Absence of PIA and proximal culprit lesions are associated with higher thrombus grade. Higher thrombus grade is associated with larger infarct size and slightly worse LV function. This may have clinical implications in planning strategies, particularly regarding pharmacotherapy, that aim to decrease thrombus burden prior to stent implantation.
Objectives Traditionally, early repolarisation (ER) is ► Athletes have a 50% higher prevalence of early repolarisation (ER). ► There is a 30% higher prevalence of ER in the inferior leads specifically in athletes.
A cardiac evaluation before orthotopic liver transplantation (OLT) is imperative. Previous investigations have demonstrated that mild to moderate reversible perfusion defects on myocardial perfusion scintigraphy (MPS) in general are associated with a low risk for perioperative cardiac events. The objective of this study was to assess any perfusion defects in consecutive patients with chronic liver disease who were undergoing OLT. OLT candidates underwent extensive cardiovascular screening that included, among other methods, MPS. Patients who had no contraindications for surgery and underwent OLT were followed up. The occurrence and risk of complications and mortality were compared in 3 groups of patients: patients with normal MPS results, patients with any reversible defect, and patients with a fixed perfusion defect on MPS. In all, 156 subsequent patients underwent OLT. One or more reversible segmental perfusion defects on MPS were present in 14 patients (<3 segments, n = 12; 3 segments without obstructive coronary artery disease, n = 2). The risk of complications did not differ significantly between patients with normal MPS findings and patients with a reversible perfusion defect (odds ratio = 3.04, 95% confidence interval = 0.65-14.26, P = 0.16), although the study was not sufficiently powered to show a difference. The presence of 1 or more reversible defects on MPS was significantly associated with an increased incidence of all-cause 1-year mortality (hazard ratio = 3.17, 95% confidence interval = 1.02-9.83, P = 0.046). No significant difference in the outcomes of patients with normal MPS findings and patients with a fixed defect on MPS was found; the study was, however, not adequately powered to do so. In conclusion, the results of this small cohort study indicate that patients with mild to moderate reversible perfusion defects on MPS may have inferior survival characteristics in comparison with patients with normal MPS results. A prospective, adequately powered study is required to confirm the results of this study.
Increased RV afterload was associated with increased haemodynamic complications and worse long-term survival in OLT recipients. Right ventricular function in patients with increased RV afterload was within normal range and not associated with postoperative outcome.
A n 83-year old woman with no cardiac history was admitted because of a non-ST-segment elevation myocardial infarction for which she underwent a diagnostic coronary angiography.The culprit lesion was considered to be a 70% stenosis in the mid left anterior descending coronary artery (LAD) just after the origin of a large septal branch ( Figure 1A). Percutaneous coronary intervention (PCI) was carried out with implantation of a drugeluting stent (3.0 Â 12-mm Promus Element, Boston Scientific, Natick, Massachusetts). After stent implantation, there was an occlusion of the septal branch, presumably caused by plaque shift. Despite several attempts, the branch could not be rewired, so the occlusion was accepted ( Figure 1B). The patient was discharged in good clinical condition 2 days after the procedure (maximum creatine kinase, 1,760 U/l).However, 8 days later, she was readmitted because of acute pulmonary edema. Transthoracic echocardiography showed a ventricular septal rupture with a large interventricular septal defect, as confirmed on cardiac computed tomography ( Figures 1C and 1D).Initially, she was stabilized and recompensated with the use of intravenous diuretics and an intra-aortic balloon pump. The defect was closed surgically with a bovine pericardial patch ( Figures 1E and 1F). The patient had an uneventful postoperative recovery.This case shows the post-PCI complication of an iatrogenic occlusion of a septal branch that caused extensive infarction of the interventricular septum leading to ischemic rupture. It reminds us that leaving a septal branch occluded after PCI of the LAD is not without risk, and every attempt should be made to restore flow.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.