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PubMed2006

A longitudinal examination of breadth and intensity of youth activity involvement and successful development.

Connections between youth activity involvement and indicators of successful development were examined in a longitudinal high school sample. Drawing on theories of expertise skill development (e.g., J. Côté, 1999); the selection, optimization, and compensation framework (P. B. Baltes, 1997); and theories of positive youth development (e.g., R. M. Lerner, J. B. Almerigi, C. Theokas, & J. Lerner, 2005), reciprocal associations between breadth and intensity of activity involvement and developmental success were explored. Time 1 breadth (but not intensity) and increases in breadth predicted higher levels of successful development at Time 2 (20 months later). Time 1 developmental success and improvements predicted greater Time 2 breadth and intensity. Implications for research and theory related to connections between youth activity involvement and successful development are discussed.

Achievement↗

PubMed2004

Penalties for success: reactions to women who succeed at male gender-typed tasks.

A total of 242 subjects participated in 3 experimental studies investigating reactions to a woman's success in a male gender-typed job. Results strongly supported the authors' hypotheses, indicating that (a) when women are acknowledged to have been successful, they are less liked and more personally derogated than equivalently successful men (Studies 1 and 2); (b) these negative reactions occur only when the success is in an arena that is distinctly male in character (Study 2); and (c) being disliked can have career-affecting outcomes, both for overall evaluation and for recommendations concerning organizational reward allocation (Study 3). These results were taken to support the idea that gender stereotypes can prompt bias in evaluative judgments of women even when these women have proved themselves to be successful and demonstrated their competence. The distinction between prescriptive and descriptive aspects of gender stereotypes is considered, as well as the implications of prescriptive gender norms for women in work settings.

Adult↗

PubMed1989

Genetic differences in mating success and female choice in seaweed flies (Coelopa frigida).

An association is described in seaweed flies, Coelopa frigida, between the genotype at the alcohol dehydrogenase (Adh) locus and mating success in pairwise mating trials. Significantly higher mating success was observed in females that carried the Adh-C allele, but no association was observed between Adh genotype and male mating success. There was heterogeneity in the success of different combinations of males and females, but only when the female lacked the C allele. Analyses of video recordings indicated that C-bearing females spent longer mounted by males and that they less frequently rejected males. Evidence is presented for mate discrimination by females not carrying a C allele. The significance of there being genetic differences in both mating success and in female discrimination are discussed in the context of previous results on mating behaviour in natural populations.

Alcohol Dehydrogenase↗

PubMed2003

Zeroing in on the dark side of the American Dream: a closer look at the negative consequences of the goal for financial success.

Recent research has demonstrated that aspiring to the American Dream of financial success has negative consequences for various aspects of psychological well-being. The present longitudinal study examining the relation between the goal for financial success, attainment of that goal, and satisfaction with various life domains found that the negative impact of the goal for financial success on overall life satisfaction diminished as household income increased. The negative consequences of the goal for financial success seemed to be limited to those specific life domains that either concerned relationships with other people or involved income-producing activities, such as one's job; satisfactions with two of those life domains, however, were among the strongest predictors of overall life satisfaction in this sample of well-educated respondents in their late 30s. The negative consequences were particularly severe for the domain of family life; the stronger the goal for financial success, the lower the satisfaction with family life, regardless of household income.

Aspirations, Psychological↗

PubMed2000

Relapse of hirsutism following long-term successful treatment with oestrogen-progestogen combination.

