Introduction: Non-specific ST–T (NST) wave abnormalities are frequently encountered on resting ECG, yet their clinical relevance remains debated. This study evaluated myocardial perfusion and left ventricular function using Gated-SPECT in patients with isolated NST abnormalities compared to those with normal ECGs. Materials and Methods: In this cross-sectional study, 226 patients referred for MPI were enrolled (normal ECG: n = 113; isolated NST: n = 113). Patients with BBBs, ventricular pacing, pre-excitation, significant arrhythmias, and LVH with strain were excluded. Semi-quantitative perfusion scores, defect extent, and Gated-SPECT functional parameters were assessed. Multivariable logistic and linear regressions were performed to adjust for cardiovascular risk factors Results: Typical chest pain was more prevalent in the normal ECG group (12.4% vs. 0.9%, p < 0.001), while atypical symptoms predominated in the NST group (75.2% vs.<4%, p < 0.001). Perfusion scores (SSS, SRS, SDS) and defect extent were significantly higher in the NST group (p < 0.001). Patients with NST changes demonstrated significantly lower LVEF (65.13 ± 12.67% vs. 70.72 ± 12.50%, p = 0.001) and lower PFR (2.52 ± 1.17 vs. 2.87 ± 1.10 EDV/s, p = 0.021). After multivariable adjustment, isolated NST changes independently predicted the presence of perfusion defects (SSS ≥ 4; OR = 4.87, 95% CI: 2.58–9.21, p < 0.001) and higher SSS (β = 3.12, 95% CI: 2.04–4.20, p < 0.001) Discussion: Patients with isolated non-specific ECG changes showed worse perfusion abnormalities and lower PFR, while ventricular functional indices remained largely unchanged. Conclusion: Isolated NST abnormalities are independently associated with myocardial perfusion defects and subtle left ventricular functional impairment. In symptomatic patients, NST changes should prompt further non-invasive evaluation, where Gated-SPECT serves as an effective risk-stratification tool
Background: Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is usually performed through a left-sided approach; however, in carefully selected patients, right-sided MIDCAB (r-MIDCAB) may provide an alternative surgical approach for isolated right coronary artery disease. In this case, the Right Internal Mammary Artery (RIMA) was used as an in situ graft to the Right Coronary Artery (RCA). Case Presentation: We report a 65-year-old man with a history of inferior myocardial infarction treated with two RCA stents in 2015. Recurrent anginal symptoms developed in 2024 despite medical therapy. Coronary angiography demonstrated a severely calcified, tortuous subocclusive RCA lesion immediately distal to the previously stented segment. Repeat PCI was unsuccessful because the lesion could not be crossed. Following multidisciplinary Heart Team evaluation, off-pump r-MIDCAB was performed through a right mini-thoracotomy using an in situ RIMA-to-RCA graft. Transit-Time Flow Measurement (TTFM) showed a mean graft flow of 25 mL/min, pulsatility index of 1.6, diastolic filling of 54%, and backflow of 0.1%. At five-month follow-up, CT coronary angiography demonstrated a patent graft with good distal runoff. Conclusion: This case demonstrates the technical feasibility of RIMA-to-RCA revascularization via a right mini-thoracotomy in a carefully selected patient with isolated RCA disease that is unsuitable for PCI. The short-term clinical and imaging findings were favorable; however, a single case with five months of follow-up cannot establish safety, effectiveness, or long-term graft durability. Larger studies with longer follow-up are required.
