Objective: To compare the efficacy of intravascular ultrasound (IVUS) and coronary angiography guided drug eluting stent (DES) implantation for the treatment of left main coronary artery (LMCA) lesions. Methods: Randomized controlled trials (RCT) and observational studies, which compared IVUS with coronary angiography guided DES implantation for the treatment of LMCA lesions published before August 2021 were searched in PubMed, Embase and Cochrane Library databases. Baseline data, interventional procedures and endpoint events of each study were collected. The primary endpoint was major cardiovascular adverse events (MACE), and the secondary endpoints were all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and target vessel revascularization (TVR). The Newcastle-Ottawa Scale (NOS) and the Cochrane Collaboration Risk of Bias tool were used to evaluate the quality of the included studies. Results: Nine studies were included, including 3 RCT and 6 observational studies, with a total of 5 527 cases of LMCA. All the 6 observational studies had NOS scores≥6, and the 3 RCT had a low risk of overall bias. The results of meta-analysis showed that compared with coronary angiography guided group, MACE rate (OR=0.55, 95%CI 0.47-0.66, P<0.001), all-cause death (OR=0.56, 95%CI 0.43-0.74, P<0.001), cardiac death (OR=0.43, 95%CI 0.30-0.61, P<0.001), MI (OR=0.64, 95%CI 0.52-0.79, P<0.001), TLR (OR=0.49, 95%CI 0.28-0.86, P=0.013) and TVR (OR=0.77, 95%CI 0.60-0.98, P=0.037) were all significantly lower in the IVUS guided group. Conclusions: Compared with angiography guided, IVUS guided PCI with DES implantation in LMCA lesions could significantly reduce the risk of MACE, death, MI, TLR and TVR. IVUS is thus superior to coronary angiography for guiding PCI treatment among patients with LMCA.
Humans ; Coronary Artery Disease/complications* ; Coronary Angiography ; Drug-Eluting Stents/adverse effects* ; Treatment Outcome ; Percutaneous Coronary Intervention/methods* ; Ultrasonography, Interventional/methods* ; Risk Factors ; Myocardial Infarction/etiology*

No abstract available.
*Aorta, Thoracic/ultrasonography ; Aortic Diseases/*complications/diagnosis ; Catheterization, Peripheral/*adverse effects ; Cerebral Angiography/*adverse effects ; Electrocardiography ; Fatal Outcome ; *Femoral Artery ; Heart Arrest/diagnosis/etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/*etiology ; Punctures ; *Sinus of Valsalva/ultrasonography ; Thrombosis/diagnosis/*etiology

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. The incidence, causes, pathogenesis, and treatment have not been defined clearly, but spontaneous coronary artery dissection should be considered in young patients without major cardiovascular risk factors or in patients in the peripartum period who present with acute coronary syndrome. The treatment is often challenging. Medical treatment is usually considered, and percutaneous coronary intervention or coronary artery bypass surgery may be possible in some patients. We herein report two cases of middle-aged males with myocardial infarction who were treated with percutaneous coronary angioplasty.
Adult ; Coronary Artery Disease/*complications/surgery/ultrasonography ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*etiology/surgery/ultrasonography ; *Percutaneous Coronary Intervention ; Rupture, Spontaneous/surgery/ultrasonography ; Ultrasonography, Interventional

OBJECTIVETo evaluate whether garlicin can prevent reperfusion no-reflow in a catheter-based porcine model of acute myocardial infarction (AMI).

METHODSTwenty-two male Chinese mini swines were randomized into 3 groups: sham-operation group (n=6), control group (n=8), and garlicin group (n=8). The distal part of left anterior descending coronary artery (LAD) in swines of the latter two groups was completely occluded by dilated balloon for 2 h and a successful AMI model was confirmed by coronary angiography (CAG) and electrocardiograph (ECG), which was then reperfused for 3 h. In the sham-operation group, balloon was placed in LAD without dilatation. Garlicin at a dosage of 1.88 mg/kg was injected 10 min before LAD occlusion until reperfusion for 1 h in the garlicin group. To assess serial cardiac function, hemodynamic data were examined by catheter method before AMI, 2 h after occlusion and 1, 2, and 3 h after reperfusion. Myocardial contrast echocardiography (MCE) and double staining with Evans blue and thioflavin-S were performed to evaluate myocardial no-reflow area (NRA) and risk area (RA).

