Search

The Clinical Efficacy of Permanent Internal Mammary Artery Occlusion in Chronic Coronary Syndrome (CLIMACCS) trial, a randomized, sham-controlled trial, tested the clinical efficacy of permanent internal mammary artery (IMA) device occlusion on symptoms in patients with chronic coronary syndrome (CCS), coronary artery occlusive blood supply, and myocardial ischemia. This was a prospective trial in 101 patients with CCS randomly allocated (1:1) to IMA device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study end point was the change in treadmill exercise time (ET) (ΔET in seconds) at 6 weeks after trial intervention. Secondary study end points were the changes in collateral flow index (CFI) and angina pectoris during a simultaneous 1-minute proximal balloon occlusion of a coronary artery. CFI is the ratio between simultaneous mean coronary occlusive, divided by mean aortic pressure, both subtracted by central venous pressure. In the verum and placebo groups, the ET changed from 398 ± 176 seconds to 421 ± 198s in the verum group (p = 0.1745) and from 426 ± 162 seconds to 430 ± 166 seconds in the placebo group (p = 0.55); ΔET amounted to +23 ± 116s and +4 ± 120 seconds, respectively (p = 0.44). CFI change during follow-up equaled +0.022 ± 0.061 in the verum and -0.039 ± 0.072 in the placebo group (p <0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20 of 48 patients in the verum group and in 9 of 47 patients in the placebo group (p = 0.0242). In conclusion, permanent IMA device occlusion tends to augment treadmill ET in response to increased coronary artery occlusive blood supply, which is reflected by mitigated symptoms and signs of myocardial ischemia., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest Dr. Bourque owns equity in Locus Health and is a consultant for Pfizer and General Electric. Dr. Salerno receives research support from Siemens. The remaining authors have no competing interests to declare.

The presence of collateral channels providing distal blood supply is a distinctive characteristic of chronic total occlusion (CTO) lesions. However, data about the distinct baseline and procedural characteristics of each collateral subset are scarce. Accordingly, we sought to explore the procedural aspects specific for each collateral typology (ipsilateral collaterals [ICs], contralateral collaterals [CCs] or mixed) in CTO-percutaneous coronary intervention (PCI). A retrospective analysis of our CTO-PCI registry was performed to investigate the prevalence, procedural characteristics, and outcomes specific for each CTO-PCI subset, defined according to the inter-arterial connection anatomy. A total of 209 cases were included. Of the included cases, 45 (22%) and 92 (44%) patients displayed solely IC or CC, respectively, whereas in 72 (34%) both IC and CC were present (mixed). The procedural success rate was high (91.1%) and comparable among the different groups, despite greater lesion complexity in the CC group. The most frequent target vessel was the left circumflex in the IC group (51% of cases) and the right coronary artery in the CC (63%) and mixed (57%) groups. Among the IC cases, 42% showed a poor collateral connection function (2% and 10% for the CC and mixed group, respectively), and 46% showed a suboptimal collateral recipient artery filling (21% and 20% for the CC and mixed group, respectively). Most of the IC cases were performed using a single access (96%). In conclusion, the success and complication rates were comparable among the collateral typology groups, irrespective of the differences in the baseline and procedural characteristics. Phenotyping CTO as hereby proposed might be helpful for targeted procedural considerations., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Although fractional flow reserve (FFR) and myocardial perfusion imaging (MPI) findings fundamentally differ, several cohort studies have revealed that these findings correlate. Here, we investigated whether flow-limiting FFR could be predicted from adenosine stress thallium-201 MPI with single-photon emission computed tomography (SPECT) findings derived from 84 consecutive, prospectively identified patients with stable coronary artery disease and 212 diseased vessels. Among them, FFR was measured in 136 diseased vessels (64%). The findings were compared with regional perfusion abnormalities including stress total perfusion defect (TPD) - rest TPD determined using quantitative perfusion single-photon emission computed tomography software. The FFR inversely correlated the most accurately with stress TPD - rest TPD (r = -0.552, p <0.001). Predictors of major vessels of interest comprising FFR <0.80, included stress TPD - rest TPD, the transient ischemic dilation ratio, left ventricular ejection fraction at rest and beta blockers for left anterior descending artery (LAD) regions, and stress TPD - rest TPD, left ventricular mass, left ventricular ejection fraction at rest, right coronary artery lesions, the transient ischemic dilation ratio, and age for non-LAD regions. The diagnostic accuracy of formulas to predict major vessels of interest with FFR <0.80 was high (sensitivity, specificity and accuracy for LAD and non-LAD: 84%, 87% and 86%, and 75%, 93% and 87%, respectively). In conclusion, although somewhat limited by a sample size and a single-center design, flow-limiting FFR could be predicted from MPI findings with a defined probability. A cohort study might validate our results and provide a novel adjunctive tool with which to diagnose functionally significant coronary artery disease from MPI findings. [ABSTRACT FROM AUTHOR]

