Indications for Cardiac Catheterization in the Diagnosis and Management of Coronary Artery Disease

In 1979 coronary angiography remains the standard test for diagnosing the presence and extent of coronary artery disease. Non-invasive studies such as exercise testing are only relative predictors of coronary anatomy. Therefore, to define specifically whether or not coronary disease exists in a given patient and, if present, to delineate its location, severity and the potential for bypass surgery, a coronary angiogram is the test to obtain. The purpose of this paper is to discuss indications for coronary angiography in the management of patients with established or suspected coronary disease

A Review of Bleeding Risk with Impella-Supported High-Risk Percutaneous Coronary Intervention

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk–benefit considerations, with Impella-related bleeding risk being a major factor that can impact decisions for planned use. While bleeding risk related to large bore access is a concern, published data on the risk have been quite variable. Thus, the goal of this article is to provide a comprehensive review of reports describing bleeding and vascular complications for Impella-supported HR-PCI

Myocardial contrast echocardiography for the assessment of coronary blood flow reserve: Validation in humans

AbstractObjectives. The aim of this study was to validate the use of myocardial contrast echocardiography to determine coronary blood flow reserve in humans.Background. Although myocardial contrast echocardiogrephy has been used to accurately quantify coronary flow reserve in animals, validation for its use in humans to measure flow reserve is lacking.Methods. We analyzed the time-intensity curve from the anteroseptal region of the left ventricular short axis produced after a left main coronary artery injection of sonicated albumin before and after intracoronary administration of papaverine in 16 patients without angiographically significant coronary artery disease. The ratio of half-time of video intensity disappearance from peak intensity, variable of curve width, area under the timeintensity curve and corrected peak contrast intensity after papaverine compared with baseline were correlated with coronary flow reserve measured simultaneously with an intracoronary Doppler probe in the left anterior descending coronary artery.Results. There was a strong inverse correlation with half-time of contrast washout and coronary flow reserve (r = −0.76, p = 0.0007) and a strong positive correlation between the variable of curve width (which is inversely proportional to curve width) and coronary flow reserve (r = 0.71, p = O.002). There was a weak but significant inverse correlation between area under the timeintensity curve and coronary flow reserve (r = −0.54, p = 0.03) but no correlation between corrected peak contrast inteasity and coronary flow reserve (r = −036, p = NS), Despite the strong correlation for the ratios for half-time of contrast washout and variable of curve width and actual coronary flow reserve measured with intracoronary Doppler probe, the transit time ratios consistently underestimated coronary flow reserve.Conclusions. Myocardial contrast echocardiography performed with left main coronary artery injections of sonicated albumin can be utilized to measure coronary flow reserve in humans. Transit time variable ratios (half-time of contrast washout and variable of curve width) derived from the time-intensity curve correlate most strongly with coronary flow reserve