Comparison of Left Ventricular Contractile Abnormalities in Stress-Induced Cardiomyopathy versus Obstructive Coronary Artery Disease Using Two-Dimensional Strain Imaging

2016 ◽  
Vol 33 (6) ◽  
pp. 863-870 ◽  
Author(s):  
Alexandros Briasoulis ◽  
Karolina Marinescu ◽  
Marian Mocanu ◽  
Assad Sattar ◽  
Osama Qaqi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Two Dimensional ◽  
Artery Disease

scholarly journals Importance of two-dimensional strain imaging in diagnosis of coronary artery disease

2019 ◽  
Vol 60 (4) ◽  
pp. 179-184
Author(s):  
Ahmed M. Hussein ◽  
Mahdi S. Alzaidi ◽  
Bashar M. Abed
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Significant Coronary Artery Disease ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Two Dimensional ◽  
Artery Disease

Background: Strain imaging assessing regional myocardial deformation and can be used to quantify regional myocardial function and differentiate between ischemic and non ischemic myocardium. Objectives: to assess sensitivity and specificity of strain imaging in detection of coronary artery disease in comparison with coronary angiography.Patients and Methods: ninety six patients were referred to Ibn albitar center for cardiac surgery, Baghdad, Iraq with symptoms of coronary artery disease for a period between June 2014 and April 2015, all of whom were evaluated by two dimensional echocardiography and all were found to have good left ventricular systolic function with no regional wall motion abnormalities (RWMA), coronary angiography were done for all patients. Results: of the 96 patients: 69(71.9%) were males and 27(28.1%) females, with mean age 55.7 ± 9.71 years. Thirty-one (32.3%) patients have no significant coronary artery disease and sixty-five (67.7%) have significant coronary artery disease. The sensitivity and specificity of global longitudinal strain in detection of coronary artery disease are 67.7% and 80.6% respectively. Global longitudinal strain appears to be useful in localization of coronary artery disease. Conclusions: speckle tracking Strain echocardiography is simple, noninvasive and non-angle dependent with acceptable sensitivity and specificity in early detection of cardiomyopathy including ischemic myopathy.

scholarly journals A STEMI gone viral

2017 ◽  
Vol 4 (3) ◽  
pp. 34
Author(s):  
William Wung ◽  
Alison G Chang ◽  
Thomas WR Smith
Keyword(s):  
Coronary Artery Disease ◽  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Electrical Storm ◽  
Ecg Changes ◽  
Artery Disease

A 65-year-old male with a history of coronary artery disease and ankylosing spondylitis presented with focal ECG changes and elevated cardiac biomarkers suggestive of an acute lateral ST-elevation myocardial infarction. Emergent coronary angiography surprisingly showed non-obstructive coronary artery disease. Further workup including a cardiac MRI, viral serologies, and an endomyocardial biopsy was consistent with focal Coxsackie viral myocarditis. The patient subsequently developed recurrent, pulseless ventricular tachycardia requiring multiple rounds of ACLS, and his left ventricular ejection fraction acutely dropped from 55% to 20%. An emergent intra-aortic balloon pump was placed, and an intravenous lidocaine infusion and high-dose corticosteroids were started for the patient’s electrical storm and myocarditis, respectively. The patient was eventually discharged in stable condition with an implantable cardiac defibrillator. No further episodes of ventricular tachycardia were noted at six-month follow-up. In patients with acute ECG changes, elevated cardiac biomarkers, and no evidence of obstructive coronary artery disease, myocarditis should be considered as a leading diagnosis given the potentially life-threatening sequelae as seen in our patient.

scholarly journals Clinical utility of brain-derived neurotrophic factor as a biomarker with left ventricular echocardiographic indices for potential diagnosis of coronary artery disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
K. G. Monisha ◽  
Paramasivam Prabu ◽  
M. Chokkalingam ◽  
Ram Murugesan ◽  
Dragan Milenkovic ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Total Cholesterol ◽  
Neurotrophic Factor ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Two Dimensional ◽  
Bdnf Level ◽  
Artery Disease ◽  
Serum Bdnf

