Validation of the MIRACLE Score for Prognostication After Out-of-hospital Cardiac Arrest.

Background: Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE score provides a simple method of neuro-prognostication but as yet it has not been externally validated.

In-stent Thrombosis and COVID-19 Infection: Current Insights on the Mechanistic Relationship.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been demonstrated as a major risk factor in inducing coronary stent thrombosis due to its propensity to create a pro-thrombotic state. This review explores the mechanisms that may contribute to the increased thrombosis risk seen in COVID-19. Furthermore, we discuss the patient and haematological factors that predispose to an increased risk of stent thrombosis, as well as the role of certain antiplatelet and anticoagulation therapies, including ticagrelor and enoxaparin, that may reduce the likelihood and severity of in-stent thrombosis, in SARS-CoV-2 infection.

Challenges in Primary PCI: How to Treat a Large Intracoronary Thrombus With TIMI 3 Flow?

This case highlights 2 important issues: the immediate management of large intracoronary thrombus in the ST-segment elevation myocardial infarction setting with TIMI 3 flow, and the risks/benefits associated with sealing a plaque in an unobstructed artery by stenting. Potent antithrombotic therapy with a view to subsequent intracoronary imaging to define etiology and plaque morphology appears to be a reasonable initial strategy in this specific population. Furthermore, for patients with acute coronary syndromes diagnosed with plaque erosion by optical coherence tomography and residual diameter stenosis <70%, deferred stenting appears a viable option.

Acute Coronary Syndromes Due to Atherosclerotic Coronary Artery Disease in Young Patients.

Young patients represent about 4-10% of the population presenting with acute coronary syndrome. In this focused mini-review, we highlight the data regarding acute coronary syndromes in young patients with atherosclerotic coronary artery disease. Differences in the underlying pathologies and pathophysiological mechanisms should yield to different clinical management and treatment strategies.

PCSK9 Inhibitors for the Management of Dyslipidemia in People with Type 2 Diabetes: How Low is Too Low?

Diabetic patients are considered to be at high risk for the development of atherosclerotic disease. Management of hypercholesterolemia is of paramount importance to optimize cardiovascular outcomes in this subset of patients and statins are regarded as the mainstay of treatment. However, the recent advent of PCSK-9 inhibitors has provided a useful alternative in the management of dyslipidemia, especially when statins cannot be tolerated or when hypolipidemic targets cannot be achieved.

Acute Circumflex Occlusion After a Successful Mitral Valve Repair.

We herein present an interesting case of acute iatrogenic coronary artery occlusion after a successful mini mitral valve repair in a young patient with Barlow's disease. It was successfully managed with percutaneous coronary intervention. This is a well-recognized complication of mitral valve surgery and is often misdiagnosed or late recognized.

Spinal Hematoma Following Coronary Angioplasty: An Uncommon Complication.

We report an unusual case of post-procedural spontaneous spinal epidural hematoma in a 65 year old man who presented with an acute coronary syndrome and underwent complex coronary intervention with adjunct use of a GPIIb/IIIa inhibitor. Although spontaneous spinal epidural hematoma (SSEH) following coronary intervention is extremely rare, clinicians should be aware of this unusual diagnosis. Prompt investigation with MRI and early referral for neurosurgical input are recommended to prevent potentially significant sequelae.

Global longitudinal strain and long-term outcomes in asymptomatic extracardiac sarcoid patients with no apparent cardiovascular disease.

Purpose: Global longitudinal strain (GLS) is increasingly accepted as a predictor of mortality in various clinical settings. This study tested the hypothesis that GLS is associated with increased event rate in patients with extracardiac sarcoidosis, who have no overt symptoms of cardiovascular disease and preserved ejection fraction (EF).

Methods: We retrospectively studied 117 patients with extracardiac sarcoidosis and 45 age- and sex-matched controls, who underwent comprehensive echocardiographic study, while GLS was measured by an offline speckle tracking algorithm.

Balloon-assisted tracking: A practical solution to avoid radial access failure due to difficult anatomical challenges.

Aim: The balloon assisted tracking (BAT) technique is utilised to overcome various anatomical difficulties during radial procedures when standard measures such as adequate sedation, pain relief, vasodilators and use of hydrophilic guidewires, fail. The aim of this study was to evaluate the success rates of the BAT technique in overcoming anatomical difficulties during radial coronary interventional procedures.

Methods: We retrospectively reviewed 1100 consecutive patients undergoing coronary procedures from the transradial approach (TRA) between May 2015 and May 2017.

When everything else fails: High-pressure balloon for undilatable lesions.

Heavily calcified lesions are encountered with increasing frequency during percutaneous coronary interventions (PCI). This poses a significant problem as it often leads to suboptimal stent expansion, which in turn is a major cause for stent restenosis and thrombosis. Various technologies have been developed to tackle this.

Mechanical Wenckebach Phenomenon in Thrombosed Tricuspid Valve Prosthesis.

• Mechanical valve thrombosis is a serious complication. • Echocardiography and fluoroscopy are cornerstones of diagnosis. • Echocardiography in more than two loops can identify intermittent valve obstruction.

Effect of gender on the prognostic value of dobutamine stress myocardial contrast echocardiography.

Background: Dobutamine stress contrast echo (DSCE) has a well-established prognostic value in the context of coronary artery disease (CAD). However, data regarding its prognostic capability separately in men and women are scarce. The aim of the current study was to assess gender-related differences in the prognostic performance of DSCE.

Two-dimensional speckle tracking for the assessment of coronary artery disease during dobutamine stress echo: clinical tool or merely research method.

Background: Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography.

Methods: We studied 100 patients (mean age 60.

Real-time three-dimensional echocardiography: never before clinical efficacy looked so picturesque.

Over the years echocardiography has served the clinical cardiologist in a variety of clinical scenarios, assisting in patient diagnostic and therapeutic managements. With the advent of novel imaging modalities we now experience the renascence of imaging. As a result, the field of cardiovascular medicine is strongly connected to imaging, which in turn requires thorough knowledge of each modality's distinct advantages and limitations.