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O119 Identification of inducible ischemic myocardium by strain rate imaging during low-dose dobutamine stress echocardiography
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Oral Sessions / International Journal of Cardiology 125 Suppl. 1 (2008) S39–S50
O119 Identification of inducible ischemic myocardium by strain rate imaging during low-dose dobutamine stress echocardiography G.Q. Du *, J.W. Tian, M. Ren, H.M. Wang, S.N. Li, S.Q. Jiang, Y. Wang. Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China Objective: The purpose of the present study was to identify the inducible ischemic myocardium by strain rate imaging (SRI) during low-dose dobutamine stress echocardiography (LDDSE). Methods: 34 patients with coronary angiography confirmed left anterior descending stenosis and 30 healthy volunteers were assessed by SRI. All patients underwent LDDSE with incremental dobutamine infusion from 5 to 20 mg kg−1 min−1 . Regional myocardial peak systolic strain rate (SRS ), peak systolic strain (esys), maximal systolic strain (emax), postsystolic strain(eps), postsystolic strain index (PSI = eps/esys) and corrected time to onset of regional relaxation (TR-correct ) were investigated. Receiver operating characteristic (ROC) analysis was used to compare the value of the above parameters in predicting myocardial ischemia by their area under the curves (AUC). Results: SRS , esys and emax increased in all segments as the dosage of dobutamine increased, while TR-correct decreased. However the degree was lower in ischemic than in nonischemic segments. When the cutoff values of increased in SRS , esys and emax were less than 20%, the sensitivity in predicting ischemia were 0.825, 0.865 and 0.713, respectively, while specificity were 0.768, 0.839 and 0.764, respectively. The optimal cutoff value of decreased in TR-correct was less than 10%, the sensitivity and specificity were 0.907 and 0.809, respectively. eps and PSI were significantly increased at rest and stress in ischemic than in nonischemic segments. The best cutoff values for eps and PSI were increased of 25% that yielded the sensitivity in predicting of ischemia were 0.876 and 0.957, respectively, and the specificity were 0.867 and 0.891, respectively. Conclusions: Combined with LDDSE, SRI can quantitatively differentiate the ischemic from nonischemic myocardium. eps, PSI and TR-correct at stress can be used as optimal parameters to identify the inducible ischemia. O120 Demonstrations of coronary artery bypass grafts and anastomoses with 64-slice computed tomography H.Y. Ju1 *, Z.L. Cai1 , L. Yang1 , X.J. Wang1 , T. Li1 , C.S. Xiao2 . 1 Department of Radiology, 2 Cardiac Surgery, Department of PLA General Hospital, Beijing, 100853, China Objective: The purpose of this study was to investigate the clinical value of 64-slice computed tomography (CT) in demonstrate the patency of the coronary artery bypass grafts and anastomoses. Methods: Sixty-four-slice CT was performed in consecutive 154 patients (303 grafts, 142 arterial and 161 venous; 374 anastomoses, 142 arterial and 232 venous) a mean of 3.1 years after coronary artery bypass surgery. The assessment criteria was defined as 3-grade: patency to slight stenosis (diameter reduction 30%), moderate stenosis (diameter reduction >30% and 70%) and striking stenosis to occlusion (diameter reduction >70%). The grafts and anastomoses were assessed respectively according to the criteria described above. Results: All 303 grafts and 374 anastomoses were assessable, and none of the grafts was excluded from evaluation. For the arterial grafts, 73% (104/142) showed patency to slight stenosis, 18% (25/142) showed moderate stenosis and 9% (13/142) showed striking stenosis to occlusion; for the venous grafts, 86% (139/161) showed patency to slight stenosis, 11% (17/161) showed moderate stenosis and 3% (5/161) showed striking stenosis to occlusion. For arterial and venous anastomoses, patency to slight stenosis rate was 69% (98/142) and 73% (169/232) respectively, moderate stenosis rate was 20% (29/142) and 14% (32/232), striking stenosis to occlusion rate was 11% (15/142) and 13% (31/232). Conclusion: Sixty-four-slice CT angiography is considered as a valuable noninvasive method for displaying the patency, stenosis or occlusion of coronary artery bypass grafts and anastomoses.
