Eventual role of myocardial muscular «bridges» in the pathogenesis of acute coronary syndrome

Aim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI

Непосредственные и среднеотдаленные (6 месяцев) результаты стентирования биодеградируемыми коронарными скаффолдами BVS Absorb у пациентов с хроническими формами ишемической болезни сердца

Aim of study To evaluate the immediate and medium-term (6 months) results of BVS Absorb biodegradable stents implantation in patients with chronic forms of coronary artery disease, taking into account their location in coronary vessels, morphological nature of the initial lesion of the coronary arteries and technical features of implantation as well.Material and methods From June 2014 to December 2015, 199 biodegradable stents (Absorb Bioresorbable Vascular Scaffold — BVS; Abbott Vascular, CA, USA) were routinely installed in 114 patients treated at the Interventional Cardioangiology Center of I.M. Sechenov First Moscow State Medical University. The analysis of the obtained results was carried out depending on the type of coronary artery lesion, the length and diameter of the stents, and the details of the angioplasty procedure. To characterize the type of coronary artery lesion, the ACC/AHA classification was used: type A vascular lesion (95 coronary segments); type B vascular disease (68 coronary segments); type C vascular disease (36 coronary segments). The ultimate goal of the study was to study the frequency of thrombosis and in-stent stenosis of stented coronary arteries.Results The immediate success of scaffold implantation was 98.2%. Complications in the early hospital period were 1.8% (acute stent thrombosis was observed in 2 cases on the first day after implantation). In the medium-term (~6 months), 102 patients (89.5%) with 172 previously placed stents underwent comparison selective coronary angiography. The rest of the patients with stents refused to undergo coronary angiography due to good health and underwent a telephone survey.The satisfactory result of stenting in the medium-term (6 months) was a completely preserved lumen of the stented area, or with less than 50% stenosis of this place, which comprised 94.3%. The frequency of in-stent stenosis (narrowing of the lumen of the stented area by 50% or more) was 5.7%. In-stent stenosis was detected in groups of patients with type B and C lesions, respectively, in 4% and 1.7%. In the group with type A coronary artery disease, in-stent stenosis was not detected in the medium-term period.Conclusion The immediate and medium-term results of stenting with the biodegradable BVS Absorb stent were successful in the vast majority of cases (94.3%). Only in 2 cases (1.8%), acute thrombosis of the stent was observed immediately after stenting.Цель Оценить у пациентов с хроническими формами ишемической болезни сердца непосредственные и среднеотдаленные (6 месяцев) результаты имплантации биодеградируемых стентов BVS Absorb с учетом их локализации в коронарном русле; морфологического характера исходного поражения коронарных артерий; технических особенностей имплантации.Материал и методы В НПЦ интервенционной кардиоангиологии ФГАОУ ВО Первого МГМУ им. И.М. Сеченова МЗ РФ с июня 2014 года по декабрь 2015 года в плановом порядке 114 пациентам были установлены 199 биодеградируемых стентов (Absorb Bioresorbable Vascular Scaffold — BVS; Abbott Vascular, CA, USA). Анализ полученных результатов проводили в зависимости от типа поражения коронарных артерий; от длины и диаметра стентов; от деталей процедуры ангиопластики. Для характеристики типа поражения коронарных артерий использовали классификацию ACC/AHA: поражение сосудов типа A (95 коронарных сегментов); поражение сосудов типа В (68 коронарных сегментов); поражение сосудов типа С (36 коронарных сегментов). Конечной целью исследования явилось изучение частоты тромбозов и in-stent стенозов стентированных коронарных артерий.Результаты Непосредственный успех имплантации скаффолдов составил 98,2%. Осложнения в раннем госпитальном периоде составили 1,8% (в 2 случаях наблюдали острый тромбоз стентов в первые сутки после имплантации). В среднеотдаленном периоде (~6 месяцев) 102 пациентам (89,5%) с установленными ранее 172 стентами выполняли контрольную селективную коронарографию. Остальные стентированные больные в связи с хорошим самочувствием отказались от коронарографии и прошли телефонный опрос.Удовлетворительный результат стентирования в среднеотдаленные сроки (6 месяцев), заключающийся в полностью сохраненном просвете стентированного участка, либо со стенозированием этого места менее 50%, составил 94,3%. Частота in-stent стеноза (сужения просвета стентированного участка на 50% и более) составила 5,7%. In-stent стеноз был выявлен в группах пациентов с типом поражений B и C соответственно в 4% и 1,7%. В группе с поражением коронарных артерий типа А in-stent стеноз в среднеотдаленном периоде не был выявлен.Выводы Непосредственные и среднеотдаленные результаты стентирования биодеградируемым стентом BVS Absorb в подавляющем большинстве случаев (94,3%) были успешными. Лишь в 2 случаях (1,8%) непосредственно после стентирования наблюдали острый тромбоз стента

