Study on Epidemiological Profile, Clinical Profile, and Angiographic Patterns in Acute Coronary Syndrome Patients in a Tertiary Health Care Center in Haryana

Background: Cardiovascular diseases are the leading cause of death in India, with coronary artery disease (CAD) accounting for a majority of the deaths. There are few large registries on acute coronary syndrome (ACS) from India. Our aim is to study the clinical and epidemiological profile of ACS PATIENTS presenting to our institute, including their angiographic features. Methods: This hospital-based observational, single tertiary care center, prospective study was conducted on patients admitted in the Department of Cardiology at a tertiary care center in Haryana. The study included 400 patients aged greater than 18 years who were admitted with the diagnosis of ACS, and it was carried out for 1 year. The epidemiological profile, clinical history, risk factors, electrocardiogram findings, and angiographic pattern were studied and analyzed with appropriate statistical tools. Results: The mean age of the study population was 55.12 ± 11.78 years. Male and female ratio was 2.4:1. The majority of the patients came from rural background (80%);24% of the patients were illiterate. Smoking was the most common risk factor (51.5%) in our study population followed by hypertension (40%) and diabetes (28%). Unstable angina was the most common type of ACS, which was found in 68.25% of patients. Premature CAD was found in 27.8% of patients and obstructive CAD was found in 63% of patients. Coronary angiography revealed that 39% had single vessel disease (SVD), 23.5% had double vessel disease (DVD), and 27.5% had triple vessel disease (TVD). LAD was more commonly involved, followed by RCA and LCX. Within the first 24 hours, 67% of patients sought medical assistance and only 38.5% received definitive treatment, suggesting a delay in seeking definitive treatment in our study population. Conclusion: The study suggests that unstable angina is the most common form of ACS in the study population, which is mostly of rural background with significant delay in seeking medical help. Smoking is the most common risk factor in the study population.

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Clinical and angiographic characteristics of asymptomatic restenosis after PCI

Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.

Assessment of Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients with Angiographically Normal Coronary Arteries

Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery （LAD） in 37 of 40 patients with angiographically normal coronary arteries （men 22, women 15, age 20-75 years, mean age 54±12 years）. Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 110 μg/ kg per min within 48 h after ICD technique. Average peak velocity at baseline （APVb）, average peak velocity during hyperemia （APVh） and CFVR determined from TTDE were correlated closely with those from ICD measurements （APVb： y= 0. 64x＋ 5. 04, r=0. 86, P〈0. 001; APVh： y=0. 63x＋14. 36, r=0.82, P〈0.001; CFVR： y=0.65xq-0.92, r=0.88, P〈0.001）. For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension （P〈0.05）. Intravascular ultrasound （IVUS） was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 （50%） patients. No significant difference in CFVR was found between the patients without plaque formation （3. 11±0. 49） and those with plaque formation （2. 76±0.53, P=0. 056）. It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal I.AD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.

Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature

BACKGROUND Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage.The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis.Due to the rarity of gastroduodenal artery pseudoaneurysms,most of the current literature consists of case reports.Limited knowledge about the disease causes diagnostic difficulty.CASE SUMMARY A 39-year-old man with a previous history of chronic pancreatitis was hospitalized due to hematemesis and melena for 2 wk,with a new episode lasting 1 d.Two weeks prior,the patient had visited a local hospital for repeated hematemesis and melena.Esophagogastroduodenoscopy indicated hemorrhage in the descending duodenum.The patient was discharged after the bleeding stopped,but hematemesis and hematochezia recurred.Bedside esophagogastroduodenoscopy showed no obvious bleeding lesion.On admission to our hospital,he had hematemesis,hematochezia,left middle and upper abdominal pain,severe anemia,and elevated blood amylase.After admission,intermittent hematochezia was observed.Abdominal contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreas head.Angiography confirmed the diagnosis of gastroduodenal artery pseudoaneurysm.The pseudoaneurysm was successfully embolized with a coil and cyanoacrylate.No bleeding was observed after the operation.After discharge from the hospital,a telephone follow-up showed no further bleeding signs.CONCLUSION Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is very rare.This diagnosis should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent.Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.

Angiographic “misery collaterals”-grave findings!

