PURPOSE: When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG. MATERIALS AND METHODS: In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups. RESULTS: The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping. CONCLUSION: Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.
Aged ; *Coronary Angiography ; Coronary Artery Disease/etiology/*radiography ; Coronary Occlusion/diagnosis/*therapy ; Coronary Stenosis/etiology/*radiography ; Coronary Vessel Anomalies/radiography ; Coronary Vessels/*pathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Percutaneous Coronary Intervention/adverse effects/methods ; Predictive Value of Tests ; Proportional Hazards Models ; Radiography, Interventional

OBJECTIVE: To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. MATERIALS AND METHODS: Eleven pigs underwent intracoronary injection of small-sized microspheres (42 microm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. RESULTS: Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 +/- 2.0% at baseline to 20.3 +/- 2.3% at 6 hours and 31.5 +/- 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. CONCLUSION: Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.
Animals ; Coronary Angiography/*methods ; Coronary Vessels/*pathology ; Disease Models, Animal ; Embolism/*pathology ; Female ; Heart/radiography ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Microspheres ; Myocardial Contraction/physiology ; Myocardial Infarction/*pathology ; Myocardium/pathology ; Nitroblue Tetrazolium ; Staining and Labeling ; Swine ; Troponin T/blood ; Ventricular Function, Left

PURPOSE: In this study, we aimed to evaluate whether nonalcoholic fatty liver disease (NAFLD) was associated with the presence and morphology of coronary atherosclerotic plaques shown by multidetector computed tomography (MDCT) in asymptomatic subjects without a history of cardiovascular disease. MATERIALS AND METHODS: We retrospectively enrolled 772 consecutive South Korean individuals who had undergone both dualsource 64-slice MDCT coronary angiography and hepatic ultrasonography during general routine health evaluations. The MDCT studies were assessed for the presence, morphology (calcified, mixed, and non-calcified), and severity of coronary plaques. RESULTS: Coronary atherosclerotic plaques were detected in 316 subjects (40.9%) by MDCT, and NAFLD was found in 346 subjects (44.8%) by hepatic ultrasonography. Subjects with NAFLD had higher prevalences of all types of atherosclerotic plaque and non-calcified, mixed, and calcified plaques than the subjects without NAFLD. However, the prevalence of significant stenosis did not differ between groups. After adjusting for age, smoking status, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome, NAFLD remained a significant predictor for all types of coronary atherosclerotic plaque [odds ratio (OR): 1.48; 95% confidence interval (CI): 1.05-2.08; p=0.025] in binary logistic analysis, as well as for calcified plaques (OR: 1.70; 95% CI: 1.07-2.70; p=0.025) in multinomial regression analysis. CONCLUSION: Our study demonstrated that NAFLD was significantly associated with the presence and the calcified morphology of coronary atherosclerotic plaques detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of NAFLD in coronary atherosclerosis.
Adult ; Aged ; Asian Continental Ancestry Group/statistics & numerical data ; Calcinosis/ethnology/*radiography ; Case-Control Studies ; Coronary Angiography/*methods ; Coronary Artery Disease/ethnology/pathology/*radiography ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Non-alcoholic Fatty Liver Disease/epidemiology/*ultrasonography ; Odds Ratio ; Plaque, Atherosclerotic/*diagnosis/epidemiology ; Prevalence ; Regression Analysis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Ultrasonography

