1054 Noninvasive Qp/Qs ratio measurement with phase-contrast cine MRI in patients with atrial septal defect: comparison with heart catheterization

The correlation analysis showed a good overlap between measurements (Qp: r = 0.65, p = 0.0004; Qs: r = 0.64, p = 0.0005; Qp/Qs ratio: r = 0.68, p = 0.0002), also confirmed by regression analysis (R2 = 0.42, p < 0.001 for Qp; R2 = 0.41, p = 0.001 for QS; R2 = 0.46, p < 0.001 for Qp/Qs ratio), and by the Bland-Altman statistical analysis for method comparison (see Figure 1). The interobserver variability was low

Management of heart failure in Piedmont Region

emerging problem in industrialized countries: it continues to be diagnosed at high rates and has an decreased survival time, raising new problems, such as the need of an adequate medical service organization and resource expenditure. Aim of this analysis was a quantitative evaluation of diagnostic and therapeutic resource use for CHF in outpatient departments in Piedmont, Italy. Methods. We performed a cross-sectional observational study, based on a two-month data collection in 12 outpatient departments dedicated to congestive heart failure. Information was obtained on each patient using a specific anonymous data collection form. Results. We obtained and analyzed for the study 547 forms. Mean patient age was 66.1 years, mean ejection fraction was 36.6%. Coronary artery disease accounted for 34.6% of congestive heart failure cases, followed by idiopathic etiology (26.4%). Main comorbidities were diabetes (22.3%) and chronic obstructive pulmonary disease (17.7%). Sixty-nine% of patients received a medical treatment with angiotensin-converting enzyme (ACE) inhibitors, 72.6% with β-blockers, 48.8% with aldosterone antagonists. As far as diagnostic resource use during a six-month period preceeding observation, 46.8% of patients underwent echocardiographic examination, 9.9% Holter ECG, 6.0% coronary angiography. Therapy was more often increased in patients who underwent an instrumental evaluation during the preceeding six-month period. Conclusions. Data suggests that in Piedmont outpatients with chronic heart failure receive a high drug prescription level and a small number of instrumental evaluations, as suggested in main international guidelines

Renin-angiotensin-aldosterone system polymorphisms: a role or a hole in occurrence and long-term prognosis of acute myocardial infarction at young age

<p>Abstract</p> <p>Background</p> <p>The renin-angiotensin-aldosterone system (RAAS) is involved in the cardiovascular homeostasis as shown by previous studies reporting a positive association between specific RAAS genotypes and an increased risk of myocardial infarction. Anyhow the prognostic role in a long-term follow-up has not been yet investigated.</p> <p>Aim of the study was to evaluate the influence of the most studied RAAS genetic Single Nucleotide Polymorphisms (SNPs) on the occurrence and the long-term prognosis of acute myocardial infarction (AMI) at young age in an Italian population.</p> <p>Methods</p> <p>The study population consisted of 201 patients and 201 controls, matched for age and sex (mean age 40 ± 4 years; 90.5% males). The most frequent conventional risk factors were smoke (p < 0.001), family history for coronary artery diseases (p < 0.001), hypercholesterolemia (p = 0.001) and hypertension (p = 0.002). The tested genetic polymorphisms were angiotensin converting enzyme insertion/deletion (ACE I/D), angiotensin II type 1 receptor (AGTR1) A1166C and aldosterone synthase (CYP11B2) C-344T. Considering a long-term follow-up (9 ± 4 years) we compared genetic polymorphisms of patients with and without events (cardiac death, myocardial infarction, revascularization procedures).</p> <p>Results</p> <p>We found a borderline significant association of occurrence of AMI with the ACE D/I polymorphism (DD genotype, 42% in cases vs 31% in controls; p = 0.056). DD genotype remained statistically involved in the incidence of AMI also after adjustment for clinical confounders.</p> <p>On the other hand, during the 9-year follow-up (65 events, including 13 deaths) we found a role concerning the AGTR1: the AC heterozygous resulted more represented in the event group (p = 0.016) even if not independent from clinical confounders. Anyhow the Kaplan-Meier event free curves seem to confirm the unfavourable role of this polymorphism.</p> <p>Conclusion</p> <p>Polymorphisms in RAAS genes can be important in the onset of a first AMI in young patients (ACE, CYP11B2 polymorphisms), but not in the disease progression after a long follow-up period. Larger collaborative studies are needed to confirm these results.</p