OBJECTIVE: While several forms of treatment have been reported to be successful in relieving hirsutism over periods of 6-12 months, there is little if any information on the long-term outcome of hirsutism following the withdrawal of successful treatment. The combination of ethinyl oestradiol, 35 micrograms, and cyproterone acetate, 2 mg (EE-CA) for 21 days followed by 7 days without treatment is widely used in a cyclical manner in the treatment of hirsutism. The present study was undertaken to evaluate the outcome of withdrawal of long-term successful treatment of hirsutism with EE-CA. DESIGN, PATIENTS AND MEASUREMENT: In this retrospective study the clinical records of 57 patients with idiopathic hirsutism or polycystic ovary syndrome who had been treated with EE-CA were reviewed. The degree of hirsutism had been assessed by the Ferriman and Gallwey scoring system (FG). The testosterone/sex hormone binding globulin ratio (T/SHBG), was derived prior to and following the introduction of treatment with EE-CA. RESULTS: Fifty-two of the 57 patients achieved a satisfactory clinical response. In the group of patients who were satisfied with the outcome of treatment, FG decreased from 12.9 +/- 3.6 to 5.5 +/- 2.5 and T/SHBG ratio decreased from 11.3 +/- 9.5 to 1 +/- 0.8 (reference range: 1-5.2). The duration of treatment prior to its withdrawal in this group was 28.2 +/- 13.7 months. The five patients who were not satisfied with the response abandoned treatment after 16 +/- 2.8 months; the pretreatment FG was 16.2 +/- 8.3, while the T/SHBG decreased from 6.1 +/- 3.1 to 1.1 +/- 0.6 in these patients. Subsequent follow-up data, after withdrawal of treatment, were available on 34 of these 52 patients. Twenty-eight of the 34 patients exhibited relapse of hirsutism after 6.15 +/- 2.8 months. Six patients did not relapse during a follow-up period of 18.8 +/- 7. 8 months. The six patients who did not relapse were treated for a significantly longer period than the group who relapsed, 40 +/- 6.9 and 26.1 +/- 8.3 months, respectively, P < 0.01. However, the groups did not differ significantly when examined for pretreatment FG, 11.5 +/- 3.8 and 13.2 +/- 3.6 and pretreatment T/SHBG 8.9 +/- 5 and 13.4 +/- 11.9. CONCLUSION: These data indicate that ethinyl oestradiol and cyproterone acetate achieved a satisfactory clinical outcome in the treatment of hirsutism in 90% of patients. However, on withdrawal of treatment after a mean duration of over 2 years, relapse occurred in 80% of these patients after a mean of 6 months. If it is assumed that the successfully treated patients lost to follow-up all maintained long-term remission, the relapse rate is still an unsatisfactory 65% at 6 months. These are disappointing results which indicate for the first time that successful outcome requires that treatment be maintained for several years. Patients embarking upon treatment for hirsutism should be advised that maintenance of reduced hair growth requires long-term treatment, probably for at least 3-4 years.

Adult↗

PubMed2001

Predictive factors of successful testicular sperm recovery in non-obstructive azoospermia patients.

Recovery of testicular spermatozoa from non-obstructive azoospermic patients for intracytoplasmic sperm injection (ICSI) is a recent advance in the treatment of male infertility. The purpose of this study is to identify predictive factors for sperm recovery in non-obstructive azoospermic patients. A total of 178 men with non-obstructive azoospermia had multiple testicular sperm extraction (TESE) procedures to recover spermatozoa for intracytoplasmic sperm injection (ICSI) from June 1996 to February 1999. Testicular volume, serum follicle stimulating hormone (FSH) level and testicular histology were examined as positive predictive factors for sperm recovery. Testis biopsies were categorized as severe hypospermatogenesis, maturation arrest and Sertoli cell-only syndrome based on the most advanced pattern of spermatogenesis seen on histology. Sperm retrieval success rates for the patients in three histopathological categories were compared. Spermatozoa were successfully recovered in 94 of 178 (52.8%) men. Sperm were retrieved in 13 of 80 (16.3%) with Sertoli cell-only syndrome, 15 of 24 (62.5%) with maturation arrest, and 66 out of 74 (89.2%) with severe hypospermatogenesis. Spermatozoa recovery has no correlation with testicular volume or serum FSH level. When compared against Sertoli cell-only syndrome, the odds of sperm retrieval success rate was 44.3 times higher in severe hypospermatogenesis and 8.4 times in maturation arrest. These results demonstrate meaningful correlation between successful testicular sperm recovery and testis histopathology. Only testicular histopathology can be used as a predictor of successful sperm recovery.

