The purpose of this study was to assess the difference in coronary artery distensibility and plaque composition determined by Virtual Histology-IVUS between non-culprit lesions of stable angina pectoris (SAP) and those of acute myocardial infarction (AMI). One-hundred thirty cross sectional areas (CSA) of 12 non-culprit de novo coronary artery lesions from 8 SAP patients and 128 CSAs of 12 non-culprit de novo coronary artery lesions from 10 AMI patients were imaged by IVUS (Volcano Therapeutics) with simultaneous intracoronary pressure (ICP) recording. Systolic and diastolic lumen areas (LA), vessel areas (VA), and plaque areas (PA) were measured. Lumen diameters (LD) were calculated with an assumption that the cross section was circular. Plaque burden; (PA/VA) X100, coronary compliance; {(LA change/diastolic LA)/(ICP change)} × 10 3 and stiffness index β (SI-β); {ln (systolic ICP/diastolic ICP)}/(LD change/diastolic LD) were calculated at each site. Color tissue maps were reconstructed from radio frequency data using IVUS-Virtual Histology software. Coronary compliance, SI-β and 4 tissue composition areas (Fibrous, Fibro-fatty, Dense-calcium and Necrotic core) were compared between SAP group and AMI group. LA, VA and PA were significantly larger in AMI group than in SAP group (7.88mm 2 vs 6.45 mm 2 , p<0.0001, 16.77 mm 2 vs 14.18 mm 2 , p<0.0001 and 8.88 mm 2 vs 7.73 mm 2 , p<0.0001). However, plaque burden showed no significant difference between AMI and SAP groups (53.4%vs 54.0%, p=0.60). Coronary compliance was significantly lower and SI-β was significantly higher in AMI group than in SAP group (0.82±0.75vs1.85±1.28, p<0.0001, 34.8±25.1vs 20.1±17.2, p<0.0001). Fibrous and Fibro-fatty areas were significantly smaller in AMI group than in SAP group (51.6% vs 71.3% p<0.0001, 10.1% vs 15.5% p<0.0001). Dense-calcium area and Necrotic core area were significantly larger in AMI group than in SAP group (15.2% vs 2.6% p<0.0001, 22.9% vs 9.9% p<0.0001). Coronary atherosclerosis assessed by Virtual Histology-IVUS was more advanced and severe, and coronary distensibility was impaired even in non-culprit lesions of AMI compared to those of SAP.
A 49-year-old male was admitted to our hospital because of chest pain. The pain occurred simultaneously with tachycardia-dependent left bundle branch block (LBBB) during exercise-stress and atropine-stress electrocardiogram (ECG) and on 24-h ambulatory ECG monitoring. Myocardial perfusion and metabolic scintigraphy with Tl-201 and I-123 BMIPP, respectively, showed no evidence of ischemia. Coronary arteriography revealed no atherosclerotic lesions, but did show a fistula between three major coronary arteries and the main pulmonary artery. The left-to-right shunt was undetectably small. Administration of diltiazem and metoprolol suppressed LBBB by attenuating the heart rate response to exercise, and reduced the chest pain. Therefore we presume that the exertional chest pain was not caused by myocardial ischemia but by the tachycardia-dependent LBBB. Coronary artery-pulmonary artery fistula is the most common type of coronary artery fistulae found incidentally in adulthood. Involvement of three major coronary branches is, however, rare. The case is discussed with a review of the literature.
Introduction: The purpose of this study was to investigate potential causes of mitral regurgitation (MR) in chronic atrial fibrillation using real-time three-dimensional transesophageal echocardiog...
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