Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosi...Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.展开更多
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiolo...Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.展开更多
BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis case...BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor prognosis.Although the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been hypothesized.Early detection and prompt management of cardiac sarcoidosis remains pivotal.CASE SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by rest.Submaximal exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de pointes.Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis.The magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was initiated.Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.CONCLUSION Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.展开更多
Cardiovascular disease is the leading cause of mortality in patients with diabetes mellitus (DM). We sought to establish for the first time in Saudi Arabia an intravascular ultrasound (IVUS) profile of DM patients wit...Cardiovascular disease is the leading cause of mortality in patients with diabetes mellitus (DM). We sought to establish for the first time in Saudi Arabia an intravascular ultrasound (IVUS) profile of DM patients with acute coronary syndrome (ACS). Patients and methods: We retrospectively analyzed 210 IVUS studies in 181 patients hospitalized in King Salman Heart Centre for ACS. IVUS was performed to guide percutaneous coronary interventions (PCI) of borderline moderate lesions. Results: Mean age was 58 ± 10 years, 78% (n = 163) of IVUS studies were performed in men. There were 71% (n = 128) patients with DM. ST elevation myocardial infarction (STEMI) was the most common clinical presentation (47%, n = 88 patients). As compared to non-DM, the intermediate lesions of DM patients had a significantly larger IVUS plaque volume (267 ± 174 mm3 versus 193 ± 111 mm3, p Conclusion: IVUS demonstrates longer lesions to be treated in DM patients with ACS in Saudi Arabia, however no difference in average plaque burden or remodelling index. These findings are likely to impact our understanding of optimal PCI strategies in DM patients.展开更多
文摘Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
文摘Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.
文摘BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor prognosis.Although the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been hypothesized.Early detection and prompt management of cardiac sarcoidosis remains pivotal.CASE SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by rest.Submaximal exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de pointes.Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis.The magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was initiated.Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.CONCLUSION Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.
文摘Cardiovascular disease is the leading cause of mortality in patients with diabetes mellitus (DM). We sought to establish for the first time in Saudi Arabia an intravascular ultrasound (IVUS) profile of DM patients with acute coronary syndrome (ACS). Patients and methods: We retrospectively analyzed 210 IVUS studies in 181 patients hospitalized in King Salman Heart Centre for ACS. IVUS was performed to guide percutaneous coronary interventions (PCI) of borderline moderate lesions. Results: Mean age was 58 ± 10 years, 78% (n = 163) of IVUS studies were performed in men. There were 71% (n = 128) patients with DM. ST elevation myocardial infarction (STEMI) was the most common clinical presentation (47%, n = 88 patients). As compared to non-DM, the intermediate lesions of DM patients had a significantly larger IVUS plaque volume (267 ± 174 mm3 versus 193 ± 111 mm3, p Conclusion: IVUS demonstrates longer lesions to be treated in DM patients with ACS in Saudi Arabia, however no difference in average plaque burden or remodelling index. These findings are likely to impact our understanding of optimal PCI strategies in DM patients.
