on-invasive assessment of angiographic culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. 1,2 However, identification of these lesions would improve risk assessment and further management for patients after AMI. 3 In comparative studies with intracoronary ultrasound (ICUS), multidetector row computed tomography (MDCT) provides an accurate identification of coronary plaque crosssectional area, vessel size and coronary remodeling. [4][5][6] Furthermore, MDCT density values measured within plaques reflect echogenity and plaque composition. 4 MDCT has a high accuracy for the detection of significant coronary artery disease in patients with stable angina. 7 Furthermore, MDCT has been shown to be safe and accurate in assessing the severity of the infarct-related artery and the number of diseased vessels during the first week after AMI. [8][9][10][11] However, there is scarce published data on plaque texture evaluated by 64-slice MDCT in patients early after AMI. In this prospective study, we focus on MDCT to predict culprit lesions and identify multiple complex lesions in patients early after first AMI. Methods PatientsOne hundred and twenty-eight consecutive patients with first non-ST elevation AMI were admitted to our hospital. Diagnosis of non-ST elevation AMI was made on the basis of typical anginal pain lasting more than 30 min, new electrocardiographic change that included ST-segment depression ≥0.1 mV in ≥2 contiguous electrocardiographic leads, Q wave or other ST/T changes lasting more than 48 h, peak creatine kinase more than 2 times the upper limit of normal, and wall motion abnormalities by echocardiography.We excluded 25 of 128 patients according to our criteria, including: cardiogenic shock (2 patients), clinical signs of severe heart failure (4 patients), chronic atrial fibrillation (2 patients), allergy history to contrast (2 patients), bronchial asthma (1 patient), persistent chest pain undergoing rescue angioplasty (3 patients), refuse to participate in the study (3 patients), serum creatinine clearance below 70 ml/min (2 patients), motion artifacts (2 patients) and heavy calcifiCirc J 2008; 72: 1806 -1813 (Received February 22, 2008; revised manuscript received June 1, 2008; accepted June 24, 2008; released online September 24, 2008 Assessing Culprit Lesions and Active Complex Lesions in Patients With Early Acute Myocardial Infarction by Multidetector Computed TomographyWei-Chun Huang, MD* , **; Ming-Ting Wu, MD** , † ; Kuan-Rau Chiou, MD* , **; Guang-Yuan Mar, MD*; Shih-Hung Hsiao, MD*; Shih-Kai Lin, MD*; Tung-Cheng Yeh, MD*; Yi-Luan Huang, MD † ; Hsiang-Chiang Hsiao, MD* , **; Doyal Lee, MD*; Chuen-Wang Chiou, MD* , **; Shoa-Lin Lin, MD* , **; Chun-Peng Liu, MD* , ** Background Accurate, non-invasive characterization of culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. In this prospective study, multidetector row computed tomography (MDCT) is used to assess culprit and active complex lesions in patients early after AMI. ...
Persistent left superior vena cava occurs in approximately 0.5% of the population. This may complicate pacemaker implantation by making lead insertion difficult and causing lead instability through the left cephalic vein and the subclavian vein approach. We used a wide loop technique in the right atrium and successfully advanced the lead in the right ventricle apex. A persistent left superior vena cava does not preclude successful lead placement.
It is found that the frequency components of atrial rate variation (ARV) of A V-block patient with fixed-rate ventricular pacing valy irregularly with the pacing rates.We attempt to learn about the relationship between the oscillation frequency of AR V and the blood pressure (BP) pattern in this study.The beat-to-beat AR Vs extracted from esophageal ECG and noninvasive BP waveforms of seven AV-block patients were recorded. Each patient was paced under 60, 90, 120 beatdmin of three ventricular rates. Results reveal that the oscillation frequency of ARV does not correlate to the variation frequency of systolic or diastolic BP or respiration frequenc.y. Instead, it may be an aliasing phenomenon of BP pulse frequency exactly equal to ventricular rate when the mean atrial rate is considered as the sample rate of ARV signal. This study suggests that the BP pulse dominate the ARV in AV asynchronous situation IntroductionTwo main frequency components of heart rate variation (HRV) in low frequency (0.04-0.15 Hz) and high frequency (0.15-0.4 Hz) bands, respectively, have been identified and used to clinical assessment of autonomic balance in cardiac control. The high frequency oscillation of HRV correlating to the respiration has been verified. But the origin of low frequency oscillation is more complicated and still under investigation.The heart rate variation expresses the dynamics in the feedback system of heart rate control. To observe the atrial rate variability (ARV) of AV-block patient paced with different fixed ventricular pacing rate will help to understand the heart rate control mechanism. Recently, we have used the PP intervals on an esophageal lead for analysis of ARV in patients with AV block [ 11. It was shown that AV block patients had ARV differing from normal subjects. Some studies also have reported that ventricular rate and AV-delay have marked influences on ARV [2-41. Moreover, we found that the frequency components of ARV of AV-block patient with fixed-rate ventricular pacing vary irregularly with the pacing rates in a pilot study [5]. Hence we hardly figured out any conclusion for the influences of ventricular rates and AVdelays to ARV. Some evidences have reveal that the blood pressure (BP) variations play an important role in HRV [6,7]. Therefore, we attempt to learn about the relationship between the oscillation frequency of ARV and the BP pattern in this study. 2.Materials and methods PatientsSeven AV block patients loaded with VDD pacemakers were included in this study. All these patients demonstrated normal atrial activity in surface ECG and absence of ventriculo-atrial conduction during ventricular pacing. Patients lay on a table and breathed normally. During the whole experimental procedure, the breathing rate had no marked change. MethodsAn esophageal lead was used to non-invasively record the atrial ECG. PP intervals on the atrial ECG were acquired with the method used in a previous studyThe ARVs of each patient at three different fixed ventricular pacing rates (VVI mode, 60, 90 and 120 bp...
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