There is impairment of LV systolic and diastolic function in SCF patients with clinical impact on exercise capacity which emphasizes the importance of close follow-up of these patients for risk stratification.
Patients with slow coronary flow have increased mean platelet volume which was associated with insulin resistance in non-diabetic slow coronary flow patients. TIMI frame counts correlated with mean platelet volume and increased insulin resistance. Thus, insulin resistance and platelet activity may have a role in the pathogenesis of slow coronary flow. Also, they may have a possible benefit as follow-up markers in non-diabetic patients with slow coronary flow.
The study found pain to reperfusion time, MI territory, ST resolution, basal GLS value are the most important predictors of myocardial functional recovery. Regular follow-up with echocardiography for STEMI patients with different reperfusion strategies has informative impact on long-term clinical outcome. Also the study confirmed that PPCI is better than thrombolysis not only in restoring epicardial coronary flow but also in restoring microvascular and tissue perfusion assuring better myocardial functional recovery and better long-term clinical outcomes.
Background Arterial stiffness is strongly predictive for cardiovascular events in hypertensive individuals and it may increase the risk of stroke. This study was designed to evaluate the possible relationship between arterial stiffness and atrial electromechanical delay and P wave dispersion (PWD), as determinants of AF risk.
Materials and MethodsThe study included 75 hypertensive patients and 45 healthy control subjects. Atrial electromechanical coupling (time interval from the onset of P wave on ECG to the beginning of A wave with tissue Doppler echocardiography [PA]), intraatrial and interatrial electromechanical delay (EMD) and PWD were measured. Stiffness index β & PWV was measured to assess the arterial stiffness. Results The interatrial EMD and PWD were prolonged in hypertensive patients compared to controls (p< 0.01 for both), There was increased arterial stiffness (PWV and stiffness index β) in hypertensive patients compared to controls (6.43 ± 1.73 vs. 4.8 ± 1.6 m/sec & 4.9 ± 2.8 vs. 2.63 ± 1.2, p<0.01 for both). By multivariate analysis; PWV and Stiffness index β were independently correlated with interatrial EMD (B ± SE= 0.42 ± 1.87, B ± SE=0.39 ± 0.21 p<0.01 for both) and PWD (B ± SE=0.37 ± 1.93, p<0.01, B ± SE=0.25 ± 0.18, p<0.05 respectively). Conclusion In hypertensive patients arterial stiffness indexes increased and showed a significant correlation with interatrial EMD and PWD independent of other variables. Further research is needed to determine whether interventions that reduce arterial stiffness will limit the growing incidence of AF.
Plaque rupture (PR) and superimposed thrombosis have been shown as the most frequent underlying substrate in acute coronary syndromes (ACS). Coronary angiography is a luminogram not able to define in vivo features of the culprit plaques. The aim of the study was to use optical coherence tomography (OCT) to investigate the pathology underlying complex (CL) and non-complex angiographic lesions (NCL). We retrospectively enrolled 107 ACS patients admitted to our institution; 83 with non-ST elevation ACS (NSTE-ACS) and 24 with ST-elevation myocardial infarction. Coronary angiography was performed and culprit lesions were classified according to Ambrose criteria into NCL (n = 47) and CL (n = 60). OCT imaging was then performed to better identify plaque morphology; either PR or intact fibrous cap, the presence of superimposed thrombosis, lipid rich plaque, and thin cap fibroatheroma (TCFA). OCT analysis showed that 58 lesions (54.2%) were classified as PR and 48 lesions (44.9%) were associated with thrombi. Lipid rich plaques were identified in 62 lesions (57.9%). PR, intracoronary thrombi, lipid rich plaques and TCFA were more frequent in CL compared with NCL (71.7 vs 31.9%, 63.3 vs 21.3%, 71.7 vs 40.4% and 46.7 vs 21.3% respectively), but PR with superimposed thrombus may be also detected in NCL. OCT demonstrates PR and thrombosis in the majority of ACS patients presenting with CL. However, one-third of NCL show PR by OCT, suggesting that additional intracoronary imaging by OCT may better identify the underlying mechanism of coronary instability than coronary angiography alone.
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