Impact of severe coronary disease associated or not associated with diabetes mellitus on outcome of interventional treatment using stents: Results from HERZ (heart research group of Kanazawa) analyses

金沢大学医薬保健研究域医学系Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) leads to less re-stenosis than PCI using a bare metal stent (BMS), however there is still controversy whether use of a DES for severe coronary disease leads to an acceptable outcome in patients with diabetes mellitus (DM). In this study 8159 lesions were treated in 6739 patients (mean age 68.9 years) with coronary artery disease. Use of a DES significantly decreased the re-stenosis rate compared with BMS in both DM (9.6% versus 21.3%) and non-DM (9.5% versus 17.1%) patients. The re-stenosis rate was significantly higher in DM than in non-DM patients in the BMS group but not in the DES group. There was no statistically significant difference in event-free survival after stenting of patients with left main coronary artery (LMCA) disease between the BMS and DES groups. It was concluded that, compared with BMS, DES reduced re-stenosis in patients with DM, however, we advise careful treatment after using DES for severe coronary disease, including LMCA lesions, in patients with DM. © 2011 Field House Publishing LLP

Myocardial energy depletion and dynamic systolic dysfunction in hypertrophic cardiomyopathy

Evidence indicates that anatomical and physiological phenotypes of hypertrophic cardiomyopathy (HCM) stem from genetically mediated, inefficient cardiomyocyte energy utilization, and subsequent cellular energy depletion. However, HCM often presents clinically with normal left ventricular (LV) systolic function or hyperkinesia. If energy inefficiency is a feature of HCM, why is it not manifest as resting LV systolic dysfunction? In this Perspectives article, we focus on an idiosyncratic form of reversible systolic dysfunction provoked by LV obstruction that we have previously termed the 'lobster claw abnormality' — a mid-systolic drop in LV Doppler ejection velocities. In obstructive HCM, this drop explains the mid-systolic closure of the aortic valve, the bifid aortic pressure trace, and why patients cannot increase stroke volume with exercise. This phenomenon is characteristic of a broader phenomenon in HCM that we have termed dynamic systolic dysfunction. It underlies the development of apical aneurysms, and rare occurrence of cardiogenic shock after obstruction. We posit that dynamic systolic dysfunction is a manifestation of inefficient cardiomyocyte energy utilization. Systolic dysfunction is clinically inapparent at rest; however, it becomes overt through the mechanism of afterload mismatch when LV outflow obstruction is imposed. Energetic insufficiency is also present in nonobstructive HCM. This paradigm might suggest novel therapies. Other pathways that might be central to HCM, such as myofilament Ca2+ hypersensitivity, and enhanced late Na+ current, are discussed

Role of Echocardiography in Evaluation of Women with Chest Pain

© Springer-Verlag London 2013. All rights are reserved. This chapter reviews the role of echocardiography in evaluation of women with chest pain. Stress echocardiography is a well-established and diagnostically reliable modality for assessment of women with chest pain and suspected myocardial ischemia due to epicardial coronary artery disease. The technique is particularly suitable in women because of the lack of radiation and applicability in individuals who are or are not able to exercise. The chapter addresses the difficult issue of chest pain in women with angiographically normal coronary arteries, including prognostic role of stress echocardiography in these women, and newer echocardiographic techniques for assessment of coronary flow reserve and detection of microvascular disease. The importance of coronary flow reserve abnormalities in women with chest pain is examined. The chapter concludes with a discussion of the role of transthoracic echocardiography in assessment of two other important cardiac causes of chest pain in women with angiographically normal coronary arteries - hypertrophic cardiomyopathy and stress-induced cardiomyopathy. The typical echocardiographic features of both types of cardiomyopathies are reviewed. Also, the role of coronary flow reserve and myocardial contrast in clarifying the causes of ischemia in these entities is examined