Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00010
L. D. Rasmussen, S. Winther, S. Karim, A. Eftekhari, E. Christiansen, L. Gormsen, J. Ejlersen, M. Bøttcher
In the anterior/apical myocardium, the perfusion was normal (2.9 ml/g/min). Global stress-flow was 2.4 ml/g/min. The patient was referred to invasive coronary angiography (ICA) showing a 70% stenosis of the proximal LAD, 90% stenosis of the LAD/D1 bifurcation, and CTO of RCA with retrograde filling from the LAD through the septals and ipsilateral filling from marginal branches from the RCA. Corresponding to the LAD lesion, fractional flow reserve (FFR) was 0.77, coronary flow reserve 2.4, and index of microcirculatory resistance 10. As the patient was part of a research protocol (the Dan-NICAD II trial 3) ), the invasive cardiologist was blinded to the 82 RbPET re-sult, and the revascularization strategy was based solely on the invasive information. Hence, the LAD and LAD/D1 lesions were treated with percutaneous coronary intervention (PCI) using A patient with chest pain and inferoseptal ischemia at Rubidium-82 Positron Emission Tomography ( 82 RbPET) was revascularized in a stenosis in the LAD/D1 bifurcation, while a CTO RCA was left untreated. One-year follow-up with Seattle Angina Questionnaire and repeat 82 RbPET revealed symptom relief and improved inferoseptal perfusion likely through LAD collateralization.
{"title":"PCI of LAD Improved Inferoseptal Perfusion in RCA CTO Patient","authors":"L. D. Rasmussen, S. Winther, S. Karim, A. Eftekhari, E. Christiansen, L. Gormsen, J. Ejlersen, M. Bøttcher","doi":"10.7793/jcad.26.20-00010","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00010","url":null,"abstract":"In the anterior/apical myocardium, the perfusion was normal (2.9 ml/g/min). Global stress-flow was 2.4 ml/g/min. The patient was referred to invasive coronary angiography (ICA) showing a 70% stenosis of the proximal LAD, 90% stenosis of the LAD/D1 bifurcation, and CTO of RCA with retrograde filling from the LAD through the septals and ipsilateral filling from marginal branches from the RCA. Corresponding to the LAD lesion, fractional flow reserve (FFR) was 0.77, coronary flow reserve 2.4, and index of microcirculatory resistance 10. As the patient was part of a research protocol (the Dan-NICAD II trial 3) ), the invasive cardiologist was blinded to the 82 RbPET re-sult, and the revascularization strategy was based solely on the invasive information. Hence, the LAD and LAD/D1 lesions were treated with percutaneous coronary intervention (PCI) using A patient with chest pain and inferoseptal ischemia at Rubidium-82 Positron Emission Tomography ( 82 RbPET) was revascularized in a stenosis in the LAD/D1 bifurcation, while a CTO RCA was left untreated. One-year follow-up with Seattle Angina Questionnaire and repeat 82 RbPET revealed symptom relief and improved inferoseptal perfusion likely through LAD collateralization.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00024
Y. Sugawara, T. Ohwada, Ken-ichi Watanabe, T. Sakamoto, K. Nakazato, Y. Takeishi
We performed coronary angiography within 3 hours after symptom onset because the patient came to the hospital immediately after he felt chest pains. Control coronary angiogram total ob-Case No-reflow phenomenon is a condition in which blood flow to the ischemic myocardium is significantly reduced despite percutaneous coronary intervention. So far, a standard treatment to improve this condition has not been established. We here report an interesting case that illustrates an effective treatment for no-reflow phenomenon. A 66-year-old male was admitted to our hospital for acute myocardial infarction and underwent emergent catheterization. Coronary angiogram showed total obstruction of the distal right coronary artery (RCA). We used an AL2 guiding catheter and passed a coronary guidewire into the RCA. Coronary flow was then slightly restored, and severe stenosis of the distal RCA with massive thrombus was observed. Intravascular ultrasound revealed that the thrombus was large and diffuse. Firstly, thrombus aspiration was performed. Then, no-reflow phenomenon was observed in the far distal RCA. An infusion catheter (Lumune TM ) was advanced to the distal RCA and 50 µg nitroprusside was injected. Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was immediately achieved. Two weeks after the first catheterization, a second catheterization was performed. Coronary angiogram showed no stenosis in the RCA and most of the thrombus disappeared. Left ventriculography showed severe hypokinesis of the inferior wall, but ejection fraction increased to 59%. He was discharged and has been followed as an outpatient at our hospital. We experienced a case of no-reflow phenomenon clearly ameliorated by intracoronary nitroprusside injection with a Lumine TM infusion catheter. This method could be a powerful option to treat no-reflow phenomenon.
