary lesion severity and distal coronary flow velocity reserve are good and independent predictors for the assessment of functional severity of coronary stenosis, emphasizing the complementary role of these parameters for clinical decision making.

Adult↗
PubMed2000

"False-positive" myocardial perfusion scintigraphy findings in patients with angiographically normal coronary arteries: insights from intravascular sonography studies.

UNLABELLED: Abnormal exercise perfusion findings have been described as false-positive for coronary artery disease in patients with suspected angina and angiographically normal coronary arteries. METHODS: The significance of this finding was further investigated by obtaining intravascular sonograms and Doppler guidewire measurements of at least 2 coronary arteries in 20 consecutive patients who had chest pain, normal coronary angiography findings, and positive stress-rest sestamibi SPECT findings. The summed reversible score was used to describe the extent and severity of reversible perfusion defects. On the basis of scintigraphy findings, vessels were grouped as supplying underperfused myocardial segments (target vessels, n = 20) or normal territories (reference vessels, n = 25). The presence and extension of atherosclerotic disease of the epicardial arteries were assessed by intracoronary sonography. Measurements of plaque area (PA), vessel area (VA), and relative cross-sectional PA (RPA) (RPA = PA/VA) were obtained at the site of maximum plaque concentration. The coronary flow velocity reserve (CFR) was assessed during adenosine-induced hyperemia, and the relative flow reserve was calculated as the target-to-reference coronary reserve ratio. RESULTS: The median summed reversible score was 3 (range, 1-6). Intracoronary sonography showed occult atherosclerosis in 19 patients (95%), with RPA greater than 40% in 16 patients (80%). Mean RPA was significantly greater in the target vessels (46% +/- 14%) than in reference vessels (12% +/- 18%; P < 0.0001). Doppler flow velocity measurements showed abnormal vasodilation capacity (CFR < 2.5) in 14 patients (70%). Mean CFR was significantly lower in the target vessels than in the reference vessels (2.3 +/- 0.5 versus 3.1 +/- 0.6; P < 0.0001). A significant inverse correlation was seen between the summed reversible score and the coronary reserve ratio (y = 9.05x - 9.9; r = 0.70; P < 0.005). CONCLUSION: Reversible perfusion defects seen on SPECT images are often associated with angiographically unrecognized occult atherosclerotic changes and an abnormal vasodilation capacity of the coronary circulation. The tendency to dismiss abnormal exercise perfusion findings as false-positive in these patients may be unjustified.

Adult↗
PubMed1999

High dose dipyridamole myocardial imaging: simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. Italian Group of Nuclear Cardiology.

BACKGROUND: Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. METHODS: One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. RESULTS: During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (> or = 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P < 0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P < 0.0001). CONCLUSIONS: Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion of functional defects.

Aged↗
PubMed1998

Stent implantation versus balloon angioplasty in chronic coronary occlusions: results from the GISSOC trial. Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche.

OBJECTIVES: In this multicenter, randomized trial we evaluated whether stent implantation after successful recanalization of a chronic coronary occlusion reduced the incidence of restenosis. BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) in chronic total occlusions is associated with a higher rate of angiographic restenosis and reocclusion than PTCA in subtotal stenoses. Preliminary reports have suggested a decreased restenosis rate after stent implantation in coronary total occlusions. METHODS: We randomly assigned 110 patients with recanalized total occlusion to Palmaz-Schatz stent implantation, followed by 1 month of anticoagulant therapy versus no other treatment. The primary end point was the minimal lumen diameter (MLD) of the treated segment at follow-up, as determined by quantitative angiography at a core laboratory. RESULTS: Repeat coronary angiography was performed 9 months after the procedure in 88% of patients. The MLD (mean +/- SD) at follow-up was 1.74 +/- 0.88 mm in patients assigned to stent implantation and 0.85 +/- .75 mm in patients assigned to PTCA (p < 0.001). Stent implantation was associated with a lower incidence of restenosis (defined as diameter stenosis > or =50% at follow-up) (32% vs. 68%, p < 0.001) and reocclusion (8% vs. 34%, p = 0.003) than balloon PTCA. Likewise, stent-treated patients had less recurrent ischemia (14% vs. 46%, p = 0.002) and target lesion revascularization (5.3% vs. 22%, p = 0.038), but experienced a longer hospital stay. CONCLUSIONS: Palmaz-Schatz stent implantation after successful balloon PTCA of chronic total occlusions improves the midterm angiographic and clinical outcome and could be the preferred treatment option in selected patients with occluded vessels.

Adult↗
PubMed1997

Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe).

