Anomalous origin of the left main from the right coronary sinus presenting with sudden cardiac death: utility of mechanical circulatory support

Anomalies involving the origin of the coronary arteries are extremely rare, with the left main artery coronary artery (LMCA) originating from the right coronary sinus (RCS) one of its rarest forms. Anomalous origin of left main from right coronary sinus poses a high risk of sudden cardiac arrest. In our report, we shed light on the case of a 43-year-old female who suffered a witnessed cardiac arrest due to underlying anomalous origin of the left main artery from right coronary sinus. The patient was initially pronounced dead until return of spontaneous rhythm with concomitant myocardial infarction led to the diagnosis of anomalous coronary artery. This case stresses important points to consider when dealing with the acute management and chronic treatment plan for this subset of high-risk patients. We also consider the utility of mechanical circulatory support in management of this condition.

Lesion Length Improves Diagnostic Accuracy of Intravascular Ultrasound for Detecting Functional Intermediate Coronary Stenosis Evaluated With Coronary Angiography-Derived Fractional Flow Reserve in Non-left Main Artery

Objective: Intravascular ultrasound (IVUS) parameters, for example, minimal lumen area (MLA) and area stenosis (AS), poorly identified functional intermediate coronary stenosis (ICS). For detecting functional ICS defined by coronary angiography-derived fractional flow reserve (caFFR), our study aims to determine whether IVUS parameters integrated with lesion length (LL) by three-dimensional quantitative coronary analysis (3D-QCA) could improve diagnostic value.Methods: A total of 111 patients with 122 ICS lesions in the non-left main artery were enrolled. MLA and AS were calculated in all lesions by IVUS. Diameter stenosis (DS%) and LL were measured by 3D-QCA. caFFR was computed by the proprietary fluid dynamic algorithm, a caFFR ≤ 0.8 was considered as functional stenosis. Receiver-operating curve analyses were used to compare the diagnostic accuracy among indices to predict functional stenoses.Results: Mean caFFR values in all lesions were 0.86 ± 0.09. Lesions with caFFR ≤ 0.8 showed lower MLA and higher AS (MLA: 3.3 ± 0.8 vs. 4.1 ± 1.2, P = 0.002; AS: 71.3 ± 9.6% vs. 63.5 ± 1.3%, P = 0.007). DS% and LL were more severe in lesions with caFFR ≤ 0.8 (DS%: 45.5 ± 9.6% vs. 35.5 ± 8.2%, P < 0.001; LL: 31.6 ± 12.9 vs. 21.0 ± 12.8, P < 0.001). caFFR were correlated with MLA, AS, and LL (MLA: r = 0.36, P < 0.001; AS: r = −0.36, P < 0.001; LL: r = −0.41, P < 0.001). Moreover, a multiple linear regression analysis demonstrated that MLA (β = 0.218, P = 0.013), AS (β = −0.197, P = 0.029), and LL (β = −0.306, P > 0.001) contributed significantly to the variation in caFFR. The best cutoff value of MLA, AS, and LL for predicting caFFR ≤ 0.8 were 3.6 mm2, 73%, and 26 mm, with area under the curve (AUC) of 0.714, 0.688, and 0.767, respectively. Combined with MLA, AS, and LL for identifying functional ICS, the accuracy was the highest among study methods (AUC: 0.845, P < 0.001), and was significantly higher than each single method (All P < 0.05).Conclusion: Lesion length can improve the diagnostic accuracy of IVUS-derived parameters for detecting functional ICS.