{"title":"A Case of No-reflow Phenomenon Improved by Intracoronary Nitroprusside Injection with Lumine™ Infusion Catheter","authors":"Y. Sugawara, T. Ohwada, Ken-ichi Watanabe, T. Sakamoto, K. Nakazato, Y. Takeishi","doi":"10.7793/jcad.26.20-00024","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00024","url":null,"abstract":"We performed coronary angiography within 3 hours after symptom onset because the patient came to the hospital immediately after he felt chest pains. Control coronary angiogram total ob-Case No-reflow phenomenon is a condition in which blood flow to the ischemic myocardium is significantly reduced despite percutaneous coronary intervention. So far, a standard treatment to improve this condition has not been established. We here report an interesting case that illustrates an effective treatment for no-reflow phenomenon. A 66-year-old male was admitted to our hospital for acute myocardial infarction and underwent emergent catheterization. Coronary angiogram showed total obstruction of the distal right coronary artery (RCA). We used an AL2 guiding catheter and passed a coronary guidewire into the RCA. Coronary flow was then slightly restored, and severe stenosis of the distal RCA with massive thrombus was observed. Intravascular ultrasound revealed that the thrombus was large and diffuse. Firstly, thrombus aspiration was performed. Then, no-reflow phenomenon was observed in the far distal RCA. An infusion catheter (Lumune TM ) was advanced to the distal RCA and 50 µg nitroprusside was injected. Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was immediately achieved. Two weeks after the first catheterization, a second catheterization was performed. Coronary angiogram showed no stenosis in the RCA and most of the thrombus disappeared. Left ventriculography showed severe hypokinesis of the inferior wall, but ejection fraction increased to 59%. He was discharged and has been followed as an outpatient at our hospital. We experienced a case of no-reflow phenomenon clearly ameliorated by intracoronary nitroprusside injection with a Lumine TM infusion catheter. This method could be a powerful option to treat no-reflow phenomenon.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00014
Eriho Shirai, Kuniyasu Harimoto, T. Kawasaki, S. Matoba
An 81-year-old woman presented to the emergency room with back pain. The patient had been in her normal state of health until three days before presentation, when exertional chest pain developed and lasted for approximately five minutes. On the day of presentation, she woke up due to back pain and called an ambulance because the pain did not resolve. Her previous medical history was diabetes, which was well controlled with diet therapy alone. She did not take any medication. The patient did not drink, smoke, or use illicit drugs, and had no known allergies. There was no family history of cardiovascular diseases. On examination, she was alert and oriented. Her vital signs were normal except for a blood pressure of 190/80 mmHg. Neither additional heart sounds nor murmurs were heard on auscultation, and the remaining examinations were normal. Electrocardiography demonstrated ST-segment elevations in leads V1 to V4. Anteroposterior chest radiography was normal. The complete blood cell counts were normal, as were the renal and liver function tests. Although the creatinine kinase level was 128 U/L, the heart-type fatty acid binding protein was positive and the high-sensitivity cardiac troponin T level was 0.181 ng/dL (reference value, ≤0.100). The level of brain natriuretic peptide was elevated to 303.3 pg/mL (reference value, ≤18.4). In addition, echocardiography demonstrated hypokinesis in the anterior wall and the apex of the left ventricle. A diagnosis of ST-segment elevation acute myocardial infarction was made, and oral clopidogrel (300 mg), oral aspirin (200 mg), and intravenous heparin (10,000 units) were administered. Emergency coronary angiography demonstrated total occlusion in the mid-portion of the left anterior descending coronary artery and severe stenosis in the mid-portion of the right coronary artery (Fig. 1). Collateral flow to the right coronary artery from the first septal perforator of the left anterior descending coronary artery, which branched before the total occlusion of the left anterior descending coronary artery, was observed. After thrombus aspiration, recanalization of the left anterior descending coronary artery was obtained. Unexpectedly, thrombi migrating to the distal part of the right coronary artery was observed (Fig. 2, videos Case Report
