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PREVENZIONE CARDIOVASCOLARE SECONDARIA DOPO SINDROME CORONARICA ACUTA NELLA PRATICA CLINICA. DOCUMENTO DI CONSENSO DELLE SOCIETA' SCIENTIFICHE DI MEDICINA CARDIOVASCOLARE E MEDICINA INTERNA DELLA REGIONE LAZIO.
No full textRotational arherectomy in the distal left anterior descending coronary artery through an internal mammary artery graft.
Full text linkWe report the case of a 53-year-old white man who began complaining of dyspnoea and angina 19 months after coronary artery bypass graft surgery. Coronary angiography revealed the presence of a long and critical stenosis in the native left anterior descending coronary artery, shortly after distal anastomosis of the left internal mammary artery. After failed predilatations with standard or cutting balloons, we successfully used the rotablator system, which allowed us to implant a bare-metal stent in the native left anterior descending coronary artery. However, stent deployment caused long linear graft dissection, which was reduced by drug-eluting stent implantation in the proximal and distal segments of the left internal mammary artery
La trombectomia nell’angioplastica primaria
Full text linkPrimary percutaneous coronary intervention is the standard treatment in patients with ST-segment
elevation myocardial infarction achieving a TIMI 3 flow in more than 90% of patients. However, despite
a brisk epicardial coronary flow in the infarct-related artery, frequently post-ischemic microvascular
damage limits the efficacy of primary PCI. Recent studies suggest that thrombectomy
during primary PCI, in patients with intracoronary angiographically visible thrombus, represents a
useful adjunct to pharmacotherapy able to prevent distal embolization
Studio funzionale del microcircolo coronarico nei soggetti con coronarie angiograficamente indenni: dati preliminari
No full textEffects of levosimendan on left ventricular diastolic function after primary angioplasty for acute anterior myocardial infarction: A Doppler echocardiographic study
No full textBackground: Levosimendan is a new Ca-sensitizing drug with combined positive inotropic and vasodilatory effects that offers new therapeutic possibilities in patients with severe heart failure. Compared with other inotropic agents, animal studies demonstrated that levosimendan does not impair left ventricular diastolic function. Objective. We sought to evaluate the effects of levosimendan on left ventricular diastolic function, using conventional transmitral Doppler and Doppler tissue imaging parameters, in patients with anterior acute myocardial infarction undergoing primary angioplasty. Methods. After a successful primary angioplasty, we randomized 52 consecutive patients with anterior acute myocardial infarction to levosimendan or placebo infusion and analyzed the diastolic function using conventional transmitral Doppler flow and Doppler tissue imaging at mitral annulus. Results. At 24 hours after the index intervention, patients treated with levosimendan (n = 26) showed a significant reduction of the isovolumetric relaxation time (114.6 +/- 15.1-69.2 +/- 5.6 milliseconds; P = .001) and the ratio between the early diastolic flow and early tissue velocity (E/E') (21.4 +/- 10.7-12.8 +/- 7.3; P = .04), and a significant increase of the ratio between the early and late diastolic flow (E/A) (0.86 +/- 0.33-1.52 +/- 0.88; P = .03) and E' (6.4-7.9 cm/s; P = .001). On the other hand, only a significant increase in E/A ratio (0.97 +/- 0.32-1.64 0.51; P = .002) was observed in the placebo group (n = 26). Conclusions. Levosimendan, after primary angioplasty in patients with anterior acute myocardial infarction, appears to improve the Doppler echocardiographic parameters of left ventricular diastolic function
Attivita' dei Linfociti LFA1+ in pazienti con Sindrome coronarica acuta trattati con strategia invasiva.
No full textGli Stent a rilascio di farmaco inibiscono il reclutamento di linfociti T CD3+CD27- effettori
No full textCombined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction
No full textBACKGROUND: Myocardial contrast echocardiography and dobutamine echocardiography have recently emerged as potentially useful clinical tools to detect reversible myocardial dysfunction. However, the relative accuracy of these two techniques in predicting regional wall motion improvement after coronary interventions is still unclear. The aim of the present study was to compare their diagnostic value in predicting functional recovery after coronary revascularization in patients with recent acute myocardial infarction. METHODS AND RESULTS: Twenty-four patients with acute myocardial infarction underwent myocardial contrast echocardiography and dobutamine echocardiography within 2 weeks of hospital admission. Infarct zone contrast score and wall motion score indexes were derived in each patient. Infarct-related artery revascularization was performed before hospital discharge in all selected patients. Resting echocardiography was repeated 3 months after revascularization, and regional function recovery was analysed. The degree of wall motion score improvement at 3-month follow-up and the percentage of positive responses to dobutamine echo were greater (P or = 0.50). Conversely, no significant changes were observed either during dobutamine echo or after revascularization in the group of patients without residual perfusion within the infarct area. Diagnostic agreement between both techniques in predicting reversible dysfunction was high (81% of segments). The sensitivity and negative predictive value in predicting functional outcome were 100% (95% confidence interval [CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrast echo, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%) by dobutamine echo. The specificity and positive predictive value were 90% (95% CI, 80% to 96%) and 81% (95% CI, 64% to 93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76% (95% CI, 58% to 90%) by dobutamine echo. The combination of myocardial contrast and dobutamine echocardiography positive responses improved specificity and positive predictive value in detecting functional recovery after revascularization to 100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively. However, the sensitivity and negative predictive value slightly decreased with the use of both methods (85% [95% CI, 66% to 96%)] and (93%[95% CI, 85% to 98%)], respectively. CONCLUSIONS: In patients with recent myocardial infarction, reversible dysfunction after coronary revascularization and the response to dobutamine infusion are strictly dependent on microvascular integrity. However, microvascular perfusion does not always imply functional recovery after coronary revascularization. The integration with dobutamine echo results seems particularly helpful to further improve myocardial contrast echo specificity and positive predictive values
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