Adult↗

PubMed2000

Students, tutors and relationships: the ingredients of a successful student support scheme.

BACKGROUND: Medical students suffer from stress and psychological morbidity. Much of this stress is related to uncertainty about course work and workload. Although several student support systems are on offer at various medical schools, few have been shown to meet the needs of students. OBJECTIVE: To evaluate one student support scheme and determine the factors which are essential for success. METHOD: A total of 144 second- and third-year medical students were randomly selected at the University of Dundee. They were asked to complete questionnaires regarding contact with their personal tutors, frequency of meetings, activities during meetings, opinions on how to improve the system and how satisfied they were with the present system. In addition 28 tutors were also asked to complete a questionnaire which matched as far as possible that for students. Qualitative data was collected from semi-structured interviews, free-text responses from questionnaires, email communications with student group representatives and telephone interviews. RESULTS: The scheme was rated as successful or very successful by 25 (18.4%) students and five (29.4%) tutors. A high success rating was associated with regular and frequent meetings, with tutors actively seeking their students and taking part in social as well as academic activities. CONCLUSIONS: The relationship that is formed between students and tutors is the most important factor contributing to the success of the scheme. Taking part in social activities encourages the relationship to develop, whilst addressing academic problems helps to meet the needs of students. Those students who fail exams appear to have the same needs as those who pass.

Education, Medical, Undergraduate↗

PubMed1998

Male mating success in an aquatically mating pinniped, the harbour seal (Phoca vitulina), assessed by microsatellite DNA markers.

Similar to many other pinniped species, harbour seals (Phoca vitulina) mate exclusively at sea. Here we present the first attempt to measure male mating success in an aquatically mating pinniped. Male mating success was estimated by paternity analysis in two cohorts of pups born at Sable Island, Nova Scotia, Canada, using microsatellite DNA markers. The genotypes of 275 pups born in 1994 and 1995 were compared to those of 90 candidate males at six microsatellite loci using a likelihood approach to resolve paternity. Paternity could be assigned for two, 22, 40 and 85 pups at confidence levels of 95, 80, 65 and 50%, respectively. Most successful males were assigned the paternity of a single offspring, suggesting a low variance in male mating success relative to most pinniped species. The proportion of paternal half sibs within cohorts and between maternally related sibs estimated by maximum likelihood were not significantly different from zero. It is thus unlikely that most offspring were sired by a small number of highly successful unsampled males, and that female harbour seals do not usually exhibit fidelity to the same male in sequential breeding seasons. A low level of polygyny in Sable Island harbour seals is consistent with predictions based on their breeding ecology, as females are highly mobile and widely dispersed in the aquatic mating environment at Sable Island.

Animals↗

PubMed2001

Microsatellite determination of male reproductive success in a natural population of the territorial ornate dragon lizard, Ctenophorus ornatus.

It is now evident that the genetic mating system can be very different to the observed mating system. However, it is less well known what makes particular individuals more (or less) successful than expected from the observed system. In this study the observed territorial structure of a field population of the agamid lizard, Ctenophorus ornatus, was compared with the mating system as evidenced by microsatellite parentage assignment. This study also investigated whether any male traits predicted reproductive success. Sixty-five per cent of clutches were sired at least partially by a male other than the main territory-holding male and 35% of clutches were sired by a male with no overlap of the female's territory. Multiple paternity was moderately frequent at 25% of clutches. Male chest patch size predicted territory size and the number of females in the territory, but did not predict reproductive success. Instead, male head depth and body size were independently related to the number of offspring sired. As male head depth also predicted the number of females in a territory, these males are likely to be gaining increased reproductive success as a consequence of the higher number of females in their territories. Larger body size males, however, did not have a greater number of females in their territory and instead had more extra-territorial copulations. Whether these extra-territorial copulations are due to female choice or success in male competition is unknown.