{"title":"A Case of Acute Myocardial Infarction with Myocardial Damage Caused by Thrombi Originally Located in the Non-culprit Lesion","authors":"Eriho Shirai, Kuniyasu Harimoto, T. Kawasaki, S. Matoba","doi":"10.7793/jcad.26.20-00014","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00014","url":null,"abstract":"An 81-year-old woman presented to the emergency room with back pain. The patient had been in her normal state of health until three days before presentation, when exertional chest pain developed and lasted for approximately five minutes. On the day of presentation, she woke up due to back pain and called an ambulance because the pain did not resolve. Her previous medical history was diabetes, which was well controlled with diet therapy alone. She did not take any medication. The patient did not drink, smoke, or use illicit drugs, and had no known allergies. There was no family history of cardiovascular diseases. On examination, she was alert and oriented. Her vital signs were normal except for a blood pressure of 190/80 mmHg. Neither additional heart sounds nor murmurs were heard on auscultation, and the remaining examinations were normal. Electrocardiography demonstrated ST-segment elevations in leads V1 to V4. Anteroposterior chest radiography was normal. The complete blood cell counts were normal, as were the renal and liver function tests. Although the creatinine kinase level was 128 U/L, the heart-type fatty acid binding protein was positive and the high-sensitivity cardiac troponin T level was 0.181 ng/dL (reference value, ≤0.100). The level of brain natriuretic peptide was elevated to 303.3 pg/mL (reference value, ≤18.4). In addition, echocardiography demonstrated hypokinesis in the anterior wall and the apex of the left ventricle. A diagnosis of ST-segment elevation acute myocardial infarction was made, and oral clopidogrel (300 mg), oral aspirin (200 mg), and intravenous heparin (10,000 units) were administered. Emergency coronary angiography demonstrated total occlusion in the mid-portion of the left anterior descending coronary artery and severe stenosis in the mid-portion of the right coronary artery (Fig. 1). Collateral flow to the right coronary artery from the first septal perforator of the left anterior descending coronary artery, which branched before the total occlusion of the left anterior descending coronary artery, was observed. After thrombus aspiration, recanalization of the left anterior descending coronary artery was obtained. Unexpectedly, thrombi migrating to the distal part of the right coronary artery was observed (Fig. 2, videos Case Report","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00003
Onichi Furuya, S. Higashiue, Satoshi Kuroyanagi, Masatoshi Komooka, Saburo Kojima, Makoto Matsuura, K. Kasuga, Tetsushi Takemoto, Norihiko Hiramatsu
Preoperative renal dysfunction is a major risk factor in heart surgery-. On the one hand, it is common knowledge that results of heart surgery in dialysis patients, in particular, are extremely poor, but on the other hand, there are only a few reports that focused on non-dialysis patients with chronic kidney disease (CKD) in Japan . We report the outcomes of coronary artery bypass grafting (CABG) performed on non-dialysis patients with renal dysfunction at our hospital. II. Materials and methods
{"title":"Results of Coronary Artery Bypass Grafting in Non-dialysis Patients with Renal Dysfunction","authors":"Onichi Furuya, S. Higashiue, Satoshi Kuroyanagi, Masatoshi Komooka, Saburo Kojima, Makoto Matsuura, K. Kasuga, Tetsushi Takemoto, Norihiko Hiramatsu","doi":"10.7793/jcad.26.20-00003","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00003","url":null,"abstract":"Preoperative renal dysfunction is a major risk factor in heart surgery-. On the one hand, it is common knowledge that results of heart surgery in dialysis patients, in particular, are extremely poor, but on the other hand, there are only a few reports that focused on non-dialysis patients with chronic kidney disease (CKD) in Japan . We report the outcomes of coronary artery bypass grafting (CABG) performed on non-dialysis patients with renal dysfunction at our hospital. II. Materials and methods","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.19-00015
Ai Ishizawa, A. Hamasaki, T. Uchida, Y. Kuroda, M. Mizumoto, Atsushi Yamashita, S. Hirooka, K. Akabane, M. Sadahiro
Despite the widespread use and superior patency of the arterial graft for coronary artery bypass grafting (CABG), the saphenous vein (SV) continues to be the most commonly used graft. The SVs, however, sometimes have anatomical problems such as varicose veins, small or large diameter, and duplication. Ultrasonography has been the main modality for preoperative SV evaluation because of its simplicity and low invasiveness ; however, it has drawbacks, such as a lack of objectiveness, poor reproducibility, and difficulty in capturing the entire image of SV. Meanwhile, computed tomography (CT) can clearly visualize the SV without contrast. Although CT is performed as a standard preoperative examination for CABG in Japan, it is only used for evaluating the thoracoabdominal area in most facilities. To evaluate graft suitability of the SV preoperatively, we extended the CT scanning range to the lower extremities. The present study was conducted to clarify the usefulness of CT in the preoperative evaluation of the SV and to elucidate the incidence of an inadequate SV as a graft.