Object With the broad application of endovascular aneurysm coiling on grade IV and V patients, the specific angiographic findings of grave prognosis could be detected. This unique finding will be considered as an indicator which would be the urgent treatment option between aggressive ICP control including EVD/decompressive craniectomy and continuing coiling. Methods Very interesting angiographic finding could be found in 7 cases of grave IV & V SAH patients and 3 cases of procedural rupture cases. Especially in the procedural rupture cases, these abnormal collaterals could be disappeared easily with the aggressive medical ICP control as early this finding was detected as possible. Conclusions The author names it “misery collaterals” and it has been defined as whole intracranial large vessels are seen on one vessel angiography.It has been caused by severe brain edema and pressurized contrast injection which has changed the flow hemodynamics through A-com & P-com aretries. When we faced this finding during the aneurysm coiling, urgent ICP control with or without surgical method should be initiated. Regardless of massive ICP control, there is no hemodynamic recover and still this finding remains, almost all patients will show grave course.

Clinical Signifi cance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma

Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.

Spontaneous coronary artery dissection:A review of diagnostic methods and management strategies

Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.

Giant Calcified Renal Artery Aneurysm: Traditional RX versus Three-Dimensional Computed Tomography

A 65-year-old woman with no history of previous flank trauma, renal stone or upper urinary tract infections, presented for flank pain and left hydro-uretero-nephrosis seven days after hysterectomy. Percutaneous pielography revealed narowing of the distal ureter, without endoureteral mass. The plain abdomen film incidentally showed a 3-cm calcified ring on the left renal shadow, who resulted external to the collecting system at pielography. A 3-dimensional-CT scan with angiographic reconstruction revealed a 3-cm calcified renal artery aneurysm. The vascular surgeon suggested a watchful waiting. The patient underwent ureteral reimplantation with ureteral stenting, allowing a complete recovery of iatrogenic stenosis two months postoperatively.

Renal arterial embolization:Indications,angiographic findings,and outcomes in a series of 170 patients

Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients.Materials and methods:A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019.History,physical examination,and laboratory data were reviewed for all patients.Abdominal ultrasound was the initial imaging study,and all patients underwent subsequent computed tomography or magnetic resonance imaging.The outcome of RAE was determined based on radiographic and clinical findings.Results:Data from 202 patients were analyzed,with a mean age of 45±15 years,and 71.3%of patients were male.Iatrogenic injury was the most common indication for RAE(54%),followed by renal tumors,trauma,and spontaneous,in 27.7%,10.4%,and 8.4%of patients,respectively.Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding(40.6%),whereas no lesions were identified on angiography in 32 patients(15.8%),after which RAE was subsequently aborted.Renal arterial embolization was successful in 158 of 170 patients(92.9%)after 1 or more trials(maximum of 4).Microcoil alone or with other embolic materials was the most commonly used material for embolization(85%).Conclusions:latrogenic injury was the most common indication for RAE.Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography;however,angiography showed a negative result in 16%of patients,even those with symptoms.When lesions are present on angiography,the overall success of repeated trials of RAE reached 92.9%.

Angiographic prevalence of myocardial bridging in a defined very large number of Chinese patients with chest pain

Background Muscle fibers overlying the intramyocardial segment of an epicardial coronary artery are termed myocardial bridging （MB）. Variable prevalence of MB has been described at autopsy and angiographic series with small and large sample size studies. In addition, no similar study was reported in Chinese population. The aim of this study was to investigate the angiographic prevalence of MB in consecutive 37 106 Chinese patients with chest pain from our center. Methods We conducted an observational study to evaluate the consecutive cases with MB among patients undergone selective coronary angiography, and analyzed the angiograhic prevalence and clinical features of MB in this study of very large sample size. Results Among 37 105 patients with chest pain we found 1002 cases with 1011 MBs in a retrospective manner, and the overall prevalence was 2.70%. Although more than 99% （991/1002） of patients had single bridge, 8 cases were found to have more than two MBs （seven with two, and one with three）. Altogether 54.39% of cases （545/1002） had MB without atherosclerotic lesions, and 96.24% （973/1011） of bridging located in the left anterior descending coronary artery （LAD）, mainly in the middle of LAD （792/1011,78.33%）. According to Nobel classification, of the single bridge （n=-991）, 〈50% of obstruction was predominant （471/991,47.52%）. Totally 50%-69% accounted for 34.81% （345/991）, 〉70% of obstruction was 17.65% （175/991）. Conclusions These data showed that the prevalence of angiographically detectable MB in Chinese patients with chest pain was similar to those of the previous studies, with 2.7% prevalence in this very large sample size.

Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

Background：Polypoidal choroidal vasculopathy （PCV） is characterized by the presence of polyps with or without a branching vascular network and more prevalent among Asians.The aim of this study was to compare the outcomes of conbercept therapy between two different angiographic subtypes of PCV.Methods：Fifty-eight patients of PCV were classified into two phenotypes according to indocyanine green angiography （ICGA）.In Type 1,both feeder and draining vessels are visible on ICGA and network vessels are numerous.In Type 2,neither feeder nor draining vessels are detectable,and the number of network vessels is small.The patients were treated with intravitreal conbercept （IVC） for 3 months.Additional 1VC was given at subsequent monthly visits,if needed.The patients were followed up for 12 months,and changes in mean best-corrected visual acuity （BCVA）,central retinal thickness （CRT）,subretinal fluid （SRF） thickness,pigmented epithelial detachment （PED）,hemorrhage,and number of polypoidal lesions were evaluated.Results：The mean BCVA in Type 2 PCV （15.92 ± 9.76 letters） achieved a significantly greater improvement than that in the Type 1 （14.10± 9.07 letters） at month 12 （t=2.37,P〈 0.01）.Moreover,the mean CRTdecrease was numerically greater in Type 2 （120.44± 73.81μm） compared with Type 1 （106.48 ± 72.33 μm） at month 6 （t =4.31,P 〈 0.01）,and greater in Type 2 （130.21 ± 76.28 μm） compared with Type 1 （111.67 ± 79.57μm） at month 9 （t =1.87,P 〈 0.0l）.There was no significant difference between the two types for the decrease in SRF thickness,PED height,and regression of polyps from month 3 to 12 （t =2.97,P〉 0.05）.Conclusion：Classification systems for PCV will show differences in presentation,natural history,or response to anti-vascular endothelial growth factor treatment and might,therefore,provide a new key to the choice of treatment for the disease.

Inter-and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion(CatLet©)angiographic scoring system in patients with acute myocardial infarction

Background:Previously,we developed a novel Coronary Artery Tree description and Lesion EvaluaTion(CatLet©)angiographic scoring system,which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction(AMI).Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.However,the reproducibility of the CatLet score in both inter-and intra-observer remains to be evaluated.Methods:A total of 30 consecutive AMI patients,admitted in September of 2015,were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score.Another set of 49 consecutive AMI patients,admitted between September and October in 2014,were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score.The weighted kappa was used to express the degree of agreement.Results:The weighted kappa values(95%confidence interval)for the intra-and inter-observer reproducibility of the CatLet Score were 0.82(0.59-1.00,Z=7.23,P<0.001)and 0.86(0.54-1.00,Z=5.20,P<0.001),respectively,according to the tertile analysis(≤14,15-22,>22).Regarding the adverse characteristics pertinent to lesions and dominance parameters,the kappa values for the inter-observer variability were 0.80(0.56-1.00,Z=6.47,P<0.001)for total number of lesions,0.57(0.28-0.85,Z=3.03,P<0.001)for bifurcation,0.69(0.43-0.96,Z=5.06,P<0.001)for heavy calcification,1.00(0.72-1.00,Z=6.93,P<0.001)for tortuosity,0.54(0.26-0.82,Z=3.78,P<0.001)for thrombus,0.69(0.48-0.91,Z=6.29,P<0.001)for right coronary artery dominance,0.69(0.41-0.96,Z=4.91,P<0.001)for left anterior descending artery length,and 0.22(0.06-0.51,Z=1.56,P=0.06)for diagonal size.Equivalent values for the intra-observer variability were moderate to almost perfect(range 0.54-1.00).Conclusions:The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent.The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.

Study of brain-derived neurotrophic factor gene transgenic neural stem cells in the rat retina