Lesion morphology poorly predicts functional significance of intermediate coronary artery stenosis. The aim of this study was to determine whether a coronary artery-based myocardial segmentation method that quantifies subtended myocardium can improve the diagnostic accuracy of intravascular ultrasound (IVUS)-derived parameters for detecting ischemia-producing lesions. Coronary computed tomography angiography, IVUS, and fractional flow reserve (FFR) data were analyzed in 101 non-left main lesions (20% to 80% angiographic stenosis). Using the coronary artery-based myocardial segmentation method, total left ventricular myocardial volume (Vtotal), myocardial volume subtended by the stenotic coronary segment (Vsub), and Vratio (the ratio of the Vsub to the Vtotal) were assessed. Both Vsub >30.7 cm(3) and Vratio >25.4% were determinants of FFR ≤0.75 (area under the curve = 0.696 and 0.744). Overall, an IVUS-measured minimum lumen area (IVUS-MLA) ≤2.83 mm(2) predicted FFR ≤0.75 with a sensitivity 88% and specificity 73%. Among lesions with IVUS-MLA ≤2.83 mm(2) and FFR >0.75, 89% showed Vsub <30.7 cm(3). In 50 lesions with Vsub >30.7 cm(3), an IVUS-MLA ≤2.85 mm(2) predicted FFR ≤0.75 with sensitivity 85%, specificity 92%, positive predictive value 92%, and negative predictive value 85%. Conversely, in 51 lesions with a Vsub ≤30.7 cm(3), IVUS-MLA ≤2.67 mm(2) showed sensitivity 100%, specificity 69%, positive predictive value 38%, and negative predictive value 100% for predicting FFR ≤0.75. Body surface area, reference lumen diameter, and vessel area had modest correlations with Vsub. In those lesion subsets, IVUS-MLA ≈2.8 mm(2) accurately predicted an FFR ≤0.75, whereas the clinical relevance of assessing and treating lesions with a smaller myocardial territory may be limited (ClinicalTrials.gov number NCT1696006). [ABSTRACT FROM AUTHOR]

The red blood cell distribution width (RDW) is a quantitative measure of the variability in the size of circulating erythrocytes. We aimed to study whether higher levels of the RDW were associated with heart failure in a Fontan circulation and to analyze its clinical value compared to brain natriuretic peptide. This retrospective study included 38 consecutive pediatric patients with a Fontan circulation who underwent routine cardiac catheterization at the International Medical Center, Saitama Medical University from October 2010 to July 2014. We assessed the relation between the RDW and catheterization data such as the central venous pressure (CVP), mixed venous oxygen saturation (SvO2), and cardiac index (CI). The RDW was positively correlated with the CVP (p = 0.0002). The elevated RDW group had a significantly greater CVP than the normal RDW group (p = 0.0003). Also, the RDW was negatively correlated with the SvO2 (p = 0.0004). The elevated RDW group had a significantly less SvO2 than the normal RDW group (p <0.0001). The CI in the elevated RDW group was lower than that in the normal RDW group (p = 0.0421). In the multivariate regression analysis, the RDW was a significant independent predictor of the CVP and SvO2. The BNP level did not have any significant relation with the CVP, SvO2, or CI. The RDW is a convenient and powerful marker for detecting heart failure in a Fontan circulation. [ABSTRACT FROM AUTHOR]

The article presents abstracts on coronary circulation which include relationship between adropin levels and the slow coronary flow phenomenon, aortic and clinical features of patients with aneurysm/dilatation, and effects of corticosteroids on coronary slow flow and ophthalmic angina.

Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 ± 15.7 mm Hg before TAVI to 3.6 ± 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 ± 0.17 to 1.99 ± 0.35 cm2 (p <0.001). The cardiac output increased from 3.4 ± 1.1 to 3.8 ± 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 ± 5.4 to 17.3 ± 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 ± 9.3 to 30.5 ± 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 ± 16.9 to 53.7 ± 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 ± 10.5 to 29.7 ± 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 ± 3.7 to 7.7 ± 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 ± 8.7 to 22.0 ± 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = --0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP. [ABSTRACT FROM AUTHOR]

Although statins reduce cardiac events in hypertensive patients with cardiovascular risk factors, the effect of statins on coronary flow reserve (CFR) has not been examined. We tried to examine the effect of rosuvastatin on CFR in hypertensive patients at cardiovascular risk. CFR was studied in 56 hypertensive patients (40 men, 61 ± 9 years) with cardiovascular risk factors and without coronary artery disease in a prospective clinical trial. Using Doppler echocardiography, coronary flow velocity in the distal left anterior descending artery was recorded at baseline and during intravenous adenosine infusion, and CFR was defined as the ratio of hyperemic to basal average peak diastolic flow velocity. The primary efficacy measure was defined as the change in CFR after rosuvastatin therapy for 12 months. CFR was measured successfully in 55 of 56 enrolled patients (98%). CFR was 3.16 ± 0.44 at baseline and negatively correlated with age (R = -- 0.30, p = 0.025). All patients continued rosuvastatin 10 mg/day without any serious adverse events. After rosuvastatin therapy, serum total cholesterol, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein significantly decreased from 222 ± 18 to 142 ± 20 mg/dl, 148 ± 21 to 85 ± 18 mg/dl, and 1.7 ± 2.9 to 1.2 ± 3.1 mg/L, respectively (all p <0.01). CFR significantly increased from 3.16 ± 0.44 to 3.31 ± 0.42 (p <0.001). The change in CFR correlated with the change in low-density lipoprotein cholesterol (R = -- 0.28, p = 0.040) but not with the change in high-sensitivity C-reactive protein. In conclusion, CFR was significantly improved after 12 months of rosuvastatin therapy in hypertensive patients at cardiovascular risk and average levels of serum cholesterol. [ABSTRACT FROM AUTHOR]

Impaired coronary flow after primary percutaneous coronary intervention (PPCI) is associated with short- and long-term morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Recent studies have demonstrated that plateletto- lymphocyte ratio (PLR) is associated with adverse cardiovascular outcomes. The aim of this study was to assess the relation between admission PLR and angiographic reflow after PPCI. A total of 520 patients with acute STEMI (age 60 ± 13 years; 74% men) occurring within 12 hours of the onset of symptoms who underwent PPCI were enrolled. The PLR and other laboratory parameters were measured before PPCI. The patients were divided into 2 groups based on the postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: normal-reflow group (defined as postintervention TIMI grade 3 flow) and none-reflow group (consisted of both patients with angiographic no-reflow defined as postintervention TIMI grades 0 to 1 flow and slow flow defined as postintervention TIMI grade 2 flow). There were 117 patients (22.5%) in the none-reflow group (age 68 ± 13 years and 77% men) and 403 patients in the normal-reflow group (age 58 ± 12 years and 63% men). The none-reflow group had significantly higher PLR compared with the normal-reflow group (219 ± 79 vs 115 ± 59, p <0.001). In logistic regression analysis, PLR (odds ratio 1.818, 95% confidence interval 1.713 to 1.980, p <0.001) and total stent length (OR 1.052, confidence interval 1.019 to 1.086, p = 0.002) were independent predictors of none-reflow after PPCI. In conclusion, preintervention PLR is a strong and independent predictor of slow flow/no-reflow after PPCI in patients with acute STEMI. [ABSTRACT FROM AUTHOR]

Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes. [ABSTRACT FROM AUTHOR]

Coronary slow flow (CSF) may be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. In this study, the CSF group consisted of 24 men (77.4%) and 7 women (22.5%). An age- and gender-matched normal coronary artery (control) group was composed of 21 men (72.4%) and 8 women (27.5%). Retinal arteriovenous circulation time was measured using fundus fluorescein angiography as a part of the microcirculation and the circulation time between the antecubital vein and the retina as a part of the systemic circulation in patients with CSF and controls with normal coronary arteries. The mean arm-retina circulation time was 19.0 ± 5.7 seconds in the CSF group and 14.1 ± 3.1 seconds in the control group (p <0.001). The mean retinal arteriovenous passage time was 2.6 ± 0.9 seconds in the CSF group and 2.1 ± 0.7 seconds in the control group (p=0.001). Strikingly, retinal findings of chronic central serous retinopathy were observed in 3 patients in the CSF group. In conclusion, CSF may indeed be a part of a systemic slow-flow phenomenon. The association of central serous retinopathy with this condition suggests that corticosteroids and the sympathetic system may play important roles in the pathogenesis of the disease by causing or contributing to increases in microvascular resistance and tonus. [ABSTRACT FROM AUTHOR]

Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, it is unknown whether coronary artery dominance also influences the distribution of coronary blood flow volume. The aim of this study was to evaluate volumetric coronary blood flow in 1,322 vessels from 496 patients in the Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Wall Morphology (PREDICTION) study. Patients were divided into 2 groups (right-dominant and left-dominant or balanced circulation). Coronary blood flow volume was calculated by coronary segment volume measurement using angiography and intravascular ultrasound and the contrast transit time through the segment. Coronary blood flow in the left circumflex coronary artery was significantly higher in left-dominant or balanced circulation than in right-dominant circulation (113 - 43 vs 72 - 37 ml/min, p <0.001), whereas flow in the right coronary artery was significantly lower in left-dominant or balanced circulation than in right-dominant circulation (56 - 40 vs 113 - 49 ml/min, p[0.003). There was no significant difference in the left anterior descending coronary artery. In conclusion, coronary artery dominance has an impact on coronary blood flow volume in the left circumflex and right coronary arteries but not in the left anterior descending coronary artery. These findings suggest that the extent of myocardial perfusion area is associated with coronary blood flow volume. [ABSTRACT FROM AUTHOR]

Quantification of myocardial perfusion reserve (MPR) using vasodilator stress cardiac magnetic resonance is increasingly used to detect coronary artery disease. However, MPR can also be altered because of changes in microvascular function. We aimed to determine whether MPR can distinguish between ischemic cardiomyopathy (IC) secondary to coronary artery disease and non-IC (NIC) with microvascular dysfunction and no underlying epicardial coronary disease. A total of 60 patients (mean age 65 ± 14 years, 30% women), including 31 with IC and 29 with NIC, were identified from a pre-existing vasodilator stress cardiac magnetic resonance registry. Short-axis cine slices were used to measure left ventricular ejection fraction (LVEF) using the Simpson method of disks. MPR index (MPRi) was determined from first-pass myocardial perfusion images during stress and rest using the upslope ratio, normalized for the arterial input and corrected for rate pressure product. Patients in both groups were divided into subgroups of LVEF ≤35% and LVEF >35%. Differences in MPRi between the subgroups were examined. MPRi was moderately correlated with LVEF in patients with NIC (r = 0.53, p = 0.03), whereas the correlation in patients with IC was lower (r = 0.32, p = 0.22). Average LVEF in NIC and IC was 34% ± 8% and 35% ± 8%, respectively (p = 0.63). MPRi was not significantly different in IC compared with NIC (1.17 [0.88 to 1.61] vs 1.23 [1.07 to 1.66], p = 0.41), including the subgroups of LVEF (IC: 1.20 ± 0.56 vs NIC: 1.15 ± 0.24, p = 0.75 for LVEF ≤35% and IC: 1.35 ± 0.44 vs NIC: 1.58 ± 0.50, p = 0.19 for LVEF >35%). However, MPRi was significantly lower in patients with LVEF ≤35% compared with those with LVEF>35% (1.17 ± 0.40 vs 1.47 ± 0.47, p = 0.01). Similar difference between LVEF groups was noted in the patients with NIC (1.15 ± 0.24 vs 1.58 ± 0.50, p = 0.006) but not in the patients with IC (1.20 ± 0.56 vs 1.35 ± 0.44, p = 0.42). MPRi can be abnormal in the presence of left ventricular dysfunction with nonischemic etiology. This is a potential pitfall to consider when using this approach to detect ischemia because of epicardial coronary disease using myocardial perfusion imaging., Competing Interests: Disclosures Dr. A. Patel has received research support from Philips, Arterys, CircleCVI, and Neosoft. The remaining authors have no conflicts of interest to declare., (Copyright © 2022. Published by Elsevier Inc.)