{"title":"Preoperative Detection of Inadequate Saphenous Vein by Noncontrast Three-dimensional Computed Tomography","authors":"Ai Ishizawa, A. Hamasaki, T. Uchida, Y. Kuroda, M. Mizumoto, Atsushi Yamashita, S. Hirooka, K. Akabane, M. Sadahiro","doi":"10.7793/jcad.26.19-00015","DOIUrl":"https://doi.org/10.7793/jcad.26.19-00015","url":null,"abstract":"Despite the widespread use and superior patency of the arterial graft for coronary artery bypass grafting (CABG), the saphenous vein (SV) continues to be the most commonly used graft. The SVs, however, sometimes have anatomical problems such as varicose veins, small or large diameter, and duplication. Ultrasonography has been the main modality for preoperative SV evaluation because of its simplicity and low invasiveness ; however, it has drawbacks, such as a lack of objectiveness, poor reproducibility, and difficulty in capturing the entire image of SV. Meanwhile, computed tomography (CT) can clearly visualize the SV without contrast. Although CT is performed as a standard preoperative examination for CABG in Japan, it is only used for evaluating the thoracoabdominal area in most facilities. To evaluate graft suitability of the SV preoperatively, we extended the CT scanning range to the lower extremities. The present study was conducted to clarify the usefulness of CT in the preoperative evaluation of the SV and to elucidate the incidence of an inadequate SV as a graft.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00022
Kohtaro Takayasu, A. Okamura, K. Iwakura, M. Iwamoto, H. Nagai, A. Sumiyoshi, Koichi Inoue, M. Date, Y. Ueda, K. Fujii
Coronary angiography (CAG) with fractional flow reserve is the gold standard method for assessing ischemic heart disease (IHD). However, it is expensive, invasive, and is associated with risks of significant complications. Therefore, the exercise stress test (EST) has been commonly used in patients with a low or intermediate risk of developing IHD . However, EST can be associated with serious complications, as described in this case.
{"title":"Acute Coronary Syndrome due to Plaque Rupture Induced by Negative Exercise Stress Test","authors":"Kohtaro Takayasu, A. Okamura, K. Iwakura, M. Iwamoto, H. Nagai, A. Sumiyoshi, Koichi Inoue, M. Date, Y. Ueda, K. Fujii","doi":"10.7793/jcad.26.20-00022","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00022","url":null,"abstract":"Coronary angiography (CAG) with fractional flow reserve is the gold standard method for assessing ischemic heart disease (IHD). However, it is expensive, invasive, and is associated with risks of significant complications. Therefore, the exercise stress test (EST) has been commonly used in patients with a low or intermediate risk of developing IHD . However, EST can be associated with serious complications, as described in this case.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00017
K. Tamura, T. Maruyama, S. Sakurai
Objective: Delirium is a morbid and costly problem. Though melatonin receptor agonist (Ramelteon) is also reported to decrease delirium, the effect of orexin receptor antagonist (Suvorexant) is unclear. We examine the effectiveness of Suvorexant in decreasing postoperative delirium in comparison with Ramelteon retrospectively. Materials and methods: We reviewed 138 patients (29 women, mean age 69.7 ± 3.4 years) who underwent coronary artery bypass grafting (CABG) alone. Patients have divided into three groups; patients received orexin receptor antagonist (S-group, n=45), patients received melatonin receptor agonist (R-group, n=26), and patients not received neither orexin receptor antagonist nor melatonin receptor agonist (N-group, n=67), and the following data were analyzed in three groups. Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S-group compared with N and R-group (N: S: R=2.4 ± 2.0: 0.9 ± 1.1: 2.2 ± 1.4, p<0.001). Although POD was present in two patients (4.4%) in S-group, seven patients (26.9%) in R-group and twenty patients in N-group (29.9%) developed (p=0.002). In S-group, hospital stay (N: S: R=23.6 ± 8.9: 18.8 ± 2.9: 20.7 ± 4.4 days, p=0.005) was significantly shorter than in R and N-group. Conclusion: Orexin receptor antagonists has shown positive outcomes in the prevention of delirium after CABG. Large trials are necessary to further comparing the efficacy of Suvorexant to other sleep modulating options.