Animals↗

PubMed2003

Breeding success of male brook trout (Salvelinus fontinalis) in the wild.

Competition for females generally results in some males adopting alternative reproductive tactics to acquire matings. For fish, the ecological and evolutionary consequences of these tactics are not well understood because of an inability to link directly the interactions of individuals on the breeding grounds with genetic data. This study combines behavioural observations with genetic estimates of male reproductive success within an intensively studied wild population of lacustrine brook trout (Salvelinus fontinalis). Male brook trout exhibit a conditional reproductive strategy with small males adopting a peripheral position to that of larger dominant males in their proximity to spawning females. Parentage analysis of eggs collected from wild redds confirmed the reproductive success of individual males. Males relegated to peripheral positions during spawning participated frequently in spawning events, but in most cases the first male to spawn was the sole contributor, and no more than two males contributed successfully to a single brood. While behavioural observations of salmonines suggests that reproduction is partitioned among males in a manner dependent upon body size and proximity to spawning females, the genetic evidence from this study suggests a more limited distribution of reproductive success in the field. The genetic contributions of male brook trout are highly skewed towards larger males for this population. A review of the salmonine literature suggests little difference in individual reproductive success for males exhibiting size-related tactics within a conditional mating strategy vs. precocial maturation. Collectively, these genetic studies provide new insights on the evolution of alternative life histories among salmonines.

Animals↗

PubMed2003

Standardized stimulation protocol to predict the long-term success of radiofrequency ablation of postinfarction ventricular tachycardia.

BACKGROUND: The ability to predict the success of radiofrequency ablation (RFA) is an essential step in the management of ventricular tachycardia (VT) in patients with ischemic heart disease. METHODS: This study tested a standardized programmed stimulation protocol and pre-specified definitions of procedural outcome. Consecutive patients referred for RFA of delayed post infarction VT were enrolled. Programmed stimulation was performed at the beginning and the end of an RFA procedure, and consisted of an 8 beat drive followed by up to 5 extrastimuli. Immediate success was defined as no inducible monomorphic VT, and a modified result was defined as the inducibility of VT with > 2 extrastimuli beyond those required at baseline. Procedural failure was defined when these criteria were not met. Recurrences of sustained VT and arrhythmic deaths were monitored during long-term follow-up. RESULTS: The study enrolled 112 patients. Immediate procedural success was achieved in 38%, a modified result in 34%, and procedural failure in 28% of patients. During a mean follow-up of 78 +/- 16 months, recurrent sustained VT was observed in 25 patients. VT recurrence was 3% (3/79) in patients with a successful or modified result, compared with 67% (22/33) in those who had undergone unsuccessful procedures (P < 0.001). CONCLUSIONS: This standardized stimulation protocol and definitions of procedural success, enabled us to predict with high accuracy a VT recurrence-free long-term follow-up. This may have implications in recommending devices or other treatments after RFA for postinfarction VT.

Adult↗

PubMed2003

Dose-response relationship for successful internal atrial defibrillation.

The dose-response relationship for successful defibrillation has been determined in man for the ventricle but not for the atrium. The purpose of this study was to determine the dose-response relationship for internal atrial defibrillation in humans. Seventy-seven consecutive patients underwent internal atrial defibrillation for acute (n = 14) or chronic AF (n = 63). Shocks were delivered in 40-V increments between electrodes positioned in the coronary sinus and the right atrium until successful conversion or a maximum of 400 V was reached. The shock strength versus success of shock data were subjected to a Kaplan-Meier survival analysis combined with a nonparametric probability analysis to arrive at the dose-response relationship. Using this relationship, comparisons were made between acute and chronic AF and clinical relevant conversion percentages (20, 50, 80 and 95%) were estimated and were compared with the conventional mean threshold. There were significant dose-response relationships in both patients groups (P < 0.05). The Kaplan-Meier analysis comparing patients with chronic and acute AF showed significant differences in their dose-response relationships (P < 0.001). The estimated shock intensity for 95% conversion in patients with acute and chronic AF was 279 V (2.9 J) and 433 V (6.6 J), respectively (P < 0.001). The conventional mean defibrillation threshold in patients with acute (192 +/- 15 V. 1.4 +/- 0.2 J) and chronic AF (343 +/- 8 V, 4.4 +/- 0.2 J) predicted the 60% and 45% chance of successful conversion, respectively. In conclusion, this study demonstrates that single shock conversion data can be used to determine a dose-response relationship, which can be used to estimate the shock intensity required for specific successful atrial defibrillation efficacy and to compare different clinical factors that affect defibrillation efficacy.