Impact of routine angiographic follow-up after percutaneous coronary drug-eluting stenting for unprotected left main disease: The Turin Registry

Background: Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy. Methods: Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI). Results: A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 ± 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35). Conclusions: An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained. © 2010 Springer-Verlag

Results of Percutaneous Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease According to Left Ventricular Systolic Function

Objectives: We aimed to appraise the early and long-term outcome after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with unprotected left main disease (ULM) and left ventricular systolic dysfunction (LVD). Background: PCI with DES has being performed with increasing frequency in subjects with ULM and LVD, but few specific data are available. Setting and Patients: We identified patients undergoing PCI with DES for ULM at our Center and distinguished those with ejection fraction (EF) >50% from those with 40% 50%, 32.0% with 40% 50%, 41.6% in those with 40% <EF <= 50%, and 61.9% in those with EF <= 40%, P = 0.4). Specifically, death occurred in 2.7%, 7.9%, and 28.6% (P < 0.001), cardiac death in 1.8%, 4.8%, and 23.8% (P = 0.001), MI in 8.0%, 7.9% and 0 (P = 0.4), and TVR in 15.9%, 11.1% and 33.3% (P = 0.6). Conclusion: Systolic ventricular dysfunction is highly correlated with in-hospital and long term death rates in patients undergoing PCI with DES for ULM disease. However it does not confer an increased risk of nonfatal adverse events or stent thrombosis. (C) 2010 Wiley-Liss, Inc

The retrograde coronary approach for chronic total occlusions: Mid-term results and technical tips & tricks

Background: Coronary chronic total occlusions (CTO) remain a challenging lesion subset for interventional cardiologists. The retrograde approach is a novel but still incompletely described technique. We report our 5-year-long experience in retrograde percutaneous coronary intervention (PCI) for CTOs. Methods: We abstracted patient and procedural data on all cases with attempted retrograde approach by means of a native septal or epicardial collateral pathway. End-points were wiring, angiographic and procedural success, plus long-term major adverse cardiovascular events (MACE). Results: The retrograde approach was used in 18 patients, including 11 CTOs of right coronary artery (RCA), 3 of left circumflex (LCX), and 4 of left anterior descending (LAD), with procedural success in 12 (67%). Conversely, two cases of wiring failures, three angiographic failures despite successful retrograde wiring, and one postprocedural myocardial infarction in an otherwise angiographically successful procedure were found. Causes of wiring failure were inability to retrogradely cross the distal (1) or the proximal stump (1) with the wire, while angiographic failures were due to interruption of the procedure due to rupture of a minor septal collateral branch during attempts at advancing the noninflated balloon (1) or persistent inability to deliver the balloon through the chosen collateral (2). Follow-up at a mean of 15 months showed MACE had occurred in five (28%) subjects. Conclusions: The retrograde approach appears feasible and safe in the percutaneous management of coronary occlusions, and its application can be envisioned as a promising alternative in selected patients in whom antegrade approaches fail or are unsafe. © 2007, the Authors

Current management of unprotected left main coronary artery disease: Run-in survey of the RITMO (Registro Italiano sul Trattamento del tronco coMune non protettO) study

The optimal approach for a significant unprotected left main coronary stenosis (ULM) is debated, in light of the recent progresses of percutaneous coronary intervention (PCI). However, coronary artery bypass grafting (CABG) is still considered the first choice treatment. Randomized trials comparing PCI and CABG are ongoing, yet patient selection will considerably limit their clinical applicability. We thus designed a prospective multicenter registry which will include patients with ULM disease independently from the subsequent medical, interventional or surgical treatment: the RITMO Study (Registro Italiano sul Trattamento del tronco coMune non protettO). During the RITMO run-in phase, we conducted a systematic survey of Italian catheterization laboratories to define current management strategies for ULM. A total of 240 Italian catheterization laboratory were sent an email questionnaire on current practices for ULM, with 45 (19%) detailed replies, for a total of 61,370 annual coronary angiographies. Data provided from responders showed a 5% (95% interval: 2-16) prevalence of ULM, with 50% (9-99) of ULM treated surgically and 10% (0-81) treated percutaneously. In conclusion, treatment of ULM in Italy remains prevalently surgical, even if PCI is performed in a sizable portion of patients with ULM. (C) 2008 Elsevier Ireland Ltd. All rights reserved