Introduction: Diagnostic features of myelodysplastic syndromes (MDS) are often polymorphic and nonspecific including anemia in most cases. Standard parameters provided by an automated analyzer seldom bring any argument for this diagnosis. The aim of this study was to investigate whether some structural parameters, not routinely provided by Sysmex (TM) XE 2100 analyzer, could help diagnose MDS in a simple way, adapted to routine practice.Methods: Blood samples from 184 MDS fully annotated cases and 3545 normal blood count controls were performed with XE 2100 Sysmex (TM) analyzer. Quantitative and structural parameters were considered.Results: We found that the structural neutrophil parameter, NEUT-X, converted into a semi-quantitative parameter, the granularity index (GI), could be used as a flag for MDS in front of anemia. Negative GI and anemia were able to make otherwise unrecognized MDS stand out in routine practice, increasing the number of slides addressed to review from 67% to 96%, without leading to a large excess of unfounded slide review among non-MDS.Conclusion: Including the GI index in the routine parameters provided by the Sysmex analyzer could be of major help for nonspecialized routine laboratories in detecting MDS.

BACKGROUND The aims of the present study were to determine the prevalence of inducible myocardial ischemia (IMI) in renal transplant recipients (RTR) more than 50 years old, to identify predictors of IMI, and to search for its prognostic value. METHODS Among the 377 renal transplantations performed between 1989 and 1998 in a single institution, 120 were done in patients > or =50 years old, and 97 were recruited for the study. During the last quarter of 1998, all of them underwent an exercise test (EST), an exercise-thallium 201 single photon emission computed tomography coupled with dipyridamole (SPECT), and 81% of them had a dobutamine stress echocardiography (DSE). Patients with IMI subsequently underwent coronary angiography to detect coronary stenosis. RESULTS IMI was present in 12 of the 97 patients (10%). The diagnosis was evidenced by EST in four cases, by SPECT in 11 cases, and DSE in three cases. Five of these 12 patients (42%) had significant coronary artery stenosis (> or =50%). Multivariate analysis of several pre- and post-transplant variables evidenced acute rejection and left ventricular hypertrophy as significant correlates of IMI (both P < 0.03). Patients were prospectively followed-up for 48 months for the occurrence of major cardiovascular events. Kaplan-Meier analysis revealed a significant increase in cardiovascular events in the IMI group (P < 0.0001). In addition, the Cox proportional hazards model revealed that IMI and diabetes mellitus had an independent significant effect on the occurrence of major cardiovascular events. CONCLUSION IMI was present in 10% of RTR aged > or =50 years, and was predicted by acute rejection and left ventricular hypertrophy. IMI had a strong effect on major cardiovascular events in this population.