ST-segment depression during exercise stress testing in asymptomatic subjects showing normal coronary arteries is considered a “false-positive” result. Coronary microvascular dysfunction, however, might be a possible cause of ST-segment depression in these cases. We assessed the coronary blood flow response to adenosine and to cold pressor test in the left anterior descending artery, using transthoracic Doppler echocardiography in 14 asymptomatic subjects with exercise-induced ST-segment depression and normal coronary arteries (group 1), 14 patients with microvascular angina (group 2), and 14 healthy subjects (group 3). Flow-mediated dilation was assessed in the brachial artery. Central pain processing was assessed using cortical laser evoked potentials during chest and right hand stimulation with 3 sequences of painful stimuli. The coronary blood flow response to adenosine was 1.8 ± 0.4, 1.9 ± 0.5, and 3.1 ± 0.9 in groups 1, 2, and 3, respectively (p <0.001). The corresponding coronary blood flow responses to the cold pressor test were 1.74 ± 0.4, 1.53 ± 0.3, and 2.3 ± 0.6 (p <0.001). The flow-mediated dilation was 5.5 ± 2.3%, 4.6 ± 2.4%, and 9.8 ± 1.2% in the 3 groups, respectively (p <0.001). The laser evoked potential N2/P2 wave amplitude decreased throughout the 3 sequences of stimulation in groups 1 and 3 but not in group 2 (chest, −19 ± 22%, +11 ± 42% and −36 ± 12%, p <0.001; right hand, −22 ± 25%, +12 ± 43% and −30 ± 20%, p = 0.009; in groups 1, 2, and 3). In conclusion, exercise stress test-induced ST-segment depression in asymptomatic subjects with normal coronary arteries cannot be considered as a simple false-positive result, because it can be related to coronary microvascular dysfunction. The different symptomatic state compared to patients with microvascular angina can, at least in part, be explained by differences in cortical processing of neural pain stimuli. [Copyright &y& Elsevier]

The term “coronary instability” commonly refers to the sequence of events that lead from plaque erosion or rupture to the occurrence of acute coronary syndromes (ACS). However, evidence indicates that coronary microvascular dysfunction plays a relevant pathophysiologic and prognostic role in the setting of ACS, both in ST-segment elevation myocardial infarction and in non–ST-segment elevation ACS. Our group have recently demonstrated that Tako-Tsubo syndrome, which clinically mimics ACS, is sustained by a common pathophysiologic mechanism represented by reversible coronary microvascular dysfunction. Given this evidence, we propose a reappraisal of the concept of coronary instability, extending this notion from the dramatic event represented by plaque erosion or rupture to a more diffuse process that can acutely affect each segment of the coronary circulation. [ABSTRACT FROM AUTHOR]

In patients with heart failure (HF), statin treatment might improve myocardial perfusion, but could also have detrimental effects on myocardial metabolism. A predefined substudy of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA) trial sought to determine the effects of statin treatment on myocardial blood flow reserve and cardiac metabolism. Sixteen patients with HF (New York Heart Association class II or III) were randomized to rosuvastatin 10 mg/day (n = 8) or placebo treatment (n = 8). At baseline and after 6 months of treatment, nitrogen-13 ammonia at rest and after dipyridamole stress and 18-fluorodeoxyglucose positron emission tomography were performed. Rosuvastatin treatment significantly lowered total (−36%, p <0.01) and low-density lipoprotein (−47%, p <0.001) cholesterol and C-reactive protein levels (−36%, p <0.05). Myocardial perfusion reserve (ratio) changed from 1.64 ± 0.90 to 1.30 ± 0.37 in placebo-treated and from 1.51 ± 0.18 to 1.55 ± 0.34 in rosuvastatin-treated patients (p = NS). Metabolic mismatch changed from 4.25 ± 2.37% to 4.38 ± 3.81% in placebo-treated and from 5.13 ± 2.75% to 3.50 ± 2.73% in rosuvastatin-treated patients (p = NS). In conclusion, changes regarding myocardial perfusion and metabolic mismatch after 6 months of rosuvastatin treatment in patients with HF did not suggest any beneficial or adverse effects in this pilot study, although due to the small numbers of patients small effects might have been missed. [Copyright &y& Elsevier]

The aim of this study was to assess the change in coronary flow in patients who underwent percutaneous aortic valve replacement (PAVR) for severe aortic stenosis. The left main coronary artery was visualized using transesophageal echocardiography in 17 patients who underwent PAVR. The peak systolic and diastolic velocities of coronary flow and the time-velocity integral were obtained before and after PAVR using pulsed-wave Doppler. The median age was 80.0 years (interquartile range [IQR] 80.0 to 88.0). Median gradients decreased from 40.0 mm Hg (IQR 35.0 to 50.0) before PAVR to 4.0 mm Hg (IQR 2.75 to 4.2) afterward (p <0.001). Aortic valve area increased from 0.6 cm2 (IQR 0.5 to 0.7) to 1.9 cm2 (IQR 1.7 to 2.0) (p <0.001). Cardiac output increased from 3.3 L/min (IQR 2.4 to 4.0) to 3.6 L/min (IQR 3.1 to 4.4) (p <0.001). Aortic systolic pressure did not change significantly, from 126.0 mm Hg (IQR 11.7 to 137.7) before to 134 mm Hg (IQR 116.3 to 142.5) after valve implantation (p = 0.8). Left ventricular end-diastolic pressure decreased significantly from 19.0 mm Hg (IQR 18.0 to 22.0) before to 14.0 mm Hg (IQR 12.0 to 17.0) after valve implantation (p = 0.01). The medians of the following coronary flow parameters increased significantly after PAVR: peak systolic velocity, 25.0 cm/s (IQR 17.0 to 30.0) to 37.0 cm/s (IQR 23.0 to 44.0) (p <0.001); peak diastolic velocity, 49.0 cm/s (IQR 39.5 to 61.0) to 57.0 cm/s (IQR 42.9 to 83.9) (p = 0.006); total velocity-time integral, 23.7 cm (IQR 15.0 to 27.1) to 28.1 cm (IQR 21.3 to 34.7) (p = 0.001); and systolic velocity-time integral, 5.4 cm (IQR 3.5 to 6.2) to 9.0 cm (IQR 4.5 to 9.8) (p = 0.001). The diastolic time-velocity integral increased from 17.2 cm (IQR 12.0 to 24.0) to 20.1 cm (IQR 15.0 to 25.9) (p = 0.02). In conclusion, after PAVR, there is a significant increase in coronary flow as measured by peak systolic velocity, diastolic velocity, and velocity-time integral using pulsed-wave Doppler by transesophageal echocardiography. [Copyright &y& Elsevier]

