scholarly journals Cardiac MRI viability study and its role in revascularization- Excerpts from a tertiary care cardiac centre

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Ruia ◽  
TR Muralidharan ◽  
R Jebaraj ◽  
B Vinodkumar ◽  
J S N Murthy ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Medical Management ◽  
Ischemic Cardiomyopathy ◽  
Wall Motion ◽  
Tertiary Care ◽  
Severity Index ◽  
Coronary Angiogram ◽  
Viability Testing ◽  
Coronary Syndrome ◽  
Viability Percentage

Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of cardiac viability based revascularization has not convincingly demonstrated, to improve patient outcomes statistically even by large trials like STITCH and PPAR-2 using SPECT and PET analysis. Here we used cardiac viability by cardiac MRI to guide us for revascularization and also found out problems arising in the statistical analysis for the same Methods It is a retrospective observational longitudinal follow up study whereby patients who had ischemic cardiomyopathy (confirmed with coronary angiogram) and who were admitted with features of heart failure or with acute coronary syndrome and who subsequently underwent cardiac MRI viability testing during the period from 1/02/2017 to 31/01/2020 were included. Patients were excluded who had non ischemic cardiomyopathy. Using cardiac MRI- LVEF, RVEF, Wall motion severity Index and Total viability percentage were additionally computed and analyzed. Patients were deemed having viable myocardium on ≤50% LGE in cardiac MRI and final treatment of CABG, PCI or only medical management was analyzed for the Primary end points of CV mortality, non-fatal CVA and non-fatal AMI  Results Based on the criteria total of 94 patients were selected for the study, 53 patients kept on only medical management, 19 patients underwent PCI and 22 patients had CABG. The baseline characteristics of the study population were an average age of 60years, male (76%) with Diabetes Mellitus(69%) and Hypertension (41.5%) in them. Coronary Angiogram showed that 10.6% patients had LM involvement, 92% had LAD disease, 72% patients had LCX lesion and 74% had RCA disease. While average Echo LVEF was 35.82%, Cardiac MRI based mean LVEF was 30.78%. It was found that patients who were kept only on medical management had higher Wall motion Severity Index (2.05) over patients who  were treated with PCI (1.94) or CABG (1.80) (p = 0.006). Also it was found that the Total viability percentage was less in patients kept only on medical management (74%) vs patients who were treated with PCI (78%) or CABG (77.8%)(p = 0.08) .It was found by cardiac MRI that patients with significant LAD lesions with viable LAD territory, those who underwent CABG or PCI based therapy had lesser mortality(7.69%,10%) over patients kept only on medical management (23%) (p = 0.407). Among patients with significant LAD lesions with non-viable LAD territory, those who underwent CABG or only medical management had lesser mortality (11.5%) than patients who underwent PCI (50%) (p = 0.137). Conclusion(s) Cardiac MRI based viability testing may guide the physician for optimal treatment but it does not reach statistical significance. The reasons maybe different arterial segments having different viability and anatomical hazards acting as cofounding factors. Viability being a continuum process does not follow a strict cut off of 50% LGE and 100% acute occluded vessel may not allow LGE.

scholarly journals Triple Whammy: Concurrent High-Altitude Exposure and COVID-19 Infection Presenting With STEMI

2021 ◽  
pp. 263246362110034
Author(s):  
Rajeev Chauhan ◽  
Krishna Prasad ◽  
Krishna Santosh Vemuri ◽  
Rohit Manoj Kumar
Keyword(s):  
High Altitude ◽  
Medical Management ◽  
Care Center ◽  
Tertiary Care ◽  
Medical Emergency ◽  
Symptomatic Therapy ◽  
Rt Pcr ◽  
Coronary Syndrome ◽  
Altitude Exposure ◽  
The World

