Usefulness of a new grading system based on coronary flow velocity pattern in predicting outcome in patients with acute myocardial infarction having percutaneous coronary intervention.

In acute myocardial infarction, the coronary blood flow velocity waveform changes with the damage in the infarcted myocardium. We developed a grading system using the shorter diastolic deceleration time (DDT), appearance of systolic flow reversal (SFR), and disappearance of systolic anterograde flow. We studied 72 patients with a first anterior acute myocardial infarction.

Trends in myocardial contrast echocardiography: parameteric versus volumetric imaging.

It is now possible to perform myocardial contrast echocardiography at the bedside with an intravenous injection of commercially available contrast media. Although myocardial contrast echocardiography is a sensitive method for the detection of coronary stenosis and myocardial viability, its diagnosis has relied largely on the subjective interpretation of regional perfusion by experienced clinicians. Thus, quantification of myocardial contrast echocardiography data and displaying comprehensive images have been necessary for its routine application.

Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device.

Objectives: We investigated whether embolic particles could be detected as high-intensity transient signals (HITS) with a Doppler guide wire during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) We also assessed whether these signals could be reduced using a distal protection (DP) device.

Background: Embolization of thrombi and plaque components to the microcirculation is a major complication of PCI in patients with AMI. Embolic particles running in the cerebral artery are detected as HITS by transcranial Doppler ultrasound.

Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices.

Aims: Doppler guidewire studies demonstrated that the no-reflow phenomenon in acute myocardial infarction is associated with characteristic coronary blood flow pattern. We investigated the potential of coronary flow measurement with transthoracic Doppler technique to detect the no-flow in the patients with reperfused infarction, and compared it to that of other modalities.

Methods And Results: We performed intracoronary myocardial contrast echocardiography after successful primary coronary intervention in the 94 patients with first, anterior wall infarction.

Hemodynamics of microvascular dysfunction in patients with anterior wall acute myocardial infarction.

This study investigated whether the no-reflow phenomenon in acute myocardial infarction (AMI) is associated with an increase in coronary zero flow pressure (ZFP), a decrease in coronary arterial conductance, or both phenomena. Coronary blood flow velocity and pressure were measured with a Doppler guidewire and a pressure wire, respectively, during vasodilation with adenosine triphosphate after coronary intervention. The data indicate that the no-reflow phenomenon is not necessarily associated with a decrease in coronary arterial conductance but with an increase in ZFP.

Prediction of the no-reflow phenomenon with ultrasonic tissue characterization in patients with anterior wall acute myocardial infarction.

The no-reflow phenomenon after acute myocardial infarction seems to be related to ischemic injury before reperfusion. Analyzing cardiac cycle-dependent variation of integrated backscatter (IBS) is a unique method to assess myocardial viability. In this study, the ability of ultrasonic tissue characterization with IBS to predict the no-reflow phenomenon was investigated in 90 patients with first anterior wall infarction who underwent successful primary percutaneous coronary intervention.

Myocardial contrast echocardiography with a new calibration method can estimate myocardial viability in patients with myocardial infarction.

Objectives: We have developed a novel calibration technique applicable for myocardial contrast echocardiography (MCE). We assessed the value of this technique in the recognition of myocardial infarction (MI) and its spatial extent, and we also performed a validation study in normal subjects.

Background: The heterogeneity of contrast intensity (CI) among myocardial segments limits the clinical use of MCE.

Aortic arch replacement with proximal first technique.

Background: Deep hypothermic circulatory arrest (DHCA) without retrograde cerebral perfusion (RCP) has a strict time limit. We modified a surgical technique for anastomosis to shorten the period of DHCA and unilateral cerebral perfusion (UCP).

Methods: Between March 1993 and August 2001, retrospective analysis was done on 23 consecutive patients, who underwent aortic arch replacement with branches.

Changes in left anterior descending coronary artery flow profiles after coronary artery bypass grafting examined by means of transthoracic Doppler echocardiography.

Objective: We sought to investigate the changes of velocity profiles in the left anterior descending coronary artery after coronary artery bypass grafting using transthoracic Doppler echocardiography.

Methods: Forty-five patients who received a bypass graft to the left anterior descending coronary artery were studied. Before coronary artery bypass grafting, Doppler velocity profiles of the distal left anterior descending coronary artery were recorded with transthoracic Doppler echocardiography.

Detection of TIMI-3 flow before mechanical reperfusion with ultrasonic tissue characterization in patients with anterior wall acute myocardial infarction.

Background: Spontaneous coronary reperfusion with TIMI-3 flow is associated with favorable clinical outcomes in patients with acute myocardial infarction (AMI). We investigated the ability of analyzing cardiac cycle-dependent variation of myocardial integrated backscatter (IBS) for predicting spontaneous reperfusion in anterior AMI.

Methods And Results: We recorded IBS images on admission in 104 patients with first anterior wall AMI and subsequently performed coronary angiography and coronary intervention.

Intravenous nicorandil in conjunction with coronary reperfusion therapy is associated with better clinical and functional outcomes in patients with acute myocardial infarction.

