scholarly journals Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography

1999 ◽  
Vol 34 (1) ◽  
pp. 163-169 ◽  
Author(s):  
Jeroen J. Bax ◽  
Don Poldermans ◽  
Abdou Elhendy ◽  
Jan H. Cornel ◽  
Eric Boersma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chronic Coronary Artery Disease ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Coronary heart disease

ESC CardioMed ◽  
2018 ◽  
pp. 441-445
Author(s):  
Thomas H. Marwick
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Suspected Coronary Artery Disease ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Acute Setting ◽  
Artery Disease

Echocardiography is a vital part of the assessment of patients with known or suspected coronary artery disease. In the acute setting, the absence of wall motion abnormalities in a patient with ongoing chest pain is reassuring, and echocardiography provides a means of excluding alternative diagnoses. In patients with a complicated course, the technique provides the ability to evaluate left ventricular ejection fraction and haemodynamics in heart failure, the pericardium, evidence of disturbances of myocardial or valvular structure, and function (relevant to the mechanical complications of infarction). Cardiac imaging is indispensable in the management of heart failure, and echocardiography is the most widely used test for this purpose. However, no single test satisfies all imaging requirements in heart failure. In the non-acute setting, stress echocardiography is helpful for the recognition and prognostic evaluation of coronary artery disease, and in stable chronic disease, dobutamine stress echocardiography can be used to recognize myocardial viability. The challenges to echocardiography in all of these settings pertain to adequate training, the need for quantification of regional function, and the need to limit the use of this test to situations where it will influence management.

scholarly journals Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001165 ◽  
Author(s):  
Nicolas Lamblin ◽  
Sandro Ninni ◽  
Olivier Tricot ◽  
Thibaud Meurice ◽  
Gilles Lemesle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chronic Coronary Artery Disease ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

ObjectiveTo assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.MethodsWe analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).ResultsPatients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).ConclusionsIn a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.

scholarly journals Results of prospective multicenter study on heart failure on Campania Internal Medicine wards: the FASHION study

2017 ◽  
Vol 11 (2) ◽  
pp. 184 ◽  
Author(s):  
Fernando Gallucci ◽  
Ilaria Ronga ◽  
Andrea Fontanella ◽  
Generoso Uomo ◽  
And the FASHION Study Group
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Social Impact ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Campania Region ◽  
Artery Disease

Heart failure (HF) is characterized by a high prevalence and hospitalization rate with considerable health and social impact; the knowledge of its epidemiological features remains the mainstay to assess adequacy of the health care needs. The aim of this study was to evaluate the prevalence of HF in Internal Medicine Units of the Campania region (Italy) and patients’ characteristics. We recruited all patients with HF admitted between April 1 and June 30, 2014, in 23 Units of Internal Medicine: 975 patients (19.5% of 5000 admissions), 518 women and 457 men, mean age 76.9±9.9 (range 34-100) with 741 (76%) older than 70 years. The mean age was higher in women than men; 35.8% of patients had atrial fibrillation, with higher prevalence in women than in men. Coronary artery disease represented the leading etiology while prevalence of non-ischemic heart failure was higher in women. New York Heart Association class was indicated in 926 patients. Left ventricular ejection fraction (LVEF) was measured in 503 patients; 18.4% of patients had a severely reduced LVEF&lt;35%, mostly men (P=0.0001) and 67.4% presented a LVEF&gt;40%. At least one hospital admission in the previous 12 months was registered in 39.6% of patients. One, two and more than two relevant comorbidities were present in 8.6%, 24.7% and 64.8% of patients, respectively. Arterial hypertension and coronary artery disease were more frequent in female. In conclusion, advanced age and clinical complexity were the main characteristics of HF patients hospitalized in the Internal Medicine Units in Campania. Gender differences also emerged from the analysis of demographic parameters and etiopathogenetic features. Some diagnostic and therapeutic aspects not in line with that recommended by the most recent HF international guidelines were registered.

scholarly journals Circulating Levels of IL-13, TGF-β1, and Periostin as Potential Biomarker for Coronary Artery Disease with Acute Heart Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xuan Qiu ◽  
Fengyi Ma ◽  
Huanxin Zhang
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Serum Levels ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction ◽  
Artery Disease ◽  
Tgf Β1