PURPOSE: Many patients admitted for acute myocardial infarction (AMI) have chronic renal insufficiency and erectile dysfunction (ED). This study aimed to evaluate the relationship between ED and the glomerular filtration rate (GFR) in patients with coronary artery disease. MATERIALS AND METHODS: We studied 183 patients undergoing coronary angiography owing to AMI. The GFR was calculated and the International Index of Erectile Function-5 (IIEF-5) was used to evaluate ED. The relations between erectile function, GFR, and the number of occluded coronary arteries were evaluated. RESULTS: Of 183 patients with a mean age of 55.2+/-11.16 years who underwent coronary angiography owing to AMI, 100 (54.64%) had ED. The ED rate was 45.36% (44/97) in patients with single-vessel disease, 64.5% (31/48) in patients with two-vessel disease, and 65.7% (25/38) in patients with three-vessel disease. The ED rate in patients with single-vessel disease was significantly lower than in the other groups (p<0.001). The mean IIEF scores were 24.2+/-4.3, 20.4+/-4.9, and 20.5+/-4.2 in the three groups, respectively (p<0.001). Mean GFRs were similar in patients with single-vessel disease, two-vessel disease, and three-vessel disease (128.2+/-46.8, 130.8+/-70.9, and 110.8+/-44.6, respectively, p=0.171). The GFR was significantly lower in the presence of ED only for single-vessel disease (p=0.001). CONCLUSIONS: This study confirmed that the presence and severity of ED are linked to the number of occluded vessels as documented by coronary angiography. The presence of ED and reduced GFR are associated with single-vessel coronary artery disease. This relationship can be used to predict the likelihood of coronary artery disease.
Adult ; Aged ; *Coronary Angiography ; Coronary Artery Disease/*radiography ; Coronary Occlusion/*radiography ; Erectile Dysfunction/*epidemiology ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*radiography ; Renal Insufficiency, Chronic/*epidemiology ; Risk Factors ; Severity of Illness Index

BACKGROUND/AIMS: The aim was to determine which of three sets of metabolic syndrome (MetS) criteria (International Diabetes Federation [IDF], National Cholesterol Education Program Adult Treatment Panel III [ATP III], and European Group for the Study of Insulin Resistance [EGIR]) best predicts the coronary artery calcification (CAC) score in a cross-sectional study. This has not been evaluated in previous studies. METHODS: A total of 24,060 subjects were screened for CAC by multi-detector computed tomography. The presence of CAC was defined as a CAC score > 0. The odds ratio for the presence of CAC was analyzed for three different sets of MetS criteria and according to number of MetS components. RESULTS: CAC was observed in 12.6% (3,037) of the subjects. Patients with MetS, as defined by the IDF, ATP III, and EGIR criteria, had a CAC rate of 23.0%, 25.1%, and 29.5%, respectively (p < 0.001). Comparisons of C statistics for multivariate regression models revealed no significant difference among the three sets of criteria. After adjustment for risk factors, the ATP III criteria produced a slightly higher odds ratio for CAC compared with the other criteria, but this difference was not significant. The risk factor-adjusted odds ratio for the presence of CAC increased from 1 to 1.679 as the number of MetS components defined by ATP III increased from 0 to > or = 3 (p for trend < 0.001). CONCLUSIONS: The presence of MetS was associated with the presence of CAC. There was no significant difference among the three sets of MetS criteria in terms of the ability to predict CAC. An increase in the number of MetS components was associated with an increased odds of CAC.
Adult ; Asymptomatic Diseases ; Biological Markers/blood ; Calcium/*analysis ; Coronary Angiography/methods ; Coronary Artery Disease/blood/*epidemiology/radiography ; Coronary Vessels/*chemistry/radiography ; Cross-Sectional Studies ; Female ; Humans ; Male ; Metabolic Syndrome X/blood/diagnosis/*epidemiology ; Middle Aged ; Multidetector Computed Tomography ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Vascular Calcification/blood/*epidemiology/metabolism/radiography