O121 Low-dose adenosine stress real-time myocardial contrast echocardiography can quantitatively evaluate coronary artery stenosis and myocardial perfusion X. Zhou *. Cardiovascular Department, General Hospital of PLA, FuXing Road 28#, Beijing 100853, China Objectives: To test if quantitative low-dose adenosine stress Realtime Myocardial Contrast Echocardiography (RT-MCE) can accurately differentiate among the myocardium of normal perfusion, perfusion defect and successful reperfusion. Methods: In 14 unselected patients who were going to have coronary angiography, the RT-MCE was performed under a low-dose adenosine stress(70 mg/kg/min), with continuously infused Sonovue (Bracco) (23 ml/h) and CPS imaging system (Siemens). The myocardial segments were divided into 3 groups according to the angiography results: group 1, without significant stenosis (<60%); group 2, successfully reperfused (TIMI 3 flow); group 3, significant stenosis (>80%). Perfusion images of these segments were analyzed to obtain the refilling curves. A, b and A·b of baseline and stress, and the improvement of each viable by adenosine stress were compared among groups. Results: Among a total of 49 segments, 20 were in group 1 (41%), 12 were in group 2 (24%), 17 were in group 3 (35%). Perfusion of group 3 did not decrease significantly at baseline, but was lower than group 1 and 2 (p < 0.05) after adenosine stress; during adenosine stress, perfusion of group 1 (A, b, A·b; A, b, p < 0.05; A·b, p < 0.01) and 2 (A·b, p < 0.05) were improved. The improvement of A·b and b were significantly higher in group 1 than group 2 and 3 (p < 0.05). In ROC curve analysis, A·b under adenosine stress <1.74 dB/s has a sensitivity and specificity of 71% for diagnosis of coronary stenosis and perfusion defect; for the diagnosis of low-reserved perfusion, adenosine-improving percentage of A·b < 81% has a sensitivity and specificity of 83% and 79%, improving percentage of b < 54%, 86% vs 79%. Conclusions: The rest perfusion of severely stenosed arteries is normal, but adenosine stress can detect the impaired perfusion reserve. Low-dose adenosine stress (70 mg/kg/min) RT-MCE provides good accuracy for the evaluation of coronary perfusion reserve. For the diagnosis of coronary stenosis, A·b under adenosine stress and the adenosine-improving percentage of b and A·b can be used. O122 Arsenic trioxide eluting stents inhibit expression of inflammatory factors and inflammatory cell infiltration in injured coronary arteries in pigs W.J. Tian *, J.B. Ge, W. Yang, H. Lu, L. Shen, K.Q. Wang, Y.Z. Zou. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China Objective: Our previous study showed arsenic trioxide (As2 O3 ) eluting stents significantly promoted apoptosis of vascular smooth muscle cells and reduced restenosis in a rabbit iliac artery model. This study was designed to observe the effect of As2 O3 eluting stents on expression of monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) and to assess whether arsenic trioxide eluting stents can inhibit the local inflammatory cell infiltration in injured coronary arteries in pigs. Methods: Bare metal stents, rapamycin eluting stents and As2 O3 eluting stents were randomly and double-blindly implanted into the anterior descending branches, circumflex branches, and right coronary arteries in eight pigs. Animals were euthanized and coronary arteries were isolated 7 days after stents implantation. The expression level of protein and mRNA of MCP-1 and IL-6 were respectively determined by western blot analysis and reverse transcription polymerase chain reaction (RT-PCR), and the inflammatory cell infiltration was observed by HE staining. Results: As compared to bare metal stents, As2 O3 eluting stents and rapamycin eluting stents identically and markedly inhibited protein expression level of MCP-1 (0.421±0.055 and 0.406±0.042
Oral Sessions / International Journal of Cardiology 125 Suppl. 1 (2008) S39–S50