Aged↗

PubMed2003

Clinical predictors and time course of arrhythmia recurrence in patients with early reinitiation of atrial fibrillation after successful internal cardioversion.

Early reinitiation of atrial fibrillation (ERAF) was commonly observed after successful electrical cardioversion, however, the effect of ERAF on the subsequent time course of arrhythmia recurrence remains unclear. The aim of this study was to evaluate the clinical predictors and time course of AF recurrence with respect to the occurrence of ERAF after successful cardioversion. The clinical predictors and time course of AF recurrence were prospectively evaluated in 124 patients (94 men, 30 women; mean age 65 +/- 9 years) with persistent AF (mean AF duration 36 +/- 40 months), who underwent internal cardioversion. After cardioversion, all patients received treatment with sotalol and were monitored for AF recurrence. Successful restoration of sinus rhythm was achieved in 104 (84%) of 124 patients. ERAF was observed in 28 (27%) of 104 patients in whom 26 of them were successfully treated acutely with intravenous sotalol and repeated cardioversion. After a mean follow-up of 26 months, 29 (28%) of 104 patients remained in sinus rhythm. Kaplan-Meier analysis revealed a significantly poorer outcome with regard to the recurrence of AF in patients with ERAF (hazard ratio 1.7,P = 0.03) and in those with AF for more than 3 years (hazard ratio 1.6,P = 0.03). Despite treatment with sotalol, patients with ERAF had a significantly higher AF recurrence rate within the first day (13/26 [50%] vs 12/76 [16%],P < 0.01), but not during long-term follow-up (21/26 [81%] vs 52/76 [68%],P = 0.3). In contrast, patients with AF for more than 3 years had a similar AF recurrence rate within the first day (7/29 [24%] vs 18/73 [25%],P = 1.0), but a significantly higher recurrence rate during long-term follow-up (27/29 [93%] vs 46/73 [37%],P < 0.01). In conclusion, the occurrence of ERAF and long AF duration were independent predictors for AF recurrence after successful internal cardioversion. The difference in the time course of AF recurrence in patients with ERAF from those with long AF duration suggests distinct arrhythmogenic mechanisms.

Aged↗

PubMed2003

The influence of comorbidity on the effect of levofloxacin treatment success of ambulatory respiratory tract infections.

The influence of patient relevant parameters such as age, comorbidity, or duration of disease on the treatment success of levofloxacin for community-acquired respiratory tract infections (CARTI) has not been thoroughly elucidated. We therefore conducted a prospective cohort study of 9831 patients with CARTI in a clinical practice setting. The patients received 500 mg of levofloxacin once a day over a mean of seven days. Twenty-two attributes per patient were recorded before treatment initiation and after seven to fourteen days after start of treatment. Descriptive and explorative statistics such as the k-means and C4.5 algorithms were used to analyze the dataset. The overall success rate of levofloxacin therapy for CARTI was over 98%, side effects occurred in 1.6% of patients. Descriptive analysis revealed a weak correlation between parameters which significantly influence the course of disease, such as the number of comorbidities, the duration of infection before levofloxacin start, or the severity of symptoms and the treatment success. Explorative statistics yielded similar results. Two homogenous clusters, holding 34 and 45% of patients respectively, yielded the number of comorbid conditions and the duration of infection as main attributes negatively influencing treatment success. We therefore conclude, that the number of co-morbid conditions and the duration of infection before start of treatment as the strongest negative predictors for treatment success.