Multidetector computed tomography (MDCT) detects coronary artery disease. However, an overestimation of coronary artery stenosis and artifacts can prevent accurate identification of significant coronary narrowing. The combination of MDCT with coronary flow reserve (CFR), the hyperemic/baseline peak flow velocity ratio, measured by transthoracic Doppler echocardiography might be helpful. We studied 144 consecutive patients with CFR and quantitative coronary angiography, obtained using both MDCT and invasive coronary angiography (reference method). It was hypothesized that the CFR might provide an incremental value to MDCT in detecting significant (≥70%) left anterior descending (LAD) coronary artery stenosis. A CFR cutoff of <2 was used to discriminate significant stenosis. CFR was feasible in 141 (98%) of 144 patients, and MDCT was feasible in 131 (91%) of 144 patients (p <0.02). In a univariate model, the prediction of significant LAD stenosis was slightly, but significantly (p <0.0001), better with CFR (sensitivity 90%, specificity 96%, positive predictive value 84%, negative predictive value 97%, and diagnostic accuracy 94%, chi-square = 97.5) than with MDCT (sensitivity 80%, specificity 93%, positive predictive value 71%, negative predictive value 95%, diagnostic accuracy 90%, chi-square = 63.2). When the findings from transthoracic Doppler echocardiography and MDCT agreed, the diagnostic accuracy increased (96%; chi-square = 86.1, p <0.0001). In a multivariate prediction of significant LAD stenosis using a logistic neural network, CFR overshadowed MDCT, and the area under the receiver operating curve was 0.99. Of the 13 patients missed by MDCT, the diagnostic accuracy of transthoracic Doppler echocardiography to predict significant LAD stenosis was 100%. Thus, CFR could improve the diagnostic accuracy of MDCT to detect significant LAD stenosis. [Copyright &y& Elsevier]

Transcatheter closure of atrial septal defects (ASDs) was performed mainly in children and adolescents. Information about outcome and complications in adults was limited. From November 1997 to November 2005, percutaneous closure of ASDs using the Amplatzer septal occluder was attempted in 650 consecutive adult patients. Median patient age was 45.8 ± 16.2 years (range 18 to 90), mean systolic artery pressure was 33.3 ± 10.6 mm Hg (range 11 to 85), and mean pulmonary and systemic blood flow (Qp/Qs) ratio was 1.9 ± 0.7 (range 0.8 to 6.6). Mean stretched diameter of the ASD was 21.2 ± 5.1 mm (range 3.1 to 43). Seventy-eight patients (12%) had multiple defects. Of 572 patients with a single ASD, device implantation was successful in 563 patients (98%). During follow-up, complete closure could be achieved in 96% of patients with a single ASD and 71% of patients with multiple defects. Mean systolic artery pressure decreased to 28.3 ± 10.1 mm Hg and mean Qp/Qs ratio decreased to 1 ± 0.3. The 3 complications that occurred during the procedure were device embolization (2 patients; 0.3%) and transient ST depression (1 patient; 0.2%). The most common complication immediately after the procedure and during follow-up was new-onset atrial fibrillation (28 patients; 4.3%). Electrical cardioversion was successfully in most. Complications requiring emergency or elective surgery occurred in 6 patients (0.9%; hemopericardium, 2 patients, 0.3%; device embolization, 3 patients, 0.5%, and pericardial tamponade, 1 patient, 0.2%). In conclusion, closure of ASDs using the Amplatzer septal occluder in adults was efficient and safe, with excellent long-term success rates. Serious complications were rare. [Copyright &y& Elsevier]

Little is known about changes in myocardial perfusion of myocardial regions supplied by angiographically normal or near-normal coronary arteries after percutaneous coronary intervention (PCI) of the target lesion. The purpose of this study was to assess the effect of PCI on coronary blood flow at rest in sites remote from the PCI. We studied 85 patients who underwent successful elective PCI for stable angina. We used the Thrombolysis In Myocardial Infarction frame count to provide a simple continuous index of coronary flow and myocardial perfusion in the target and nontarget arteries. Coronary artery diameters of nontarget vessels did not significantly differ before and after PCI and at 6 months’ follow-up. At baseline, the greater the percent diameter stenosis in the target artery, the slower the flow in the target (r = 0.22, p <0.01) and nontarget arteries (r = 0.28, p <0.01). Relief of stenosis using PCI did not account for simultaneous changes in epicardial coronary blood flow of the nontarget artery. After 6 months, coronary blood flow improved in both the target (p <0.05) and nontarget arteries (p = 0.007). In conclusion, this study provided evidence of a functional link between coronary blood flow in diseased and nondiseased arteries. Relief of a significant stenosis using PCI globally improved regional and global myocardial blood flow at rest in patients with stable angina. Flow improvement was not apparent at the time of revascularization, but at 6 months’ follow-up. Late upturn of the microcirculation may account for delayed recovery of myocardial perfusion. [Copyright &y& Elsevier]

