Should coronary CT angiography be routinely performed before coronary surgery to detect myocardial bridging?

Abstracts / Cardiovascular Revascularization Medicine 8 (2007) 116 – 154 Background: Although adult bone marrow cells (BMC) have been explored therapeutically in clinical trials, there is still concern about the long-term safety of this strategy. We investigated the long-tem safety of stem cell therapy in patients undergoing incomplete CABG for severe coronary artery disease (CAD). Methods: Thirty-four patients (4 women), 61F7 years old, with limiting angina and three-vessel CAD, not optimal candidates for complete CABG due to the extension of the disease, were enrolled. Two patients died from acute coronary syndrome during baseline evaluation. BMC were obtained immediately prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During surgery, 5 ml of the cell suspension containing approximately 13F3107 BMC (CD34+=1.30F0.40%) was delivered by multiple injections in nongrafted areas of ischemic myocardium. Before (B) and during the first year (at 1, 3, 6, and 12 months) after surgery, patients underwent laboratory tests, 24-h ECG monitoring, echocardiogram, and cardiac magnetic resonance imaging (MRI). Thereafter, patients were assessed on a clinical basis only. Results: Follow-up varied from 6 to 48 months (median=18). Injected segments included the inferior (n=18), anterior (n=11), and lateral (n=3) walls. Two patients died in-hospital from cardiogenic shock. Except for a mild and transient anemia at 1 month after surgery, laboratory tests were within normal ranges; during the first year, no patient presented complex arrhythmias or increased ectopic beats compared to baseline ( P=ns), and no structural abnormalities were seen either by echo or MRI, including pericardial effusion, fibrosis, or growing of noncardiac tissues. Clinically, there was a reduction in functional class of angina from 3.3F0.5 (B) to 1.2F0.5 (12M). After the first year, non-fatal complications included: nonST-elevation MI (n=1), ST-elevation MI+ventricular arrhythmia (n=1), and gastric neoplasia (n=1). Two patients died from septic shock. Conclusions: In the long-term, intramyocardial injection of autologous BMC combined to CABG appears to be safe. Theoretical concerns with arrhythmias, structural abnormalities, or uncontrolled vascular growth after cell therapy were not confirmed in this safety trial. doi:10.1016/j.carrev.2007.03.096

Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts R Jabaraa, N Chronosa, L Kleinb, S Eisenberga, R Allena, S Bradford a, S Frohweina a Saint Joseph’s Research Institute/Saint Joseph’s Hospital of Atlanta, GA, USA b University of North Carolina, Chapel Hill, NC, USA

Background: Currently, the ability of 64-slice computed tomographic angiography (CTA) to assess bypass graft patency has not been established. Objectives: The goal of this study was to prospectively evaluate the diagnostic accuracy of 64-slice CTA in assessing the patency of coronary artery bypass grafts compared to invasive coronary angiography. Methods: A total of 147 bypass grafts (100 venous grafts and 47 mammary artery grafts) were evaluated in 50 consecutive patients. A contrastenhanced 64-slice CTA was performed and compared to invasive angiography within 3 weeks. The CTA scan protocol used 640.5-mm slice collimation and 0.33 s gantry rotation time during simultaneous ECG gating. Patients with heart rate above 65 bpm received beta blockers. Results: Overall, 145 (98.6%) out of 147 bypass grafts were detected by CTA. The two unvisualized grafts were occluded at the time of invasive angiography. Of the grafts visualized, 28 were totally occluded, 103 were patent, and 14 had significant stenoses which were confirmed by invasive angiography. Ninety-five percent (111/117) of the patent grafts demonstrated good run-off distal to anastomoses, but without the ability to accurately evaluate the presence of retrograde flow. Only 83% (97/117) of distal anastomoses were adequately evaluated while the remaining 17% (20/ 117) were not well visualized due to vascular clips and/or calcification

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artifacts. Two grafts were not demonstrated by invasive angiography but were easily detected by CTA and found to be widely patent. Conclusions: Multidetector 64-slice CTA is a valuable tool for direct visualization of coronary bypass grafts and assessment of their patency. Dysfunctional bypass grafts can be detected with high diagnostic accuracy. With further improvements, particularly the ability to assess distal anastomoses, CTA may become a preferred method for bypass graft assessment. doi:10.1016/j.carrev.2007.03.097

Should coronary CT angiography be routinely performed before coronary surgery to detect myocardial bridging? E Konen, O Gotein, L Sternik, Y Eshet, J Shemesh, E Di Segni The Chaim Sheba Medical Center, Tel Hashomer and Tel Aviv University, Tel Aviv, Israel

Objective: The objective of this study was to investigate the capability of CCTA in diagnosing and precisely defining the anatomic patterns of myocardial bridging (intramuscular coronary artery) (MB). Background: MB has been detected in autopsy series in one third of the cases while it is underdiagnosed in vivo, being identified at coronary angiography in less than 5% of patients. MB may be the cause of technical problems and complications during coronary bypass surgery including perforation of the right ventricle. Preoperative diagnosis of MB may reduce the risk of complications and help to choose between conventional sternotomy and minimally invasive approach for coronary artery bypass surgery. Methods: The study group was composed of 118 consecutive patients submitted to CCTA using a Brilliance 40/64 MDCT (Philips Medical Systems), for suspected or known coronary artery disease. The following parameters were recorded: number, length, depth, and diameter of the intramuscular segment and its course in relation to the interventricular septum and the right ventricular endocardium. Results: A total of 47 MBs were identified in 36 (30.5%) of 118 patients. Most MBs were located in the LAD (34/47; 72%). CCTA features of intramuscular segments in LAD showed three patterns: in the first two patterns the intramuscular segment runs on the interventricular septum, superficially in 10 (29.4%) of 34 and deeply in 14 (41.1%) of 34. In the third pattern, found in 10 (29.4%) of 34, the intramuscular segment crossed the right ventricle, occasionally entering the right ventricular cavity. Conclusion: The prevalence of MB at CCTA was similar to that of pathological reports and much higher than that reported with coronary angiography. CCTA allows accurate diagnosis of MB demonstrating the presence, the course, and the anatomic features of the intramuscular segments. CCTA may thus provide useful information in the preoperative evaluation of candidates to coronary bypass surgery. doi:10.1016/j.carrev.2007.03.098

One-year insulin-dependent diabetic outcomes in the Taxus Cypher — bWhat’s Your Real-World ExperienceQ study W O’Neill a, DE Kandzari b, RL Minor Jrc, TP Gradyd, K Olsond, for the TC-WYRE Investigators, W Strausse, T Maloneye, M Deshpandee a University of Miami, Miami, FL, USA b Duke Clinical Research Institute, Durham, NC, USA c OSF St. Anthony Medical Center, Rockford, IL, USA d Aspirus Wausau Hospital Center, Wausau, WI, USA e Boston Scientific Corporation, Natick, MA, USA Background: Insulin-dependent diabetic mellitus (IDDM) status has been associated with poorer outcomes in patients undergoing percutaneous coronary intervention (PCI) than their non-insulin-requiring