HomeCirculationVol. 101, No. 10Myocardial Infarction in Children With Hypoplastic Coronary Arteries Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBMyocardial Infarction in Children With Hypoplastic Coronary Arteries A. Fraisse, J. Quilici, I. Canavy, B. Savin, F. Aubert and M. Bory A. FraisseA. Fraisse From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. , J. QuiliciJ. Quilici From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. , I. CanavyI. Canavy From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. , B. SavinB. Savin From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. , F. AubertF. Aubert From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. and M. BoryM. Bory From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d'enfants de la Timone (F.A.), Marseille, France. Originally published14 Mar 2000https://doi.org/10.1161/01.CIR.101.10.1219Circulation. 2000;101:1219–1222An 11-year-old boy with a past history of asthma was admitted to the pediatric intensive care unit (ICU) for a non–Q-wave myocardial infarction that occurred during sustained exercise (a handball match). He presented with chest pain, anterior ST-segment depression on the ECG (Figure 1), and elevation of creatinine kinase (peak, 2580 mU; MB, 240). Initial physical examination was normal, and his ICU course was uncomplicated. He was discharged to the ward after 2 days, and cardiac catheterization was performed 8 days after admission. Left ventriculography (Figure 2) revealed mild apical hypokinesia with an ejection fraction of 55%. Selective coronary arteriography showed no atherosclerotic lesion but hypoplasia of the distal left anterior descending (LAD) and right coronary (RCA) arteries (Figures 3 and 4). There was no supply of the inferior aspect of the interventricular septum by a posterior branch from the RCA or left circumflex coronary artery (LCx). The proximal LAD was normal, with well-developed septal branches but no diagonal branches filled by contrast on the anterolateral free wall of the left ventricle (Figure 4). Intracoronary infusion of nitroglycerin showed no significant changes in coronary artery diameter (Figure 5). Total cholesterol, HDL, sedimentation rate, serological studies for connective-tissue diseases, antithrombin III, protein C, protein S, endogenous tissue plasminogen activator, and plasminogen activator inhibitor were normal. The patient was discharged home on diltiazem after a normal maximal exercise test 16 days after admission.In 85% of patients, the coronary circulation is right-dominant, and the RCA supplies the inferior aspect of the interventricular septum by giving rise to the posterior descending artery. The LCx, which is often small, does not reach the crux of the heart. Conversely, when the LCx is the dominant coronary artery, it courses to the crux of the heart and the RCA is often small.1 In ≈7% of patients, there is a codominant or balanced system in which both RCA and LCx give rise to a posterior descending branch. Hypoplastic coronary artery disease (HCAD) occurs rarely and refers to the underdevelopment of ≥1 coronary arteries or their major branches.2 Most of the patients reported were young adults and experienced sudden cardiac death without antecedent symptoms. Diagnosis is often made at autopsy.12 Although reversible myocardial ischemia has previously been angiographically documented in an infant, it is unusual to see a patient with myocardial infarction and isolated HCAD diagnosed at coronary angiography, as in our patient.3 Hypoplasia of the RCA and LCx with no posterior descending artery supplying the inferior aspect of the interventricular septum is more commonly found.1 Hypoplasia of the LAD has also been reported.23 In addition, HCAD was found in several cases of myocardial infarction distal to atherosclerotic or thrombotic occlusions.2The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. ECG on admission showing anterior ST-segment depression.Download figureDownload PowerPoint Figure 2. A 30° right anterior oblique left ventriculograph in end diastole (left) and end systole (right) showing apical hypokinesia.Download figureDownload PowerPoint Figure 3. Lateral-view angiogram showing hypoplastic RCA without posterior descending artery supplying crux of heart.Download figureDownload PowerPoint Figure 4. A 30° right anterior oblique left main coronary artery angiogram showing hypoplasia of distal LAD with well-developed septal branches but no diagonal branches filled by contrast on anterolateral free wall of left ventricle. There is no supply of inferior aspect of interventricular septum by a posterior branch from LCx (no left-dominant system).Download figureDownload PowerPoint Figure 5. Lateral-view angiogram showing hypoplasia of distal LAD with absence of diagonal branches and no significant changes in coronary artery diameter after intracoronary infusion of nitroglycerin.FootnotesCorrespondence to A. Fraisse, MD, Service de Cardiologie A, Hôpital de la Timone, Blvd Jean Moulin, 13385 Marseille Cedex 5, France. E-mail [email protected] References 1 Roberts WC, Glick BN. Congenital hypoplasia of both right and left circumflex coronary arteries. Am J Cardiol.1992; 70:121–123.CrossrefMedlineGoogle Scholar2 Zugibe FT, Zugibe FT Jr, Costello JT, Breithaupt MK. Hypoplastic coronary artery disease within the spectrum of sudden unexpected death in young and middle age adults. Am J Forensic Med Pathol.1993; 14:276–283.CrossrefMedlineGoogle Scholar3 Casta A. Hypoplasia of the left coronary artery complicated by reversible myocardial ischemia in a newborn. Am Heart J.1987; 114:1238–1241.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Morales R, Bokowski J, Aljemmali S, Murphy J, Bharati S and Abdulla R (2020) A Rare Report of Hypoplastic Coronary Arteries and Pulmonary Veins: A Case Report and Review of the Literature, Pediatric Cardiology, 10.1007/s00246-020-02334-x, 41:6, (1231-1237), Online publication date: 1-Aug-2020. Shi X, Liu J, Wu J, Hua Y, Zhou K and Li Y (2020) Hypoplastic coronary arteries in a child with a mutation in Notch1, Medicine, 10.1097/MD.0000000000021355, 99:33, (e21355) Sueda S and Kohno H (2019) Clinical characteristics in patients with rest angina and hypoplastic right coronary artery, Heart and Vessels, 10.1007/s00380-019-01507-w, 35:4, (443-450), Online publication date: 1-Apr-2020. Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E and Tousoulis D (2018) Overview of coronary artery variants, aberrations and anomalies, World Journal of Cardiology, 10.4330/wjc.v10.i10.127, 10:10, (127-140), Online publication date: 26-Oct-2018. Foley T and Krantz M (2017) Resuscitated sudden cardiac death due to diminutive coronary artery syndrome, HeartRhythm Case Reports, 10.1016/j.hrcr.2016.11.003, 3:2, (141-144), Online publication date: 1-Feb-2017. Wang Y, Wu B, Lu P, Zhang D, Wu B, Varshney S, del Monte-Nieto G, Zhuang Z, Charafeddine R, Kramer A, Sibinga N, Frangogiannis N, Kitsis R, Adams R, Alitalo K, Sharp D, Harvey R, Stanley P and Zhou B (2017) Uncontrolled angiogenic precursor expansion causes coronary artery anomalies in mice lacking Pofut1, Nature Communications, 10.1038/s41467-017-00654-w, 8:1, Online publication date: 1-Dec-2017. Riede F, Bulla S, Grundmann S, Werner M, Riede U and Otto C (2013) Isolated hypoplastic circumflex coronary artery: a rare cause of haemorrhagic myocardial infarction in a young athlete, Diagnostic Pathology, 10.1186/1746-1596-8-91, 8:1, Online publication date: 1-Dec-2013. Ma S, Kim D, Hur J, Kim K, Byun S, Park K and Yoon S (2012) Right Ventricular Myocardial Infarction due to Right Coronary Artery Total Occlusion Originating From the Distal Left Circumflex Artery, Korean Circulation Journal, 10.4070/kcj.2012.42.8.565, 42:8, (565), . Dermengiu D, Dermengiu S, Curca C and Ceausu M (2011) Sudden Death Due to Coronary Tree Hypoplasia, American Journal of Forensic Medicine & Pathology, 10.1097/PAF.0b013e318219c8e6, 32:3, (227-231), Online publication date: 1-Sep-2011. McFarland C, Swamy R and Shah A (2011) Hypoplastic coronary artery disease: A rare cause of sudden cardiac death and its treatment with an implantable defibrillator, Journal of Cardiology Cases, 10.1016/j.jccase.2011.08.005, 4:3, (e148-e151), Online publication date: 1-Dec-2011. De Giorgio F, Abbate A, Stigliano E, Capelli A and Arena V (2010) Hypoplastic coronary artery disease causing sudden death. Report of two cases and review of the literature, Cardiovascular Pathology, 10.1016/j.carpath.2009.05.002, 19:4, (e107-e111), Online publication date: 1-Jul-2010. Durán A, Arqué J, Fernández B, Fernández M, Fernández-Gallego T, Rodríguez C and Sans-Coma V (2009) Rudimentary Coronary Artery in Syrian Hamsters ( Mesocricetus auratus ) , Anatomia, Histologia, Embryologia, 10.1111/j.1439-0264.2009.00935.x, 38:4, (270-274), Online publication date: 1-Aug-2009. Wick R, Otto S and Byard R (2007) Is Right Coronary Artery Hypoplasia and Sudden Death an Underdiagnosed Association?, American Journal of Forensic Medicine & Pathology, 10.1097/PAF.0b013e31805c93fd, 28:2, (128-130), Online publication date: 1-Jun-2007. Kim M, Han J, Lee S, Kim S, Park K, Koo B and Lee H (2007) Cases of Right Ventricular Myocardial Infarction in Patients with an Absent or Hypoplastic Right Coronary Artery, Korean Circulation Journal, 10.4070/kcj.2007.37.2.84, 37:2, (84), . Feger J (2021) Hypoplastic left anterior descending artery Radiopaedia.org, 10.53347/rID-86359 Jones J and Feger J (2021) Coronary hypoplasia Radiopaedia.org, 10.53347/rID-86153 March 14, 2000Vol 101, Issue 10 Advertisement Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.101.10.1219 Originally publishedMarch 14, 2000 PDF download Advertisement