Introduction: Transseptal catheterization is a critical step in percutaneous mitral balloon commissurotomy (PMBC), yet conventional techniques can be technically challenging and sometimes lead to procedural risks. Our study aimed to use a simplified modification to improve anatomical guidance and reduce complications. Methods: This prospective multicenter study was conducted over one-year and included 161 patients with severe mitral stenosis who underwent PMBC using a modified septal puncture technique in Addis Ababa, Ethiopia. Data were entered and analyzed using SPSS version 25. Descriptive statistics were used to summarize patient characteristics and procedural outcomes. Continuous variables were expressed as mean ± standard deviation (SD) or median with range, as appropriate. Paired t-tests were used to compare pre- and post-procedural parameters, with a pvalue < 0.05 considered statistically significant. Results: Our findings showed that the technique used was successful in all patients, with optimal results achieved in 160 (99.4%). Nonetheless, four patients developed new-onset atrial fibrillation during catheterization that resolved before discharge. The increase in mean mitral valve area and the reduction in transmitral mean gradient were statistically significant. The mean safety distance from the puncture site to the left atrial border was 24.8 mm (range 13 to 48 mm), while the average vertebral body height (VBH) was 17.3 mm (range 12 to 23 mm). The ratio of safety distance to VBH was 1.4 (range 1.0 to 2.4; SD = 0.26). Discussion: Our study introduces a novel modification of the atrial septal puncture technique, simplifying the conventional approaches described by Inoue and Hung. The left atrial shadow, carinal angle, and VBH were identified as important radiographic landmarks for atrial septal puncture. Conclusion: The innovative modified transseptal puncture approach demonstrated a safe and effective technique, with a high success rate for mitral valve balloon commissurotomy.
Introduction: Nicotine is a highly addictive alkaloid that exerts significant cardiovascular and autonomic effects through activation of nicotinic cholinergic receptors, leading predominantly to sympathetic nervous system stimulation. This review synthesizes evidence on the cardiovascular impact of nicotine delivered via non-combustible routes, including Nicotine Replacement Therapies (NRT) and Electronic Nicotine Delivery Systems (ENDS). Methods: A narrative literature review was conducted using major biomedical databases, focusing on studies published between 2000 and 2025 that evaluated autonomic regulation, hemodynamic responses, and vascular effects associated with nicotine exposure. Results: The evidence consistently shows that nicotine, independent of the route of administration, increases heart rate, alters blood pressure, reduces heart rate variability, and disrupts sympathovagal balance, key markers of cardiovascular risk. Discussion: While NRT provides controlled and predictable nicotine dosing with a relatively stable hemodynamic profile and remains an effective smoking cessation strategy, it is not devoid of cardiovascular effects, particularly when combined with ongoing nicotine use. In contrast, ENDS are characterized by substantial variability in nicotine delivery, greater oxidative stress, and more pronounced autonomic responses, raising concerns about their cardiovascular safety. Conclusion: Nicotine cannot be considered physiologically neutral for the cardiovascular system, underscoring the importance of distinguishing therapeutic from recreational nicotine use and the need for continued critical evaluation of emerging nicotine delivery products.
Abstract: Augmented spatial heterogeneity of ventricular repolarization is considered to constitute an arrhythmogenic substrate that predisposes to malignant ventricular arrhythmias. Since acute myocardial infarction is inherently accompanied by increased repolarization dispersion, understanding the role of repolarization heterogeneity in arrhythmogenesis has clinical significance. This review aims to summarize experimental evidence on the genesis and electrocardiographic manifestations of repolarization dispersion, focusing specifically on electrophysiological markers associated with ventricular tachyarrhythmias in animal models of ischemia–reperfusion. Although the transmural repolarization gradient, along with apicobasal and interventricular gradients, was documented in intact hearts, its magnitude was significantly smaller than that of the inter-regional gradients, suggesting only a minor contribution to T wave genesis. Experimentally induced local myocardial ischemia increased global, apicobasal, and ischemia–border zone repolarization dispersions and was associated with prolongation of the Tpeak–Tend and corrected QT intervals, as well as increased T-wave amplitude dispersion. However, ventricular tachyarrhythmias were associated with increased duration of repolarization in the nonischemic zone rather than with repolarization dispersion, and this repolarization prolongation was reflected in the electrocardiogram as terminal T-wave inversion. In conclusion, ventricular arrhythmogenesis in ischemia–reperfusion is determined not only by spatial dispersion of repolarization but also by region-specific alterations in repolarization duration. ECG-derived markers, including morphological features, provide a noninvasive assessment of both repolarization dispersion and local repolarization duration abnormalities and therefore have the potential to improve risk stratification for malignant ventricular arrhythmias.
