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Transthoracic echocardiography using second harmonic imaging -: Diagnostic alternative to transesophageal echocardiography for the detection of atrial right to left shunt in patients with cerebral embolic events

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期34卷 1823-1830页

作者： Kühl, HP Hoffmann, R Merx, MW Franke, A Klötzsch, C Lepper, W Reineke, T Noth, J Hanrath, P Univ Hosp Inst Biometry Aachen Germany Univ Hosp Med Clin 1 Aachen Germany Univ Hosp Dept Neurol Aachen Germany

OBJECTIVES We sought to evaluate whether transthoracic contrast echocardiography using second harmonic imaging (SHI) is a diagnostic alternative to transesophageal contrast echocardiography (TEE) for the detection of atrial right to left shunt. BACKGROUND Paradoxic embolism is considered to be the major cause of cerebral ischemic events in young patients. Contrast echocardiography using TEE has proven to be superior to transthoracic echocardiography (TTE) for the detection of atrial shunting;SHI is a new imaging modality that enhances the visualization of echocardiographic contrast agents. METHODS We evaluated 111 patients with an ischemic cerebral embolic event for the presence of atrial right to left shunt using an intravenous (IV) contrast agent in combination with three different echocardiographic imaging modalities: 1) TTE using fundamental imaging (FI);2) TTE using SHI;and 3) TEE. The severity of atrial shunting and the duration of contrast visibility within the left heart chambers were evaluated for each imaging modality. Image quality was assessed separately for each modality by semiquantitative scoring (0 poor to 3 excellent). Presence of atrial right to left shunt was defined as detection of contrast bubbles in the left atrium within the first three cardiac cycles after contrast appearance in the right atrium either spontaneously or after the Valsalva maneuver. RESULTS A total of 57 patients showed evidence of atrial right to left shunt with either imaging modality. Fifty-one studies were positive with TEE, 52 studies were positive with SHI, and 32 were positive with FI (p < 0.001 for FI vs. SHI and TEE). The severity of contrast passage was significantly larger using SHI (61.6 +/- 80.2 bubbles) compared to Fl (53.7 +/- 69.6 bubbles;p < 0.005 vs. SHI) but was not different compared to TEE (43.9 +/- 54.3 bubbles;p = NS vs. SHI). The duration of contrast visibility was significantly longer for SHI (17.4 +/- 12.4 s) compared to FI (13.1 +/- 9.7 s;p < 0.001) a

关键词：冠状动脉瘤/并发症冠状动脉血栓形成/并发症冠状动脉血栓形成/诊断显像超声心动描记术/方法超声心动描记术经食管栓塞反常/并发症栓塞反常/诊断显像房间隔缺损/并发症房间隔缺损/诊断显像图像增强颅内栓塞/并发症颅内栓塞/病理生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Thrombogenesis in acute coronary syndromes

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第6期8卷 724-729页

作者： Crea, F Finocchiaro, ML IstitutodiCardiologia UniversitaCattolicaRomeItaly.

It is well-established that intracoronary thrombosis, which may be associated with plaque fissure and enhanced coronary vasoconstriction, is the immediate cause of a sudden impairment of regional myocardial perfusion, which is transient in unstable angina and is, eventually, irreversible in acute myocardial infarction. It is also well-known that increased platelet reactivity, increased procoagulant activity, and reduced endogenous fibrinolysis are risk factors for acute coronary events. Nevertheless, the primary causes responsible for sudden intracoronary thrombosis and for coronary vasoconstriction causing acute coronary syndromes are still largely speculative. Recent studies have shown activated inflammatory cells both in the coronary arterial wall and in the systemic circulation of patients with unstable angina. Furthermore, the intensity of the inflammatory response is correlated with an adverse prognosis. This inflammatory component may have important pathogenetic and prognostic roles because an outburst of inflammatory cytokines has the potential to increase the sensitivity of platelets to agonists, to turn the anticoagulant and vasodilator physiological properties of the endothelium into procoagulant and vasoconstrictor properties, and to cause plaque fissure by the release of proteolytic enzymes.

