Bilateral coronary arteriovenous fistula (CAVF), arising from both the right and left coronary arteries, are rare. We experienced a 44 years old male patient with bilateral CAVF, and coronary atherosclerosis, whose diagnosis was confirmed by coronary angiography. The hemodynamic result revealed minimal left-to-right shunt. Therefore, only percutaneous coronary artery intervention of the coronary artery stenosis was performed. Here, this rare case is reported, with a review of the literature.
Adult ; Arteriovenous Fistula* ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Hemodynamics ; Humans ; Male

OBJECTIVEThe objective was to delineate the current knowledge of fractional flow reserve (FFR) in terms of definition, features, clinical applications, and pitfalls of measurement of FFR.

DATA SOURCESWe searched database for primary studies published in English. The database of National Library of Medicine (NLM), MEDLINE, and PubMed up to July 2014 was used to conduct a search using the keyword term "FFR".

STUDY SELECTIONThe articles about the definition, features, clinical application, and pitfalls of measurement of FFR were identified, retrieved, and reviewed.

RESULTSCoronary pressure-derived FFR rapidly assesses the hemodynamic significance of individual coronary artery lesions and can readily be performed in the catheterization laboratory. The use of FFR has been shown to effectively guide coronary revascularization procedures leading to improved patient outcomes.

CONCLUSIONSFFR is a valuable tool to determine the functional significance of coronary stenosis. It combines physiological and anatomical information, and can be followed immediately by percutaneous coronary intervention (PCI) if necessary. The technique of FFR measurement can be performed easily, rapidly, and safely in the catheterization laboratory. By systematic use of FFR in dubious stenosis and multi-vessel disease, PCI can be made an even more effective and better treatment than it is currently. The current clinical evidence for FFR should encourage cardiologists to use this tool in the catheterization laboratory.

Coronary Stenosis ; diagnosis ; Fractional Flow Reserve, Myocardial ; physiology ; Humans

Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Disease ; diagnosis ; pathology ; Coronary Stenosis ; diagnosis ; pathology ; Fractional Flow Reserve, Myocardial

OBJECTIVETo study the association of red blood cell distribution width (RDW) and lipoprotein-associated phospholipase A2 (LP-PLA2) with the degree of coronary artery stenosis in patients with coronary artery disease (CAD) and the value of RDW combined with LP-PLA2 detection in accurate evaluation of coronary artery stenosis.

METHODSA total of 224 patients including 119 non-CAD cases and 105 CAD cases admitted in our hospital between June, 2013 and June, 2014 were enrolled in this study. The patients' baseline clinical data were collected and venous blood samples were obtained for detecting WBC, RDW-CV and LP-PLA2. The Gensini score of the CAD patients was calculated based on coronary angiographic findings.

RESULTSCompared with the non-CAD patients, CAD patients had significantly higher RDW-CV (P=0.009) and LP-PLA2 (P=0.004) levels. The CAD patients with high Gensini scores had also significantly higher RDW-CV (P=0.001) and LP-PLA2 (P<0.001) levels than those with low scores; RDW-CV and LP-PLA2 were significantly correlated with the Gensini score, and the area under curve of their combined detection was 0.931.

CONCLUSIONCombination of RDW and LP-PLA2 can improve the diagnostic accuracy of the degree of coronary artery stenosis in patients with CAD.

1-Alkyl-2-acetylglycerophosphocholine Esterase ; blood ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Coronary Stenosis ; diagnosis ; Erythrocyte Count ; Erythrocytes ; cytology ; Humans

