1.Redo-left Ventricular Volume Reduction Surgery in a Patient with Left Ventricular Aneurysm: 1 case.
Sak LEE ; Chang Young LEE ; Kyo Jun LEE ; Kyung Jong YOO
The Korean Journal of Thoracic and Cardiovascular Surgery 2005;38(1):63-66
Surgical anterior ventricular endocardial restoration (SAVER) is a technique that improves hemodynamic status by excluding akinetic or dyskinetic portions of the left ventricle, restores the ventricle to normal elliptical shape and reduces ventricular wall tension to normal level in patients with acute anterior wall myocardial infarction that accompanies aneurysm. We performed redo-SAVER procedure in a 40-year old man with remodeled dilated ventricle who had already underwent LV aneurysmectomy 12 years earlier, and the results were satisfactory.
Adult
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Aneurysm*
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Anterior Wall Myocardial Infarction
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Heart Ventricles
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Hemodynamics
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Humans
2.Coronary Slow Flow Phenomenon Leads to ST Elevation Myocardial Infarction.
Korean Circulation Journal 2013;43(3):196-198
The exact etiology of the coronary slow flow phenomenon (CSFP) is not certain. CSFP is not a normal variant as it is an absolutely pathological entity. Furthermore, CSFP not only leads to myocardial ischemia but it can also cause classical acute ST elevation myocardial infarction, which necessitates coronary angiography for a definite diagnosis.
Anterior Wall Myocardial Infarction
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Coronary Angiography
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Myocardial Infarction
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Myocardial Ischemia
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No-Reflow Phenomenon
3.Correlation of ST Segment Elevation in Lead V1 and the Conal Branch of Right Coronary Artery in Patients with Acute Anterior Wall Myocardial Infarction.
Ho Shik SHIN ; Su Hong KIM ; Eun Seok KIM ; Jin Wuk HUR ; Byung Joo CHOI ; Seong Man KIM ; Tae Joon CHA ; Seung Jae JOO ; Jae Woo LEE
Korean Circulation Journal 2003;33(10):871-877
BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction*
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Arteries
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Coronary Vessels*
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Electrocardiography
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Heart Failure
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Humans
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Incidence
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Myocardial Infarction
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Prognosis
4.Usefulness of Myocardial Longitudinal Strain in Prediction of Heart Failure in Patients with Successfully Reperfused Anterior Wall ST-segment Elevation Myocardial Infarction
Sun Hwa LEE ; Sang Rok LEE ; Kyoung Suk RHEE ; Jei Keon CHAE ; Won Ho KIM
Korean Circulation Journal 2019;49(10):960-972
BACKGROUND AND OBJECTIVES: Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LSant) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF. METHODS: A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups. RESULTS: In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LSant was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF. CONCLUSIONS: GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LSant was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.
Anterior Wall Myocardial Infarction
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Arteries
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Echocardiography
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Heart Failure
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Heart
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Humans
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Multivariate Analysis
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Myocardial Infarction
5.Cognition and progress of de Winter electrocardiogram pattern.
Aihua WANG ; Jing XU ; Zijun CHEN
Journal of Central South University(Medical Sciences) 2021;46(4):421-425
The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.
Anterior Wall Myocardial Infarction
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Cognition
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Coronary Angiography
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Electrocardiography
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Humans
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ST Elevation Myocardial Infarction/diagnosis*
6.Incidence of Left Ventricular Thrombus after Acute Myocardial Infarction.
In Ho LEE ; Lim Do SUN ; Wan Joo SHIM ; Young Hoon KIM ; Hong Suck SUH ; Young Moo RO
Korean Circulation Journal 1992;22(1):48-55
BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction
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Echocardiography
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Humans
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Incidence*
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Inferior Wall Myocardial Infarction
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Myocardial Infarction*
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Prospective Studies
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Thrombolytic Therapy
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Thrombosis*
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Urokinase-Type Plasminogen Activator
7.Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction.
Man Yong HONG ; Dae Hee SHIN ; Jang Hoon KWON ; Woo Sung CHANG ; Kyu Un CHOI ; Yun A SONG ; Kwang Hoon OH ; Je Hoon LEE
Korean Circulation Journal 2013;43(6):408-410
Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.
Angiography
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Anterior Wall Myocardial Infarction
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Arteries
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Coronary Angiography
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Coronary Vessel Anomalies
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Coronary Vessels
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Myocardial Infarction
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Percutaneous Coronary Intervention
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Sinus of Valsalva
8.Assessment of risk factors for patients with anatomical left ventricular aneurysm post acute ST-elevation myocardial infarction by use of multiple-risk-factor assessment models.
Wanglexian SUN ; Huiling LIU ; Na ZHANG ; Aiwen ZHANG ; Mingfei JU ; Wenfeng WANG ; Fei SHI ; Na HU ; Jing SUN ; Haiwei BU ; Chunhua LI
Chinese Journal of Cardiology 2015;43(1):51-55
OBJECTIVETo set up the multiple risk factors model of patients with anatomical left ventricular aneurysm (LVA) post acute ST-elevation myocardial infarction (STEMI) and quantitatively assess the pathopoiesis of all the factors.
METHODSA total of 518 consecutive inpatients with acute STEMI hospitalized from June 2010 to December 2013 in our hospital were enrolled in this study, patients were divided into two groups: LVA group (n = 106, 20.5%) and non-LVA group (n = 412, 79.5%). All demographic and clinical data were collected by cardiologists. Finally, all of the risk factors for anatomical LVA in the acute STEMI patients were quantitatively analyzed by a binary logistic regression model.