关键词：急性病冠心病/病因学冠心病/病理生理学冠状动脉血栓形成/并发症冠状动脉血栓形成/病理生理学危险因素人类

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Pl^A polymorphism of glycoprotein IIIa and risk of adverse events after coronary stent placement

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第1期36卷 84-89页

作者： Kastrati, A Koch, W Gawaz, M Mehilli, J Böttiger, C Schömig, K von Beckerath, N Schömig, A Deutsch Herzzentrum Munich D-80636 Munich Germany Tech Univ Munich Med Klin Rechts Isar 1 D-8000 Munich Germany

OBJECTIVE We designed this prospective study to test the hypothesis that platelet antigen (P1(A)) polymorphism of glycoprotein (GP) IIIa is associated with an increased risk for adverse events after coronary stent placement. BACKGROUND Platelets play a central role in arterial thrombosis. The P1(A) polymorphism of GP IIIa, a constituent of the fibrinogen receptor, may influence the platelet function and, thereby, the early outcome of patients after coronary stent placement. METHODS The study included 1,759 consecutive patients with stable or unstable angina and successful coronary stent placement. Platelet antigen genotypes were determined by allele-specific restriction enzyme analysis. The end point of the study was a composite of death, myocardial infarction and urgent revascularization during the first 30 days after stent placement. RESULTS The P1(A) genotype of the patients included was: 70.2% were homozygous for platelet antigen 1 (P1(A1)), 2.6% homozygous for platelet antigen 2 (P1(A2)), and 27.2% were heterozygous (p1(A1/A2)). The incidence of the composite end point was 5.5% among P1(A2) carriers and 5.4% in homozygous P1(A1) subjects (p = 0.94). It was 5.4% in p1(A1/A1) patients, 4.8% in p1(A1/A2) patients and 13.0% in P1(A2/A2) patients (P = 0.06). The combined incidence of death or myocardial infarction was 4.3% in P1(A1/A2) p1(A2/A2) patients (p = 0.02). CONCLUSION The isolated presence of the p1(A2) allele in heterozygous patients is not associated with anp detectable increase in the risk for an adverse 30-day outcome after coronary stenting. This study suggests also that an increased risk is likely to be present in homozygous carriers of the P1(A2) allele, but this should be confirmed in a much larger series of patients. (J Am Coil Cardiol 2000;36: 84-9) (C) 2000 by the American College of Cardiology.

关键词：等位基因心绞痛/外科学抗原 CD/遗传学抗原 CD/代谢抗原人血小板/血液抗原人血小板/遗传学冠状血管造影术冠状动脉血栓形成/血液冠状动脉血栓形成/并发症冠状动脉血栓形成/诊断显像冠状动脉血栓形成/遗传学 DNA/分析 DNA引物/化学表位/血液表位/遗传学遗传标记基因型整合素β3 整合素类/血液整合素类/遗传学心肌梗死/血液心肌梗死/诊断显像心肌梗死/病因学比值比血小板膜糖蛋白类/遗传学血小板膜糖蛋白类/代谢聚合酶链反应多态现象遗传预后前瞻性研究危险因素支架/副作用老年人女(雌)性人类男(雄)性中年人

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When young hearts are broken: Profiles of premature myocardial infarction

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AMERICAN HEART JOURNAL 2002年第1期143卷 4-6页

作者： Pasricha, A Batchelor, W St Michaels Hosp Div Cardiol Toronto ON M5B 1W8 Canada

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Detecting and differentiating white from red coronary thrombus by angiography in angina pectoris and in acute myocardial infarction

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第1期83卷 94-+页

作者： Abela, GS Eisenberg, JD Mittleman, MA Nesto, RW Leeman, D Zarich, S Waxman, S Prieto, AR Manzo, KS Michigan State Univ Dept Med Cardiol Clin Ctr B208 E Lansing MI 48824 USA Harvard Univ Sch Med Deaconess Hosp Dept MedDiv Cardiol Boston MA USA

To determine the ability to detect thrombus by angiography, angioscopy was performed before angiography in patients undergoing interventional procedures and the data collected in a blinded fashion. These data demonstrated that the sensitivity of angiography to detect white thrombus was 50% and the specificity was 95%, whereas the sensitivity and specificity to detect red thrombus was 100%, respectively;the positive and negative predictive value of detecting thrombus in general was 89% and 83%, respectively.

