Evidence of impaired coronary flow reserve and elevated microvascular resistances in a case of recurrent left apical ballooning.

A 56-year old man was admitted for precordial pain associated with dyspnea and evidence of myocardial ischemia on ECG and cardiac ultrasound. His previous history included an episode of left apical ballooning five years before. At angiography, no evidence of significant epicardial coronary artery disease was manifest. Interestingly, both coronary flow reserve and the index of microvascular resistances were abnormal, showing evidence of impaired microvascular function. This is the first report providing direct evidence of microvascular dysfunction in a patient with (recurrent) apical ballooning.

Heart Failure: Really Idiopathic?

Coronary angiography is necessary in the differential diagnosis of a newly discovered heart failure, which may be caused by multivessel disease and/or stenoses of major vessels. However, angiography is associated with a relatively high percentage of false negative findings in the assessment of left main disease. FFR allows unveiling these false negatives, even though special precautions need to be taken when stenoses are present also in the bifurcation branches.

TCT-408 Thirty-day Outcome Following Polymeric Bioresorbable Scaffold Implantation in 347 STEMI Patients Enrolled in the Multicenter “Registro Absorb Italiano” (RAI Registry)

Transmural myocardial ischaemia complicating recovery after dobutamine-atropine stress echocardiography in patients with non-significant coronary artery disease: insights from invasive assessment of coronary physiology

In the proposed selection of cases, traditional imaging is integrated with contemporary diagnostic tools available in the cath-lab to navigate the potential mechanisms underlying a very rare complication occurring in the recovery phase of dobutamine-atropine stress echocardiography. The data, collected in a time frame of nearly 15 years, provide interesting elements to possibly evolve from speculative considerations to plausible confirmation of the candidate pathophysiological mechanism mediating the occurrence of transmural myocardial ischaemia after beta-blockers administration.

Long-term outcome after drug-eluting stents implantation: Target lesion versus nontarget lesion repeated intervention

Abstract We sought to investigate the relative clinical significance of target and nontarget lesions repeated percutaneous coronary intervention (re-PCI) in patients implanted with drug-eluting stents (DES). Out of 2626 consecutive DES patients, we retrospectively selected 166 (6.3%; 123 males, aged 65±10years) who had a clinically-driven re-PCI over a mean follow-up of 15months. Seventy-five patients (45%) underwent the second procedure for disease progression in nontarget lesions (nontarget lesion re-PCI group) while 91 (55%) showed target lesion in-stent restenosis or thrombosis (target lesion re-PCI group), with no significant intergroup difference in the temporal trends of re-PCI. The …

Using FFR to Detect Ischemia in Myocardial Bridge Lesions

Beyond atherosclerosis, a number of other phenomena may result in cardiac ischemia. Among these, extracoronary compression due to myocardial bridges may cause a dynamic stenosis and typical angina. The assessment of the hemodynamic relevance and the treatment of such lesions have unique characteristics that are due to the fact that extracoronary compression from myocardial bridges is mostly a systolic phenomenon and is dependent on the inotropic state. The consequence is that other hyperemic stimuli, such as dobutamine, may be more adequate to unveil ischemia in these settings.