O119 Identification of inducible ischemic myocardium by strain rate imaging during low-dose dobutamine stress echocardiography G.Q. Du *, J.W. Tian, M. Ren, H.M. Wang, S.N. Li, S.Q. Jiang, Y. Wang. Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China Objective: The purpose of the present study was to identify the inducible ischemic myocardium by strain rate imaging (SRI) during low-dose dobutamine stress echocardiography (LDDSE). Methods: 34 patients with coronary angiography confirmed left anterior descending stenosis and 30 healthy volunteers were assessed by SRI. All patients underwent LDDSE with incremental dobutamine infusion from 5 to 20 mg kg−1 min−1 . Regional myocardial peak systolic strain rate (SRS ), peak systolic strain (esys), maximal systolic strain (emax), postsystolic strain(eps), postsystolic strain index (PSI = eps/esys) and corrected time to onset of regional relaxation (TR-correct ) were investigated. Receiver operating characteristic (ROC) analysis was used to compare the value of the above parameters in predicting myocardial ischemia by their area under the curves (AUC). Results: SRS , esys and emax increased in all segments as the dosage of dobutamine increased, while TR-correct decreased. However the degree was lower in ischemic than in nonischemic segments. When the cutoff values of increased in SRS , esys and emax were less than 20%, the sensitivity in predicting ischemia were 0.825, 0.865 and 0.713, respectively, while specificity were 0.768, 0.839 and 0.764, respectively. The optimal cutoff value of decreased in TR-correct was less than 10%, the sensitivity and specificity were 0.907 and 0.809, respectively. eps and PSI were significantly increased at rest and stress in ischemic than in nonischemic segments. The best cutoff values for eps and PSI were increased of 25% that yielded the sensitivity in predicting of ischemia were 0.876 and 0.957, respectively, and the specificity were 0.867 and 0.891, respectively. Conclusions: Combined with LDDSE, SRI can quantitatively differentiate the ischemic from nonischemic myocardium. eps, PSI and TR-correct at stress can be used as optimal parameters to identify the inducible ischemia. O120 Demonstrations of coronary artery bypass grafts and anastomoses with 64-slice computed tomography H.Y. Ju1 *, Z.L. Cai1 , L. Yang1 , X.J. Wang1 , T. Li1 , C.S. Xiao2 . 1 Department of Radiology, 2 Cardiac Surgery, Department of PLA General Hospital, Beijing, 100853, China Objective: The purpose of this study was to investigate the clinical value of 64-slice computed tomography (CT) in demonstrate the patency of the coronary artery bypass grafts and anastomoses. Methods: Sixty-four-slice CT was performed in consecutive 154 patients (303 grafts, 142 arterial and 161 venous; 374 anastomoses, 142 arterial and 232 venous) a mean of 3.1 years after coronary artery bypass surgery. The assessment criteria was defined as 3-grade: patency to slight stenosis (diameter reduction 30%), moderate stenosis (diameter reduction >30% and 70%) and striking stenosis to occlusion (diameter reduction >70%). The grafts and anastomoses were assessed respectively according to the criteria described above. Results: All 303 grafts and 374 anastomoses were assessable, and none of the grafts was excluded from evaluation. For the arterial grafts, 73% (104/142) showed patency to slight stenosis, 18% (25/142) showed moderate stenosis and 9% (13/142) showed striking stenosis to occlusion; for the venous grafts, 86% (139/161) showed patency to slight stenosis, 11% (17/161) showed moderate stenosis and 3% (5/161) showed striking stenosis to occlusion. For arterial and venous anastomoses, patency to slight stenosis rate was 69% (98/142) and 73% (169/232) respectively, moderate stenosis rate was 20% (29/142) and 14% (32/232), striking stenosis to occlusion rate was 11% (15/142) and 13% (31/232). Conclusion: Sixty-four-slice CT angiography is considered as a valuable noninvasive method for displaying the patency, stenosis or occlusion of coronary artery bypass grafts and anastomoses.