BACKGROUND: The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction. METHODS AND RESULTS: In 297 patients, a Doppler guidewire was used to measure basal and maximal hyperemic flow velocities proximal and distal to the stenosis before and after angioplasty. In 225 patients with an angiographically successful percutaneous transluminal coronary angioplasty (PTCA), postprocedural distal coronary flow reserve (CFR) and percent diameter stenosis (DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiographic restenosis (defined as DS > or = 50% at follow-up). Logistic regression and receiver operator characteristic curve analyses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal cutoff criteria for predictors of these clinical events were DS, 35%; CFR, 2.5. A distal CFR after angioplasty > 2.5 with a residual DS < or = 35% identified lesions with a low incidence of recurrence of symptoms at 1 month (10% versus 19%, P=.149) and at 6 months (23% versus 47%, P=.005), a low need for reintervention (16% versus 34%, P=.024), and a low restenosis rate (16% versus 41%, P=.002) compared with patients who did not meet these criteria. CONCLUSIONS: Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for the short- and long-term outcomes after PTCA, and thus may be used to identify patients who will or will not benefit from additional therapy such as stent implantation.

Aged↗
PubMed1996

Assessment of myocardial area at risk by technetium-99m sestamibi during coronary artery occlusion: comparison between three tomographic methods of quantification.

The aim of this study was to directly compare three currently used quantitative methods of analysis of technetium-99m sestamibi images in patients with selective balloon-induced transmural ischaemia. The area at risk (AR) was assessed in 19 patients undergoing single-vessel percutaneous transluminal coronary angioplasty by injecting the 99mTc-sestamibi at the time of coronary artery occlusion during balloon inflation. After imaging, the patients were classified according to localization of the perfusion defect as having anteroseptal (group I, 11 patients) or posterolateral defects (group II, eight patients). The planimetric technique based on polar maps, proposed by Verani et al. (J Am Coll Cardiol, 1988) (method A), the method described by Tamaki et al. (Circulation, 1982) (method B) and the technique validated by O Connor et al. (Eur J Nucl Med, 1990) (method C) were tested. Three threshold values of 45%, 50% and 60% of the maximum left ventricular count were used to define the limits of the perfusion defect. The mean values of the AR calculated by the three techniques with the original cut-off level (method A=16.5%+/-12.9; method B=10.4%+/-7.6%; method C=29.6%+/-15.7%) were statistically different (one-way analysis of variance: P<0.001; paired t test: method A vs B, P=0.003; method B vs C and method A vs C, P<0.0001). There was no significant difference between the mean values of the AR estimated by the three methods using the same cut-off levels. The use of 60% of the maximum left ventricular count provided the best correlation between the techniques (method A vs B, r=0.95; method B vs C, r=0.92; method A vs C, r=0.95). Nevertheless, a difference >10% between the values of AR assessed by the three methods was found in four subjects. There was no significant difference between the three methods in the evaluation of AR in the subjects of group I and group II. Reproducibility was good for all methods. It is concluded that the three methods of analysis of the AR by 99mTc-sestamibi SPET imaging showed comparable performance and good reproducibility using the same cut-off level. The location of perfusion defect does not affect the comparability of the three techniques. We suggest the use of a cut-off level of 60% for all three methods in the assessment of the AR by 99mTc-sestamibi SPET imaging.

Angioplasty, Balloon, Coronary↗
PubMed1996

High energy transcatheter cardioversion for chronic, poorly tolerated atrial fibrillation.

Between August 1991 and May 1993, 14 patients affected by chronic, poorly tolerated atrial fibrillation (AF) were submitted to high energy transcatheter cardioversion. Mean duration of AF was 27.4 +/- 45.1 months. In nine patients (56%), AF lasted for > 1 year. All patients had underlying heart disease, with a mean LVEF of 45.2% +/- 11.8% and a NYHA Class > or = II. Previously, a mean of 2.9 +/- 1.3 patients failed external electrical cardioversion, with and without antiarrhythmics, have been attempted. Transcatheter conversion was performed by pulling the His-bundle catheter back in the right atrial cavity until no His bundle activity was recorded on distal poles, and then delivering the shock between a proximal electrode (cathode) and a back plate (anode). In all patients, transcatheter conversion restored sinus rhythm. Transient complete atrioventricular (AV) block was observed in four patients (28%), and treated by prophylactic temporary pacing. At 1 year, seven patients (50%) were still in sinus rhythm. In this series, only younger age could be related to AF recurrence (46.1 +/- 10.8 vs 63.4 +/- 6.8 years, P < or = 0.004), even if prophylaxis with amiodarone showed a positive trend versus sinus rhythm maintenance (71% vs 14%, P = NS). In conclusion, high energy transcatheter cardioversion is a safe and effective method of restoring sinus rhythm in patients with chronic, poorly tolerated AF. In these patients, high energy transcatheter cardioversion could be considered as an alternative to AV node ablation techniques, avoiding pacemaker implant and embolic risk. Larger studies are needed to determine better patient selection and delineate drug strategy after the procedure.

Age Factors↗
PubMed1996

Stenting of the Infarct-Related Artery During Complicated Angioplasty in Acute Myocardial Infarction.

