scholarly journals The Effect of Clinical Characteristics and Stent Parameters on Left Ventricular Mechanical Dyssynchrony

2021 ◽  
Vol 17 (3) ◽  
pp. 438-443
Author(s):  
S. Mostafa ◽  
O. Sanad ◽  
M. Shawky ◽  
M. Magdy ◽  
E. Elkeshk
Keyword(s):  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stent ◽  
Strong Negative Correlation ◽  
Ventricular Ejection Fraction ◽  
Time To Peak ◽  
Stent Length ◽  
Left Ventricular Mechanical Dyssynchrony ◽  
Stent Diameter

Aim. To study short term effect of stent size and number on left ventricular mechanical dyssynchrony after elective percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery.Materials and methods. the study included 150 adult patients with LAD lesion treated with PCI using drug-eluting stent. Patients were evaluated pre PCI then 1 month and 3 months post PCI for evaluation of mechanical dyssynchrony using tissue synchronization image (TSI).Results. Before revascularization mean left ventricular ejection fraction was 51.2±5.7 %, mean time to peak TSI was 213.6±10.9 ms; 1 month after PCI TSI improved significantly to 163.7±17.6 ms (p<0.001), 3 months after PCI showed more improvement to 120.7±26.9 ms (p<0.001). After 3m; 61 patients (40.7%) showed recovery to normal TSI value. The predictors of non-improvement of time to peak TSI after 3 months were diabetes mellitus (p=0.007), dyslipidemia (p=0.001) and stent length (p=0.001), number of stents (p=0.004). There were strong negative correlation between stent length and improvement of the time to peak TSI at 1 month (r=-0.352, p<0.001) and at 3 months (r=-0.509, p<0.001),and also with number of stent at 1 month (r= -0.173, p=0.034) and at 3 months (r=-0.499, p<0.001), but the correlation between stent diameter and improvement of the TSI wasn’t significant neither at 1 month nor at 3 months (r=0.055, p=0.504 and r= -0.018, p=0.827) respectively.Conclusion. Increased number and length of the implanted stents were predictors to non-improvement of mechanical dyssynchrony, while stent diameter didn’t affects the recovery.

scholarly journals Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chuan Yang ◽  
Yong Sun ◽  
Deling Zou ◽  
Zhaoqing Sun ◽  
Xinzhong Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Transcatheter Closure ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stent ◽  
Ventricular Septal Rupture ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Intra Aortic Balloon Pump

Abstract Background Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases. Case presentation A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2–3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction. Conclusions Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.

scholarly journals Increased QRS duration and dispersion are associated with mechanical dyssynchrony in patients with permanent right ventricular apical pacing

Discoveries ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. e128
Author(s):  
Elibet Chávez-González ◽  
◽  
Arian Nodarse-Concepción ◽  
Ionuț Donoiu ◽  
Fernando Rodríguez-González ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Qrs Duration ◽  
Right Ventricular Apical Pacing

Background: Permanent right ventricular apical pacing may have negative effects on ventricular function and contribute to development of heart failure. We aimed to assess intra- and interventricular mechanical dyssynchrony in patients with permanent right ventricular apical pacing, and to establish electrocardiographic markers of dyssynchrony. Methods: 84 patients (46:38 male:female) who required permanent pacing were studied. Pacing was done from right ventricular apex in all patients. We measured QRS duration and dispersion on standard 12-lead ECG. Intra- and interventricular mechanical dyssynchrony and left ventricular ejection fraction were assessed by transthoracic echocardiography. Patients were followed-up for 24 months. Results: Six months after implantation, QRS duration increased from 128.02 ms to 132.40 ms, p≤0.05. At 24 months, QRS dispersion increased from 43.26 ms to 46.13 ms, p≤0.05. Intra- and interventricular dyssynchrony increased and left ventricular ejection fraction decreased during follow-up. A QRS dispersion of 47 ms predicted left ventricular dysfunction and long-term electromechanical dyssynchrony with a sensitivity of 80% and a specificity of 76%. Conclusion: In patients with permanent right ventricular apical pacing there is an increased duration and dispersion of QRS related to dyssynchrony and decreased left ventricular ejection fraction. This study shows that QRS dispersion could be a better predictive variable than QRS duration for identifying left ventricular ejection fraction worsening in patients with permanent right ventricular apical pacing. The electrocardiogram is a simple tool for predicting systolic function worsening in these patients and can be used at the bedside for early diagnosis in the absence of clinical symptoms, allowing adjustments of medical treatment to prevent progression of heart failure and improve the patient's quality of life.

