Reproducible microvascular dysfunction with dobutamine infusion in Takotsubo cardiomyopathy presenting with ST segment elevation.

Takotsubo (ampulla) cardiomyopathy, or broken heart syndrome, is an underrecognized cardiac illness that usually presents as an acute coronary syndrome in postmenopausal females. The disorder is frequently associated with episodes of mental or physical stress, implicating an abnormal cardiac response to increased catecholamines. Although death has been reported during the index event, the long-term prognosis is good with full recovery of left ventricular function.

Coronary 64-slice computed tomographic angiography models employing aortic root and selective catheter directed contrast enhancement in swine: technical feasibility and preliminary results using 3D and 4D reconstructions.

Purpose: The technical feasibility of combining catheter directed coronary enhancement and multidetector computed tomographic angiography (MD-CTA) is presented in a swine model at various cardiac and injection rates.

Materials/methods: A 64-slice CT scanner was used under animal IRB approval in four sedated swine. Common femoral venous/arterial access with a 5 Fr micropuncture kit was ultrasound guided.

Intracoronary fibrin-specific thrombolytic infusion facilitates percutaneous recanalization of chronic total occlusion.

Objectives: We sought to investigate the benefit, predictors of procedural success, and safety of pre-procedural intra-coronary fibrin-specific lytic infusion (ICL) in patients with failed prior percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).

Background: Percutaneous coronary intervention for CTO remains a challenge with a high incidence of procedural failure secondary to inability to cross the occlusion with the guidewire.

Methods: Eighty-five patients who underwent unsuccessful PCI procedures of CTO (more than three months' duration) had a repeat attempt of recanalization with the use of pre-procedural ICL.

Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction.

We examined the incidence, presentation, and outcome of patients who developed gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction in the Primary Angioplasty in Myocardial Infarction trials. Of the 3,130 patients, 71 (2.3%) developed gastrointestinal bleeding, which was more likely to occur in elderly patients.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

HOCM is a rare disorder of myocardium that may result in asymmetrical left ventricular septal hypertrophy and dynamic outflow obstruction. This may result in hemodynamic sequel that leads to deterioration of functional class in the majority of patients. Alcohol septal ablation may provide symptomatic relief in the majority of patients who fail medical therapy or who experience significantly high outflow gradients.

Success, safety, and mechanisms of failure of percutaneous coronary intervention for occlusive non-drug-eluting in-stent restenosis versus native artery total occlusion.

We compared the procedural success, mechanism of failure, and safety of percutaneous coronary intervention in 235 procedures for de novo chronic total occlusions with 78 procedures for chronic occlusive in-stent restenosis. Despite similar rates of procedural success and safety profile, angiographic predictors of successful percutaneous coronary intervention for de novo chronic total occlusions played a limited role in patients who had chronic occlusive in-stent restenosis, and the mechanisms of failure were different.

Clinical correlation between increased lung to heart ratio of technetium-99m sestamibi and multivessel coronary artery disease.

Background: An increased lung to heart ratio (LHR) on thallium-201 (Tl-201) stress myocardial perfusion imaging (MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease (CAD). The implications of increased LHR in patients undergoing stress technetium-99m (tc-99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc-99m sestamibi MPI.

Frequency of returning to work one and six months following percutaneous coronary intervention for acute myocardial infarction.

We conducted an analysis of the frequency and variables associated with early (after 1 month) and late (after 6 months) return to work after percutaneous coronary intervention for acute myocardial infarction in patients who had been randomized in the Stent Primary Angioplasty in Myocardial Infarction trial. Of 450 patients who were employed before the acute myocardial infarction, 230 (51%) returned to work within 1 month with no increases in in-hospital and 1- or 6-month event rates compared with those who did not return to work. Multivariate analysis showed that predictors of early return to work were employment in the United States, no history of smoking, and single-vessel coronary disease.

Acute angiographic analysis of non-ST-segment elevation acute myocardial infarction.

Most revascularization studies on acute myocardial infarction have included patients who have ST-segment elevation or new-onset left bundle branch block. However, the characteristics of patients who have non-ST-segment elevation acute myocardial infarction and who have undergone angiographic analysis of their infarct-related arteries have not been adequately described. This study suggests that these patients are likely to have had coronary bypass surgery (odds ratio 4.