scholarly journals P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Sukhanova ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
A V Ivanov ◽  
D Shmatov
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Ejection Fraction ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Maximal Velocity ◽  
Myocardial Mass ◽  
Coronary Flow Velocity ◽  
Apparently Healthy

Abstract Funding Acknowledgements university Grand Background Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39. Methods This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed. Results Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm. Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p < 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p < 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions. Conclusion There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.

P1469Comparison prognostic values of coronary flow velocity assessment and ejection fraction during routine echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
N Zhuravskaya ◽  
O Guseva ◽  
E Kalinina ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Arteries ◽  
Acute Coronary Syndromes ◽  
Coronary Flow ◽  
Maximal Velocity ◽  
Coronary Flow Velocity ◽  
Coronary Syndromes

Abstract Background Ejection fraction (EF) is a parameter that has traditionally been used for prognostic aims during echocardiography. However, it is known that its prognostic role is accurate only if EF has clearly decreased. So, in the large group of patients who had no prior myocardial infarction, with normal EF but with severe narrowing of main coronary arteries, it is impossible to predict a high risk of adverse coronary events in the near future with transthoracic echocardiography at rest. The aim of the study was to compare prognostic values of coronary flow velocity assessment and EF during transthoracic echocardiography. Methods A prospective cohort study comprises 747 patients (380 males; age 58+13 years) referred for echocardiography. Left side coronary artery (left main - LM, left descending – LAD, and circumflex arteries -LCx) flows were scanned in addition to conventional echocardiography. Cardiac death, nonfatal myocardial infarction (MI), acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACE). The period of follow-up was 3 years. Results During a median follow-up of 36 months, 192 patients experienced 224 MACE. Twenty-six deaths, 16 non-fatal MI, 2 acute coronary syndromes, 180 revascularizations were observed. EF and maximal velocity in proximal segments of coronary arteries were independents predictors of death/MI/acute coronary syndromes. The maximal velocity had a significantly higher predictive value (p<0.004) in the whole group (Figure 1A) as well as among the patients with near normal/normal EF (Figure 1B, 1C). The maximal velocity had a significantly higher predictive value (p<0.0001) of MACE (Figure 1D). Conclusion Coronary artery scan assessment had the statistically significantly higher predictive accuracy of MACE in comparison with traditional EF in the whole group and in the subgroups with different degrees of decreasing EF.

scholarly journals Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Kalinina ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Area Under Curve ◽  
Left Coronary Artery ◽  
Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity &gt;110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p &lt; 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p &lt; 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of &gt;66 cm/s (27% vs. 2%; p &lt; 0.002). The rates of MACE were 58.0% vs. 2%; p &lt; 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

Intraoperative transesophageal assessment of coronary artery flow can predict 5 type myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Zagatina ◽  
M Novikov ◽  
N Zhuravskaya ◽  
V Balakhonov ◽  
S Efremov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Index Number ◽  
Left Main ◽  
Coronary Flow Velocity ◽  
Before And After ◽  
Flow Velocities

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p&lt;0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p&lt;0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

P4981The reduction of coronary flow velocity reserve in heart failure with reduced, mid-range or preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Daros ◽  
L Cortigiani ◽  
Q Ciampi ◽  
N Gaibazzi ◽  
A Zagatina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Left Ventricular ◽  
Control Group ◽  
Contractile Reserve ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity ◽  
Asymptomatic Patients

Abstract Background Coronary microvascular disease has been described in heart failure (HF) in presence of angiographically normal epicardial coronary arteries. The prevalence of a reduction of coronary flow velocity reserve (CFVR) in different types of HF and its link with left ventricular contractile reserve (LVCR) is unclear. Aim To assess CFVR and LVCR in HF. Methods In a prospective, observational, multicenter study, we recruited 380 patients (234 male, 61%, age 66±11 years): 143 (38%) with HF and reduced (<40%) ejection fraction (HFrEF); 98 (26%) with HF and mid-range (40–50%) ejection fraction (HFmrEF); 139 (36%) patients with HF and preserved (>50%) ejection fraction (HFpEF). A control group of 52 asymptomatic patients (23 male, 44%, age 61±14 years) referred to testing for screening was also selected (Controls). All patients underwent dipyridamole (0.84 mg/kg) stress echocardiography in 12 accredited laboratories of 3 countries (Argentina, Brazil and Italy). CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of left anterior descending (LAD) artery flow. We assessed left ventricular contractile reserve (LVCR) based on global LV Force (systolic blood pressure/end-systolic volume). Results Reduced (≤2.0) CFVR was observed in 0/52 controls (0%); 25/139 HFpEF (18%); 28/98 HFmrEF (29%); 78/143 HFrEF (54%, p<0.001 vs all other groups). CFVR was highest in controls (2.80±0.57), lower in HFpEF (2.51±0.57) and HFmrEF (2.26±0.44), lowest in HFrEF (2.04±0.48, p<0.001 vs all other groups). The correlation with LVCR was absent in controls (r=0.098, p=0.491) and HFmrEF (r=0.032, p=0.756), present in HFrEF (r=0.375, p<0.001) and HFpEF (r=0.314, p<0.001). LVCR vs CFVR Conclusions CFVR is frequently abnormal in all types of HF, although more frequently and more profoundly in HFrEF. CFVR mirrors contractile reserve in HFrEF and - less tightly - in HFpEF.

scholarly journals P1564 Changes in coronary flow velocity measuring during coronary bypass grafting can predict elevation of cardiac troponin

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
M Novikov ◽  
N Zhuravskaya ◽  
V Balakhonov ◽  
D Shmatov
Keyword(s):  
Coronary Artery ◽  
Flow Velocity ◽  
Cardiac Troponin ◽  
Coronary Flow ◽  
Bypass Grafting ◽  
Left Main ◽  
Coronary Flow Velocity ◽  
Before And After ◽  
Velocity Changes ◽  
75Th Quartile

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to a hemodynamic law. The range of decreased velocity can hypothetically reflect the effectiveness of a graft. Grafting effect insufficiencies often cause elevations in periprocedural cardiac troponin (cTn) elevation. The aim of the study is to determine, if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict further cTn elevation. Methods and results Consecutive 68 patients (48 men, 64 ± 9 years old), who were referred for CABG, were included into the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries’ proximal segments. Measurements of coronary flow velocities was performed before and after grafting in the same sites of the arteries. The maximal value of cTnI within 48 hours after CABG was accounted for in the analysis. All patients had arterial hypertension, 15 patients (22%) had diabetes mellitus, 12 patients (18%) was current smokers. Forty-one patients (60%) had prior myocardial infarctions, 18 persons (26%) had previous coronary stenting. The ejection fraction before the operation was 56 ± 13%. Before grafting the mean velocity in the left main artery was 79 cm/s (25th-75th quartile, 42-111), in LAD 98 cm/s (25th-75th quartile, 71-125), and in LCx 116 cm/s (25th-75th quartile, 68-156). There was a strong significant correlation between changes in coronary flow velocities and the value of cTnI (R = 0.56, p &lt; 0.0004). The patients with and without significant elevations in cTnI had differences in coronary velocity changes before and after grafting (p &lt; 0.009). Patients with elevated cTnI in more than 5 times, had, on average, an increase in the velocities for native arteries of 21 ± 19 cm/s. Conclusion Coronary flow velocity assessment during CABG could predict an elevation of cardiac troponins after cardiac surgery. Abstract P1564 Figure.

Sign in / Sign up

Export Citation Format

Share Document