scholarly journals Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention

Pulse ◽  
2021 ◽  
pp. 1-8
Author(s):  
Ragab A. Mahfouz ◽  
Marwa M. Gad ◽  
Mohamed Arab ◽  
Moei-E. deen Abulfotouh
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Left Atrial Volume ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
St Segment ◽  
Stent Diameter

<b><i>Objective:</i></b> We aimed to investigate the relation between CHA<sub>2</sub>DS<sub>2</sub>-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). <b><i>Subjects and Methods:</i></b> The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA<sub>2</sub>DS<sub>2</sub>-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA<sub>2</sub>DS<sub>2</sub>-VASc score. <b><i>Results:</i></b> Subjects were stratified into 2 groups based on IMR &#x3c;/≥ 40 U; 72 patients (62.6) with IMR &#x3c;40 U and 43 patients (37.4) with IMR ≥40 U. Patients with IMR ≥40 U had higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (<i>p</i> &#x3c; 0.001). CHA<sub>2</sub>DS<sub>2</sub>-VASc score was significantly correlated with increased left atrial volume index, diastolic dysfunction, wall motion score index, and inversely correlated left ventricular ejection. Moreover, CHA<sub>2</sub>DS<sub>2</sub>-VASc score was strongly correlated with IMR (<i>p</i> &#x3c; 0.001). At multivariate analysis, low systolic blood pressure, stent diameter, and CHA<sub>2</sub>DS<sub>2</sub>-VASc score were associated with MVD. Besides, CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥4 was the optimal value in predicting MVD (IMR ≥40) in STEMI patients. <b><i>Conclusions:</i></b> The data of the current study point out that increased CHA<sub>2</sub>DS<sub>2</sub>-VASc score, lower systolic blood pressure &#x3c;90 mm Hg, and stent diameter are associated with increased incidence of MVD (increased IMR) after PPCI of STEMI. We suggest that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score may be a simple, inexpensive useful risk score for the prediction of MVD risk after PPCI for STEMI patients.

scholarly journals Effect of different ranges of systolic blood pressure on left ventricular structure and diastolic function in a Chinese population: a cross-sectional population-based Shunyi study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028398
Author(s):  
Liu Yongtai ◽  
Lai Jinzhi ◽  
Zhou Lixin ◽  
Zhai Feifei ◽  
Zhang Dingding ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Function ◽  
Chinese Population ◽  
Reference Group ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Cross Sectional ◽  
Group 1

ObjectivesTo evaluate the effect of different ranges of systolic blood pressure (SBP) on left ventricular (LV) geometry and diastolic function in Chinese population.DesignCross-sectional study.SettingPeking Union Medical College Hospital in Beijing, China.ParticipantsAll inhabitants aged 35 years or older, living in five villages of Shunyi were invited. Exclusion criteria included individuals who declined participation, presence of moderate to severe valvular heart disease, persistent atrial fibrillation and suboptimal echocardiograms.InterventionsThe baseline data of 1051 participants were analysed. The relationship between SBP and LV geometric and diastolic function assessed by echocardiography was analysed after adjusting for conventional cardiac risk factors.ResultsThe adjusted value of SBP was independently associated with LV hypertrophy (LVH) and LV diastolic dysfunction (LVDDF) (all p<0.01). Setting individuals with SBP <120 mm Hg as the reference group (group 1), those with SBP between 120 mm Hg and 140 mm Hg (group 2) had higher risk odds of LVH and those with SBP ≥140 mm Hg (group 3) had higher risk odds of LVH and LVDDF (all p<0.01). With the increase of SBP, LV mass index (LVMI) and E/e′ stepwise increased and e′ stepwise decreased significantly from group 1 to 3 (all p<0.05). In the whole population, SBP was independently correlated with LVMI, LVEDD, Left Atrial Volume Index, e′, and E/e′ (all p<0.01).ConclusionsSBP was independently related to LVH and LVDDF, SBP between 120 and 140 mm Hg was independently related to worse LV remodelling and diastolic function, these findings indicated the potential benefit of intensive SBP control.