Abstract Brain-derived neurotrophic factor (BDNF) plays a central pivotal role in the development of the cardiovascular system. Recent evidence suggests that BDNF has adverse subclinical cardiac remodeling in participants with cardiovascular disease risk factors. Relating serum BDNF levels with two-dimensional echocardiographic indices will provide insights into the BDNF mediated pathophysiology in coronary artery disease (CAD) that may shed light upon potential diagnostic biomarkers. For the study, 221 participants were recruited and classified based on coronary angiogram examination as control (n = 105) and CAD (n = 116). All participants underwent routine blood investigation, two-dimensional echocardiography, and serum BDNF estimation. As a result, total cholesterol, triglyceride, low-density lipid, high-density lipid, HbA1c (glycosylated hemoglobin), serum creatinine, eosinophils, lymphocyte, monocytes, neutrophils, and platelets were significantly elevated in CAD individuals compared to controls. Notably, the serum BDNF was significantly lower in individuals with CAD (30.69 ± 5.45 ng/ml) than controls (46.58 ± 7.95 ng/ml). Multivariate regression analysis showed neutrophils, total cholesterol, left ventricular mass index, mitral inflow E/A ratio, and pulmonary vein AR duration were associated with low BDNF in CAD. Four independent support vector machine (SVM) models performed to ensure the BDNF level in the classification of CAD from healthy controls. Particularly, the model with serum BDNF concentration and blood parameters of CAD achieved significant improvement from 90.95 to 98.19% in detecting CAD from healthy controls. Overall, our analysis provides a significant molecular linkage between the serum BDNF level and cardiovascular function. Our results contribute to the emerging evidence of BDNF as a potential diagnostic value in CAD that might lead to clinical application.

P2715Diastolic dysfunction in women with ischemia and no obstructive coronary artery disease: novel insight from left atrial feature tracking

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Z Zamani ◽  
T J Samuel ◽  
J Wei ◽  
L E J Thomson ◽  
B Tamarappoo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Pressure Gradient ◽  
Left Atrium ◽  
Feature Tracking ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Women with signs and symptoms of ischemia but no obstructive coronary artery disease (INOCA) are at increased risk of developing heart failure with preserved ejection fraction (HFpEF); however, the exact mechanism for HFpEF progression remains to be elucidated. Prior studies have focused specifically on impaired left ventricular diastolic function in INOCA. We hypothesized that extending our evaluation to include the left atrium (LA)– a key constituent of the transmitral pressure gradient and left ventricular filling– would provide additional, novel, pathophysiological insight. Purpose To evaluate LA function in women with INOCA using cardiac MRI (CMR). Methods We performed retrospective feature tracking analysis of cine images from CMR (Figure 1A), to evaluate LA strain, in 58 INOCA women with normal sinus rhythm (three were excluded due to suboptimal image quality). All strain measurements were performed in duplicate by an experienced investigator blinded to clinical status. We subdivided the cohort by an established threshold of resting left ventricular end diastolic pressure (LVEDP) <12 mmHg vs >12 mmHg, performed invasively within a median of 27 days of the CMR. As illustrated in Figure 1B, LA function was divided into three established phases: (1) reservoir strain, passive expansion of the left atrium from the pulmonary circulation while the mitral valve is closed; (2) conduit strain, passive emptying of the atrium into the ventricle; and (3) booster strain, active emptying of the left atrium following atrial depolarization. Results Reservoir strain was higher in the elevated LVEDP group (n=20, 26.1 + 1.3%) vs. not elevated group (n=35, 22.8 + 0.9%, p=0.03; Figure 1C). In contrast, we observed no group difference in conduit strain (16.5 + 1.0 and 16.5 + 0.7, p=0.78, respectively; Figure 1D), resulting in significantly higher atrial booster strain in the elevated LVEDP group (10.0 + 1.1% and 7.0 + 0.6, p<0.01, respectively; Figure 1E). Conclusions To our knowledge, this is the first report of LA function in women with INOCA. That reservoir strain was higher in subjects with elevated LVEDP provides important pathophysiologic insight regarding diastolic hemodynamics of the LA. The similar conduit function between groups– despite different LVEDP's– strongly suggests a ventricular contribution to the impaired transmitral pressure gradient. Together, these initial proof-of-concept data support the evaluation of LA function in our quest to better understand heart failure progression in INOCA.

scholarly journals Ventricular Rupture due to Myocardial Infarction without Obstructive Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hendrik Lapp ◽  
Marcel Keßler ◽  
Thomas Rock ◽  
Franz X. Schmid ◽  
Dong-In Shin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment ◽  
Ventricular Rupture ◽  
Life Threatening ◽  
Artery Disease

An 87-year-old woman presenting with myocardial infarction and ST-segment elevation in the electrocardiogram suffered from pericardial effusion due to left ventricular rupture. After ruling out obstructive coronary artery disease and aortic dissection, she underwent cardiac surgery showing typical infarct-macerated myocardial tissue in situ. This case shows that even etiologically unclear and small-sized myocardial infarctions can cause life-threatening mechanical complications.

scholarly journals Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

2019 ◽  
Vol 20 (8) ◽  
pp. 875-882 ◽  
Author(s):  
Seong-Mi Park ◽  
Janet Wei ◽  
Galen Cook-Wiens ◽  
Michael D Nelson ◽  
Louise Thomson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Flow Reserve ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

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