RESULTSThe multiple risk factors logistic regression model was set up for the anatomical LVA in patients with acute STEMI. Anterior wall myocardial infarction, occlusion of the left anterior descending branch, two or three vessels stenosis, high systolic blood pressure, sinus tachycardia and white blood cell count over 10 000 per microliter were all independent risk factors of the LVA in acute STEMI, with the odds ratio (OR) 18.21, 21.56, 4.22, 7.16, 1.98 and 1.57, respectively (all P < 0.05) . However, first medical contact less than 12 hours (OR = 0.60), collateral circulation of the coronary arteries(OR = 0.53), primary percutanous coronary intervention(OR = 0.23) and venous thrombolysis(OR = 0.12) were all protecting factors of the LVA in acute STEMI patients (all P < 0.05).
CONCLUSIONAnterior wall STEMI, occlusion of the left anterior descending branch, two or three vessels stenosis, high systolic blood pressure, sinus tachycardia and white blood cell count over 10 000 per microlitre are independent risk factors of the LVA in acute STEMI patients. However, first medical contact less than twelve hours, collateral circulation of the coronary arteries, together with the primary percutanous coronary intervention and venous thrombolysis are protective factors of the LVA in patients with acute STEMI. It is important for cardiologists to assess the risks of LVA and make emergent and suitable efforts to reduce the risk of developing LVA in STEMI patients.
Acute Disease ; Anterior Wall Myocardial Infarction ; Collateral Circulation ; Heart Aneurysm ; epidemiology ; Humans ; Logistic Models ; Myocardial Infarction ; Risk Factors
9.The relationship between plasma BNP level and the left ventricular dysfunction parameters in patients with acute myocardial infarction and it's value in diagonosing heart failure..
Yi MAO ; Yue-Jin YANG ; Jian ZHANG ; Ling YE ; Dong-Yun ZHAO ; Xin-Hai NI ; Ji-Lin CHEN ; Run-Lin GAO ; Zai-Jia CHEN
Chinese Journal of Cardiology 2009;37(3):218-222
OBJECTIVETo explore the correlation between plasma BNP level and left ventricular dysfunction parameters in patients with acute myocardial infarction (AMI).
METHODSPlasma BNP level was determined in 230 consecutive inpatients with AMI and 111 normal controls. Patients were grouped according Killip grades, LVEF and LVEDd, respectively. BNP was transformed into lnBNP for the normal distribution. The receiver operator characteristic curve (ROC curve) was drawn to determine the best threshold and criteria for diagnosing heart failure.
RESULTSAfter AMI, lnBNP levels increased significantly in proportion with increasing Killip grades (I-III), and decreasing LVEF (all P < 0.05). lnBNP level was significantly higher in LVEDd > 55 mm group than in the LVEDd < 55 mm group (P < 0.01). lnBNP, LVEDd and LVEF all linearly correlated with Killip grades (P < 0.05) and the best correlation was shown between lnBNP and Killip grades (r = 0.53, P < 0.05). lnBNP also positively correlated with LVEDd (r = 0.17, P < 0.05) and negatively correlated with LVEF (r = -0.41, P < 0.01). Among the parameters, lnBNP level presented the largest AUC in their ROC curves (P < 0.01) for diagnosing decompensated heart failure and cardiogenic shock. The sensitivity, specifiticity and accuracy rates for diagnosing decompensated heart failure were 84.9%, 45.0% and 70.0% respectively by lnBNP at the cut point of 140 ng/L. The sensitivity, negative predicting value and accuracy rate for diagnosing cardiac shock were 82.8%, 66.7% and 67.4% respectively by BNP at the cut point of 400 ng/L.
CONCLUSIONlnBNP level in hospitalized patients with AMI was positively correlated with Killip grades and LVEDd, negatively correlated with LVEF and could serve as a parameter for diagnosing the decompensated heart failure and excluding the cardiac shock.
Anterior Wall Myocardial Infarction ; Heart Failure ; diagnosis ; Humans ; Myocardial Infarction ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Ventricular Dysfunction, Left ; diagnosis
10.Ischemic postconditioning improves longitudinal contractile function of the reperfused myocardium in patients with anterior wall acute myocardial infarction.
Zurong YANG ; Qichang ZHOU ; Zhenfei FANG ; Li YU ; Jiawei ZHOU ; Baihua ZHAO
Journal of Central South University(Medical Sciences) 2019;44(12):1397-1405
To investigate whether ischemic postconditioning (IPTC) can promote the recovery of left ventricular impaired regional or global longitudinal systolic function.
Methods: The trial was divided into a percutaneous coronary intervention (PCI) group, an PCI+IPTC group and a control group. Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCI group, 28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in the PCI+IPTC group, while 30 patients underwent coronary angiography in the control group. Two-dimensional dynamic echocardiography was collected before operation, 0.5 h, 1 day, 3 days, 1 week, 1 month and 6 months after operation, respectively. The longitudinal strain parameters at different time points were analyzed and compared in the 3 groups.
Results: The regional longitudinal strain of infracted segments in the PCI+IPTC group after the operation within 1 week was higher than that in the PCI group (P<0.05). The left ventricular global longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI group after the operation within 1 week, but there was not statistically difference (P>0.05). There was no significant difference in the long-term regional and global longitudinal strains of left ventricle between the PCI+IPTC group and the PCI group (both P>0.05).
Conclusion: The IPTC can improve the short-term longitudinal systolic function of the reperfused myocardium in patients with acute anterior wall STEMI after PCI.
Anterior Wall Myocardial Infarction
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Humans
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Ischemic Postconditioning
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Myocardium
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Percutaneous Coronary Intervention
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ST Elevation Myocardial Infarction
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Treatment Outcome
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Ventricular Function, Left