O121 Low-dose adenosine stress real-time myocardial contrast echocardiography can quantitatively evaluate coronary artery stenosis and myocardial perfusion X. Zhou *. Cardiovascular Department, General Hospital of PLA, FuXing Road 28#, Beijing 100853, China Objectives: To test if quantitative low-dose adenosine stress Realtime Myocardial Contrast Echocardiography (RT-MCE) can accurately differentiate among the myocardium of normal perfusion, perfusion defect and successful reperfusion. Methods: In 14 unselected patients who were going to have coronary angiography, the RT-MCE was performed under a low-dose adenosine stress(70 mg/kg/min), with continuously infused Sonovue (Bracco) (23 ml/h) and CPS imaging system (Siemens). The myocardial segments were divided into 3 groups according to the angiography results: group 1, without significant stenosis (<60%); group 2, successfully reperfused (TIMI 3 flow); group 3, significant stenosis (>80%). Perfusion images of these segments were analyzed to obtain the refilling curves. A, b and A·b of baseline and stress, and the improvement of each viable by adenosine stress were compared among groups. Results: Among a total of 49 segments, 20 were in group 1 (41%), 12 were in group 2 (24%), 17 were in group 3 (35%). Perfusion of group 3 did not decrease significantly at baseline, but was lower than group 1 and 2 (p < 0.05) after adenosine stress; during adenosine stress, perfusion of group 1 (A, b, A·b; A, b, p < 0.05; A·b, p < 0.01) and 2 (A·b, p < 0.05) were improved. The improvement of A·b and b were significantly higher in group 1 than group 2 and 3 (p < 0.05). In ROC curve analysis, A·b under adenosine stress <1.74 dB/s has a sensitivity and specificity of 71% for diagnosis of coronary stenosis and perfusion defect; for the diagnosis of low-reserved perfusion, adenosine-improving percentage of A·b < 81% has a sensitivity and specificity of 83% and 79%, improving percentage of b < 54%, 86% vs 79%. Conclusions: The rest perfusion of severely stenosed arteries is normal, but adenosine stress can detect the impaired perfusion reserve. Low-dose adenosine stress (70 mg/kg/min) RT-MCE provides good accuracy for the evaluation of coronary perfusion reserve. For the diagnosis of coronary stenosis, A·b under adenosine stress and the adenosine-improving percentage of b and A·b can be used. O122 Arsenic trioxide eluting stents inhibit expression of inflammatory factors and inflammatory cell infiltration in injured coronary arteries in pigs W.J. Tian *, J.B. Ge, W. Yang, H. Lu, L. Shen, K.Q. Wang, Y.Z. Zou. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China Objective: Our previous study showed arsenic trioxide (As2 O3 ) eluting stents significantly promoted apoptosis of vascular smooth muscle cells and reduced restenosis in a rabbit iliac artery model. This study was designed to observe the effect of As2 O3 eluting stents on expression of monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) and to assess whether arsenic trioxide eluting stents can inhibit the local inflammatory cell infiltration in injured coronary arteries in pigs. Methods: Bare metal stents, rapamycin eluting stents and As2 O3 eluting stents were randomly and double-blindly implanted into the anterior descending branches, circumflex branches, and right coronary arteries in eight pigs. Animals were euthanized and coronary arteries were isolated 7 days after stents implantation. The expression level of protein and mRNA of MCP-1 and IL-6 were respectively determined by western blot analysis and reverse transcription polymerase chain reaction (RT-PCR), and the inflammatory cell infiltration was observed by HE staining. Results: As compared to bare metal stents, As2 O3 eluting stents and rapamycin eluting stents identically and markedly inhibited protein expression level of MCP-1 (0.421±0.055 and 0.406±0.042