akotsubo-like left ventricular (LV) dysfunction ischaracterized by a unique morphologic feature on left ventriculography (LVG) and some clinical features, including a predominance in elderly women, as well as a favorable prognosis. [1][2][3][4][5][6][7][8][9] The LV wall motion abnormality is quite different from that in myocardial infarction; it occurs in the LV apical region (LV apical ballooning), but improves within several weeks. The precise mechanism remains still unclear. Kurisu et al reported that coronary microcirculation, assessed by thrombolysis in myocardial infarction trial frame count, is impaired in patients with takotsubo-like LV dysfunction. 4 And Nishikawa et al reported that coronary microvascular function assessed by 99m Tc-tetrofosmin myocardial single photon emission computed tomography is impaired in patients with takotsubo-like LV dysfunction. 6 It has been also reported that the coronary flow velocity (CFV) pattern and CFV reserve (CFVR), measured with a Doppler guidewire, reflect the degree of coronary microvascular dysfunction under stable hemodynamic conditions in the absence of epicardial coronary stenosis, 10-14 so the aim of the present study was to evaluate coronary microcirculation in patients with takotsubo-like LV dysfunction by analyzing CFV pattern and CFVR in the acute phase and 3 weeks later. Methods Study PatientsWe studied 8 consecutive patients with takotsubo-like LV dysfunction (7 females, 1 male). All patients were diagnosed with takotsubo-like LV dysfunction according to the following criteria: (1) LV wall motion abnormality mainly at the apex on LVG; (2) ST-segment elevation or T-wave abnormality in at least 2 contiguous electrocardiogram (ECG) leads; (3) no history of prior myocardial infarction; and (4) normal coronary angiography (CAG) (luminal narrowing of <25% in all 3 coronary arteries). We excluded patients with subarachnoid hemorrhage, pheochromocytoma crisis, atrial fibrillation, hypertrophic cardiomyopathy, severe valvular heart disease and post-tachycardia condition. The existence of hypertension, hyperlipidemia, diabetes mellitus, and smoking were determined, using the following criteria: hypertension was defined as blood pressure >140/90 mmHg or current medication; hyperlipidemia was defined as total cholesterol concentration >220 mg/dl, triglyceride concentration >150 mg/dl or current medication; diabetes mellitus was defined as fasting plasma glucose concentration >120 mg/dl, plasma glucose concentration (anytime) >200 mg/dl or current medication. Within 24 h of symptom onset, LVG and CAG were performed by the femoral approach after intravenous infusion of 5,000 U of heparin. LV end-diastolic pressure (LVEDP) was obtained before LVG. After confirming the LV apical wall motion abnormality and normal CAG, the phasic CFV spectrum was recorded at rest and during hyperemia induced by an intravenous injection of 0.15 mg·kg -1 ·min -1 adenosine 5'-triphosphate, in the middle portion of the left anterior descending coronary artery (LAD), the left circumflex ar...

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecause of the rapid increase in cases of calcific aortic stenosis (AS) in industrialized countries, there are increasing numbers of symptomatic elderly patients who do not undergo aortic valve surgery because the surgical intervention poses significant risks related to coexisting comorbidities. 1,2 As a result, there are growing concerns regarding the poor prognosis of these patients and the increased associated medical costs. 3 Transcatheter aortic valve implantation (TAVI) has recently emerged as an alternative to surgery in high-risk patients with AS. 4-7 Detailed anatomical information regarding the aortic root geometry is important for selecting candidates for successful TAVI while avoiding associated complications. Recent studies have reported that multidetector computed tomography (MDCT) provides 3-dimensional (D) morphological information on the geometry of the aortic root, as well as the spatial relationship between the aortic annulus and the ostia of the left and right coronary arteries (LCA and RCA, respectively). 8-11 However, because of its known limitations, MDCT cannot be performed in all patients.Real-time 3D transesophageal echocardiography (3DTEE) has the potential to provide 3D information regarding aortic root morphology. We hypothesized that real-time 3DTEE could be a useful alternative for assessing aortic root geometry. Accordingly, the aims of this study were: (1) to validate 3DTEE measurements of aortic root using MDCT measurements as a reference, and (2) to examine whether the aortic root geometry differs between patients with and without AS. Methods Study PopulationProtocol 1 We retrospectively enrolled 35 patients referred for MDCT coronary angiography who underwent Background: Precise evaluation of the aortic root geometry prior to transcatheter aortic valve implantation is important for procedural success in patients with aortic stenosis (AS). To determine the potential for 3-dimensional transesophageal echocardiography (3DTEE), the aims of the present study were: (1) to assess the accuracy of 3DTEE measurements of the aortic root using multidetector computed tomography (MDCT) as a reference, and (2) to examine whether aortic root geometry differs between patients with and without AS.

LAVIs by both 2DE and 3DE are powerful predictors of future cardiac events. 3D LAVImin tended to have a stronger and additive prognostic value than 3D LAVImax.

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