Adolescent↗

PubMed2004

[Uterine fibroid embolization with spheric micro-particles using flow guiding: safety, technical success and clinical results].

PURPOSE: To evaluate safety and mid term efficacy (> or = 1 year follow-up) of uterine fibroid embolization (UFE) using spherical particles (Embosphere) in a study applying criteria identical to those submitted to the FDA for initial material approval. MATERIALS AND METHODS: Twenty of the first 26 consecutive patients referred for potential UFE were enrolled in the study. Pre-interventional MRI was used to assess morphologic contraindication to UFE. The embolization procedures were performed from a unilateral femoral approach using 4F selective catheters in straight vessels, > 2 mm in diameter, and micro-catheters in smaller and tortuous arteries. The endpoint of the "flow guided" embolization was defined by reaching the angiographic "pruned tree" appearance and sluggish flow in the main stem of the uterine artery. Assessment of morphologic mid term success was done by MRI 10 days, 3 months, 6 months, 9 months and 1 year after UFE. The clinical mid term success was assessed by having questionnaires completed for menstrual bleeding, retention of clinical (symptomatic) benefit and quality of life. RESULTS: Technical success was 100 %, with 8 minor (2 post-interventional collapses, 2 hematomas, 4 relevant post-embolizations syndromes, 1 spontaneous expulsion of a submucous myoma) and 3 major complications (1 hysterectomy because of vaginal bleeding for 5 weeks, 1 transient amenorrhea and 1 spontaneous expulsion of myoma with transient bleeding requiring admission). In 17 of 19 patients, MRI showed total fibroid devascularization throughout the entire follow-up. The average shrinkage of the dominant fibroid was 71.3 % at one year. The menstrual bleeding record in the cohort group fell from an average of 501.6 before treatment to 76.2 points at one year. At the same time, the clinical symptoms significantly improved. The patient satisfaction with the applied therapy was > 95 % at 1 year. One patient with residual fibroid perfusion underwent a second procedure, which achieved complete devascularization and adequate clinical success at one year. The second patient with incomplete devascularization had a persistent clinical benefit. CONCLUSION: Under controlled study conditions, flow guided UFE with spherical particles achieves high overall success and patient satisfaction. MRI provides exact morphologic description of the fibroid for the initial evaluation and for post-procedural follow-up.

Adult↗

PubMed1997

[How successful is the filtering bleb "needling"?].

BACKGROUND: "Needling" may become necessary when filtering blebs fail due to scarring or encapsulation. Our goal was to calculate the medium term success rate of the needling procedure. METHODS: The results of 90 needling procedures performed on 58 eyes were analyzed, 52 eyes required one single needling (group 1) after simple trabeculectomy, whereas 19 eyes had to have double needling (group 2) and 3 eyes had to be needled 3 times (group 3). These figures do not include a 4th group of 16 eyes which had been needled after repeated and complicated surgery. Success rates were calculated at t1 = 0 - 1 day, t2 = 1 - 4 weeks, t3 = 4 - 8 weeks, t4 = 3 - 5 months and t5 = > 6 months after the treatment. RESULTS: The mean IOP (n = 90) was 29 +/- 6 mm Hg preoperatively, 15 +/- 10 mm Hg at t1, 23 +/- 9 mm Hg at t2, 20 +/- 7 mm Hg at t3, 17 +/- 5 at t4 and 17 +/- 3 at t5. The overall success rates were 80% (t1), 45% (t2), 37% (t3), 35% (t4) and 31% (t5). The corresponding success rates were 74%, 36%, 32%, 28% and 26% for group 1.89%, 52%, 37%, 37% and 31% for group 2.67% at all times for group 3 and 100%, 69%, 54%, 54% and 45% for group 4. CONCLUSIONS: In one third of all cases the needling is effective for more than 6 months. A complicated pressure lowering surgery does not necessarily diminish the effectiveness of a needling procedure. Re-needlings are as successful as the first one.