{"title":"Efficacy of Orexin Receptor Antagonist for Delirium after Coronary Artery Bypass Grafting Compared with Melatonin Receptor Agonist","authors":"K. Tamura, T. Maruyama, S. Sakurai","doi":"10.7793/jcad.26.20-00017","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00017","url":null,"abstract":"Objective: Delirium is a morbid and costly problem. Though melatonin receptor agonist (Ramelteon) is also reported to decrease delirium, the effect of orexin receptor antagonist (Suvorexant) is unclear. We examine the effectiveness of Suvorexant in decreasing postoperative delirium in comparison with Ramelteon retrospectively. Materials and methods: We reviewed 138 patients (29 women, mean age 69.7 ± 3.4 years) who underwent coronary artery bypass grafting (CABG) alone. Patients have divided into three groups; patients received orexin receptor antagonist (S-group, n=45), patients received melatonin receptor agonist (R-group, n=26), and patients not received neither orexin receptor antagonist nor melatonin receptor agonist (N-group, n=67), and the following data were analyzed in three groups. Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S-group compared with N and R-group (N: S: R=2.4 ± 2.0: 0.9 ± 1.1: 2.2 ± 1.4, p<0.001). Although POD was present in two patients (4.4%) in S-group, seven patients (26.9%) in R-group and twenty patients in N-group (29.9%) developed (p=0.002). In S-group, hospital stay (N: S: R=23.6 ± 8.9: 18.8 ± 2.9: 20.7 ± 4.4 days, p=0.005) was significantly shorter than in R and N-group. Conclusion: Orexin receptor antagonists has shown positive outcomes in the prevention of delirium after CABG. Large trials are necessary to further comparing the efficacy of Suvorexant to other sleep modulating options.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Nakajima, Shintaro Saito, S. Yoshida, H. Wakabayashi
Various new imaging modalities provide multiple options with which to clinically diagnose coronary artery disease (CAD). Among such modalities, the major indications for nuclear cardiology remain the diagnosis of myocardial perfusion including stress-induced ischemia and infarction. However, the popularity of non-invasive X-ray computed tomography (CT) with coronary CT coronary angiography (CCTA) to visualize CAD, has rapidly increased , whereas nuclear imaging with Tcand I-labeled tracers has reached a plateau at ~200,000– 300,000 studies annually according to Japanese Radioisotope Association. Fusion imaging with combined CCTA and single-photon emission computed tomography (SPECT) is also a popular option for integrated displays of coronary artery and perfusion . The most pressing matter is how to integrate or effectively use information about coronary anatomy and perfusion in clinical practice. Myocardial perfusion reserve has so far been assessed in Japan only by positron emission computed tomography (PET) with N-ammonia and O-water. However, the number of cardiac PET studies has been lower than expected in Japan except for F-fluorodeoxy glucose (FDG) in cardiac sarcoidosis. In contrast, SPECT could be an alternative to PET for assessing myocardial flow reserve (MFR), if further validated. Newer solid-state, cadmium-zinc telluride (CZT) cameras offer 10-fold higher sensitivity than conventional gamma camera SPECT, which has enabled dynamic studies of tracer transit from intravenous injection to myocardial fixation that provides MFR . While fractional flow reserve (FFR) has provided adjunctive information during coronary angiography in patients with coronary stenosis , the roles of MFR and FFR need to be further validated from the viewpoint of diagnosis and prognosis. Compounds labeled with I such as I-β-methyliodophenylpentadecanoic acid (BMIPP) and I-metaiodobenzylguanidine (MIBG) are used in 20% of nuclear cardiology studies, which is unique in Japan. Current clinical guidelines include the Guidelines for Diagnosis of Chronic Coronary Heart Diseases Review Article