НЕИНВАЗИВНАЯ ОЦЕНКА ФРАКЦИОННОГО РЕЗЕРВА КРОВОТОКА У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА ПО ДАННЫМ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ: ПЕРВЫЕ РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ. СРАВНЕНИЕ С ДАННЫМИ ИНВАЗИВНОГО ИЗМЕРЕНИЯ

Objectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).Methods. Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.Conclusion. FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. Цель исследования: оценить диагностическую значимость неинвазивного измерения фракционного резерва кровотока (FFR) по данным МСКТ-коронарографии (FFRCT) в определении значимых стенозов коронарных артерий у пациентов с ишемической болезнью сердца (ИБС).Материал и методы. В проспективное исследование было включено 16 пациентов (м/ж – 13/3, средний возраст 47,8 ± 2,3 года) с ИБС и стенозами коронарных артерий 40–75% просвета артерии. Вначале пациентам выполняли КТ-ангиографию, затем – инвазивную коронарографию с измерением FFR. Измерение FFRCT проводили слепым методом независимой лабораторией Core Laboratory (HeartFlow, США). Результаты FFRCT были сопоставлены с инвазивным измерением FFR. Пороговое значение значимости стеноза определялось как FFR и FFRCT ≤ 0,80.Результаты. Площадь под ROC-кривой (AUC) (95% CI) для FFRCT составила 0,9. Чувствительность и специфичность в определении гемодинамически значимых стенозов для FFRCT составили 91 и 79% соответственно.Выводы. FFRCT представляет собой инновационный метод, демонстрирующий высокую диагностическую значимость для выявления или исключения поражения коронарных артерий, вызывающих ишемию

EFFECTS OF ENDOVASCULAR INTERVENTION VS. THROMBOLYSIS ON INTRACARDIAC HEMODYNAMICS AND LEFT VENTRICULAR REMODELLING IN ACUTE MYOCARDIAL INFARCTION

Aim. To assess the dynamics of myocardial contractility, geometry, and diastolic function in patients with acute myocardial infarction (AMI) after endovascular intervention vs. thrombolysis. Material and methods. In total, 60 patients (mean age 48,9±2 years) with AMI and ST segment elevation (STEMI) were examined within the first 6 hours from the AMI onset. All participants were divided into three groups: Group I – 22 patients with primary stenting; Group II – 22 patients with the stenting within 24 hours after successful thrombolysis; and Group III – 16 patients with effective thrombolysis and no endovascular intervention. At Day 1 and 7, all participants underwent Doppler echocardiography with the assessment of left ventricular (LV) diastolic function, LV size and volume parameters, total and segmental myocardial contractility (biplane Simpson’s method). Results. According to the comparative analysis results, LV volume parameters did not deteriorate substantially only in Group I. By Day 7, Group III demonstrated a restrictive type of LV diastolic dysfunction, persistent reduction of ejection fraction, and more pronounced disturbances of local LV contractility, compared to Groups I and II. Conclusion. In STEMI patients, primary stenting of the infarct-related artery more effectively prevents early pathological LV remodelling, compared to successful thrombolysis or post-thrombolysis endovascular intervention

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks