70%) were involved in this study. Patients were assigned as intracoronary ?-radiation (Beta Cath 30 mm or 40 mm system, Novoste) with CBA group (n=112) and control group (n=183). Pullback radiation was performed for long ISR lesions. In the control group, the patients received intracoronary ?-radiation or CBA alone. In both groups, quantitative coronary angiography was performed, and target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) were documented. Results Clinical follow-up (6.3?1.6 months) was conducted in 106 patients (95%) in the intracoronary ?-radiation with CBA group and 172 patients (94%) in the control group. In the follow-up, in the intracoronary ?-radiation with CBA group, MLD was larger and DS was lower than that in the comparison group. Both TVR and MACE occurred significantly less in the intracoronary ?-radiation with CBA group than in the control group (5% vs 16% for TVR, and 10% vs 25% for MACE; P

The measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) with invasive intracoronary Doppler flow wire technique (ICD) was validated and the pathologicalfactors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery (LAD) in 37 of 40 patients with angiographically normal coronary arteries (men 22, women 15, age 20-75 years, mean age 54 ± 12 years). Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 140 μg/kg per min within 48 h after ICD technique. Average peak velocity at baseline (APVb), average peak velocity during hyperemia (APVh) and CFVR determined from TTDE were correlated closely with those from ICD measurements (APVb: y=0. 64x+5. 04, r=0. 86, P＜0. 001;APVh: y=0.63x+14.36, r=0.82, P＜0.001; CFVR: y=0.65x+0.92, r=0.88, P＜0. 001).For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12 ±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension (P＜0.05). Intravascular ultrasound (IVUS) was performed in 34patients. Plaque formation was found in LAD by IVUS in 17 (50 %) patients. No significant difference in CFVR was found between the patients without plaque formation (3. 11±0. 49) and those with plaque formation (2. 76±0.53, P=0. 056). It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal LAD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.

BACKGROUNDInvasive intravascular ultrasound (IVUS) is current diagnostic standard for myocardial bridging (MB). Non-invasive multislice computerized tomography coronary angiography (MSCT) technique has provided a good anatomical view of the tunnel artery now.

METHODSA total of 51 consecutive patients with atypical or typical angina scheduled for IVUS were enrolled in this study and MSCT was performed 7 days before IVUS. Coronary imaging was quantified using IVUS and MSCT. Four main vessels (left main artery (LMA), left anterior descending (LAD), left circumflex (LCX), right coronary artery (RCA)) were examined.

RESULTSForty-one out of 51 (80%) patients received metaprolol (25 mg) before the MSCT scan and 25 of them were current beta-blocker users. The mean heart rate was (64 +/- 3) beats per minute. A total of 51 patients underwent IVUS examination (30 with MB and 21 without MB) were chosen for this study. Twenty-eight out of 30 MB cases were correctly diagnosed by MSCT and 2 patients with MB were not detected. Comparison with IVUS, the sensitivity of detection by MSCT was 93%, specificity was 100%. The lumen diameter of the tunnel artery derived from MSCT and IVUS significantly decreased from (2.9 +/- 0.3) mm to (2.4 +/- 0.4) mm (P < 0.001) and from (3.3 +/- 0.3) mm to (2.6 +/- 0.5) mm (P < 0.001), respectively. Minimal and maximal diameters of MB derived from MSCT were significantly smaller than those from IVUS ((2.4 +/- 0.4) mm vs (2.6 +/- 0.5) mm, P < 0.05 and (2.9 +/- 0.3) mm vs (3.3 +/- 0.3) mm, P < 0.05), respectively.

CONCLUSIONSMSCT offers a reliable non-invasive method for MB in LAD and atherosclerosis diagnosis with diagnostic accuracy comparable with invasive IVUS.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; diagnostic imaging ; Tomography, Spiral Computed ; methods ; Ultrasonography, Interventional ; methods

BACKGROUNDThe purpose of this study was to assess the morphological changes and physiological function of coronary arteries in patients presenting with chest pain but having normal coronary angiograms, using intravascular ultrasound imaging (IVUS) and intracoronary Doppler (ICD) flow measurements, in order to elucidate the mechanism of syndrome X.

METHODSA total of 126 patients [67 males, 59 females, mean age (53.1 +/- 13.0) years] who experienced chest pain but had normal coronary angiograms were included in this study. ICD flow measurements of the left anterior descending coronary artery (LAD) were performed using a Cardiometrics FloMap II system. Coronary flow velocity reserve (CFVR) was defined as the ratio of the average peak velocity during hyperemia to that at baseline, induced by an intracoronary bolus injection of 18 microg adenosine. A 3.2F or 2.9 F 30 MHz mechanical rotating ultrasound catheter (CVIS, Boston Scientific) or a 3.0 F 20 MHz electronic ultrasound catheter (Endosonics) was used for IVUS.

RESULTSThe mean CFVR value of the LAD was 2.71 +/- 0.74. Reduction of CFVR (< 3.0) was found in 82 of 126 (65.1%) patients. IVUS images of the LAD were available for 109 patients. Plaque formation was detected in 76/109 (69.7%) patients. Based on the presence or absence of plaque formation as well as the reduction or non-reduction of CFVR, patients were divided into four groups: Group I (n = 10), normal IVUS findings and normal CFVR; Group II (n = 23), normal IVUS findings with reduction in CFVR; Group III (n = 29), IVUS evidence of plaque formation but normal CFVR; and Group IV (n = 47), IVUS evidence of plaque formation with reduction in CFVR.

CONCLUSIONThis study shows the important clinical value of a combination of IVUS and ICD in diagnosing patients with angiographically normal coronary arteries. Only 10% of patients studied (Group I) were found to be truly free of coronary disease, while 20% of patients (Group II) would be diagnosed as suffering from syndrome X.

Adult ; Aged ; Coronary Angiography ; Coronary Circulation ; Female ; Humans ; Laser-Doppler Flowmetry ; Male ; Microvascular Angina ; diagnosis ; physiopathology ; Middle Aged ; Ultrasonography, Interventional

Transthoracic Doppler echocardiography (TTDE) allows noninvasive flow measurement in the distal left anterior descending artery (LAD). The feasibility of detecting coronary flow by contrast-enhanced TTDE with second harmonic technique was assessed, the coronary flow velocity reserve (CFVR) was evaluated in comparison to intracoronary Doppler flow (ICD) analysis and the CFVR after PTCA in LAD was investigated. In 77 (96%) of 80 patients, CFVR was successfully determined with intravenous adenosine infusion. Doppler signal quality was evaluated in the first 46 patients by use of intravenous Levovist infusion and second harmonic technique. The Doppler flow was not visible in 1. patient only. CFVR determined from TTDE (2.77 +/- 0.65) was correlated closely with those from ICD (2.88 +/- 0.78) measurements (y = 0.73x + 0.67, r = 0.87, P < 0.001). In conclusion, TTDE is a feasible method and provides reliable data on CFVR which can be used for follow-up after PTCA.
Adenosine ; administration & dosage ; Adult ; Aged ; Blood Flow Velocity ; Contrast Media ; Coronary Artery Disease ; diagnostic imaging ; physiopathology ; Coronary Circulation ; physiology ; Coronary Vessels ; diagnostic imaging ; drug effects ; physiopathology ; Echocardiography, Doppler ; methods ; Female ; Humans ; Male ; Middle Aged ; Polysaccharides ; Predictive Value of Tests ; Vasodilator Agents ; administration & dosage

Arrhythmia, Sinus ; physiopathology ; therapy ; Atrial Fibrillation ; physiopathology ; therapy ; Electric Countershock ; methods ; Humans ; Male ; Middle Aged ; Treatment Outcome