{"title":"Status of Nuclear Cardiology Progress in Japan 2020","authors":"K. Nakajima, Shintaro Saito, S. Yoshida, H. Wakabayashi","doi":"10.7793/jcad.26.002","DOIUrl":"https://doi.org/10.7793/jcad.26.002","url":null,"abstract":"Various new imaging modalities provide multiple options with which to clinically diagnose coronary artery disease (CAD). Among such modalities, the major indications for nuclear cardiology remain the diagnosis of myocardial perfusion including stress-induced ischemia and infarction. However, the popularity of non-invasive X-ray computed tomography (CT) with coronary CT coronary angiography (CCTA) to visualize CAD, has rapidly increased , whereas nuclear imaging with Tcand I-labeled tracers has reached a plateau at ~200,000– 300,000 studies annually according to Japanese Radioisotope Association. Fusion imaging with combined CCTA and single-photon emission computed tomography (SPECT) is also a popular option for integrated displays of coronary artery and perfusion . The most pressing matter is how to integrate or effectively use information about coronary anatomy and perfusion in clinical practice. Myocardial perfusion reserve has so far been assessed in Japan only by positron emission computed tomography (PET) with N-ammonia and O-water. However, the number of cardiac PET studies has been lower than expected in Japan except for F-fluorodeoxy glucose (FDG) in cardiac sarcoidosis. In contrast, SPECT could be an alternative to PET for assessing myocardial flow reserve (MFR), if further validated. Newer solid-state, cadmium-zinc telluride (CZT) cameras offer 10-fold higher sensitivity than conventional gamma camera SPECT, which has enabled dynamic studies of tracer transit from intravenous injection to myocardial fixation that provides MFR . While fractional flow reserve (FFR) has provided adjunctive information during coronary angiography in patients with coronary stenosis , the roles of MFR and FFR need to be further validated from the viewpoint of diagnosis and prognosis. Compounds labeled with I such as I-β-methyliodophenylpentadecanoic acid (BMIPP) and I-metaiodobenzylguanidine (MIBG) are used in 20% of nuclear cardiology studies, which is unique in Japan. Current clinical guidelines include the Guidelines for Diagnosis of Chronic Coronary Heart Diseases Review Article","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.7793/jcad.26.20-00025
S. Sueda, T. Shinohara, N. Takahashi, J. Shite, T. Shoji, M. Akao, Y. Kijima, T. Masuyama, T. Miyaji, Katsuhito Yamamoto, Y. Iwasaki, Ritsu Yoshida, Shigeru Nakamura, Y. Ogino, K. Kimura, M. Sasai, Hiroshi Suzuki, T. Wakatsuki, H. Asajima, H. Teragawa, T. Ishikawa, K. Kitamura, T. Oda, T. Nakayama, Yoshio Kobayashi, Daiki Sunada, M. Yamaki, Fumie Nishizaki, H. Tomita, K. Usuda, H. Fujinaga, S. Kuramitsu, K. Ando, T. Kiyooka, K. Kadota, Yoshinao Ishii, H. Ohtani, Yuichiro Maekawa, E. Taguchi, K. Nakao, Nobuaki Kobayashi, Y. Seino, H. Nakagawa, Yoshihiko Saito, I. Komuro, Y. Sasaki, S. Ikeda, Osamu Yamaguchi, A. Kakutani, T. Imanaka, M. Ishihara, M. Ishii, K. Kaikita, K. Tsujita
Background : Coronary artery spasm may lead to the aborted sudden cardiac death (A-SCD). Objectives : We investigated the number of coronary vasodilators, including calcium channel blocker (CCB), implantable cardioverter-defibrillator (ICD) implantation and prognosis in patients with A-SCD due to coronary spasm in the real world. Methods : We recruited 98 patients (82 men, mean age of 59.6±13.3 years old) with A-SCD due to coronary spasm using a questionnaire. Results : Ventricular fibrillation (VF) as a cause of A-SCD was observed in 83 patients (84.7%), while pulseless electrical activity (PEA) was recognized in 12 patients (12.2%). ICD was implanted in 58 patients and appropriate ICD therapies were recognized in 8 patients (13.8%). There were no differences regarding medications between patients with and without ICD or between patients who survived and those who died. Mean follow-up duration was 27.1±19.9 months and three patients died. Mortality during the follow-up period was not different patients with ICD from those without ICD. The mean number of coronary vasodilators including CCB in patients with spasm provocation tests under medications were significantly higher than in those without. VF as an initial cause of A-SCD was recognized in all 3 patients who died, while PEA was a final cause of death in 2 of 3 patients. Conclusions : Clinical outcomes in patients with A-SCD due to coronary spasm is satisfactory under medical and mechanical therapy. Decision of requiring the ICD implantation in patients with A-SCD due to coronary spasm is a challenging clinical problem.