BACKGROUND: The interpretation of electrocardiographic change in treadmill exercise test is difficult when the test is performed in patients with abnormal resting electrocardiography. In patients with primary nagative T wave, normalization of primary negative T wave(pseudonormalization)is not uncommon finding during treadmill exercise test. The mechanism of pseudonormalization is uncertain and the interpretation is difficult. Thus this study was performed to evaluate the diagnostic significance of pseudonormalization during treadmill exercise test. METHODS: 200 cases who showed primary negative T wave at rest were included in this study. The results were classified as positive, borderline positive, borderline negative, negative, non-diagnostic and pseudonormalization. RESULTS: Pseudonormalization during treadmill exercise test was oberved in 78(39%) of the 200 cases who had primary negative T wave at rest. Coronary angiography and left ventriculography were performed in 13(mean age 56+/-7 year, male vs. female 1:2.25) of 78 cases who showed pseudonormalization during exercise. They had no history of acute myocardial infarction and no abnormalities such as abnormal Q wave, left ventricular hypertrophy,bundle branch block,right ventricular hypertrophy and QRS widening above 0.1ms in resting electrocardiography. There were significant stenosis in only 3 cases; 2 cases in left anterior descending coronary artery and 1 case in right coronary artery. CONCLUSION: In treadmill exercise tests, pseudonormalization appears as non-specific finding for the diagnosis of ischemic heart disease becuase it is observed in either patients with or without coronary artery stenosis.
Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Exercise Test* ; Female ; Humans ; Hypertrophy ; Male ; Myocardial Infarction ; Myocardial Ischemia*

OBJECTIVE: To observe the 3-dimensional speckle tracking imaging (3D-STI) in clinical diagnosis of coronary artery disease by quantitatively evaluating left ventricular segmental and global systolic function. METHODS: According to the selective coronary artery angiography, 150 inpatients suspected of coronary artery disease were divided into 5 groups according to the distribution of the affected coronary arteries: a left anterior descending coronary artery group (LAD, n=46), a left circumflex coronary artery group (LCX, n=25), a right coronary artery group (RCA, n=23), a multivessel group (n=26), and a normal group (n=30). Gensini score was calculated according to coronary artery angiography. Conventional echocardiography was applied in each patient and wall motion score index (WMSI) was calculated. 3D-STI was applied in each patient to evaluate the segmental and global systolic function in the left ventricle. RESULTS: Compared with the normal group, ejection fraction was decreased in the multi-vessel group alone (P<0.05). Peak systolic 3D strains in all segments were decreased in the multi-vessel group (P<0.01), while peak systolic 3D strains in the main blood-supply segments were decreased significantly in the rest of the groups (P<0.05). Global 3-dimensional strain (G3DS) was negatively correlated with Gensini score in patients with coronary artery disease (r= -0.76, P<0.01). Receiver operating characteristic curve analysis demonstrated that G3DS was more sensitive and accurate in clinical diagnosis of coronary artery disease. CONCLUSION 3D-STI can quantitatively evaluate the segmental and global systolic function of the left ventricle, and reflect the extent of coronary artery stenosis in patients with coronary artery disease.
Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Coronary Stenosis ; Echocardiography ; Heart Ventricles ; Humans ; Imaging, Three-Dimensional ; ROC Curve ; Systole

BACKGROUND: Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. METHODS: 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). RESULTS: The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. CONCLUSION: In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.
Ambulatory Care Facilities ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diagnosis ; Echocardiography, Stress* ; Electrocardiography* ; Exercise Test ; Female ; Head* ; Heart Rate ; Humans ; Ischemia ; Sensitivity and Specificity

OBJECTIVETo investigate the impact of depression on clinical outcome of patients undergoing revascularization.

METHODSSelf-rating depression scale (SDS) assessment was made before and after coronary artery bypass grafting (CABG, n = 345) and percutaneous coronary intervention (PCI, n = 308) procedure. Patients were divided into depression and non-depression group. All patients were followed up for 12 months after procedure for the occurrence of rehospitalization and major adverse cardiovascular events (MACE) including all-cause mortality, nonfatal myocardial infarction or target lesion revascularization.

