Background: Coronary angiographies performed during acute coronary syndrome show different coronary morphologies-vessel occlusions, thrombi and various types of stenoses. In a few cases of acute coronary syndrome, ang...Background: Coronary angiographies performed during acute coronary syndrome show different coronary morphologies-vessel occlusions, thrombi and various types of stenoses. In a few cases of acute coronary syndrome, angiography reveals normal coronary arteries. It is the purpose of this study to analyze this specific subset of patients who presented with an acute coronary syndrome but had a normal coronary angiogram with respect to the preangiographic diagnostics, risk stratification and clinical follow-up. Methods and results: A total of 897 coronary angiographies were performed as an emergency procedure in our institution. The majority of patients(n=821) presented with coronary artery disease and the majority was treated by mechanical revascularization(86.3%). In 76 patients(8.5%), no coronary artery stenosis was documented. However, according to the preangiographic risk stratification, coronary artery disease was expected in these patients. Observations documented angiographically included coronary spasms(6.6%) and muscle bridges(5.3%). During a mean follow-up of 11.2±6.4 months, one patient developed an acute myocardial infarction requiring coronary intervention. All other patients were free of any cardiac event. Conclusions: In summary, we have to consider that coronary angiography may not always detect the cause of myocardial ischemia in every patient. There is a small group of patients with normal coronary angiograms during acute coronary syndrome. Additional diagnostic procedures like intravascular ultrasound(IVUS) or the assessment of intracoronary physiological parameters may increase the diagnostic value of angiography.展开更多
Cardiovascular magnetic resonance(CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction(MI). We evaluated whether 12-lead electrocardiography can differe...Cardiovascular magnetic resonance(CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction(MI). We evaluated whether 12-lead electrocardiography can differentiate transmural from non-transmural MI or determine the site of MI by comparing the findings with those of contrast-enhanced CMR. A total of 27 patients(59.5±12.9 years) with a history of MI(6.4±2.9 months) underwent CMR(Magnetom, Siemens,Erlangen, Germany). Cine images were acquired in the horizontal and vertical long axes and short axis by TrueFISP. Contrast-enhanced CMR images were acquired in the same axes by segmented FLASH 15 min after administration of gadolinium-DTPA(0.15 mmol/kg). This showed the MI to be transmural in 11 patients and nontransmural in 16. An electrocardiogram(ECG) was recorded in all patients before CMR. T-wave alterations, descending ST depression, pathological Q-waves and absent R waves were more frequent in non-transmural MI than transmural MI, as defined by contrast-enhanced CMR (p≥0.618). However, none of the differences were statistically significant. R-wave reduction, q waves and horizontal ST-depression were more frequent in transmural than in non-transmural MI(p≥0.157). Again, the differences were not significant. The sensitivity of the ECG for MI localization was highest in inferior infarctions(85.71%), the specificity was highest in anterior infarctions (100%), the best positive predictive value(80%) was achieved for anterolateral infarctions, and the best negative predictive value for lateral infarctions(95.83%). Transmural and non-transmural MI cannot be differentiated by ECG. The ECG is most accurate in detecting anterolateral MI.展开更多
文摘Background: Coronary angiographies performed during acute coronary syndrome show different coronary morphologies-vessel occlusions, thrombi and various types of stenoses. In a few cases of acute coronary syndrome, angiography reveals normal coronary arteries. It is the purpose of this study to analyze this specific subset of patients who presented with an acute coronary syndrome but had a normal coronary angiogram with respect to the preangiographic diagnostics, risk stratification and clinical follow-up. Methods and results: A total of 897 coronary angiographies were performed as an emergency procedure in our institution. The majority of patients(n=821) presented with coronary artery disease and the majority was treated by mechanical revascularization(86.3%). In 76 patients(8.5%), no coronary artery stenosis was documented. However, according to the preangiographic risk stratification, coronary artery disease was expected in these patients. Observations documented angiographically included coronary spasms(6.6%) and muscle bridges(5.3%). During a mean follow-up of 11.2±6.4 months, one patient developed an acute myocardial infarction requiring coronary intervention. All other patients were free of any cardiac event. Conclusions: In summary, we have to consider that coronary angiography may not always detect the cause of myocardial ischemia in every patient. There is a small group of patients with normal coronary angiograms during acute coronary syndrome. Additional diagnostic procedures like intravascular ultrasound(IVUS) or the assessment of intracoronary physiological parameters may increase the diagnostic value of angiography.
文摘Cardiovascular magnetic resonance(CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction(MI). We evaluated whether 12-lead electrocardiography can differentiate transmural from non-transmural MI or determine the site of MI by comparing the findings with those of contrast-enhanced CMR. A total of 27 patients(59.5±12.9 years) with a history of MI(6.4±2.9 months) underwent CMR(Magnetom, Siemens,Erlangen, Germany). Cine images were acquired in the horizontal and vertical long axes and short axis by TrueFISP. Contrast-enhanced CMR images were acquired in the same axes by segmented FLASH 15 min after administration of gadolinium-DTPA(0.15 mmol/kg). This showed the MI to be transmural in 11 patients and nontransmural in 16. An electrocardiogram(ECG) was recorded in all patients before CMR. T-wave alterations, descending ST depression, pathological Q-waves and absent R waves were more frequent in non-transmural MI than transmural MI, as defined by contrast-enhanced CMR (p≥0.618). However, none of the differences were statistically significant. R-wave reduction, q waves and horizontal ST-depression were more frequent in transmural than in non-transmural MI(p≥0.157). Again, the differences were not significant. The sensitivity of the ECG for MI localization was highest in inferior infarctions(85.71%), the specificity was highest in anterior infarctions (100%), the best positive predictive value(80%) was achieved for anterolateral infarctions, and the best negative predictive value for lateral infarctions(95.83%). Transmural and non-transmural MI cannot be differentiated by ECG. The ECG is most accurate in detecting anterolateral MI.