关键词：心绞痛/病因学心绞痛/病理学心绞痛/放射摄影术血管镜检查冠状血管造影术冠状动脉血栓形成/并发症冠状动脉血栓形成/病理学冠状动脉血栓形成/放射摄影术冠状血管/病理学诊断鉴别心肌梗死/病因学心肌梗死/病理学心肌梗死/放射摄影术试验预期值敏感性与特异性老年人女(雌)性人类男(雄)性中年人

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Thrombosed giant coronary artery aneurysm presenting as an intracardiac mass

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ANNALS OF THORACIC SURGERY 2000年第2期69卷 611-613页

作者： Hirsch, GM Casey, PJ Raza-Ahmad, A Miller, RM Hirsch, KJ Dalhousie Univ Sch Med Dept Surg Halifax NS Canada Dalhousie Univ Sch Med Dept Pathol Halifax NS Canada Dalhousie Univ Sch Med Dept Radiol Halifax NS Canada Dalhousie Univ Sch Med Dept Anaesthesia Halifax NS Canada

Giant coronary artery aneurysms are rare in adults and are usually found in association with Kawasaki's disease arising in childhood. We report a case of a thrombosed giant right coronary artery aneurysm presenting as an intracardiac mass detected after inferior wall myocardial infarction. Histologic analysis indicated that fibromuscular dysplasia was the underlying cause of the aneurysm. (C) 2000 by The Society of Thoracic Surgeons.

关键词：冠状动脉瘤/诊断冠状动脉瘤/病因学冠状动脉瘤/病理学冠状动脉瘤/外科学冠状动脉血栓形成/并发症冠状动脉血栓形成/诊断冠状血管/病理学超声心动描记术经食管纤维肌性发育不良/并发症心肌梗死/并发症老年人人类男(雄)性

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Acute myocardial infarction in a young patient during an exacerbation of ulcerative colitis

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INTERNATIONAL JOURNAL OF CARDIOLOGY 1999年第2期70卷 211-212页

作者： Efremidis, M Prappa, E Kardaras, F Evagelismos Gen Hosp Dept Cardiol 2 Athens Greece

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Interesting cases from the University of Texas Medical Branch

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Cardiology Clinics 1999年第2期17卷 401-414页

作者： Brizolara, A.A. Stouffer, G.A. Medical Research Building University of Texas Medical Branch Galveston TX 77555-1064 301 University Boulevard United States

This article discusses the cases for four patients with unstable angina. The first case is an example of the 'high-risk' patient with widespread ECG changes, heart failure, and enzymatic elevations during an episode of chest pain. The second patient illustrates an unusual cause of unstable angina in a young women. The third patient had a large thrombus visible on angiography and management strategies for dealing with intracoronary thrombus are discussed. The final patient had an extensive past cardiac history with two prior coronary artery bypass operations and we discuss the recent advances made in the treatment of degenerative vein graft disease.

关键词：心绞痛不稳定型/并发症心绞痛不稳定型/诊断心绞痛不稳定型/治疗抗体单克隆/治疗应用抗凝药/治疗应用冠状动脉分流术冠状动脉血栓形成/并发症心电描记术免疫球蛋白Fab片段/治疗应用治疗结果成年人老年人女(雌)性人类中年人

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Factor XII deficiency associated with coronary stent thrombosis

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AMERICAN JOURNAL OF HEMATOLOGY 2000年第4期64卷 322-323页

作者： Helft, G Le Feuvre, C Metzger, JP Vacheron, A Monsuez, JJ Lachurie, ML Ahlenc-Gelas, M Hop Necker Enfants Malad Clin Cardiol Paris France Hop Paul Brousse Serv Med Interne Paris France Hop Broussais Hemostase Lab INSERM U428 F-75674 Paris France

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Formation of platelet aggregates after attacks at coronary spastic angina pectoris

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 494-497页

作者： Miyamoto, S Ogawa, H Soejima, H Takazoe, K Sakamoto, T Yoshimura, M Kugiyama, K Yasue, H Kumamoto Univ Sch Med Dept Cardiovasc Med Kumamoto 8608556 Japan

In the present study, using a novel laser-light scattering method, we examined platelet aggregability at baseline and after spontaneous coronary spastic attacks in patients with coronary spastic angina, and before and after acute myocardial ischemia induced by an exercise test in patients with stable exertional angina. We also compared the results with the data from the conventional optical density method.

关键词：乙酰胆碱/投药和剂量乙酰胆碱/诊断应用心绞痛变异型/血液心绞痛变异型/诊断心绞痛变异型/病因学冠状血管造影术冠状动脉血栓形成/血液冠状动脉血栓形成/并发症冠状动脉血栓形成/诊断冠状血管心电描记术运动试验心脏导管插入术注射动脉内血小板聚集/生理学预后血管舒张药/投药和剂量血管舒张药/诊断应用成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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