Background: High altitude is associated with altered cardiovascular, pulmonary, and blood physiology which can lead to various cardiovascular complications. The world is now facing grave pandemic of COVID-19, which has affected all regions of the world including high-altitude regions. Management of COVID-19 infection along with a medical emergency like acute coronary syndrome at high altitude is extremely challenging. Case Presentation: We present a 57-year-old paramilitary officer, acclimatized to high altitude who developed sore throat, fever, and cough while he was posted at an altitude of 3,500 m. Evaluation revealed positive reverse transcriptase polymerase chain reaction (RT-PCR) test for COVID-19; hence, he was managed in isolation ward with symptomatic therapy. During the hospital stay, he developed anterior wall ST-elevation myocardial infarction (STEMI) for which he underwent thrombolysis with Tenecteplase. He underwent air evacuation to a tertiary care center located at an altitude of 320 m. Three days later, his repeat RT-PCR was negative. However, he complained of angina at rest; hence, he underwent coronary angiography which revealed significant mid-left anterior descending artery disease for which percutaneous coronary intervention was done successfully. Patient was discharged on optimal medical management, and on follow-up at 1 month he remained asymptomatic. Conclusion: This case highlights the deleterious effects of high altitude on cardiovascular system which can get worsened by COVID-19 infection. In patients suffering triple whammy of high-altitude exposure, COVID-19 infection and STEMI, multipronged approach involving timely medical management, rapid evacuation, and necessary intervention can provide optimal clinical outcomes.

scholarly journals Morphology of Coronary Artery Disease in a Patient with, Psoriasis Presenting with an Acute Coronary Syndrome

2021 ◽  
Vol 04 (15) ◽  
pp. 01-05
Author(s):  
Ranjit Sharma
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Wall Motion ◽  
Lv Function ◽  
Coronary Angiogram ◽  
Coronary Lesion ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Time Of Presentation

Background: This study was designed to evaluate the patterns of coronary artery disease in patients with Psoriasis presenting with acute coronary syndrome (ACS). Methods: This was a prospective, observational study, conducted on 28 patients with Psoriasis, presenting with acute coronary syndrome undergoing coronary angiogram from September 2017 to March 2021. All patients had undergone coronary angiogram; severity and morphology of coronary lesion were analyzed. Echocardiography was used to analyze LV wall motion and LV function. Results: The study showed that of 28 patients with Psoriasis who presented with ACS, 45.8% of patients were presented with NSTEMI, 39.2% % STEMI, and Unstable angina 15%. The average time of presentation after the onset of the symptom was 14.8 hours. 66 % of patients were a smoker. Coronary involvement 50% had TVD, 40% DVD, and 10% had SVD. In 77.6% culprit vessel was LAD, 10.4% LCX, and 12% RCA. In 75% of patient's coronary lesion was located in the proximal LAD. Chronic total occlusion was found in almost 26% of patients. Extensive LV wall motion abnormality with severe LV systolic dysfunction was noted in Psoriasis patients at the time of presentation (mean LVEF=28%). Conclusions: Psoriasis patients presenting with ACS, associated with increased severity of coronary lesions, multivessel involvement, and depressed LV systolic function.

scholarly journals Isolated ST-Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic and Electrocardiographic Correlations from a Tertiary Care Center

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Abhishek Singh ◽  
Sudhanshu Dwivedi ◽  
Akshyaya Pradhan ◽  
Varun S Narain ◽  
Rishi Sethi ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Tertiary Care ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
St Depression ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation

Background. Determining the infarct-related artery in STEMI during a coronary angiogram can be challenging due to the affliction of multiple vessels. Isolated STEMI involving only EKG leads I and aVL is infrequent. Localization of infarct-related artery based on EKG findings has not been previously done in this subset. Methods. All consecutive de novo acute coronary syndrome (ACS) patients admitted to coronary care unit with ST elevations involving only leads I and aVL were screened for enrollment. Patients with ST elevation in any additional lead and those who refused a coronary angiogram were excluded. Subsequently, a coronary angiogram was done as part of primary PCI or a pharmacoinvasive approach to identify the infract-related artery (IRA). IRA was defined by characteristics of lesion, flow of blood through stenosis, and presence of intracoronary thrombus. Coronary angiogram was interpreted by two independent observers blinded to the EKG findings. ST changes in inferior and precordial leads were analyzed to find ECG predictors of the culprit artery. Results. A total of 54 eligible patients of ACS were included in the study. The first major diagonal (D1) was the most frequent IRA in 35.2% followed by left circumflex-obtuse marginal (LCX-OM11) in 29.6%, left anterior descending (LAD) in 20.4%, and ramus intermedius (RI) in 14.8%. Out of total patients with ST depression in lead V2, the LCX-OM11 group was IRA in 50% cases while the RI, D1, and LAD groups accounted for 31.8%, 13.6%, and 4.5%, respectively ( p < 0.001 ). Similarly, LCX-OM1 was the most frequent IRA subjects with ST depressions in leads V1 and V3 (44.4%; p = 0.010 and 46.2%; p = 0.003 , resp.). On the contrary, in patients with ST depression in lead III, LAD and D1 were the most frequent IRA as compared to LCX-OM1 and RI though statistical significance was not attained ( p = 0.857 for lead III). ST-segment depression in lead V2 had a positive predictive value of 60% and a negative predictive value of 100% for LCX-OM1 as IRA. Similarly, ST-segment depression in lead V2 had a positive predictive value of 20% and a negative predictive value of 100% for the RI group. Conclusions. In patients presenting with isolated ST elevation in leads I and aVL, the most frequent IRA on angiogram was first diagonal. ST depressions in EKG leads V1–V3 were the most common predictor of LCX–OM1 while those in inferior leads indicated LAD-D1 as the IRA.