Aged↗

PubMed1999

Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies.

BACKGROUND: The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment are not known. METHODS: We studied 350 women with tubal ectopic pregnancies who were treated with methotrexate intramuscularly according to a single-dose protocol. Pretreatment serum concentrations of human chorionic gonadotropin and progesterone, the size and volume of the gestational mass, fetal cardiac activity, and the presence of fluid (presumably blood) in the peritoneal cavity were correlated with the efficacy of therapy, as defined by resolution of the ectopic pregnancy without the need for surgical intervention. RESULTS: There was no relation between the women's age or parity, the size or volume of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. Among the 320 women in whom treatment was successful (91 percent), the mean (+/-SD) serum chorionic gonadotropin and progesterone concentrations were 4019+/-6362 mIU per milliliter and 6.9+/-6.7 ng per milliliter (21.9+/-21.3 nmol per liter), respectively, as compared with 13,420+/-16,590 mIU per milliliter and 10.2+/-5.5 ng per milliliter (32.4+/-17.5 nmol per liter) (P<0.001 and P=0.02) in the 30 women in whom treatment was not successful. Fetal cardiac activity was present in 12 percent of the successfully treated cases and 30 percent of those in which treatment was not successful (P=0.01). Regression analysis revealed the pretreatment serum chorionic gonadotropin concentration to be the only factor that contributed to the failure rate. CONCLUSIONS: Among women with tubal ectopic pregnancies, a high serum chorionic gonadotropin concentration is the most important factor associated with failure of treatment with a single-dose methotrexate protocol.

Adult↗

PubMed2002

Fate of collateral circulation after successful coronary angioplasty of total occlusion assessed by coronary angiography and myocardial contrast echocardiography.

A well-developed collateral circulation is frequently observed in patients with total coronary occlusion. However, the fate of the collateral circulation after successful percutaneous transluminal coronary angioplasty (PTCA) has not been fully characterized. The purpose of this study was to compare the efficacy of coronary angiography and myocardial contrast echocardiography (MCE) in the evaluation of the collateral circulation after PTCA and to assess the temporal changes of the collateral circulation after successful PTCA of a totally occluded artery by using these 2 diagnostic methods. The study group was comprised of 20 consecutive patients (16 male, mean age 54 years) who underwent elective PTCA for total coronary occlusion. Coronary angiography was performed before, immediately after, and 24 hours after PTCA. MCE was also performed before, immediately after, and 24 hours after PTCA, by the intracoronary injection of sonicated radiographic contrast medium. According to the angiographic findings, the collateral circulation was graded on a scale of 0 to 3 as follows: 0 = no visible filling; 1 = collateral filling of side branches; 2 = partial collateral filling of the epicardial artery; 3 = complete filling of the epicardial artery. By MCE, myocardial perfusion by the collateral circulation was assessed by scoring the contrast pattern of collateral-dependent myocardial segments as follows: 0 = none; 0.5 = patchy or epicardial; 1 = homogeneous. The left anterior descending artery was occluded in 12 patients and the right coronary artery in 8 patients. Coronary angiographic collateral grades before PTCA were grade 2 in 5 patients and grade 3 in 15. PTCA with stenting was successfully performed in all patients without significant residual stenosis. Coronary angiography showed collateral circulation disappeared after PTCA in all patients. However, residual collateral perfusion was observed in 7 patients by MCE, performed immediately after PTCA (score 1 in 3 patients; score 0.5 in 4 patients). This residual collateral perfusion could be demonstrated even 24 hours after PTCA by MCE in 3 patients (all patients were 0.5 in myocardial perfusion score). In conclusion, successful PTCA with stenting of a totally occluded coronary artery leads to a disappearance of collateral vessels by coronary angiography in most of the patients. However, although angiographically not visible, coronary collateral circulation may persist even 24 hours after successful PTCA of a totally occluded artery demonstrated by MCE.

Adult↗