The accuracy of non-invasive diagnosis of aortic dissection between transesophageal echocardiography (TEE) and computed tomography (CT) was studied in 21 patients. All patients had both diagnostic procedures. With TEE examination, De Bakey's type I was found in 9 patients, type II in 1 and type III in 10 while CT imaging revealed aortic dissection in 19 out of 21 patients. If the dissection found by both diagnostic procedures was considered definitive then both examinations were similarly sensitive. TEE is a preferred choice of non invasive work up for aortic dissection. Medical and surgical therapy in appropriate cases evaluated by TEE give rise to good results in the majority of patients.
In order to assess the diagnostic usefulness of EMB in patients with clinically suspected myocardial diseases, with and without heart failure or dysrhythmias, a prospective study was carried out in 84 consecutive patients. With EMB, the histological diagnosis was considered specific in 33 patients (39.3%), confirmative in 12 patients (14.3%) and negative in 39 patients (46.4%). It was found particularly useful in patients with unexplained heart failure and idiopathic dysrhythmias and in the differentiation between restrictive cardiomyopathy and constrictive pericarditis. The procedure can be safely performed with minimal morbidity and there was no mortality in the present study.
The usefulness of transthoracic and transabdominal two-dimensional echocardiography (2-D echo) in patients who presented with dilated aorta with or without acute chest pain and/or abdominal pain was assessed for diagnosis of aortic dissection (AD) both acute and chronic forms. The criterion for diagnosis of AD was the constant appearance of undulating motion of abnormal linear echo in the aortic lumen in more than one scan plane. During a 4-year period (1984-1988), a prospective analysis of 16 patients was carried out and the result disclosed that 11 had AD (6 in acute AD, 5 in chronic AD) while the other 5 did not have AD. 2-D echo findings were diagnostic of De Bakey Type I in 7 patients, Type II in one, Type III in two, false negative Type I in one, and true negative in the remaining five. Therefore, the sensitivity was 91 per cent and the positive predictive value was 100 per cent. Thus, our data indicates that 2-D echo is a reliable non-invasive method for diagnosis of AD in either the acute or chronic form and proximal or distal AD.
Excimer laser angioplasty was used to treat total occluded coronary arteries and instent restenosis lesions with high success rate. To assess immediate and long-term results of patients treated with excimer laser, we analyzed demographic information and the immediate results of 44 patients who underwent ELCA. The patients were followed up and assessed for clinical restenosis. The initial success rate of ELCA was 86.4 per cent which is comparable to plain balloon angioplasty performed during the same period. Clinical restenosis was 29 per cent. In conclusion, ELCA for patients with coronary artery disease can be performed with initial high success rate and reasonable long-term restenosis.
A ruptured aneurysm of the sinus of Valsalva was diagnosed by Doppler, colour, and cross sectional echocardiography in a consecutive series of seven patients. The diagnoses were confirmed at operation without cardiac catheterisation. Examination by pulsed and continuous Doppler echocardiography showed continuous turbulence in six patients with aneurysms rupturing into the right ventricular outflow tract and in the patient with rupture of an aneurysm of the non-coronary sinus into the right atrium. Colour Doppler echocardiography showed turbulent flow across the defects in all seven patients. A ventricular septal defect with aortic regurgitation was detected in one patient and an associated ventricular septal defect in another. Doppler, colour, and cross sectional echocardiography were useful non-invasive techniques for diagnosing a ruptured aneurysm of the sinus of Valsalva without the need for cardiac catheterisation.