Although coronary flow reserve (CFR) impairment was correlated with the prognosis of patients with idiopathic dilated cardiomyopathy (IDC) and microvascular ischemia was implicated in the progress of the disease, little is known about the effect of the established therapy with β blockers on coronary microcirculation. The purpose of this study was to assess the effect of β1 blockade on coronary blood flow and CFR in patients with IDC. Fourteen patients with IDC and 10 control subjects underwent time-averaged peak coronary flow velocity (APCFV) measurements (centimeters per second) in the proximal left anterior descending coronary artery at baseline and at maximal hyperemia before and after β1 blockade with intravenous esmolol. CFR was defined as APCFV at maximal hyperemia/APCFV at baseline. Although there were no significant differences in APCFV at baseline between patients with IDC and controls, patients with IDC had significantly lower APCFV at maximal hyperemia than controls (54.2 ± 12.0 vs 75.1 ± 18.6, p <0.05) and decreased CFR (2.39 ± 0.38 vs 3.50 ± 0.54, respectively, p <0.05). After β1 blockade, a significant decrease in APCFV at baseline (19.5 ± 3.7 vs 22.9 ± 5.0, p <0.05) and enhancement of APCFV at maximal hyperemia (59.5 ± 13.3 vs 54.2 ± 12.0, p <0.05) were observed in patients with IDC, but not in control subjects, leading to significant improvement in CFR (3.06 ± 0.40 vs 2.39 ± 0.38, p <0.05). In conclusion, patients with IDC had alterations in coronary blood flow and decreased CFR that improved after β1 blockade. These alterations in microvascular function, which are partially reversed by β blockade, may be 1 of the underlying mechanisms that contribute to the improved prognosis of patients with IDC under such therapy. [Copyright &y& Elsevier]

Coronary flow reserve (CFR) evaluated immediately after reperfusion is thought to reflect the degree of microvascular injury and predict left ventricular (LV) functional recovery after acute myocardial infarction. It was hypothesized that CFR immediately after reperfusion would be predictive of the occurrence of long-term adverse cardiac events. Using a Doppler guidewire, CFR was evaluated immediately after primary coronary angioplasty in 118 consecutive patients with first anterior acute myocardial infarctions. Adverse cardiac events combining cardiac death, recurrent myocardial infarction, and congestive heart failure were recorded during an average follow-up period of 62 ± 32 months. Using receiver-operating characteristic analysis, CFR ≤1.3 was the best predictor of future cardiac events (sensitivity 86%, specificity 70%). Accordingly, patients were divided into 2 groups: those with CFR ≤1.3 (n = 50) and those with CFR >1.3 (n = 68). Patients with CFR ≤1.3 had significantly higher peak creatine kinase concentrations, lower LV ejection fractions, and higher LV volumes compared with patients with CFR >1.3. CFR was significantly correlated with the LV ejection fraction at 4 weeks (r = 0.50, p <0.0001) and LV end-diastolic volume at 4 weeks (r = −0.43, p <0.0001). Kaplan-Meier survival analysis showed a higher incidence of adverse cardiac events in patients with CFR ≤1.3 (p <0.0001). In conclusion, CFR evaluated immediately after primary coronary angioplasty is a strong predictor of long-term adverse cardiac events after reperfused acute myocardial infarction. [Copyright &y& Elsevier]

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. Doppler guidewire monitoring and myocardial contrast echocardiography were performed 10 and 15 minutes after percutaneous coronary intervention, and left ventriculography was performed at discharge (24 ± 2 days) to measure regional wall motion (SD/chord). Patients were classified into 4 groups according to the coronary blood flow velocity pattern: group I (n = 39), DDT ≥600 ms; group II (n = 10), DDT <600 ms; group III (n = 17), DDT <600 ms with SFR; and group IV (n = 14), DDT <600 ms with SFR and without systolic anterograde flow. The no-reflow phenomenon was observed in no patients in group I, in 3 in group II, in 11 in group III, and all 14 patients in group IV. Regional wall motion was highest in group I and decreased with increasing group number (groups I, II, III, and IV, −1.45 ± 0.80, −2.36 ± 0.60, −2.90 ± 0.50, and −3.20 ± 0.52 SD/chord, respectively). With the progression of damage in the infarcted myocardium, the DDT shortened first, followed by the appearance of SFR, and then the disappearance of systolic anterograde flow. In conclusion, analysis of the coronary blood flow velocity pattern allows assessment of the severity of microvascular dysfunction and prediction of left ventricular functional outcomes. [Copyright &y& Elsevier]

Hypoxemic erythrocytotic residents of high altitudes lack coronary atherosclerosis and have low cholesterol levels. It was postulated that hypoxemic erythrocytotic adults with cyanotic congenital heart disease (CCHD) might be analogous. The incidence of coronary atherosclerosis in this patient population has not been established, and hypocholesterolemia has not previously been recognized. Accordingly, 279 patients were divided into 4 groups: group A: 143 cyanotic patients not operated on (54 men and 89 women, aged 18 to 69 years); group B: 47 cyanotic patients (28 men and 19 women rendered acyanotic by operation at age 22 to 69 years); group C: 41 acyanotic patients not operated on (22 men and 19 women, aged 22 to 75 years); and group D: 48 patients acyanotic before and after operation (24 men and 24 women, aged 21 to 70 years). Coronary arteries were studied angiographically in 59 patients and at necropsy in 5 subjects aged 37 to 56 years. Total cholesterol was &#60;160 mg/dl in 58% of group A, 52% of group B, 10% of group C, and 12% of group D (p &#60;0.000001, chi-square analysis). Angiograms disclosed dilated coronary arteries without obstruction. Necropsy disclosed ectatic coronary arteries with structural abnormalities of the media. In conclusion, this study provides the first quantitative and qualitative data on antiatherogenic changes in lipoproteins in adults with CCHD. The coronary arteries are atheroma free because hypocholesterolemia acts in concert with the antiatherogenic properties of upregulated nitric oxide, hyperbilirubinemia, hypoxemia, and low platelet counts. The persistence of hypocholesterolemia after the surgical elimination of cyanosis suggests a genetic determinant. [Copyright &y& Elsevier]