RESULTSLeft ventricular systolic pressure and left ventricular end-diastolic pressure significantly improved in the garlicin group after reperfusion compared with the control group P<0.05) and 2 h after AMI (P<0.05). MCE showed garlicin decreased reperfusion NRA after AMI compared with the control group (P <0.05). In double staining, NRA/RA in the garlicin group was 18.78%, significantly lower than that of the control group (49.84%, P<0.01).

CONCLUSIONSGarlicin has a preventive effect on the porcine model of myocardial infarction reperfusion no-reflow by improving hemodynamics and decreasing NRA.

Allyl Compounds ; pharmacology ; therapeutic use ; Animals ; Cardiotonic Agents ; pharmacology ; therapeutic use ; Contrast Media ; Disease Models, Animal ; Disulfides ; pharmacology ; therapeutic use ; Hemodynamics ; drug effects ; Male ; Myocardial Infarction ; complications ; diagnostic imaging ; drug therapy ; pathology ; Myocardial Reperfusion ; No-Reflow Phenomenon ; complications ; diagnostic imaging ; drug therapy ; pathology ; Swine ; Swine, Miniature ; Thiazoles ; metabolism ; Ultrasonography

Aged ; Angioplasty, Balloon, Coronary ; Heart Rupture, Post-Infarction ; complications ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; therapy ; Papillary Muscles ; Shock, Cardiogenic ; etiology ; Systolic Murmurs ; etiology ; Ultrasonography

Adult ; Aneurysm, False ; complications ; diagnosis ; Coronary Aneurysm ; complications ; diagnosis ; Coronary Angiography ; methods ; Coronary Vessels ; injuries ; Humans ; Male ; Myocardial Infarction ; etiology ; Tomography, X-Ray Computed ; methods ; Ultrasonography, Interventional ; methods

This study investigated the role of angiotensin II receptor blocker in atrial remodeling in rats with atrial fibrillation (AF) induced by a myocardial infarction (MI). MIs were induced by a ligation of the left anterior descending coronary artery. Two days after, the rats in the losartan group were given losartan (10 mg/kg/day for 10 weeks). Ten weeks later, echocardiography and AF induction studies were conducted. Ejection fraction was significantly lower in the MI rats. Fibrosis analysis revealed much increased left atrial fibrosis in the MI group than sham (2.22 +/- 0.66% vs 0.25 +/- 0.08%, P = 0.001) and suppression in the losartan group (0.90 +/- 0.27%, P 0.001) compared with the MI group. AF inducibility was higher in the MI group than sham (39.4 +/- 43.0% vs 2.0 +/- 6.3%, P = 0.005) and significantly lower in losartan group (12.0 +/- 31.6%, P = 0.029) compared with the MI. The left atrial endothelial nitric oxide synthase (NOS) and sarco/endoplasmic reticulum Ca(2+)-ATPase levels were lower in the MI group and higher in the losartan group significantly. The atrial inducible NOS and sodium-calcium exchanger levels were higher in the MI and lower in the losartan group significantly. Losartan disrupts collagen fiber formation and prevents the alteration of the tissue eNOS and iNOS levels, which prevent subsequent AF induction.
Angiotensin Receptor Antagonists/*therapeutic use ; Animals ; Atrial Fibrillation/*prevention & control ; Atrial Remodeling ; Disease Models, Animal ; Fibrosis ; Heart Failure/*etiology/ultrasonography ; Immunohistochemistry ; Losartan/*therapeutic use ; Male ; Myocardial Infarction/*complications/ultrasonography ; Nitric Oxide Synthase Type II/metabolism ; Nitric Oxide Synthase Type III/metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, Angiotensin/chemistry/metabolism ; Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism ; Sodium-Calcium Exchanger/metabolism

