A 42-year-old man was admitted to our hospital because of lumbago and tachycardia-induced heart failure. Transthoracic echocardiography revealed impaired left ventricular function and a ball mass of thrombus in the left ventricle (LV). He was found to have systemic embolism in the spleen, kidneys, brain, and limbs. The patient was treated with limb thrombectomy followed by anticoagulation. Seven days after the direct factor Xa inhibitor, rivaroxaban, was initiated, transthoracic echocardiography was repeated, revealing disappearance of the LV thrombus without any clinical signs of cardiogenic embolism. His heart failure responded well and the LV wall motion had improved. This case suggests rivaroxaban has fibrinolytic effects on thrombi even in the LV.
Introduction Data are limited regarding outcomes of cryoballoon ablation for atrial fibrillation (AF) in patients with heart failure (HF). This large‐scale multicenter study aimed to evaluate the prognosis of patients with HF after cryoballoon ablation for AF. Methods Among 3655 patients undergoing cryoballoon ablation at 17 institutions, 549 patients (15%) (391 with paroxysmal AF and 158 with persistent AF) diagnosed with HF preoperatively were analyzed. Clinical endpoints were recurrence, mortality, and HF hospitalization after ablation. Results Most patients had a preserved left ventricular ejection fraction (LVEF) ≥ 50%. During a mean follow‐up period of 25.7 months, recurrence, all‐cause death, and HF hospitalization occurred in 29%, 4.0%, and 4.8%, respectively. Cardiac function on echocardiography and B‐type natriuretic peptide (BNP) levels significantly improved postoperatively, and the effect was more pronounced in the nonrecurrence group. Major complications occurred in 33 patients (6.0%), but most complications were phrenic nerve palsy (3.6%). Although death and HF hospitalization occurred more frequently in patients with LVEF ≤ 40% (n = 73) and New York Heart Association (NYHA) class III–IV (n = 19) than other subgroups, the BNP levels, and LVEF significantly improved after ablation in all LVEF and NYHA class subgroups. High BNP levels, NHYA class, CHADS2 score, and structural heart disease, but not postablation recurrence, independently predicted death, and HF hospitalization on multivariate analysis. The patients with tachycardia‐induced cardiomyopathy had better recovery of BNP levels and LVEF after ablation than those with structural heart disease. Conclusions Cryoballoon ablation for AF in HF patients is feasible and leads to significantly improved cardiac function.
SummaryEven in the era of thrombus aspiration and distal protection for ST-segment elevation acute myocardial infarction (STEMI), microvascular dysfunction does exist and improvement of microvascular dysfunction can improve the prognosis and/or left ventricular dysfunction. We evaluated the acute effects of nitroprusside (NTP) on coronary microvascular injury that occurred after primary percutaneous coronary intervention (PCI) for STEMI in 18 patients. The final Thrombolysis in Myocardial Infarction trial (TIMI) flow grade after PCI was 3 in 17 patients and 2 in 1 patient. The index of microcirculatory resistance (IMR) was improved significantly from 76 ± 42 to 45 ± 37 (P = 0.0006) by intracoronary NTP administration. IMR improved to the normal range (IMR < 30) in 9 patients (50%). Higher TIMI flow grade and lower IMR at baseline were observed more frequently in patients whose IMR recovered to normal range after NTP administration. NTP improved the microcirculatory dysfunction at the acute phase in patients who underwent PCI for STEMI and had final TIMI 3 flow in almost all cases. (Int Heart J 2012; 53: 337-340) Key words: Acute myocardial infarction, Reperfusion, Index of microcirculatory resistance, Slow flow, Complication S everal methods have been proposed to evaluate the prognosis of patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). Despite the importance of microvascular coronary dysfunction for a prognosis, accurate estimation of microvascular function is challenging immediately after reperfusion for AMI. Although epicardial coronary blood flow at final angiography is one of the predictive factors with which to evaluate left ventricular function recovery in the chronic stage, thrombolysis in myocardial infarction trial (TIMI) flow grade 3 is not adequate and more accurate modalities have been reported, such as the corrected TIMI flow count 1) and Blush score. 2)Fearon, et al 3) reported that, compared to other traditional methods for assessing the microcirculation, the index of microcirculatory resistance (IMR) is a better predictor of microvascular damage and recovery of left ventricular function after STsegment elevation AMI (STEMI). Sezer, et al 4) also reported that the IMR measured early (2 days) after STEMI independently predicted the infarct size at follow-up (5 months). Treatment for microcirculation injury after PCI for an occluded coronary artery is important, although evidence showing its effect is scarce. On the basis of these findings, further studies evaluating therapeutic approaches for improving microvascular integrity at the acute phase of STEMI that might improve infarct healing and functional recovery are warranted. Sodium nitroprusside (NTP), which is a direct donor of nitric oxide, 5) strongly dilates the resistance arterioles and plays a significant role in coronary blood flow through the microcirculation, 6,7) and requires no intracellular metabolism to derive nitric oxide. Thus, this study was planned to evaluate the effect o...
In the field of coronary artery stenting, restenosis issue has been almost resolved after development of drug-eluting stents (DESs). In-stent restenosis (ISR) is generally considered to be a stable process, with an early peak in intimal hyperplasia followed by a quiescent period beginning 1 year after stent implantation. However, recently, extended-term problem (over 1 year) in both baremetal stents (BMSs) and DES has been reported. This phenomenon seems to be different from early ISR within one year in terms of its mechanism, prevention, and treatment. In this paper, we discuss this topic from the standpoint of intracoronary imagings and histopathology, referencing several interesting cases we experienced.
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.