Background Neural stem cells （NSCs） transplantation and gene therapy have been widely investigated for treating the cerebullar and myelonic injuries, however, studies on the ophthalmology are rare. The aim of this study was to investigate the migration and differentJatJon of brain-derived neurotrophic factor （BDNF） gene transgenic NSCs transplanted into the normal rat retinas. Methods NSCs were cultured and purified in vitro and infected with recombinant retrovirus pLXSN-BDNF and pLXSN respectively, to obtain the BDNF overexpressed NSCs （BDNF-NSCs） and control cells （p-NSCs）. The expression of BDNF genes in two transgenic NSCs and untreated NSCs were measured by fluorescent quantitative polymerase chain reaction （FQ-PCR） and enzyme-linked Jmmunosorbent assay （ELISA）. BDNF-NSCs and NSCs were infected with adeno-associated viruses-enhanced green fluorescent protein （AAV-EGFP） to track them in vivo and served as donor cells for transplantation into the subretinal space of normal rat retinas, phosphated buffer solution （PBS） served as pseudo transplantation for a negative control. Survival, migration, and differentiation of donor cells in host retinas were observed and analyzed with Heidelberg retina angiograph （HRA） and immunohistochemistry, respectively. Results NSCs were purified successfully by limiting dilution assay. The expression of BDNF gene in BDNF-NSCs was the highest among three groups both at mRNA level tested by FQ-PCR （P 〈0.05） and at protein level measured by ELISA （P 〈0.05）, which showed that BDNF was overexpressed in BDNF-NSCs. The results of HRA demonstrated that graft cells could survive well and migrate into the host retinas, while the immunohistochemical analysis revealed that transplanted BDNF-NSCs differentiated into neuron more efficiently compared with the control NSCs 2 months after transplantation. Conclusions The seed cells of NSCs highly secreting BDNF were established. BDNF can promote NSCs to migrate and differentiate into neural cells in the normal host retinas.

INTRAVASCULAR ULTRASOUND IMAGING OF ANGIOGRAPHICALLY "SILENT" LEFT MAIN CORONARY ARTERY ATHEROSCLEROSIS

Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequently detected by coronary angiography. The purpose of the study was to reveal the existence of LMCA disease in patients with normal coronary arteries by using intravascular ultrasound imaging. Ninety-seven patients with angiographically normal coronary arteries were examined with a 3.5 F or 4.8 F. 20 MHz intravascular ultrasound catheter. The vessel, lumen and plaque areas were determined and percent area and diameter stenosis were calculated. Plaque formation with or without calcific deposits identified by ultrasound accoustic shadowing were regarded as signs of atherosclerosis.

A congenital isolated left ventricular apical diverticulum simulating a tako-tsubo

Left ventricular diverticulum is a rare congenital anomaly of which the incidence was reported to be 0.26%. Diverticula are usually localized near the apex and most often involve the inferior or anterior parietal walls of the left ventricle. In this report, we describe a rare case of congenital isolated left ventricular apical diverticulum, which was tako-tsubo-like in systole, ＂dumbbell-like＂ the whole left ventricle, diagnosed by angiography and magnetic resonance imaging.

The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

It is challenging to undo early percutaneous intervention(PCI)in the elderly with acute coronary syndrome(ACS).Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4,2004 to December 12,2005.All the patients had early percutaneous coronary intervention and were followed up for 6-12 months by telephone or in the out-patient department.Nine of the 15 patients exhibited acute myocardial infarction(AMI).Six exhib-ited unstable angina(UA).All the patients had early PCI.The average door-to-balloon time was 78 minutes(40-110 minutes).The average PCI time was 99 minutes(68-120 minutes).Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total.All the procedures were considered successful.Neither deaths nor recurrent angina occurred in the 6-12 months of follow-up.It was shown that early PCI might be an effective and safe method to treat eld-erly patients with ACS.

Assessment of angiographic coronary slow flow phenomenon with intracoronary ultrasound and doppler flow mapping

In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.

Angiographic differentiation of systolic narrowing of the left anterior descending coronary artery in hypertrophic cardiomyopathy from myocardial bridges

To the Editor： I read with great interest the case report of multiple myocardial bridges affecting both coronary arteries in a patient with hypertrophic cardiomyopathy. However, I differ with the authors in their interpretation of the coronary arteriograms.

The duration of the conventional chemoembolization for hepatocellular carcinoma:factors affecting the procedural time

Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural time.Methods:In total,175 patients who underwent chemoembolization have been prospectively enrolled.The procedural length was considered the time between the insertion and the removal of the angiographic sheath.The features related to the tumor burden and angiographic procedures,which could be related to the procedural time,were recorded.Results:The chemoembolization time resulted in a mean of 58.1 min.The longer procedural time was associated with a number of nodules treated per patient≥2(P<0.001),a number of segments with nodules≥2(P<0.001),the presence of more than 1 nodule in the same segment(P<0.001),the location of the tumor in the left lobe(P=0.001),the exclusion from the Milan criteria(P<0.001),and a number of segments treated≥2(P<0.001).Only the number of nodules treated per patient resulted significantly in multivariate analysis(OR 2.927,95%CI:2.015-4.251,P<0.001).Conclusion:The factors related to longer procedural time are the number of nodules treated≥2,the number of segments with nodules≥2,the involvement of the left lobe,the tumor burden outside the Milan criteria,and the number of segments treated≥2.All these characteristics,known in the pre-procedural phase,represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.