Rheumatic Mitral Stenosis: Long-Term Follow-Up of Adult Patients with Nonsevere Initial Disease.

Introduction: There is no consensus regarding the natural history of rheumatic mitral stenosis (MS) among adults presenting with nonsevere disease. This study aims to describe the progression of stenosis among adult rheumatic MS patients, to identify predictive factors for progression, and to assess the incidence of complications.

Methods: A retrospective cohort analysis was performed among patients with rheumatic MS treated at a single center.

How long do your angiographically normal coronary arteries remain normal? A pilot study.

Coronary atherosclerosis is a progressive disease. We sought to determine whether this fact also applies to patients at an advanced age with normal coronary arteries (NCAs) undergoing repeat catheterization at least 5 years later. Of the 189 patients who were found to have NCAs, 154 (81%) remained with NCAs and 35 (19%) developed obstructive coronary artery disease (OCAD).

Collateral-dependent ischemic mitral regurgitation.

There is much debate on the pathogenesis of ischemic mitral regurgitation (MR), usually related to global or regional left ventricular dysfunction or remodeling secondary to chronic ischemic changes, altering the tethering and closing forces on the mitral apparatus. There is a paucity of literature describing MR in the setting of acute ischemia. We describe a case in which the MR was dynamic and directly related to changes in coronary collateral flow.

Length of left anterior descending coronary artery determines prognosis in acute anterior wall myocardial infarction.

Background: The left anterior descending artery (LAD) supplies blood to a large part of the myocardium. However, the amount of myocardium supplied varies depending on the length of the LAD and as a result, occlusion of its proximal portion may influence outcome. We investigated the prognosis of patients with anterior wall myocardial infarction as the initial presentation of coronary disease who underwent primary percutaneous coronary intervention (PPCI) in our institution due to isolated proximal LAD occlusion.

Isolated nondominant right coronary stenosis: clinical presentation and management.

The frequency, clinical presentation, and management of severely stenotic isolated nondominant right coronary artery (NDRCA) have not been adequately defined. We sought to do so in a large cohort of patients undergoing coronary angiography. We retrospectively analyzed all patients who underwent coronary angiography in our institute between 1995 and June 2012, looking at those with a severe lesion in the NDRCA, recording demographic, clinical, and angiographic data.

Coronary thrombus in ST elevation myocardial infarction and atrial fibrillation.

Coronary embolization is a rare cause of acute myocardial infarction (AMI) and few descriptions are found in the literature. Since atrial fibrillation is a known cause of systemic embolization our aim was to investigate the incidence of globular filling defects suggesting embolization in patients presenting with atrial fibrillation (AF) and ST elevation AMI with single vessel disease. We retrospectively analyzed all patients from our data base between 2002 and 2011 (2,067 patients) presenting with AF, AMI and single vessel disease and compared them to a randomly chosen control group with AMI, single vessel disease and in sinus rhythm.

Medical treatment versus angioplasty for isolated ostial diagonal stenoses: a comparative clinical follow-up.

Objectives: Angioplasty of a stenosis at the ostium of a diagonal branch of the left anterior descending artery as an isolated lesion often poses a dilemma due to the risk involved in treating the lesion in comparison to the potential benefit. Therefore, we sought to investigate our experience with this issue.

Methods: Between 1995 and 2010, we retrospectively analyzed 39,300 patients who underwent invasive coronary angiography in our institution.

Collateral myocardial blush in inferior wall myocardial infarction: a new diagnostic tool to differentiate between occluded right coronary and circumflex arteries.

Objectives: The infarct-related artery (IRA) in inferior wall myocardial infarction (IMI) may be problematic to identify due to occasional instances in which the right coronary (RCA) and left circumflex (CX) arteries are both occluded. We sought to investigate if impaired collateral myocardial blush (CMBG) identifies the correct IRA.

Methods: Between 2002 and 2010, we retrospectively analyzed 1907 patients who underwent primary angioplasty at our institution.

Collateral blood flow can predict myocardial blush grade in primary coronary intervention.

Objectives: Our aim was to investigate whether collateral flow may predict myocardial blush grade (MBG) in acute myocardial infarction patients undergoing primary percutaneous coronary intervention.

Background: No-reflow is a well known phenomenon associated with increased morbidity and mortality due to underperfused myocardium; therefore early prediction of no-reflow is of major importance. We have observed that in patients with good collateral filling of the infarct related artery as seen prior to primary angioplasty, the clearance of the contrast medium from the myocardium may be impaired.

Incidence, predictors and outcome of upper gastrointestinal bleeding in patients with acute coronary syndromes.

