Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

<p>Abstract</p> <p>Background</p> <p>Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR).</p> <p>Methods</p> <p>In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test ≥2 was considered normal CFR.</p> <p>Results</p> <p>Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 ± 0.5 to 2.6 ± 0.5, p = 0.03) and in LCx (1.7 ± 1 to 2.12 ± 1, p = 0.05). CFR was under normal at baseline in 30% of patients <it>vs </it>8% after six months in LAD (p = 0.027), and in 69% of patients <it>vs </it>30% after six months in LCx (p = 0.066).</p> <p>Conclusion</p> <p>CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.</p

Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire

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Ginkgo biloba-induced frequent ventricular arrhythmia

The use of herbal medications is becoming ever more widespread, but data for them are not yet as robust as for conventional drugs. The available safety information indicates that potential side effects of such use can be due to allergic reactions and bleeding. In this report, a case of frequent ventricular arrhythmias probably due to Ginkgo biloba is presented. The patient complained of palpitations twice in a month and on both occasions symptoms and electrocardiographic evidence of ventricular arrhythmias resolved with discontinuation of Ginkgo biloba. This case underlines that continuing research is needed to elucidate the pharmacological activities of the many herbal remedies now being used

A prognostic index for risk stratification for acute heart failure and death in subjects with ischemic cardiomyopathy and cardiac defibrillator

To propose a clinical prognostic index for death and heart failure in patients with ischemic cardiomyopathy implanted with an ICD. This prospective study included 192 consecutive patients (age 68 ± 10) recruited from 2004 to 2009 and implanted with an ICD for MADIT II criteria. All patients performed 24-h ambulatory blood pressure monitoring after discharge and common haematological samples. The prognostic index (PI) was built according to the formula: 120 - age + mean 24 h systolic blood pressure - (creatinine * 10). Other variables were assessed: EF, haemoglobin concentration, mean 24 h heart rate and diastolic blood pressure, sodium level, pacing mode and diabetes. Non-arrhythmic cardiac death and new hospitalizations for heart failure during 1-year follow-up were the combined end point. A total of 48 events (25 %) occurred during the follow-up: 7 cardiac deaths and 41 hospitalizations for acute heart failure. Cox proportionalhazards model showed that PI was the only predictor of events (HR = 0.96; CI 95 % 0.944–0.976, p<0.0001). ROC curve showed that PI best cut-off was 144, with AUC 0.79, p<0.0001; sensitivity 77 %, specificity 74 %, positive predictive value 50 %, negative predictive value 90 %. PI was predictive of events in a clinical setting where EF had no predictive value. PI works according to the rule ‘‘the lower the worse’’. The high negative predictive value (90 %) of PI allows to identify subjects at lower risk for death and heart failure. PI can be a practical tool to stratify risk in ischemic cardiomyopathy

A new prognostic index for acute heart failure and non- arrhythmic death in subjects with a cardiac defibrillator and ischemic cardiomyopathy

Subjects suffering from ischemic cardiomyopathy receiving a defibrillator (ICD) are still at high risk of heart failure and non-arrhythmic death. Predictors of increased risk are lacking in these patients. In a preliminary study in patients receiving an ICD for MADIT II criteria we found that age, 24 hour Systolic blood pressure, measured by Ambulatory blood pressure monitoring and creatinine, were independent predictors for acute decompensated heart failure and cardiac non arrhythmic death, while ejection fraction (EF), evaluated by 2D echo, was not predictive. In the present study we combined the same predictor factors in a Prognostic Index (PI) built according to the formula: 120 - age + m24hSBP - (creatinine*10). This PI was prospectively evaluated in 192 patients (all with ICD for MADIT II criteria and ischemic cardiomyopathy) for the combined endpoint of non-arrhythmic death and hospitalization for acute heart failure, in one year follow-up. Other variables assessed included EF, hemoglobin concentration, 24 hour mean heart rate, sodium levels, biventricular pacing and diabetes. We have registered 48 events (25%) in one year follow-up: 7 cardiac deaths and 41 hospitalizations for acute heart failure. The Cox multivariate analysis showed that low values of PI are the only independent predictor of events ( HR= 0.96; CI 95% 0.944-0.976, p 0.0001). Interestingly, in these patients with reduced ventricular function, EF was not predictive of new events, while PI was significantly associated with new events (acute heart failure and non arrhythmic death). PI is easy to calculate and could be applied in clinical practice to stratify this very high risk population