scholarly journals Stress cardiac MRI for the evaluation of CCS patients in a real-world tertiary care center

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Busi ◽  
C Fumagalli ◽  
M Vannini ◽  
G Pontecorboli ◽  
S Pradella ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Care Center ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Perfusion Magnetic Resonance Imaging ◽  
Intermediate Risk ◽  
Tertiary Care Center ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve

Abstract Background The MR INFORM trial demonstrated that myocardial perfusion Magnetic Resonance Imaging (MRI) is non-inferior to Invasive Coronary Angiography (ICA) with measurement of Fractional Flow Reserve (FFR) in guiding the management of patients with stable coronary artery disease with respect to major adverse cardiac events, despite a reduced rate of revascularized patients. We sought to evaluate if a MRI-based strategy performed well also in patients with Chronic Coronary Syndrome (CCS) with intermediate coronary plaques observed by Coronary Computed Tomography Angiography (CCTA). Methods At our tertiary care center, patients with suspicion of CCS at intermediate risk first underwent CCTA. Subsequently, those showing intermediate coronary plaques underwent dipyridamole stress cardiac MRI. Revascularization was recommended for patients showing ischemia in at least two consecutive left ventricular segments or 6% of the myocardium. ICA and instantaneous FFR was performed in all of these patients, in order to confirm the indication for revascularization. The endpoint was a composite of death, non-fatal myocardial infarction, and target-vessel revascularization within 1 year. Results 55 patients at intermediate risk underwent CCTA. 15 patients with no or only minimal plaques (stenosis &lt;30%) and those with obstructive plaques (stenosis &gt;70%) were excluded. 40 patients showed intermediate plaques (30–70% stenosis): 102 plaques total were classified as: non calcified n=9 (9%), calcified n=48 (47%), and mixed n=45 (44%). These patients underwent stress MRI, on the basis of which n=12 (30%) patients met criteria to recommend revascularization, whereas n=28 (70%) did not. The indication for revascularization was confirmed by ICA plus iFFR in 10 patients, and excluded in 2 (sensitivity = 100%, 95% CI 69%-100%; specificity = 93%, 95% CI 78%-99%; NPV = 100%, 95% CI 88%-100%; PPV = 83%, 95% CI 57%-95%; accuracy = 95%, 95% CI 83%-99%). Revascularization was obtained through PCI in 9 patients and through CABG in the remaining patient. All patients, regardless of revascularization, received optimal medical therapy (OMT), including high-dose statins. Throughout a 1-year follow-up, the composite endpoint occurred in only 1 patient belonging to the revascularized group, who was admitted to our hospital for NSTEMI. No adverse events were observed among the negative-MRI patients and the positive-MRI not-revascularized patients. All patients remained free from angina. Conclusions According to current European guidelines, in our tertiary care center patients with CCS at intermediate risk first underwent CCTA. A stress MRI-based strategy for the evaluation of intermediate plaques led us to refine the selection of patients needing coronary revascularization. No events occurred in patients with negative MRI, highlighting the accuracy of CCTA plus stress MRI strategy in these patients. In all patients, OMT may have contributed to freedom from angina. FUNDunding Acknowledgement Type of funding sources: None.

Cardiac MRI of acute coronary syndrome

2013 ◽  
Vol 9 (3) ◽  
pp. 351-370
Author(s):  
Shamruz Akerem Khan ◽  
Eric E Williamson ◽  
Thomas A Foley ◽  
Ethany L Cullen ◽  
Phillip M Young ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Mri ◽  
Coronary Syndrome

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

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