The aim of this study was to assess safety and efficacy of coronary stenting as a strategy for improving PTCA suboptimal angiographic result. From March 1993 to December 1995, 104 patients underwent PTCA during acute myocardial infarction. Unplanned coronary stenting was required in 66 pts (63.5%). Procedural success was obtained in 64 pts (97%). Two patients had an unsuccessful stenting procedure: one patient for a suboptimal stent deployment and another for LAD reocclusion requiring emergency CABG (1.5%). Palmaz-Schatz stents were used in 60 pts (91%) and AVE micro-stent in 6 pts (9%). During the hospital course, subacute reocclusion of the vessel occurred in 3 pts (4.6%); one patient underwent a successful rePTCA while the other two underwent CABG. Two patients had vascular groin complications requiring surgical repair of the femoral artery. During hospitalization, one patient underwent elective CABG for early residual myocardial ischemia. At seventy-two hours from PTCA, one patient (1.5%) died as a result of intestinal infarct. Six months survival rate was 98.3% for 59 pts discharged alive from our department. Ten pts were symptomatic during the follow-up: One patient underwent PTCA on another vessel and the other underwent CABG for a multivessel disease. CABG was used in one patient who presented residual silent ischemia in multivessel coronary artery disease. At six months, the first group of patients (18 pts) underwent planned coronary angiography: Vessel patency was present in 17 patients. One patient had an asymptomatic reocclusion of the treated vessel. This study shows a good angiographic result obtained with intracoronary stenting during primary or rescue PTCA of the infarct-related artery. It does not appear to increase major in-hospital adverse events and may reduce the need for surgical revascularization, reducing in-hospital mortality rate and favorably affecting LVEF.

Journal Article↗
PubMed1995

Myocardial uptake of indium-111 antimyosin after coronary angioplasty. Relationship with the total burden of ischaemia.

Indium-111 antimyosin scintigraphy was performed in 24 consecutive patients after percutaneous transluminal coronary angioplasty to assess whether repeated periods of ischaemia during balloon inflation results in myocardial cell damage even after a successful procedure. Patients with unstable angina, prior myocardial infarction and whose procedure was complicated were excluded. Indium-111 monoclonal antimyosin antibodies (80 MBq) were injected 24 h after coronary angioplasty and planar images were collected 24 h later. The relative antimyosin uptake was assessed subjectively and by a heart/lung count density ratio. In addition, the intracardiac gradient of activity was assessed by a count density profile analysis of the cardiac region of interest to distinguish better the focal as opposed to the diffuse antimyosin uptake. The antimyosin uptake index was calculated by multiplying the heart/lung ratio to the intracardiac gradient of activity. After coronary angioplasty, nine patients had minor ST-T wave changes on the surface ECG, but no patient demonstrated a new Q wave. Only three patients showed a mild rise in cardiac enzyme (CK-MB) serum levels. Indium-111 antimyosin uptake (heart/lung > 1.55) was present in eight patients (33%) and was intense (heart/lung > 1.9) in five (21%). Antimyosin uptake was always seen in myocardial segments corresponding to the treated coronary artery. Patients with a positive antimyosin scan had a longer duration of balloon-induced ischaemia compared with patients with no evidence of antimyosin uptake (541 +/- 211 vs 331 +/- 137 s, P < 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Maldistribution of regional myocardial perfusion at rest in patients with coronary artery disease and no previous myocardial infarction, evidenced by 99mTc-Sestamibi scintigraphy.

Since myocardial 99mTc-Sestamibi uptake is closely related to coronary blood flow and the tracer does not redistribute, resting perfusion defects may be observed even in viable regions supplied by vessels with severe stenosis. The incidence and the clinical significance of 99mTc-Sestamibi uptake defects at rest were investigated in 60 men with suspected coronary artery disease and no previous myocardial infarction, in a multicenter study. Of 60 patients, 12 showed normal coronary arteries and 48 significant coronary artery disease (> 50% luminal narrowing). Based on the presence or absence of tracer uptake defects at resting planar scans, the patients were divided into Group 1 (27 patients) and Group 2 (33 patients), respectively. A greater incidence of coronary artery disease (100% versus 64%, p < 0.01) and of multivessel disease (70% versus 36%, p < 0.05) was observed in patients of Group 1. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 min) 99mTc-Sestamibi scintigraphy, which more frequently induced transient 99mTc-Sestamibi uptake defects in Group 1 than in Group 2 (85% versus 42%, p < 0.001). A high incidence of resting 99mTc-Sestamibi uptake defects was observed in patients without previous myocardial infarction; this identified a subset of patients with a higher prevalence of coronary artery disease and multivessel involvement and with a greater impairment of the coronary reserve, as evidenced by a dipyridamole test.

Coronary Circulation↗
PubMed1992

Myocardial dissection following successful chemical ablation of ventricular tachycardia.

We describe a case of fatal myocardial rupture and tamponade following a successful transcoronary chemical ablation of incessant ventricular tachycardia. Pathological examination showed a subepicardial dissection of the heart at the ablation site with fibrous and fatty degeneration of the myocardium. The present report calls for caution, underlying a possible lethal complication of ethanol ablation which has not been described before.

Aged↗