Pulmonary Thromboembolism Caused by Prolonged Compression at the Femoral Access Site and a Venous Aneurysm of the Ipsilateral Popliteal Vein.

A 51-year-old female with dilated cardiomyopathy underwent a cardiac catheterization via right common femoral vein and artery. Prolonged compression with a bandage and extension of supine bed rest were needed. Immediately after standing up, she lost consciousness and developed electromechanical dissociation.

Relationship Between Thickness of Calcium on Optical Coherence Tomography and Crack Formation After Balloon Dilatation in Calcified Plaque Requiring Rotational Atherectomy.

Background: Target lesion calcification is known to influence percutaneous coronary intervention. We evaluated the effects of rotational atherectomy (RA) and subsequent balloon angioplasty on calcified coronary lesions using optical coherence tomography (OCT).

Methods and results: Thirty-seven calcified lesions in 36 patients were treated with RA followed by balloon angioplasty and stent implantation.

Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes.

Background: Blood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics.

Methods: In 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels.

Impact of n-3 polyunsaturated fatty acids in predicting ischemia/reperfusion injury and progression of myocardial damage after reperfusion in patients with ST-segment elevation acute myocardial infarction.

Background: In animal models of acute myocardial infarction, n-3 polyunsaturated fatty acids (PUFAs) administered before coronary occlusion have been suggested to prevent induction of ventricular arrhythmia and limit infarct size. However, the relation between the serum levels of n-3 PUFAs and ischemia/reperfusion (I/R) injury remains unclear.

Methods: 211 patients with ST-segment elevation acute myocardial infarction received emergency percutaneous coronary intervention (PCI) within 6h from the onset.

Hypercapnia in patients with acute heart failure.

Aims: Non-invasive positive pressure ventilation rapidly improves the symptoms of acute heart failure (AHF). A portion of patients, however, are forced to be intubated even though intubation is associated with serious complications, and hypercapnia is often observed in AHF requiring intubation. The purpose of this study is to examine the clinical profile and management of hypercapnia in AHF patients.

B-type natriuretic peptide as a predictor of ischemia/reperfusion injury immediately after myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction.

Background: In animal models of acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) administered before and during coronary occlusion limits infarct size. However, the relation between plasma BNP levels and ischemia/reperfusion injury remains unclear.

Methods: 302 patients with ST-segment elevation AMI (STEMI) received emergency percutaneous coronary intervention within six hours from the onset.

Morphological features of non-culprit plaques on optical coherence tomography and integrated backscatter intravascular ultrasound in patients with acute coronary syndromes.

Aims: We sought to compare the morphological features of non-culprit plaques with >50% diameter stenosis in patients with acute coronary syndromes (ACS) with those of culprit plaques in patients with ACS and stable angina pectoris (SAP) using optical coherence tomography (OCT) and integrated backscatter intravascular ultrasound (IB-IVUS).

Methods And Results: A total of 150 culprit and non-culprit coronary plaques (non-culprit vessels) in 150 patients with coronary artery disease were interrogated by OCT before percutaneous coronary intervention (PCI). Patients were categorized as follows: 73 culprit plaques in patients with ACS (ACS-C), 32 non-culprit plaques in patients with ACS (ACS-NC), and 45 culprit plaques in patients with SAP.

Refractory vasospasms of the coronary arteries due to multiple factors: an autopsy case.

A 41-year-old man was admitted with decompensated heart failure. Mechanical ventilation was maintained with a large dose of propofol. On day 4, significant ST elevation with complete atrioventricular block was noted, which subsequently induced cardiopulmonary arrest.

Utility of noninvasive endothelial function test for prediction of deep vein thrombosis after total hip or knee arthroplasty.

Background: Venous thromboembolism (VTE) is a common and sometimes lethal postoperative complication of arthroplasty. Endothelial dysfunction is important in the pathogenesis of thrombus formation. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) can noninvasively evaluate endothelial function.

Higher level at admission and subsequent decline in hemoglobin in patients with acute pulmonary edema.

Background:  Acute pulmonary edema (APE) often occurs without remarkable fluid retention, and the benefits of diuretics are unclear in such patients. Although aggressive diuresis induces an increase in intravascular substances including hemoglobin (Hb), acute changes in Hb level remain to be investigated.

Methods And Results:  We analyzed 237 consecutive acute heart failure patients (74±12 years; 60.

Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction.

Objectives: This study sought to determine the additional clinical value of gait speed to Framingham risk score (FRS), cardiac function, and comorbid conditions in predicting cardiovascular events in patients with ST-segment elevation myocardial infarction.

Background: There is growing evidence that gait speed is inversely associated with all-cause mortality, particularly cardiovascular mortality, among the elderly.

Methods: We undertook a single-center prospective observational study of gait speed in 472 patients with ST-segment elevation myocardial infarction in Japan, between 2001 and 2008.

Validity and reliability of new intravascular ultrasound analysis software for morphological measurement of coronary artery disease.

Background: Intravascular ultrasound (IVUS) analysis software enables precise planimetry measurement and tissue characterization of coronary plaque. Recently, a new IVUS analysis software compatible with integrated backscatter-IVUS, VISIATLAS(TM), was developed. The validity and reliability of VISIATLAS(TM) were evaluated.

Differences in negative T waves between takotsubo cardiomyopathy and reperfused anterior acute myocardial infarction.

Background: In both takotsubo cardiomyopathy (TC) and reperfused anterior acute myocardial infarction (AMI), negative T waves commonly appear on the ECG in the subacute phase. This study aimed to clarify the ECG differences between these diseases.

