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Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in “true” non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a highvolume university PCI center. Study included patients with “true” native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with “provisional” stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 “true” non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) – diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) < 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation’s angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298–5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after “provisional” stenting in “true” non-left main bifurcations is associated with greater MB to stent diameter ratio.

Background/Aim. Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete’s heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. Methods. A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. Results. After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p < 0.05, for both). A significant correlation was found between LA diameter and LVEDD in the steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p < 0.001). No significant differences in ejection fraction and cardiac output were observed among the groups, although mildly reduced LV ejection fraction was seen only in the AAS users. The AAS-using strength athletes had higher A-peak velocity when compared to steroidfree athletes, regardless of training type (p < 0.05 for both). Both AAS-using and AAS-free strength athletes had lower e’ peak velocity and higher E/e’ ratio than endurance athletes (p < 0.05, for all). Conclusions. There is no evidence that LV ejection fraction in elite athletes is altered by either type of training or AAS misuse. Long-term endurance training is associated with preferable effects on LV diastolic function compared to strength training, particularly when the latter is combined with AAS abuse.

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

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Introduction. Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. Case report. A 47-yearold woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2°C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patient’s symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. Conclusion. The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.