The effect of mental stress on coronary flow velocity reserve (CFVR) was examined in healthy men using transthoracic Doppler echocardiography. In the mental stress group (n = 31), CFVR was significantly reduced at 15 (to 3.3 ± 0.8, p &#60;0.001) and 30 (to 3.7 ± 0.8, p &#60;0.01) minutes after mental stress testing, compared with before mental stress (4.3 ± 0.9), whereas it did not change in each of 3 measurements in control subjects (n = 10). Mental stress impaired coronary circulation even after a certain interval after the stress. [Copyright &y& Elsevier]

Coronary disease or its risk factors has been reported to attenuate basal nitric oxide (NO) activity. Intravascular ultrasound was used in the present study to better understand this relation. Basal and stimulated NO activities were assessed in 53 stable subjects. Coronary diameter and velocity (0.014-inch Doppler wire) were measured at baseline and after intracoronary infusion of the NO synthase inhibitor NG-monomethyl-l-arginine, acetylcholine (10−6 M), nitroglycerin (200 μg), and adenosine (24 μg). Intimal thickening was quantified with intravascular ultrasound. NG-monomethyl-l-arginine resulted in significant decreases in coronary blood flow (−14 ± 48%), proximal coronary diameter (−10 ± 18%), and distal coronary diameter (−10 ± 9%, all p values &#60;0.0001). Basal NO activity was unrelated to the presence of coronary disease as assessed by angiography and the burden of atherosclerosis as assessed by intravascular ultrasound. Conversely, stimulated NO activity correlated inversely with burden of coronary atherosclerosis (p &#60;0.05). Basal NO activity is relatively preserved in patients who have moderate coronary disease and is not related to the degree of atherosclerosis as assessed by intravascular ultrasound. This is in contradistinction to the impairment of stimulated NO activity in the coronary circulation that characterizes atherosclerosis. [Copyright &y& Elsevier]

This study examined the effect of azithromycin therapy on the coronary microcirculation using measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography in 35 patients with coronary artery disease. CFVR increased significantly after azithromycin therapy (3.0 ± 0.7 vs 3.5 ± 0.7, p &#60;0.001). The changes in CFVR were negatively correlated with changes in high-sensitivity C-reactive protein levels in patients receiving azithromycin. [Copyright &y& Elsevier]

Epidemiologic studies suggest that tea consumption decreases the risk for cardiovascular events. However, there has been no clinical report examining the effects of tea consumption on coronary circulation. The purpose of this study was to evaluate the effects of black tea on coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography (TTDE). This was a double-blind crossover study of 10 healthy male volunteers conducted to compare the effects of black tea and caffeine on coronary circulation. The coronary flow velocity of the left anterior descending coronary artery was measured at baseline and at hyperemia during adenosine triphosphate infusion by TTDE to determine CFVR. The CFVR ratio was defined as the ratio of CFVR after beverage consumption to CFVR before beverage consumption. All data were divided into 2 groups according to beverage type: group T (black tea) and group C (caffeine). Two-way analysis of variance showed a significant group effect and interaction in CFVR before and after beverage consumption (p = 0.001 ). CFVR significantly increased after tea consumption in group T (4.5 ± 0.9 vs 5.2 ± 0.9, p <0.0001). The CFVR ratio of group T was larger than that of group C (1.18 ± 0.07 vs 1.04 ± 0.08, p = 0.002 ). Acute black tea consumption improves coronary vessel function, as determined by CFVR. [Copyright &y& Elsevier]

C-reactive protein (CRP) mRNA was detected in coronary plaque. Plasma CRP levels across the coronary circulation were increased much more in patients with unstable angina pectoris and somewhat more in those with stable angina pectoris compared with controls whose coronary arteries were angiographically normal. Thus, CRP within coronary plaque might contribute to increased plasma CRP levels across coronary circulation, particularly among patients with unstable angina pectoris. [Copyright &y& Elsevier]

We investigated the prognostic value of cardiac autonomic neuropathy (CAN) in relation to perfusion defects in 146 diabetic patients with suspected coronary artery disease. Perfusion defects and CAN were significant univariate predictors of death (p = 0.05 and p <0.001, respectively) and cardiac events (p <0.001 and p <0.002, respectively). However, CAN remained a significant predictor of death and cardiac events after adjustment for perfusion defects (both p <0.02), and provided prognostic information incremental to that offered by perfusion defects alone (p <0.003 and p <0.006, respectively). [Copyright &y& Elsevier]

The true 3-dimensional neointimal thickness distribution in sirolimus-eluting stents was investigated in relation to the shear stress distribution, which was obtained from computational fluid dynamics calculations. Small pits were observed between the stent struts in all patients, and a significant inverse relation between neointimal thickness and shear stress was found, indicating that deeper pits were present in the outside curve of the stented segments. [Copyright &y& Elsevier]

This study demonstrates a significant impairment in coronary blood flow reserve in most patients with idiopathic dilated cardiomyopathy despite normal epicardial coronary arteries. This change may prevent appropriate increases in coronary blood flow and thus lead to myocardial ischemia and progression of disease. An association between decreased response to adenosine and acetylcholine supports previous observations indicating that adenosine-induced vasodilation of coronary microcirculation is dependent on endothelial nitric oxide production. [Copyright &y& Elsevier]

