708-3 Impact of Exercise SPECT Thallium Imaging on Patient Management and Outcome

This study examined the impact of exercise thallium imaging on patient (pt) management Ithe need for coronary angiography and revascularization) and outcome (hard cardiac event: cardiac death or non fatal acute myocardial infarction) in 2700 pts being evaluated for diagnostic purposes. None of the pts had prior coronary angiography, PTCA or CABG or Q-wave myocardial infarction. The SPECT images were normal in 2027 pts (Group 1) and abnormal in 673 pts (Group 2). The exercise ECG was positive in 190 pts (9%), negative in 1461 pts (72%) and non-diagnostic in 376 pts (19%) in Group 1. The corresponding numbers were 218 pts (32%), 240 pts (36%) and 215 pts (32%) in Group 2. Within 6 months after thallium imaging, 53 pts in Group 1 (3%) and 242 pts in Group 2 (36%) underwent coronary angiography (P=0.0001). The pts who underwent cardiac catheterization in Group 1 had higher pre-test probability of coronary disease (48±39% vs 39±27%) and lower exercise workload (7.1±3.2 vs 9.4±4.4 METs) than the pts who did not. The pts in Group 2 who underwent coronary angiography had more perfusion defects (8.8±4.8 vs 6.3±4.4 abnormal segments, P=0.0001) than pts who did not. Coronary revascularization within 3 months of coronary angiography was performed in 1 of the 53 pts in Group 1 (2%) and in 87 of 242 pts (30%) in Group 2 (P=0.0001). Among the remaining pts who had angiography and were treated medically there were no events in Group 1 and 15 events in Group 2. The event-free survival was significantly worse in Group 2 than Group 1 (Mantel-Cox statistic=5, P=0.02). Thus, the results of exercise SPECT thallium imaging are important in pt management and outcome. Coronary angiography, coronary revascularization and events are rare in pts with normal images

Sex‐Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139084/1/jah32481-sup-0001-TableS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139084/2/jah32481.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139084/3/jah32481_am.pd

Recurrent Mitral Valve Endocarditis Caused by Streptococcus pneumoniae in a Splenectomized Host

A 72-year-old male with a remote history of splenectomy and two previous episodes of pneumococcal endocarditis of mitral valve presented with high-grade fever and confusion for 3 days. Nine months priorly, patient underwent mitral valve repair when he had the first episode of pneumococcal mitral valve endocarditis. He received pneumococcal vaccination two years ago. On examination during this admission, he was found to be febrile (104.3 F) and confused and had a grade 2/6 systolic murmur at the apex without any radiation. Laboratory data was significant for a white blood cell count of 22,000/mm3 (normal: 4000–11000/mm3). Blood cultures (4/4 bottles) grew penicillin-sensitive Streptococcus pneumoniae. Transesophageal echocardiogram revealed small vegetation on the posterior mitral leaflet without any evidence of abscess and severe mitral regurgitation. Patient clinically responded to intravenous ceftriaxone. However, due to recurrent pneumococcal mitral valve endocarditis and severe mitral regurgitation, the patient underwent mitral valve replacement. Patient had an uneventful recovery and was discharged home. Pneumococcal endocarditis itself is being uncommon in this current, penicillin, era; our case highlights the recurrent nature of pneumococcal endocarditis in a splenectomized host and the importance of pursuing aggressive treatment options in this clinical scenario

Bioresorbable vascular scaffold for coronary in-stent restenosis: A novel concept

The management of patients with significant in-stent restenosis (ISR) with drug-eluting stent is still not well defined. Various treatment modalities include plain old balloon angioplasty (POBA), metallic stent, cutting or scoring balloon and drug-eluting balloon (DEB). Bioresorbable vascular scaffold (BVS) is the latest technology for the treatment of de novo coronary artery lesions. The use of BVS in ISR is based on the rationale of local drug delivery as achieved by DEB without the permanent bi-layer of metal and also stabilizes dissection flaps and prevents acute recoil as provided by metallic stent. To the best of our knowledge this is the first case report of the use of BVS in patient with ISR