Clinical, hemodynamic and angiographic findings of 24 adolescent or adult patients with coronary artery fistula were retrospectively analyzed. There were 7 males and 17 females with the average age of 41.4 years. Nineteen of 24 patients (79.2%) were symptomatic and 18 were older than 20 years of age. Continuous murmur was present in 17 patients, "to and fro' murmur was audible in 2, apical systolic murmur was audible in 1. The remaining 4 patients had no audible murmur. Location of murmur in all patients was unusual for patent ductus arteriosus. Cardiomegaly on chest X-ray was found in 17 patients (70.8%) in whom 8 had prominent pulmonary artery. Electrocardiographic abnormalities were detected in 10 of 24 patients (41.6%) i.e. left ventricular hypertrophy (4 patients) biventricular hypertrophy (2 patients), incomplete right bundle branch block (2 patients), and ischemic changes (2 patients). The intracardiac pressures were slightly elevated and the mean Qp/Qs ratio was only 1.4 +/- 1.2. Angiographically, 28 fistulas were demonstrated in 24 patients. The origins of fistula were from right coronary artery in 12 patients (50%), left coronary artery in 8 patients (33.3%) and both coronary arteries in 4 patients (16.7%). Fistulas drained into the right atrium in 5 patients (20.8%), into coronary sinus in 2 patients (8.3%), into right ventricle in 4 patients (16.7%), into pulmonary arteries in 10 patients (41.7%) and into left ventricle in 3 patients (12.5%).
Prognostic factors in patients with acute myocardial infarction based on clinical and investigative data on admission were evaluated prospectively in 111 consecutive patients. Seventeen patients (15.3%) died during hospital stay. Age, a previous infarct, high Killip class, cardiomegaly, high serum concentrations of cardiac enzymes, a low ejection fraction, and a high wall motion score index correlated significantly with in-hospital mortality; whereas sex, risk factors, and pericardial effusion did not. Multivariate analysis showed that age and the wall motion score index were the best predictors of death in hospital. Wall motion detected by cross sectional echocardiography may reflect the extent of myocardial involvement. Age and wall motion score index predicted in-hospital mortality with a sensitivity of 76.5%, a specificity of 91.5%, and a predictive accuracy of 89.2%. Age and the wall motion score index can be determined on admission and are useful for identifying patients at high risk of cardiac death who might benefit from early intervention.
Abstract Background Indoleamine 2,3 dioxygenase (IDO), the rate-limiting enzyme in the kynurenine (Kyn) pathway of tryptophan (Trp) degradation, is modulated by inflammation, and is regarded as a key molecule driving immunotolerance and immunosuppressive mechanisms. Little is known about IDO activity in patients with active coronary artery disease (CAD). Methods We prospectively enrolled patients who were scheduled to undergo coronary angiography. Measurement of IDO, high-sensitivity troponin T (hs-TnT), and high-sensitivity C-reactive protein (hs-CRP) levels was performed at baseline, and IDO activity was monitored at the 6-month follow-up. Results Three hundred and five patients were enrolled. Ninety-eight patients (32.1%) presented with recent acute coronary syndrome (ACS). Significant difference in IDO, kynurenine, and hs-TnT between patients with and without significant CAD was observed. Baseline IDO activity, kynurenine level, and hs-TnT level were all significantly higher in significant CAD patients with 3-vessel, 2-vessel, and 1-vessel involvement than in those with insignificant CAD [(0.17, 0.13, and 0.16 vs. 0.03, respectively; p = 0.003), (5.89, 4.58, and 5.24 vs. 2.74 µM/g, respectively; p = 0.011), and (18.27, 12.22, and 12.86 vs. 10.89 mg/dL, respectively; p < 0.001)]. One-year mortality was 3.9%. When we compared between patients who survived and patients who died, we found a significantly lower prevalence of left main (LM) disease by coronary angiogram (6.1% vs. 33.3%, p = 0.007), and also a trend toward higher baseline kynurenine (5.07 vs. 0.79 µM/g, p = 0.082) and higher IDO (0.15 vs. 0.02, p = 0.081) in patients who survived. Conclusion Immunometabolic response mediated via IDO function was enhanced in patients with CAD, and correlated with the extent and severity of disease. Patients with LM disease had higher 1-year mortality. Lower level of IDO, as suggested by inadequate IDO response, demonstrated a trend toward predicting 1-year mortality. Trial registration TCTR Trial registration number TCTR20200626001. Date of registration 26 June 2020. “Retrospectively registered”.
Abstract Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.
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