Bypass in Urban Space: Creative Scenarios

Considering functional and experiential congestion in Kadıköy, the paper deals with the concept of “Bypass in Urban Space” in the context of the user-centred design. The case study is limited with the axis extending from Söğütlüçeşme and General Asım Gündüz Street which is connected to the main artery. Kadıköy, as one of the rapidly growing and transforming urban centres in Istanbul, reflects variable traumas in terms of human-environment behaviour relationships. A research model is developed to identify these traumas and produce a solution through bypassing the congestion in the area. Within the scope of the study, it is aimed to contribute to the dynamic structure of the city by creating new functional experience spaces in the capillary streets. On the other hand, it is aimed to design the spaces that lead the user to stop and perceive the environment beyond its transition function of the main artery within the dense pedestrian and vehicle traffic. By the research model, it is suggested multi-functional creative scenarios through the problems and hypotheses identified within the framework of the user-environment connection. Environmental and behavioural research, conceptual readings, sketch of ideas and visualization of conceptual studies, the designer scenarios are the main phases of the research as well as developing a proposal within the scope of contribution to the field. Most of design solutions analyses several dynamics such as bypass, main artery, in-between space, spatial conjunction, integration in urban space. So, it is aimed to design integrative mobile spaces for continuity of user-environment relationship beyond establishing a physical and visual connection.

Effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension, obesity, and type 2 diabetes

Aim. To assess the effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension (HTN), obesity, and type 2 diabetes (T2D).Material and methods. A total of 320 patients with stage II-III HTN aged 4570 years were divided into 4 groups: isolated HTN (group 1), HTN and obesity (group 2), HTN, obesity and T2D (group 3), HTN and T2D without obesity (group 4). We assessed the clinical status, parameters of visceral obesity, main artery elasticity, and vascular age. We used nonparametric statistics, Spearman correlation analysis.Results. At least 50% of all patients had visceral obesity, despite no BMI-estimated obesity in groups 1 and 4: 57,5 vs 100,0 vs 100,0 vs 50,0% in groups 1, 2, 3 and 4, respectively (p<0,0001).In the groups where hypertension was combined with obesity and T2D, the proportion of patients with leptin content above 32,7 ng/ml significantly increased to 80% (in total for groups 2 and 3) compared with 25,0% among HTN people without obesity (in total for groups 1 and 4). There was a significant increase in proportion of patients with a adiponectin decrease <14,6 ng/ml among patients with a combination of HTN and T2D ± obesity (45% in total for groups 3 and 4) in comparison with those with HTN and without T2D ± obesity (22,5% in total for groups 1 and 2).The visceral adiposity index (VAI) was significantly higher among patients with HTN, obesity and T2D compared with those with isolated HTN and HTN in combination with T2D only (2,96 [2,36; 3,98] vs 1,87 [1,40; 2,67] vs 2,22 [1,61; 3,26], respectively). A higher proportion of subjects with adipose tissue dysfunction was noted in groups 2 and 3 compared to groups 1 and 4 (75 vs 81,1 vs 41,5 vs 53,4%, respectively, p1-2<0,001, p1-3<0,001, p2-4=0,023, p3-4=0,002).The proportion of patients with a pulse wave velocity >10 m/s was consistently more common among patients of group 3 compared with patients in groups 1 and 2 (77,0 vs 57,9 and 55,3%, respectively, p1-3=0,004, p2-3=0,006).Vascular age was significantly lower in group 1 compared with groups 3 and 4 (64,0 [57,8; 71,0] vs 69,0 [62,0; 73,0] and 69,5 [66,0; 74,3] years, respectively), as well as in group 2 compared with group 4 (64,0 [56,5; 70,5] vs 69,5 [66,0; 74,3] years). The 5-year risk of cardiovascular events was significantly higher among patients with hypertension, obesity and T2D and those with HTN and T2D without obesity, compared with patients with isolated HTN, and with those with HTN and obesity (5,9 [3,9; 7,9] and 6,5 [4,7; 8,7] vs 4,4 [2,7; 6,8] and 3,6 [2,4; 5,8], respectively). Correlation analysis revealed the relationship between the visceral obesity parameters, main artery elasticity, vascular age and the 5-year risk of cardiovascular events, demonstrating the special aspects of HTN course in each of the studied groups.Conclusion. The paper showed peculiarities of the effect of visceral obesity on main artery elasticity and vascular age in patients with HTN in combination with obesity and T2D.