Aim: The aim of this study is to clarify the associated factors for the development of acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). Methods: Five hundred thirteen de novo culprit coronary artery lesions from 513 patients (ACS, n=392, SCAD, n=121) who underwent percutaneous coronary intervention using Virtual-Histology IVUS were included. External elastic membrane cross sectional areas (EEM CSA) and lumen cross sectional areas (lumen CSA) were measured and plaque + media CSA (P+M CSA): (EEM CSA) − (lumen CSA) were calculated at the minimum lumen site, and the proximal and distal reference sites. Remodeling Index (RI); lesion EEM CSA/ {(proximal reference EEM CSA + distal reference EEM CSA)/2} was calculated. Baseline characteristics, coronary risk factors, medications and IVUS parameters were compared and multivariate logistic regression analysis was performed to identify the associated factors for the development of ACS or SCAD. Results: HDL-cholesterol level, statin, ACEI/ARB and β-blocker usage were significantly lower in ACS-group than in SCAD-group (43.5±13.1 mg/dl vs 48.1±18.1 mg/dl, p=0.002; 12.8% vs 36.4%, p<0.001; 22.7% vs 33.9%, p=0.013; 7.9% vs 14.9%, p=0.022). P+M CSA and RI were significantly larger in ACS-group than in SCAD-group (14.7±5.1 mm² vs 12.0±4.5 mm², p<0.001; 1.15±0.23 vs 1.09±0.24, p=0.012). In multivariate logistic regression analysis, HDL-cholesterol (odds ratio (OR) =0.965, p=0.002) and statin (OR=0.261, p<0.001) were negative and RI (OR=3.093, p=0.044) was positive associated factor for the development of ACS.Conclusion: Serum HDL-cholesterol level, statin usage and coronary artery remodeling were independent associated factors for the development of acute coronary syndrome or stable coronary artery disease.

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Background: In coronary artery bypass surgery, postoperative graft patency have been considered to the operative success, without any functional assessment. Aim: In this study, we evaluated the functional improvement of the myocardial ischemia after CABG using coronary flow velocity reserve (CFVR) with transthoracic echocardiography. Patient and methods: One hundred and twenty five patients were enrolled in this study. Mean age was 66.6 ± 9.2 years old. The patients were divided into two groups by the existence of the left ventricular hypertrophy. One is the group with severe left ventricular hypertrophy (Group L), and the other is the group without severe LVH (Group N). Pre- and post-operative CFVR values were compared between two groups. Results: Preoperative CFVR was 1.77 ± 0.75 in group L and 1.78 ± 0.54 in group N respectively. No significant difference was observed. Intraoperative transit time flow meter revealed significantly larger flow in group L than group N, 42.9 ml/min and 25.7 ml/min. Postoperative CFVR was 2.23 ± 0.71 in group L and 2.65 ± 0.62 in group N, significant difference was observed between two groups. Occlusion: CFVR in normal populations without coronary stenosis in the same age as this study was reported about 2.47. In left ventricular hypertrophy, dysfunction of the coronary microcirculation exist in some degree and postoperative CFVR did not reach the normal value after CABG in spite of the graft patency. In those patients, myocardial ischemia may exist despite the patent graft. Postoperative medical treatment to improve microcirculation is essential in patients with microcirculatory dysfunction.

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Background: Bland-White-Garland syndrome (BWG syndrome) is a rare disorder known for congenital anomaly of left coronary artery that arises from the pulmonary artery. Surgical coronary repair is a therapeutic choice, but long term prognosis is yet to be determined. Methods: We retrospectively analyzed the coronary flow data in 31 patients with BWG syndrome who underwent surgical repair in our institution. Findings: They received surgical coronary repair at median age of 2.5 (0-24) years old. Preoperative coronary angiography showed good collateral flow from right to left coronary artery in all cases. However, postoperative coronary angiography showed left coronary flow was occluded in 2 cases, slow in 4 cases with aneurysm, dilatation of proximal site and distal stenosis, while 25 cases remained to have good flow. Two cases received re-operation, but the coronary artery occluded again. Two died from heart failure. Operative age in the poor coronary flow group was significantly high than in the good coronary flow group. There were no significant differences in sex, operative method, and preoperative cardiac function. Discussion: Most of postoperative BWG syndrome patients showed favorable clinical outcomes, while some patients remained to have poor coronary flow after surgery. Meticulous long term follow-up is warranted.

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A 43-year-old woman with a history of hyperventilation was found to have an abnormal electrocardiogram. Echocardiography showed left ventricular wall thinning and a ventricular aneurysm. She was admitted to hospital for detailed examination. Old myocardial infarction was suspected from the cardiac MRI and myocardial scintigraphy findings. While coronary angiography revealed no significant stenosis, coronary vasospasm was detected by the acetylcholine challenge test. The patient’s myocardial infarction was thought to have been caused by coronary vasospasm. Hyperventilation occurred during the acetylcholine challenge test and administration of nitroglycerin improved the patient’s hyperventilation. These findings suggest that hyperventilation is associated with coronary vasospasm in the present patient.

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