RESULTSDepression was present in 40.9% (n = 141) of patients after CABG, which was significantly higher than before procedure (24.3%, P < 0.01). The MACE rate was significantly higher in patients with post-procedure depression [8.5% (12/141)] than in patients without depression [2.9% (6/204), P < 0.05] and the incidences of target lesion revascularization and rehospitalization were also significantly higher in depression patients than in non-depression patients during the 12 months follow-up (all P < 0.05). Depression was present in 36.4% (n = 112) of patients after PCI, which was significantly higher than that before procedure (28.6%, P < 0.05). The MACE rate [8.0% (9/112) vs. 2.0% (4/196)] and rehospitalization rate [12.5% (14/112) vs. 4.6% (9/196)] were significantly higher in depression patients than in patients without depression during the 12 months follow-up (P < 0.05). There was no significant difference on SDS score between the PCI and CABG before the procedure. However, after the procedure, the SDS score for patients undergoing CABG was significantly higher than in patients undergoing PCI (48.9 ± 9.8 vs. 45.7 ± 10.5 P = 0.01). The level of serum IL-6 was significantly higher in depression patients than in patients without depression (P < 0.05).

CONCLUSIONPrevalence of depression is high in patients treated with revascularization procedures and is linked with poor post-procedure prognosis.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; diagnosis ; psychology ; therapy ; Coronary Stenosis ; Depression ; etiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: We hypothesized that simultaneous assessment of myocardial perfusion and a regional wall motion abnormality, using real-time myocardial contrast echocardiography (MCE), provides more useful information than routine two-dimensional echocardiography (2DE) in the diagnosis of acute coronary syndrome in patients with a non-diagnostic ECG. SUBJECTS AND METHODS: We prospectively enrolled 101 patients (age:61+/-10 years, 57 men) who presented with acute chest pain. A routine 2DE was performed to evaluate the regional wall motion abnormality, and a MCE to assess the perfusion defect. Coronary angiography was performed in all patients. The cardiac events (myocardial infarction, revascularization and death) were analyzed. RESULTS: Of the 101 patients studied, 64 had significant coronary artery disease (diameter stenosis >0%). Cardiac events occurred in 58 patients;21 myocardial infarction, 48 revascularization. The sensitivities of 2DE and MCE for significant coronary artery stenosis were 57.8 and 73.4%, and the specificities were 83.8 and 81.1%, respectively. Of the 58 patients with cardiac events, a regional wall motion abnormality was observed in 34 (59%), and a perfusion defect in 44 (76%). The specificities of 2DE and MCE for cardiac events were 79 and 77%, respectively. Cardiac events were more frequent in males, smokers and in those with an abnormal ECG (p<.05), but only a perfusion defect independently predicted cardiac events (p<.001, odds ratio=8.37). CONCLUSION: Real time MCE, in patients with acute chest pain, reasonably predicts significant coronary artery stenosis, and identifies those who will have cardiac events.
Acute Coronary Syndrome ; Chest Pain* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Diagnosis ; Echocardiography* ; Electrocardiography ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Prospective Studies ; Thorax*

Multislice computed tomography (CT) is emerging technology that enables imaging the moving heart with high resolution. The current technology of CT is represented by 64-slice CT. CT is becoming the first-line evaluation tool for the detection of significant coronary artery stenosis and is applied for the detection of plaque composition and functional imaging. Significant coronary artery stenosis can be detected with a high accuracy over 90% and can be reliably excluded with a high negative predictive value approaching 100% by using 64-slice CT. CT coronary angiography is recommended not only to exclude significant stenosis in patients with equivocal symptoms or intermediate results on stress test but also to assess obstructive disease in symptomatic patients. Quantification of coronary artery calcium with CT is helpful to select patients for lipid-lowering therapies, who have intermediate coronary artery disease risk. With technical improvement, spatial and temporal resolution of CT will reach the level enough to establish the diagnoses of in-stent restenosis, plaque composition, and ventricular and valvular function in the foreseeable future. Myocardial imaging including myocardial perfusion and viability may be possible without increasing radiation exposure. CT is a very promising technology for cardiac imaging because, with technical improvement, clinical benefits are expected to be greater than the risk of radiation exposure. This short review is for readers (1) to understand CT technology for cardiac imaging, (2) to understand the limitation of current technology of CT for cardiac imaging, (3) to learn the current application of CT in cardiac diseases, (4) to get a perspective on the future directions of cardiac CT.
Calcium ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Heart ; Heart Diseases ; Humans ; Multidetector Computed Tomography ; Perfusion