Ischaemic burden and changes in absolute myocardial perfusion after chronic total occlusion percutaneous coronary intervention.
- 作者列表："Schumacher SP","Kockx M","Stuijfzand WJ","Driessen RS","van Diemen PA","Bom MJ","Everaars H","Raijmakers PG","Boellaard R","van Rossum AC","Opolski MP","Nap A","Knaapen P
AIMS:The aim of this study was to explore the relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS AND RESULTS:A total of 193 consecutive patients underwent [15O]H2O positron emission tomography prior to and three months after successful CTO PCI. Change in perfusion defect size, quantitative hyperaemic myocardial blood flow (MBF) and coronary flow reserve (CFR) within the CTO area were compared among patients with limited (0-1 segment, N=15), moderate (2-3 segments, N=61) and large (≥4 segments, N=117) perfusion defects. Median reductions in defect size were 1 [0-1], 2 [1-3], and 4 [2-5] segments in patients with a limited, moderate and large defect (all comparisons p<0.01). Hyperaemic MBF and CFR improved significantly regardless of baseline defect size (overall between groups p=0.45 and p=0.55). After stratification of patients to a low, intermediate or high tertile according to baseline hyperaemic MBF or CFR levels, changes in hyperaemic MBF and CFR after CTO PCI were comparable between tertiles (overall p=0.75 and p=0.79). CONCLUSIONS:Major reductions in ischaemic burden can be achieved following CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperaemic MBF and CFR improve significantly irrespective of their baseline values or perfusion defect size. Visual summary. Major reductions in ischaemic burden can be achieved following CTO PCI. More defect size reduction in patients with a larger baseline perfusion defect. Significant hyperaemic MBF improvement irrespective of its baseline values.
目的: 本研究的目的是探讨慢性冠状动脉完全闭塞 (CTO) 经皮冠状动脉介入治疗 (PCI) 后缺血负荷与绝对心肌灌注变化之间的关系。 方法和结果: 共有193名连续的患者在成功的CTO PCI之前和之后三个月接受了 [15O]H2O正电子发射断层扫描。在局限性 (0-1段，N = 15) 、中度 (2-3段，N = 61) 和大 (≥ 4段，N = 117) 灌注缺损。在具有有限、中度和较大缺陷的患者中，缺陷大小的中值减少为1 [0-1] 、2 [1-3] 和4 [2-5] 个节段 (所有比较p<0.01)。无论基线缺陷大小如何，充血MBF和CFR均显著改善 (组间总体p = 0.45和p = 0.55)。根据基线高血MBF或CFR水平将患者分层至低、中或高三分位数后，CTO PCI后高血MBF和CFR的变化在三分位数之间具有可比性 (总体p = 0.75和p = 0.79)。 结论: CTO PCI后可实现缺血性负荷的大幅降低，灌注缺损较大的患者可减少更多的缺损，而无论其基线值或灌注缺损大小如何，高血糖MBF和CFR均显著改善。可视化摘要。CTO PCI后可显著降低缺血负荷。基线灌注缺陷较大的患者更多的缺损尺寸减小。无论其基线值如何，都显著的高血MBF改善。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.