{"title":"Clinical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm","authors":"S. Sueda, T. Shinohara, N. Takahashi, J. Shite, T. Shoji, M. Akao, Y. Kijima, T. Masuyama, T. Miyaji, Katsuhito Yamamoto, Y. Iwasaki, Ritsu Yoshida, Shigeru Nakamura, Y. Ogino, K. Kimura, M. Sasai, Hiroshi Suzuki, T. Wakatsuki, H. Asajima, H. Teragawa, T. Ishikawa, K. Kitamura, T. Oda, T. Nakayama, Yoshio Kobayashi, Daiki Sunada, M. Yamaki, Fumie Nishizaki, H. Tomita, K. Usuda, H. Fujinaga, S. Kuramitsu, K. Ando, T. Kiyooka, K. Kadota, Yoshinao Ishii, H. Ohtani, Yuichiro Maekawa, E. Taguchi, K. Nakao, Nobuaki Kobayashi, Y. Seino, H. Nakagawa, Yoshihiko Saito, I. Komuro, Y. Sasaki, S. Ikeda, Osamu Yamaguchi, A. Kakutani, T. Imanaka, M. Ishihara, M. Ishii, K. Kaikita, K. Tsujita","doi":"10.7793/jcad.26.20-00025","DOIUrl":"https://doi.org/10.7793/jcad.26.20-00025","url":null,"abstract":"Background : Coronary artery spasm may lead to the aborted sudden cardiac death (A-SCD). Objectives : We investigated the number of coronary vasodilators, including calcium channel blocker (CCB), implantable cardioverter-defibrillator (ICD) implantation and prognosis in patients with A-SCD due to coronary spasm in the real world. Methods : We recruited 98 patients (82 men, mean age of 59.6±13.3 years old) with A-SCD due to coronary spasm using a questionnaire. Results : Ventricular fibrillation (VF) as a cause of A-SCD was observed in 83 patients (84.7%), while pulseless electrical activity (PEA) was recognized in 12 patients (12.2%). ICD was implanted in 58 patients and appropriate ICD therapies were recognized in 8 patients (13.8%). There were no differences regarding medications between patients with and without ICD or between patients who survived and those who died. Mean follow-up duration was 27.1±19.9 months and three patients died. Mortality during the follow-up period was not different patients with ICD from those without ICD. The mean number of coronary vasodilators including CCB in patients with spasm provocation tests under medications were significantly higher than in those without. VF as an initial cause of A-SCD was recognized in all 3 patients who died, while PEA was a final cause of death in 2 of 3 patients. Conclusions : Clinical outcomes in patients with A-SCD due to coronary spasm is satisfactory under medical and mechanical therapy. Decision of requiring the ICD implantation in patients with A-SCD due to coronary spasm is a challenging clinical problem.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71175400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-09DOI: 10.7793/jcad.25.19-00011
Natsumi Takigami, Chieko Sakai, T. Kawasaki
{"title":"Acute Myocardial Infarction during the 2018 World Cup in Russia","authors":"Natsumi Takigami, Chieko Sakai, T. Kawasaki","doi":"10.7793/jcad.25.19-00011","DOIUrl":"https://doi.org/10.7793/jcad.25.19-00011","url":null,"abstract":"","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41517656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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