Outcome studies of percutaneous coronary intervention (PCI) with conventional balloon angioplasty have established increased in-hospital and 1-year mortality in patients with left ventricular (LV) dysfunction compared with others. It is unclear whether recent PCI practice innovations, including stents and adjunctive pharmacotherapy, have made PCI safer and more effective in patients with LV dysfunction. We evaluated the influence of LV ejection fraction (EF) indexes on in-hospital and 1-year outcomes in 1,458 patients within the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry. Patients (n = 300) with acute myocardial infarction were excluded. The remaining 1,158 patients were subdivided into 3 categories: group 1, EF ≤40% (n = 166); group 2, EF 41% to 49% (n = 126); and group 3, EF ≥50% (n = 866). We determined the frequency of individual and composite adverse events (death/myocardial infarction [MI]/coronary artery bypass grafting) at discharge and 1 year. In the Dynamic Registry patients, mean EF in the 3 groups was 32%, 45%, and 62% and in-hospital mortality was 3.0%, 1.6%, and 0.1%, respectively (p <0.001). The composite end point of death/MI was also significant, but other in-hospital adverse events did not differ between groups. The respective mortality rates were 11.0%, 4.5%, and 1.9% (p <0.001) after 1 year. The composite end points of death/MI and death/MI/coronary artery bypass grafting also occurred more frequently in group 1 patients. Thus, significant LV dysfunction was still associated with increased in-hospital and 1-year mortality in patients having contemporary PCI. [Copyright &y& Elsevier]

The aim of this study was to assess the relation between coronary blood flow and left ventricular (LV) myocardial diastolic dysfunction in arterial hypertension. The study population included 30 hypertensive patients who were free of coronary artery disease and pharmacologic therapies. They underwent standard Doppler echocardiography and color tissue Doppler of the middle posterior septum at baseline and with high-dose dobutamine, and second-harmonic Doppler flow analysis of the distal left anterior descending coronary artery at baseline and after vasodilation by dipyridamole (0.56 mg/kg IV in 4’). Coronary flow reserve (CFR) was estimated as the ratio of hyperemic and baseline diastolic flow velocities. According to CFR, hypertensives were divided into 2 groups: 15 patients with normal CFR (≥2) and 15 patients with reduced CFR (<2). The 2 groups were comparable for sex, age, body mass index, baseline heart rate, and blood pressure. LV mass index was greater in hypertensives with reduced CFR (p <0.01). By color tissue Doppler, baseline and high-dose dobutamine septal systolic velocities did not differ between the 2 groups. The ratio between myocardial velocities in early diastole and at atrial contraction (Em/Am ratio) was lower in patients with reduced CFR, both at baseline (p <0.05) and with high-dose dobutamine (p <0.00001). After adjusting for age, body mass index, LV mass index, and both high-dose dobutamine diastolic blood rate and heart rate by a multiple linear regression analysis, Em/Am ratio at high-dose dobutamine was independently associated with CFR in the overall population (β 0.62, p <0.0005) (cumulative R2 0.38, p <0.0005). In conclusion, this study provides evidence of an independent association between CFR and myocardial diastolic function. In hypertensive patients without coronary artery stenosis, CFR alteration may be a determinant of myocardial diastolic dysfunction or diastolic impairment that should be taken into account as possibly contributing to coronary flow reduction. [Copyright &y& Elsevier]

Studies the effect of atrial fibrillation (AF) and atrial tachycardia on coronary circulation. Smaller increase in coronary flow and a greater reduction in coronary flow reserve following the induction of atrial fibrillation compared to atrial tachycardia; Clinical consequences of AF in humans.

Examines the relation of stenting to decreased coronary blood flow (CBF) during primary angioplasty in acute myocardial infarction (AMI). Improvement in the CBF after PCI with balloon angioplasty; Absence of a significant change in flow after the addition of a stent; Improvement in flow after stenting only in patients with low CBF after balloon angioplasty.

Hemodynamics after Norwood palliation for hypoplastic left heart syndrome (HLHS) have been incompletely characterized, although emphasis has been placed on the role that an excess pulmonary-to-systemic blood flow ratio (Qp/Qs) may play in causing hemodynamic instability. Studies suggest that maximal oxygen delivery occurs at a Qp/Qs < 1. However, it remains unclear to what extent cardiac output can increase with increasing pulmonary perfusion. One approach is to use the oxygen excess factor omega, an index of systemic oxygen delivery, and compare omega with measured Qp/Qs. We measured Qp/Qs and omega in neonates after Norwood palliation for HLHS, and determined how they were related. In addition, we determined the temporal course of surrogate indexes of systemic perfusion in the early postoperative period. Arteriovenous oxygen saturation difference, blood lactate, and omega were recorded on admission and every 3 to 12 hours for 2 days in 18 consecutive infants with HLHS or variant after Norwood palliation. Three infants required extracorporeal membrane oxygenation (ECMO) 6 to 9 hours after admission. These infants had higher Qp/Qs, blood lactate, arteriovenous oxygen saturation difference, and lower omega than non-ECMO patients. In non-ECMO patients between admission and 6 hours, omega decreased significantly despite no appreciable change in Qp/Qs. We conclude that: (1) Oxygen delivery is significantly decreased at 6 postoperative hours unrelated to Qp/Qs. This modest decline in oxygen delivery is insufficient to compromise tissue oxygenation. (2) Patients requiring ECMO have significant derangements in oxygen delivery. [ABSTRACT FROM AUTHOR]

Acute coronary syndromes result in a global impairment of coronary blood flow with nonculprit artery blood flow being associated with culprit artery flow and vice versa. Improvements in nonculprit artery flow are related to improvements in culprit artery flow after percutaneous intervention; nonculprit arteries with abnormal flow sustain greater improvements in their flow after culprit artery intervention. [ABSTRACT FROM AUTHOR]

Studies the relation of regional sympathetic denervation and myocardial perfusion disturbance to wall motion impairment in Chagas' cardiomyopathy. Global left ventricular function; Results of segmental wall motion analysis; Correlation between sympathetic innervation and myocardial perfusion disturbances.