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Acute Disease ; Aged ; Coronary Angiography ; Diagnosis, Differential ; Heart Atria/ultrasonography ; Heart Failure/diagnosis/etiology ; Humans ; Male ; Mitral Valve Insufficiency/ultrasonography ; Myocardial Infarction/complications/*diagnosis/therapy ; Pulmonary Edema/*diagnosis/etiology/therapy ; Shock, Cardiogenic/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

OBJECTIVE: To quantitatively detect variation in regional myocardial systolic function in heart failure rat model induced by myocardial infarction by strain and strain rate imaging. METHODS: Seventy 2-month-old adult male SD rats were randomly assigned to 4 groups: a 4-week and a 8-week group after the operation (each n = 25) had thoracotomy, the pericardium opened and the anterior descending branch of left coronary artery ligated; a sham operation group (n = 10) had thoracotomy and the arcula cordis opened, but did not ligate the artery; a control group (n = 10) had no treatment. The changes of general state of health of the rats were observed and recorded every day. To assess the change of heart function, echocardiography was used at the end of the 4th week and 8th week after the surgery. To evaluate the change of heart function in heart failure rats, we quantitatively analyzed the regional myocardial systolic function in all rats by strain and strain rate imaging and myocardium to detect the level of MMP-9 at the end of the 4th week and 8th week. The repeatability and discrepancies of the results were all analyzed. RESULTS: Obviously objective signs of heart failure manifested themselves in the survived mice 10 to 14 days after the surgery. Compared with the control group and the sham operation group, the fraction shortening (FS) and ejection fraction (EF) of the 4-week group after the operation were lower (P < 0.05), the left ventricle index (LV index) of the 8-week group after the operation was higher, left ventricle posterior wall index (LVPW index), interventricular septum index (IVS index), FS, and EF of the 8-week group after the operation were lower (P < 0.05), EF and FS of the 8-week group after the operation were lower than those of the 4-week group. Except the mid-inferior wall and base-inferior wall, the systolic peak strain, systolic peak strain rate, the strain of end-systole in all segments of the operation group were lower than those of the other 2 groups (P < 0.05). The post-systolic strain index of the operation group was higher than that of the other 2 groups (P < 0.05). CONCLUSION Strain and strain rate imaging of echocardiography can quantitatively evaluate the changing of regional myocardial systolic function in the heart failure rat model induced by myocardial infarction, with good repeatability.
Animals ; Heart Failure ; diagnostic imaging ; etiology ; physiopathology ; Heart Ventricles ; diagnostic imaging ; Male ; Myocardial Infarction ; complications ; diagnostic imaging ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Systole ; Ultrasonography ; Ventricular Function, Left ; physiology

Coronary artery injury rarely occurs after blunt chest trauma, but it can lead to extensive myocardial infarction and be frequently overlooked. A 16-yr-old man was presented with comatose mental state and rapid respiration rate. He ran into guard rail while riding a motorcycle. In routine examination, his electrocardiogram showed Q wave and 2 mm ST segment elevation in all precordial leads, I and aVL. The cardiac enzymes were also elevated: creatine kinase (CK)-MB was 300 U/L, and cardiac specific troponin I was 5.7 ng/mL. Two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, ejection fraction of 28%. He could not receive any anticoagulation or thrombolytic therapy because of his brain lesion. Three weeks later, his mental state improved. A diagnostic coronary angiogram revealed total occlusion in the proximal left anterior descending artery (LAD) with collaterals from the right coronary artery and left circumflex artery. We successfully performed a percutaneous coronary intervention for the LAD lesion, and the final angiogram showed a good coronary flow without residual stenosis.
Adolescent ; Angioplasty, Transluminal, Percutaneous Coronary ; Brain/pathology ; Coronary Angiography ; Echocardiography ; Electrocardiography ; Human ; Male ; Myocardial Infarction/*etiology/therapy ; Thoracic Injuries/*complications/pathology/ultrasonography ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left