The aim of this retrospective study was to assess whether intravenous nicorandil, a hybrid of NO and a KATP channel opener, in conjunction with percutaneous coronary intervention (PCI) improves the long-term prognosis in patients with acute myocardial infarction (AMI). Intravenous nicorandil has already been shown to improve the in-hospital prognosis of patients with anterior AMI. The study population consisted of 272 patients with a reperfused AMI who were admitted during a similar time interval, before (control; n=114) and after nicorandil treatment (n=158).

Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction.

Objectives: We investigated the association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction (AMI).

Background: Hyperglycemia is associated with increased risks of heart failure, cardiogenic shock, and death after AMI, but its underlying mechanism remains unknown.

Methods: A total of 146 consecutive patients with a first AMI were studied by intracoronary myocardial contrast echocardiography (MCE) after successful reperfusion within 24 h after symptom onset.

Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: insight into mechanisms of microvascular dysfunction.

Objectives: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI).

Background: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown.

Use of echocardiography for predicting myocardial viability in patients with reperfused anterior wall myocardial infarction.

Dobutamine stress echocardiography (DSE), myocardial contrast echocardiography (MCE), and ultrasonic tissue characterization with integrated backscatter are useful methods for assessing myocardial viability in acute myocardial infarction. In this study, we compared the potential of 3 methods for predicting myocardial viability in 38 patients with reperfused anterior wall acute myocardial infarction. We performed MCE shortly after coronary reperfusion with an intracoronary injection of microbubbles.

Pressure-derived collateral flow index as a parameter of microvascular dysfunction in acute myocardial infarction.

Objectives: The goal of this study was to examine the implications of the pressure-derived collateral flow index (CFIp) in acute myocardial infarction (AMI).

Background: Higher CFIp is associated with less severe myocardial ischemia during angioplasty in the non-infarcted heart. It remains unknown whether CFIp also identifies collateral function in AMI patients with and without no-reflow phenomenon.

Prediction of wall motion recovery from the left anterior descending coronary artery velocity pattern recorded by transthoracic doppler echocardiography in patients with anterior wall myocardial infarction retrospective and prospective studies.

The diastolic deceleration slope of coronary flow velocity is steeper in patients with substantial 'no reflow' phenomenon than in those without it. This study investigated whether functional outcomes in patients with anterior wall acute myocardial infarction (AMI) can be predicted by analyzing the coronary flow velocity pattern recorded with transthoracic Doppler (TTD) echocardiography. Coronary blood flow velocity in the distal left anterior descending coronary artery was recorded with TTD at day-2 after primary percutaneous transluminal coronary angioplasty/Stent in 51 patients with anterior AMI and the diastolic deceleration half time (DHT, ms) was measured.

Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction.

Objectives: We sought to elucidate the clinical factors related to the development of no-reflow phenomenon after successful coronary reperfusion in patients with an acute myocardial infarction (AMI).

Background: Myocardial contrast echocardiography revealed that the no-reflow phenomenon is observed in some patients with a reperfused AMI, and those patients usually have poor functional and clinical outcomes. It is still unknown what clinical factors are related to the development of the no-reflow phenomenon.

No reflow phenomenon in coronary heart disease.

Prolonged myocardial ischemia often damages myocardium profoundly, and flow to the previously ischemic myocardium is significantly reduced, which is called the "no reflow" or "low reflow" phenomenon. Myocardial contrast echocardiography (MCE) shows that a not insignificant number of patients with acute myocardial infarction have a substantial no reflow phenomenon. Our studies have demonstrated that patients with MCE-no reflow have larger myocardial infarctions, poorer functional outcomes, more frequent complications, and left ventricular remodeling and higher mortality compared with those with MCE-reflow.

Assessment of perioperative predictive factors influencing survival in patients with postinfarction ventricular septal perforation. Classified by the site of myocardial infarction.

Background: The present study was designed to identify the perioperative factors and to consider a counterplan for the improvement of surgical results, based on the site of myocardial infarction.

Methods: Sixteen patients with postinfarction ventricular septal perforation underwent surgical repair. The operation was performed 5+/-3 days after the onset of ventricular septal perforation using the same method, an infarctectomy and reconstruction of the septum and right and left ventricular walls with a single Dacron patch.

[Surgical treatment for distal aortic arch aneurysm using stent grafting].

To alleviate the invasiveness of surgical treatment for distal aortic aneurysm or dissection, we have been using a stented graft to replace the distal anastomotic suture of the descending aorta. We also developed a new stent graft implanting method for distal aortic aneurysm or dissection which uses cervical branch bypasses from the ascending aorta and requires no extracorporeal circulation. These new surgical treatments for distal arch aneurysm result in low surgical mortality (3.

Early temporal changes in coronary flow velocity patterns in patients with acute myocardial infarction demonstrating the "no-reflow" phenomenon.

Coronary flow velocity pattern in patients with acute myocardial infarction demonstrating no-reflow phenomenon is characterized with early systolic retrograde flow and rapid deceleration of diastolic flow velocity. In this study, we investigated the early temporal changes in microvascular function in patients with the no-reflow phenomenon. Among 144 patients with a first acute myocardial infarction, 33 exhibited sizable no-reflow phenomenon after coronary reperfusion with myocardial contrast echocardiography.