OBJECTIVE: Silent myocardial ischemia (SMI) is more common in diabetic patients than in the general population. However, the exact prevalence of SMI is not known, and routine screening is costly. The purpose of this 1-year study was to estimate the prevalence of SMI and define a high-risk diabetic population by systematically testing patients with no symptoms of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: The criteria for inclusion in this study were age (between 25 and 75 years), duration of diabetes (>15 years for type 1 diabetes, 10 years for type 2 diabetes with no cardiovascular risk factors, and 5 years for type 2 diabetes with at least one cardiovascular risk factor), and absence of clinical or electrocardiogram (ECG) symptoms of CAD. For 1 year, 203 patients were screened, including 28 women and 45 men with type 1 diabetes (aged 41.5+/-10.9 years, mean duration of diabetes 20.9+/-7.7 years [mean +/- SD]) and 61 women and 69 men with type 2 diabetes (aged 60.7+/-8.7 years, duration of diabetes 16.5+/-7.1 years). Exercise ECG was the first choice for screening method. If exercise ECG was not possible or inconclusive, thallium myocardial scintigraphy (TMS) with exercise testing and/or dipyridamole injection was performed. If any one of these tests was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =50%. RESULTS: Positive screening results were obtained in 32 patients (15.7%). Coronary angiography demonstrated significant lesions in 19 patients (9.3%) and nonsignificant lesions in 7 patients (1 false-positive result for exercise ECG and 6 false-positive results for TMS). Coronary angiography was not performed in six patients. All but 3 of the 19 patients (15 men and 4 women) in whom silent coronary lesions were detected presented with type 2 diabetes. The main differences between the 16 type 2 diabetic patients presenting with coronary lesions and the type 2 diabetic patients without SMI were a higher prevalence of peripheral macroangiopathy (56.2 vs. 15.1%, respectively, P < 0.01) and a higher prevalence of retinopathy (P < 0.05). No correlation was found between SMI and duration of diabetes, HbA1c level, renal status, or cardiovascular risk factors except for family history of CAD. CONCLUSIONS: The results of this study allowed us to determine a high-risk group for SMI in the diabetic population. SMI with significant lesions occurs in 20.9% of type 2 diabetic male patients who are totally asymptomatic for CAD. Based on these findings, we recommend routine screening for male patients in whom the duration of type 2 diabetes is >10 years or even less when more than one cardiovascular risk factor is present.

