Nine patients with cardiac amyloidosis were studied by echocardiography and the échocardiographie abnormalities were then correlated with postmortem studies. All had congestive heart failure and autopsy-proven amyloidosis. M-mode features included; (1) small or normal left-ventricular (LV) dimensions; (2) thickened interventricular septa and LV posterior walls (89%); (3) left atrial enlargement (89%), and (4) reduced LV distensibility (78%, 100%) and contractility (22%, 44%). Serial M-mode echocardiography revealed that cardiac amylodosis was manifested initially more as diastolic than as systolic LV failure. The final stages in this disease were marked by severe impairment of both systolic and diastolic LV functions. Two-dimensional echocardiography provided additional features: (1) better appreciation of pericardial effusion (67%), and (2) a characteristic ‘granular sparkling’ appearance of ventricular walls (55%). These hyperrefractile myocardial echoes corresponded to histopathologically scattered amyloid mass deposits in 4 out of 5 cases. There was no relation between the amyloid deposit type and a hyperrefractile myocardial echo. Thus, cardiac involvement in systemic amyloidosis could be assessed noninvasively by M-mode and two-dimensional echocardiography.

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Coronary morphology and functional assessment (4)sodilation for accurate FFR assessment. Thus, we aimed to assess agreement and reproducibility of FFR measurements during intracoronary vs. intravenous administration of adenosine. Methods: Consecutive patients with borderline coronary lesions, who were scheduled for FFR, were enrolled. Subjects received intravenous adenosine infusion via 2 routes, via a 20-gauge cannula in the antecubital vein, and, after a washout period, via a 6-F femoral venous sheath. Adenosine was administered at 140 μg/kg/min from each site. Additionally adenosine infusion at 280 μg/kg/min was performed. Moreover, after washout period patients received intracoronary adenosine bolus injection with 100 μg, 200 μg, 400 μg and 600 μg. Minimal FFR achieved with intravenous adenosine from each infusion site as well as from intracoronary boluses was recorded as was the time to reaction and time to peak hyperemia. Results: Antecubital and femoral vein adenosine at 140 and 280 μg/kg/min as well as intracoronary boluses 100 μg, 200 μg, 400 μg and 600 μg recordings from 125 vessels in 50 patients were suitable for blinded analysis. The median FFR measured using adenosine administered via antecubital vein, femoral routes at 140 μg/kg/min and 280 μg/kg/min was 0.82 Background: The coronary bifurcation stenting studies did not demonstrated advantage of any two-stent technique over provisional T-stenting technique. One possible explanation is that some of bifurcation lesions treated were not functionally significant and as such treated or not will not influence clinical outcome. FFR guided PCI has shown to reduce MACE compared to angiography guided PCI. However, FFR remains underutilized and most decision are still based on angiographic %DS. In bifurcation lesions, the assessment of the severity of the stenosis is more challenging due to the step down phenomenon. Purpose: To systematically explore the rate of functionally significant coronary bifurcation lesions. Methods: Patients with stable and unstable angina (with normal baseline troponin values) were included. A fractional flow reserve measurement was systematically performed in patients with coronary bifurcation lesions having by visual diameter stenosis >50% in main vessel and side branche. All main and side branches were interrogated with intracoronary pressure recording Prime Wire (Volcano, USA) at baseline and after giving 100-200 mcg adenosine and then in stepwise fashion 60mcg, 120mcg, 180 mcg, 240 mcg. If patients developed AV-block, the previous dose was repeated for recording. Patients with significant FFR in main vessel (<0.80) were treated with provisional stent strategy. Results: Overall, 77 patients with visual angiographically significant coronary bifurcation lesions were included in the study. Of which, 39 patients were treated with DES, because of significant FFR results whereas 37 patients (48%) had deferred intervention. 62% were males, with mean age 67±10 years. The mean FFR in MV in treated vs. deferred group was 0.70±0.07 vs 0....

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