The American journal of cardiology
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Among 4,333 patients who were triaged in the emergency department (ED) over a 1-year period in 2003 because of acute chest pain, 1,747 (40%) were stratified as "low risk" on the basis of a Thrombolysis In Myocardial Infarction (TIMI) risk score of 0 to 2. Results showed that, during ED stay, TIMI risk score increased to > or =3 in 63% of patients and that such patients were more likely to be diabetic, hypertensive, hyperlipidemic, and smokers, and to have had previous myocardial infarction or revascularization. ⋯ Changes in TIMI risk score are more common in patients with multiple risk factors and/or previous diagnosis of coronary artery disease. Serial, frequent assessments of TIMI score during the ED observation period are mandatory, particularly in these subsets of patients.
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Ten patients underwent rescue percutaneous coronary intervention for myocardial infarction or ischemia soon after coronary artery bypass grafting, and 6 received drug-eluting stents (DESs). Outcomes were limited primarily by bleeding events. There was 1 episode of DES thrombosis after antiplatelet therapy was discontinued due to gastrointestinal hemorrhage. Rescue percutaneous coronary intervention is a feasible approach to reestablish coronary perfusion in the perioperative period, but DESs should be used only after appropriate risk stratification for potential bleeding complications that may require the withdrawal of antiplatelet therapy.
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Thrombolysis In Myocardial Infarction (TIMI) flow grade is widely used to evaluate myocardial tissue reperfusion in acute myocardial infarction (AMI), but the current grading system is incomplete. Therefore, we clarified the regulation of epicardial coronary flow velocity with the progression of microvascular dysfunction in AMI. We studied 36 patients with first anterior AMI. ⋯ All patients with TIMI grade 2 flow showed no reflow and the lowest values of baseline and hyperemic APVs. Regional wall motion at discharge was higher in patients with TIMI grade 3 flow/good reflow than in those with TIMI grade 3 flow/no reflow and TIMI grade 2 flow (-1.44 +/- 0.70, -2.69 +/- 0.31, and -2.88 +/- 0.48 SD/chord, respectively, p <0.01). In conclusion, compensatory reactive hyperemia preserves epicardial coronary flow velocity even in patients with microvascular damage, and with the progression of damage, this compensatory hyperemia can no longer preserve epicardial coronary flow velocity, and baseline APV is decreased in TIMI grade 2 flow.
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Extreme obesity is known to be associated with left ventricular (LV) systolic dysfunction. The relation of lesser degrees of obesity and LV systolic function is controversial. This study assessed the relation between body mass index (BMI; weight in kilograms divided by height in meters squared) and the LV ejection fraction (EF) and volumes in 1,806 subjects with normal technetium-99m sestamibi myocardial perfusion imaging results. ⋯ BMI remained an independent predictor of greater end-diastolic volumes in men and women (p <0.01) even after accounting for co-morbidities. In conclusion, mild obesity was associated with LV dilatation, but the LVEF was preserved even with severe obesity. Weight control may be recommended to reduce the incidence of obesity-related co-morbidities and their impact on adverse LV remodeling.
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This study investigated the optimal echocardiographic indexes to determine the most hemodynamically appropriate atrioventricular (AV) delay in cardiac resynchronization therapy (CRT) for heart failure. Doppler echocardiographic optimization of AV delay in CRT has not been correlated with invasive hemodynamic indexes. In 30 patients who underwent CRT, invasive left ventricular (LV) pressure measurements with a sensor-tipped pressure guidewire and Doppler echocardiographic examination were performed <24 hours after pacemaker implantation. ⋯ The optimal AV delay with the EA VTI method was concordant with LV dP/dt(max) in 29 of 30 patients (r = 0.96), with EA duration in 20 of 30 patients (r= 0.83), with LV VTI in 13 patients (r = 0.54), and with Ritter's formula in none of the patients (r = 0.35). In conclusion, to obtain the optimal acute hemodynamic benefit of CRT, Doppler echocardiography is a reliable tool to optimize the AV delay compared with the invasive LV dP/dt(max). The measurement of the maximal VTI of mitral inflow is the most accurate method.