Ischaemia has been the suggested mechanism of simultaneous left bundle branch block and chest pain on effort with normal coronary angiography. This hypothesis is very controversial and was not the mechanism in the two new cases of this syndrome.The two patients in whom effort pain and left bundle branch block were observed had been treated for paroxysmal supraventricular tachycardia with flecaine. Withdrawal of the anti-arrhtymic resulted in the disappearance of this syndrome. In these cases, the ischaemic mechanism could be excluded without ambiguity. The flecaine was the only cause of rate-related LBBB by slowing conduction in the left bundle branch with no effects on coronary reserve. It would seem that LBBB alone was the cause of chest pain. The absence of coronary artery disease was confirmed in the first patient and the diagnosis was highly improbable in the second.

Pour expliquer l'apparition simultanee d'un bloc de branche gauche et d'une douleur thoracique a l'effort avec une coronarographie normale, l'ischemie a ete incriminee. Cette hypothese est tres controversee et l'origine ischemique n'est pas le mecanisme a retenir dans les deux nouvelles observations de ce syndrome. Il s'agit de 2 patientes, chez qui est apparu un bloc de branche gauche douloureux, traitees par fleainide prescrit pour des arythmies supraventriculaires paroxystiques. L'arret de l'antiarythmique fait disparaitre ce syndrome. Dans ces observations le mecanisme ischemique peut etre ecarte sans ambiguite

Ischaemia has been the suggested mechanism of simultaneous left bundle branch block and chest pain on effort with normal coronary angiography. This hypothesis is very controversial and was not the mechanism in the two new cases of this syndrome. The two patients in whom effort pain and left bundle branch block were observed had been treated for paroxysmal supraventricular tachycardia with flecaine. Withdrawal of the anti-arrhtymic resulted in the disappearance of this syndrome. In these cases, the ischaemic mechanism could be excluded without ambiguity. The flecaine was the only cause of rate-related LBBB by slowing conduction in the left bundle branch with no effects on coronary reserve. It would seem that LBBB alone was the cause of chest pain. The absence of coronary artery disease was confirmed in the first patient and the diagnosis was highly improbable in the second.

A 42 year old patient underwent coronary angiography 3 hours after the onset of inferior myocardial infarction with the object of local thrombolysis therapy. Complete proximal obstruction of the right coronary artery was relieved mechanically by the catheter. This was associated with a return of the ST segment to the isoelectric line but Q waves persisted in Lead III and AVF. A second injection showed 70 p. 100 stenosis at the site of the obstruction and the radiolucent appearances of thrombus below it. This was followed by 4 successive periods of ST elevation as the right coronary artery reoccluded. These phenomena were relieved by injection of nitroglycerine suggesting a spastic mechanism. The radiolucent image of thrombus disappeared and was replaced by amputation of a distal branch of the right coronary artery. Further coronary opacification showed good run-off beyond the stenosis and reappearance of the distal branch. This case suggests that three factors played a role in the mechanism of infarction: stenosis accompanied by spasm and thrombosis.