scholarly journals A case report of absolute thrombocytopenia with ticagrelor

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Mahin R Khan ◽  
Govinda Adhikari ◽  
Hafiz Khan ◽  
Hameem U Changezi
Keyword(s):  
Platelet Count ◽  
Complete Blood Count ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stent ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Serum Haptoglobin ◽  
St Segment ◽  
The Right

Abstract Background We report a rare case of absolute thrombocytopenia with ticagrelor after 6 h of single loading dose of ticagrelor. Case summary A 68-year-old male with ischaemic cardiomyopathy, hypertension, and dyslipidaemia presented with chest pain. He was found to be in new-onset atrial flutter and ruled in for a non-ST-segment elevation myocardial infarction. An echocardiogram showed decreased left ventricular ejection fraction, estimated at 15–20% and serum troponin peaked at 0.2 ng/dL, baseline platelet count was 203 × 103/µL. He underwent a drug-eluting stent placement to the right coronary artery with excellent angiographic results. He received 3000 units of unfractionated heparin and 180 mg of ticagrelor during the procedure. About 6 h after the procedure, he had coffee ground emesis. A complete blood count revealed a platelet count of 2 × 103 and 0 × 103/µL on repeat testing. Peripheral smear did not show any evidence of platelet clumping and schistocytes, serum haptoglobin and lactate dehydrogenase were normal. Ticagrelor and heparin were discontinued, while the aspirin was continued. Five units of platelet were transfused. The platelet count improved to 200 × 103/µL. Since his CHADS2VASC score was 3, he was discharged on apixaban and clopidogrel in addition to other medication. No thrombocytopenia was seen on outpatient follow-up. Discussion The common side effects of ticagrelor include bleeding, dyspnoea, gynaecomastia, and rarely thrombotic thrombocytopenic purpura. Although extremely rare, absolute or profound thrombocytopenia can occur with ticagrelor, hours after administration and should be considered when other potential causes of thrombocytopenia have been ruled out.

scholarly journals A particular case of anterior STEMI in a young patient with an unexpected outcome

2020 ◽  
Vol 30 (3) ◽  
pp. 459-463
Author(s):  
Eugen Nicolae Tieranu ◽  
Radu Stavaru ◽  
Alexandru Rocsoreanu ◽  
Constantin Militaru ◽  
Ionut Donoiu ◽  
...  
Keyword(s):  
Artery Occlusion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stent ◽  
Coronary Angiogram ◽  
Ventricular Ejection Fraction ◽  
Diagonal Branch ◽  
St Segment Elevation ◽  
Near Occlusion ◽  
Unexpected Outcome

Anterior STEMI (ST-segment elevation myocardial infarction) is associated with the worst prognosis of all infarction locations. We report the case of a 37-year-old male patient who presented for two hours of severe chest pain and was diagnosed with Killip I anterior STEMI in the emergency room. The emergency coronary angiogram revealed acute thrombotic ostial LAD (left anterior descending artery) occlusion and acute thrombotic ostial ramus intermedius (RI) near-occlusion. Thrombus aspiration for the LAD occlusion was performed and a large thrombus was extracted, followed by the artery’s reperfusion. However, we noticed that there was a large diagonal branch providing septal perforating arteries and that there was a distal LAD occlusion. We implanted a drug-eluting stent on the site of the proximal LAD lesion, but we could not obtain any flow in the distal occluded LAD. The patient underwent dual antiplatelet and unfractionated heparin treatment, and, 8 days later, we performed another coronary angiogram. To our surprise, there was very few residual thrombi in the previously occluded LAD segment, and there was no more thrombus in the RI. We noticed TIMI 3 flow in all coronary arteries and an increase in the patient’s left ventricular ejection fraction was also recorded.

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