BACKGROUND/AIMS: In the bare-metal stent era, routine follow-up coronary angiography (RFU CAG) was used to ensure stent patency. With the advent of drug-eluting stents (DESs) with better safety and efficacy profiles, RFU CAG has been performed less often. There are few data on the clinical impact of RFU CAG after second- or third-generation DES implantation in clinically stable patients with coronary artery disease; the aim of this study was to examine this issue. METHODS: We analyzed clinical outcomes retrospectively of 259 patients who were event-free at 12-month after stent implantation and did not undergo RFU CAG (clinical follow-up group) and 364 patients who were event-free prior to RFU CAG (angiographic follow-up group). Baseline characteristics were compared between the groups. RESULTS: The Kaplan-Meier estimated total survival and major adverse cardiac event (MACE)-free survival did not differ between the groups (p = 0.100 and p = 0.461, respectively). The cumulative MACE rate was also not different between the groups (hazard ratio, 0.85; 95% confidence interval, 0.35 to 2.02). In the angiographic follow-up group, 8.8% revascularization was seen at RFU CAG. CONCLUSIONS: RFU CAG did not affect long-term clinical outcome after second- or third-generation DES implantation in clinically stable patients.
Aged ; *Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease/radiography/*therapy ; Coronary Restenosis/etiology/radiography/surgery ; Coronary Vessels/*radiography ; Disease Progression ; Disease-Free Survival ; *Drug-Eluting Stents ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology/radiography/surgery ; Patient Selection ; Percutaneous Coronary Intervention/adverse effects/*instrumentation ; Predictive Value of Tests ; Proportional Hazards Models ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: Although drug-eluting stents (DESs) effectively reduce restenosis following percutaneous coronary intervention (PCI), they also delay re-endothelialization and impair microvascular function, resulting in adverse clinical outcomes. Endothelial progenitor cell (EPC) capturing stents, by providing a functional endothelial layer on the stent, have beneficial effects on microvascular function. However, data on coronary microvascular function in patients with EPC stents versus DESs are lacking. METHODS: Seventy-four patients who previously underwent PCI were enrolled in this study. Microvascular function was evaluated 6 months after PCI based on the index of microvascular resistance (IMR) and the coronary flow reserve (CFR). IMR was calculated as the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of the hyperemic mean transit time (hTmn). The CFR was calculated by dividing the hTmn by the baseline mean transit time. RESULTS: Twenty-one patients (age, 67.2 +/- 9.6 years; male:female, 15:6) with an EPC stent and 53 patients (age, 61.5 +/- 14.7 years; male:female, 40:13) with second-generation DESs were included in the study. There were no significant differences in the baseline clinical and angiographic characteristics of the two groups. Angiography performed 6 months postoperatively did not show significant differences in their CFR values. However, patients with the EPC stent had a significantly lower IMR than patients with second-generation DESs (median, 25.5 [interquartile range, 12.85 to 28.18] vs. 29.0 [interquartile range, 15.42 to 39.23]; p = 0.043). CONCLUSIONS: Microvascular dysfunction was significantly improved after 6 months in patients with EPC stents compared to those with DESs. The complete re-endothelialization achieved with the EPC stent may provide clinical benefits over DESs, especially in patients with microvascular dysfunction.
Aged ; Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease/diagnosis/physiopathology/*therapy ; *Coronary Circulation ; Coronary Vessels/*physiopathology/radiography ; Drug-Eluting Stents ; *Endothelial Progenitor Cells/radiography ; Female ; Humans ; Male ; Microvessels/*physiopathology/radiography ; Middle Aged ; Percutaneous Coronary Intervention/*instrumentation ; Prosthesis Design ; *Re-Epithelialization ; *Stents ; Time Factors ; Treatment Outcome ; Vascular Resistance

The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF < or = 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age > or = 75 yr, Killip class > or = III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein > or = 2.59 mg/L, LVEF < or = 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF < or = 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.
Aged ; Coronary Angiography ; Coronary Artery Disease/mortality/*pathology/surgery ; Echocardiography ; Female ; Heart/radiography ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/*pathology ; Myocardial Infarction/mortality/*pathology/surgery ; Myocardium/pathology ; Percutaneous Coronary Intervention ; Prospective Studies ; Stroke Volume/*physiology ; Treatment Outcome ; Ventricular Dysfunction, Left/*surgery ; Ventricular Function, Left/physiology

A 69-year-old male was admitted for dyspnea and chest pain. The patient had undergone coronary artery bypass graft surgery and tube thoracostomy three years ago. The chest radiograph showed pleural effusion, which was drained using a percutaneous catheter with CT guidance. However, residual pneumothorax was observed four days later. Despite insertion of the 12 Fr trocar-type tube, pneumothorax did not improve and air leaks were observed. Chest CT showed that the tube was placed in the left main bronchus. After removal of the tube, the patient recovered uneventfully from pulmonary hemorrhage and bronchial perforation without complications.
Aged ; Bronchi ; Catheters* ; Chest Pain ; Coronary Artery Bypass ; Dyspnea ; Hemorrhage ; Humans ; Iatrogenic Disease ; Male ; Pleural Effusion ; Pneumothorax ; Radiography, Thoracic ; Thoracostomy* ; Tomography, X-Ray Computed ; Transplants

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.
Acute Disease ; Angioplasty, Balloon, Coronary ; Atrial Flutter/*surgery ; Catheter Ablation/*adverse effects ; Chest Pain/etiology ; Coronary Occlusion/etiology ; Coronary Vessels/radiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/etiology/therapy ; Thrombosis/surgery