Objective. Coronary artery disease (CAD) and associated comorbidities such as heart failure (HF) remain the leading cause of morbidity and mortality worldwide, attributed to, at least partially, the lack of biomarkers for efficient disease diagnosis. The study intended to explore potential biomarkers for predicting the presence of HF in CAD patients. Methods. According to the presence of HF, 83 CAD patients with HF were assigned to the AHF group and 52 CAD patients without HF to the CAD group. Additionally, healthy controls (n = 52) were those who had received physical examinations at the same period. The serum levels of IL-13, TGF-β1, and periostin were detected by the enzyme-linked immunosorbent assay (ELISA). Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricle-end diastolic volume (LVEDV), and left ventricular mass index (LVMI) were detected 3 times by color Doppler ultrasound. The predictive values of IL-13, TGF-β1, and periostin methods were compared by receiver-operating characteristic (ROC) analysis and the area under the curve (AUC). Results. Increased levels of IL-13, TGF-β1, and periostin were noted in the AHF group than in the control and CAD groups ( p < 0.001 ); the CAD group showed higher levels of IL-13, TGF-β1, and periostin than the control group ( p < 0.001 ). Based on the NYHA classification, there were 33 cases with grade II, 28 cases with grade III, and 22 cases with grade IV among 83 CAD patients with HF. It was found that the serum levels of IL-13, TGF-β1, and periostin were higher in the AHF-IV group than in the AHF-III and AHF-II groups ( p < 0.001 ); these levels were also higher in the AHF-III group than in the AHF-II group ( p < 0.001 ). The periostin level was positively correlated with the levels of IL-13 (r = 0.458) and TGF-β1 (r = 0.569) in CAD patients with AHF. Besides, the serum levels of periostin (r = -0.425), IL-13 (r = -0.341), and TGF-β1 (r = -0.435) were negatively correlated with the LVEF of CAD patients with AHF, respectively. When IL-13, TGF-β1, and periostin levels were used to predict the presence of AHF in CAD patients in combination, the sensitivity and specificity were 75.9% and 90.38%, respectively, with the AUC of 0.906 (95% CI: 0.912–0.996). Conclusion. These data reveal that IL-13, TGF-β1, and periostin levels might be associated with the occurrence of AHF in CAD patients and their combination shows the predictive value for the presence of AHF in CAD patients.

scholarly journals Utility of dobutamine stress echocardiography in aortic valve regurgitation and reduced left ventricular function

2021 ◽  
Author(s):  
Chihiro Saito ◽  
Kotaro Arai ◽  
Kyomi Ashihara ◽  
Hiroshi Niinami ◽  
Nobuhisa Hagiwara
Keyword(s):  
Aortic Valve ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Aortic Valve Surgery ◽  
Ventricular Ejection Fraction

Objective: Predictors for post-operative reverse remodeling in patients with severe aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) are unknown. We performed low-dose dobutamine stress echocardiography (DSE) in patients with severe AR and reduced LVEF to evaluate the relationship between contractile reserve (CR) and reverse remodeling after surgery. Methods: In 31 patients with chronic severe AR and reduced LVEF (LVEF < 50%), we performed pre-operative DSE, assessed CR and examined whether changes in preoperative DSE were associated with improvement of post-operative LVEF after aortic valve surgery. Results: The pre-operative echocardiographic findings were as follows: left ventricular (LV) end-diastolic dimension: 67 ± 10 mm, LV end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%. All patients underwent aortic valve surgery. Patients with pre-operative LVEF of >45% exhibited a significant increase in LVEF; however, patients with pre-operative LVEF of <45% showed no significant change. When we examined the results of DSE performed in patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with CR) during DSE was related to an improvement in post-operative LVEF; ΔLVEF of ≥6% during DSE predicted an improvement in post-operative LVEF, with a sensitivity and specificity of 80% and 85%, respectively. Conclusions: DSE may be a helpful tool for predicting post-operative reverse remodeling in patients with severe AR and moderately reduced LVEF.

scholarly journals Fully automated left ventricular ejection fraction and global longitudinal strain predicts obstructive coronary artery disease in patients undergoing stress echocardiography: a multi-centre study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J O'Driscoll ◽  
W Hawkes ◽  
A Beqiri ◽  
A Mumith ◽  
A Parker ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Obstructive Coronary Artery Disease ◽  
Global Longitudinal Strain ◽  
Peak Stress ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Abstract Background Assessment of LVEF and myocardial deformation with GLS has shown promise in predicting CAD, which may add prognostic information for patients undergoing SE. However, selection bias precludes an accurate assessment of routine clinical SE workflow due to the exclusion of poor image quality and contrast enhanced studies. We hypothesise that an artificial intelligence (AI) pipeline capable of fully automated contouring of the left ventricle and GLS analysis of both non-contrast and contrast SE images is feasible and can predict CAD. Purpose The aim of this study was to evaluate the prediction of obstructive coronary artery disease (CAD) from fully automated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) measures in a large multicentre population of patients undergoing stress echocardiography (SE). Methods 500 patients from five medical centres undergoing SE for the clinical evaluation of ischaemic heart disease were included in this study. LVEF and GLS was automatically calculated using AI in non-contrast and contrast images at rest and peak stress. The primary endpoint was CAD assessed using invasive coronary angiography. Results Patients with significant CAD demonstrated significantly reduced LVEF and GLS at rest and peak stress (all p&lt;0.001) compared to those without CAD. Of the 130 patients who exhibited myocardial ischaemia at peak stress, patients without significant CAD (37%) had significantly reduced LVEF and GLS when compared to those who did. Multivariate analysis demonstrated that a peak LVEF (0.93; 95% CI 0.9–0.96) and peak GLS (1.15; 95% CI 1.07–1.24) were significant independent predictors of CAD. The addition of automated LVEF and GLS to basic models significantly improved the C statistic from 0.78 to 0.83 and 0.85 (both p&lt;0.001), respectively. Conclusions Fully automated LVEF and GLS in non-contrast and contrast SE images is feasible and independently augment the prediction of obstructive CAD above and beyond traditional SE indexes. FUNDunding Acknowledgement Type of funding sources: None.

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