Background: The broad utilization of revascularization and antithrombotic therapy in patients with acute coronary syndrome (ACS) is associated with a substantial risk of bleeding primarily related to arterial punctures, which can lead to worse outcome.

Aim: To define the characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in the setting of ACS.

Methods: We identified all patients admitted to the coronary care unit between 10/96 and 11/07 with ACS who developed UGIB.

Isolated inferior wall ST segment depression as an early sign of acute anterior wall myocardial infarction.

Background: Reciprocal changes may accompany ST segment elevation in the ischemic territory during acute myocardial infarction (AMI). We examined the hypothesis that isolated inferior ST segment depression on admission is an early sign of anterior wall infarction.

Methods: 49 patients admitted to the coronary care unit between January 1996 and June 2008 who presented with inferior ST segment depression in the absence of ST segment elevation.

Cell free DNA detected by a novel method in acute ST-elevation myocardial infarction patients.

Background: High levels of circulating cell free DNA (CFD) have been associated with poor prognosis in various diseases. Data pertaining to CFD in acute myocardial infarction (MI) are scarce. The available data have been obtained by either electrophoresis or polymerase chain reaction.

Ventricular fibrillation as the presenting manifestation of adrenocortical carcinoma.

We describe a case of a young adult in whom sudden cardiac death due to ventricular fibrillation was the presenting manifestation of an adrenocortical carcinoma. The arrhythmia was precipitated by severe hypokalemia induced by the aldosterone-secreting tumor. Sudden death has not been previously described as a manifestation of this adrenal neoplasm.

Coronary stenting in warfarin treated patients.

Dual antiplatelet therapy is standard treatment following coronary stent implantation. An important minority of patients also require chronic anticoagulation, most commonly for atrial fibrillation. There are no prospective trials to guide the selection of therapy in this situation.

Impact of the community's socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention.

Background: Individual socioeconomic factors have been associated with adverse cardiovascular outcomes. It is however unclear how the socioeconomic status of a community influences the characteristics and outcome of patients treated with percutaneous coronary intervention (PCI).

Methods: The Israel Central Bureau of Statistics assigns a socioeconomic index (SI) to communities based on demographic, economic and educational parameters.

B-type natruiretic peptide levels stratify the risk for arrhythmia among implantable cardioverter defibrillator patients.

Background: We sought to study the association between brain natriuretic peptide (BNP) levels and the occurrence of ventricular arrhythmias in patients with left ventricular dysfunction (LVD) and an implantable cardioverter defibrillator (ICD).

Methods: This was a prospective study of consecutive, stable, ambulatory patients with moderate and severe ischemic LVD and an ICD. A plasma BNP level was obtained at recruitment.

Grade 3 ischemia on the admission electrocardiogram predicts failure of ST resolution and of adequate flow restoration after primary percutaneous coronary intervention for acute myocardial infarction.

Background: Failure of ST-segment resolution (STR) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction is associated with adverse outcome but currently cannot be predicted on admission. Our aim was to determine whether failure of STR can be predicted from clinical and electrocardiographic data available on admission and whether the adverse outcome associated with grade 3 ischemia (distortion of the terminal portion of the QRS complex) is mediated through impaired tissue reperfusion.

Methods: We prospectively studied 100 consecutive patients who underwent PPCI for a first ST-elevation myocardial infarction.

Predicting survival with reperfusion arrhythmias during primary percutaneous coronary intervention for acute myocardial infarction.

Background: The significance of arrhythmia occurring after successful recanalization of an occluded artery during treatment following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction is controversial.

Objectives: To study the association of reperfusion arrhythmia with short and long-term survival.

Methods: We used a prospective registry of consecutive STEMI patients undergoing PPCI.

Benefit of direct ambulance to coronary care unit admission of acute myocardial infarction patients undergoing primary percutaneous intervention.

Background: Early reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) patients improves left ventricular (LV) function and survival. However, emergency room (ER) triage may unnecessarily delay this time-dependent treatment. We sought to determine whether direct admission of STEMI patients from the mobile intensive care units to the intensive coronary care unit (ICCU), bypassing the ER, can shorten the time intervals for primary PCI (PPCI) and improve prognosis.

Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial.

Background: The aim of this study was to test whether nitroprusside (NTP) injected intracoronary immediately before primary angioplasty for acute ST-elevation acute myocardial infarction (STEMI) prevents no-reflow and improves vessel flow and myocardial perfusion.

Methods: Ninety-eight patients presenting with STEMI were evenly randomized to receive either NTP (60 microg) or placebo. The drug was selectively injected into the infarct-related artery, distal to the occlusion, in a double-blind manner.