Methods And Results: We compared the ECGs with the greatest amplitude of negative T wave from 34 patients with TC and 237 patients with a first reperfused anterior AMI who were admitted within 6 h of symptom onset and who had no abnormal Q-waves on discharge ECG.

Implications of ST-segment elevation in leads V5 and V6 in patients with reperfused inferior wall acute myocardial infarction.

During inferior acute myocardial infarction, ST-segment elevation (ST↑) often occurs in leads V(5) to V(6), but its clinical implications remain unclear. We examined the admission electrocardiograms from 357 patients with a first inferior acute myocardial infarction who had Thrombolysis In Myocardial Infarction 3 flow of the right coronary artery or left circumflex artery within 6 hours after symptom onset. The patients were divided according to the presence (n = 76) or absence (n = 281) of ST↑ >2 mm in leads V(5) and V(6).

Relation between hyperinsulinemia and nonculprit plaque characteristics in nondiabetic patients with acute coronary syndromes.

Objectives: We sought to assess whether hyperinsulinemia is associated with percentage lipid and coronary plaque burden in nondiabetic patients with acute coronary syndromes (ACS).

Background: Hyperinsulinemia carries an increased risk of cardiovascular disease even in pre-diabetic patients, but the precise mechanisms of its effects remain unclear.

Methods: Nonculprit coronary lesions associated with mild-to-moderate stenosis in 82 nondiabetic patients with ACS were examined by integrated backscatter intravascular ultrasound (IB-IVUS), using a 40-MHz intravascular catheter.

Impact of concomitant use of proton-pump inhibitors and thienopyridine derivatives on the antiplatelet effects.

Background: Although there has been an intense debate whether concomitant use of proton-pump inhibitors (PPIs) attenuates the antiplatelet effects of thienopyridine derivatives, the drug-drug interaction remains unclear in Japanese patients with coronary artery disease.

Methods And Results: Platelet function test was performed in 461 patients who were scheduled for or had undergone stent implantation, treated with 100mg/day of aspirin and a thienopyridine (200mg/day of ticlopidine or 75 mg/day of clopidogrel) for at least 14 days. Adenosine diphosphate-induced platelet aggregation was evaluated with screen filtration pressure method, and the upper quartile of high platelet reactivity was defined as high on-treatment platelet reactivity (HPR).

High QRS score on admission strongly predicts impaired myocardial reperfusion in patients with a first anterior acute myocardial infarction.

Background: In patients with acute myocardial infarction (AMI), QRS score at presentation electrocardiogram (ECG) may reflect the evolutionary stage of the infarction and allow one to predict the degree of myocardial reperfusion potentially achievable by reperfusion therapy.

Methods And Results: The relationship between QRS score on admission ECG and myocardial blush grade, an angiographic marker of myocardial reperfusion, was examined in 416 patients with a first anterior AMI who received reperfusion therapy within 6h after symptom onset. Patients were classified into 3 groups according to QRS score: 0 or 1 (n=102), 2-4 (n=228), and ≥5 (n=86).

An early and simple predictor of severe left main and/or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome.

Clopidogrel should be initiated as soon as possible in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) except those who urgently require coronary artery bypass grafting (CABG). The present study assessed the ability to predict severe left main coronary artery and/or 3-vessel disease (LM/3VD) that would most likely require urgent CABG based on only clinical factors on admission in 572 patients with NSTE-ACS undergoing coronary angiography. Severe LM/3VD was defined as ≥75% stenosis of LM and/or 3VD with ≥90% stenosis in ≥2 proximal lesions of the left anterior descending coronary artery and other major epicardial arteries.

Impact of statin pretreatment on the incidence of plaque rupture in ST-elevation acute myocardial infarction.

Objective: Several studies in experimental animals have shown that statins stabilize atheromatous plaques by increasing fibrous-cap thickness. However, direct evidence linking the use of statins to the incidence of plaque rupture in humans is lacking. We investigated whether statin treatment before the onset of ST-elevation myocardial infarction (STEMI) influences the incidence of plaque rupture detected by intravascular ultrasound (IVUS).

Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction.

Objectives: The aim of this study was to assess whether ultrasound attenuation and plaque rupture as detected by intravascular ultrasound (IVUS) are associated with the incidence of no-reflow phenomenon after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Background: No-reflow phenomenon is associated with worse long-term outcomes after STEMI. Therefore, reliable and feasible intravascular imaging techniques are needed to identify patient subgroups that would be at high risk for no-reflow phenomenon.

Association between circulating monocytes and coronary plaque progression in patients with acute myocardial infarction.

Background: Monocytes and macrophages have been shown to play major roles in the progression of atherosclerosis. This study examined whether the circulating monocyte count can be used to predict coronary plaque progression of non-culprit intermediate lesions in acute myocardial infarction (AMI).

Methods And Results: Intravascular ultrasound findings of non-culprit intermediate plaque in 90 patients were analyzed in the acute phase and at a 7-month follow up.

Plaque location in the left anterior descending coronary artery and tissue characteristics in angina pectoris: an integrated backscatter intravascular ultrasound study.

Background: Ruptured plaque and culprit lesions associated with anterior acute myocardial infarction cluster mainly in the proximal segment of the left anterior descending coronary artery (LAD). This study investigated whether the tissue characteristics of plaque in the proximal LAD differs from that of plaque in the distal LAD as assessed by integrated backscatter (IB)-intravascular ultrasound (IVUS).

Methods And Results: IVUS interrogation was used to study 107 non-culprit intermediate plaques in 68 patients with angina pectoris who underwent percutaneous coronary interventions.