Abstract
Introduction
The issue of sudden cardiac death (SCD) remains one of the most actual problem in healthcare. Several reports underscores that about 50-80% of SCD is linked to ischemic heart disease (IHD). The usage of contemporary risk-stratification criteria of SCD and implementation of new noninvasive ultrasound methods allow to improve patient’s prognosis through early start of optimal medical therapy and surgical treatment.
Material and methods: 63 years-old male with moderate class II stable angina. Patient undergone eversion endarterectomy 2 years prior to initial admittance due to an 80% left internal carotid stenosis and received appropriate optimal medical therapy provided by the modern dyslipidemia guidelines. We’ve used ECG (MAC 1600, GE); transthoracic doppler echocardiography, stress-echo, triplex scanning (VIVID E9, E95, GE); ergometry stress test (eBike, GE), quantitative coronary angiography (Innova 3100, GE).
Results
ECG (sinus rhythm, 62bpm, left ventricular hypertrophy) and brachiocephalic arteries triplex scan were unremarkable. Patient had dyslipidemia with low HDL. Transthoracic echocardiography revealed no region wall motion abnormalities, concentric remodeling, mild diastolic dysfunction, preserved ejection fraction (57%, Simpson). Transthoracic doppler echocardiography showed retrograde mid-LAD flow and patient was scheduled for noninvasive stress-echocardiography (Level III, 100W 2:00 min). Stress-echo was positive with apical anterior and lateral akinesia, septal and mid-lateral hypokinesia, GLS rest 15 %, GLS peak 13% and dynamic ST-segment changes in V4-V6. Invasive coronary angiography showed LAD CTO and subtotal LCx lesion. Then LAD and LCx PTCA with stenting were performed with good clinical outcome.
Conclusion
Novel methods of cardiac and coronary visualization are feasible in coronary flow reserve assessment and chronic total occlusions identification, especially in patients with multifocal atherosclerosis.
Significant Residual Ischemia on Myocardial Perfusion Imaging after Optimal Medical Therapy with or without Coronary Revascularization Predicts a Worse Prognosis