Clinical characteristics and myocardial function assessed by traditional and novel echocardiographic methods in competitive triathletes with and without myocardial fibrosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Knappe ◽  
J Muench ◽  
S Yildirim ◽  
K Witzel ◽  
E Tahir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Myocardial Fibrosis ◽  
Clinical Characteristics ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background The aim of the present study was to compare clinical characteristics and cardiac structure and function in competitive triathletes with and without myocardial fibrosis. Methods Cardiac fibrosis in 61 healthy male competitive triathletes (&gt;10 hrs of training per week, age 45±10 yrs) was quantified using LGE-sequences in CMR (1.5 tesla scanner). Transthoracic echocardiography, physical examination, past medical history and routine lab diagnosis for exclusion of other conditions were performed. Baseline characteristics like blood pressure at rest (BP), bodymass-index (BMI), and systolic and diastolic echocardiographic parameters (left atrial volume index (LAVI), e', E, A, right ventricular pressure gradient) as well as global longitudinal strain, were analysed by two independent observers blinded to the CMR measurements. Triathletes were sub-divided into LGE-positives (LGE+) vs. LGE-negatives (LGE-). Results All individuals appeared healthy with no drug history. Focal non-ischaemic LGE was detected in 19 triathletes. Compared to LGE-negative triathletes, LGE-positives showed significantly higher systolic BP (142 vs. 128 mmHg, p=0.004). Logistic regression showed, that per 10 mmHg enhanced blood pressure the chance for LGE rises by 89%. Triathletes with and without LGE demonstrated no difference in conventional echocardiographic measurements such as left ventricular ejection fraction and volumes and no difference in diastolic parameters. But the presence of MF did mediate global longitudinal strain (GLS). Global longitudinal strain was significantly reduced in LGE positive athletes (LGE+: −19.8±3.4; LGE-: −21.7±2.4, p=0.04) Conclusions Reduced global longitudinal strain mediated as an early echocardiographic marker for subclinical changes in asymptomatic competitive triathletes with myocardial fibrosis compared to triathletes without LGE. Novel echocardiographic parameter such as longitudinal strain might serve as an easy tool to identify high endurance athletes at higher risk for cardiovascular events and that individuals with enhanced blood pressure should undergo cardiac consultation before starting endurance-training in competitive disciplines. Funding Acknowledgement Type of funding source: None

scholarly journals Electrical storm reveals worse prognosis compared to myocardial infarction complicated by ventricular tachyarrhythmias in ICD recipients

2021 ◽  
Author(s):  
Julian Müller ◽  
Michael Behnes ◽  
Tobias Schupp ◽  
Dominik Ellguth ◽  
Gabriel Taton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Electrical Storm ◽  
Ventricular Tachyarrhythmias ◽  
Ventricular Ejection Fraction ◽  
St Segment ◽  
All Cause Mortality ◽  
Worse Prognosis

AbstractBoth acute myocardial infarction complicated by ventricular tachyarrhythmias (AMI–VTA) and electrical storm (ES) represent life-threatening clinical conditions. However, a direct comparison of both sub-groups regarding prognostic endpoints has never been investigated. All consecutive implantable cardioverter-defibrillator (ICD) recipients were included retrospectively from 2002 to 2016. Patients with ES apart from AMI (ES) were compared to patients with AMI accompanied by ventricular tachyarrhythmias (AMI–VTA). The primary endpoint was all-cause mortality at 3 years, secondary endpoints were in-hospital mortality, rehospitalization rates and major adverse cardiac event (MACE) at 3 years. A total of 198 consecutive ICD recipients were included (AMI–VTA: 56%; ST-segment elevation myocardial infarction (STEMI): 22%; non-ST-segment myocardial infarction (NSTEMI) 78%; ES: 44%). ES patients were older and had higher rates of severely reduced left ventricular ejection fraction (LVEF) < 35%. ES was associated with increased all-cause mortality at 3 years (37% vs. 19%; p = 0.001; hazard ratio [HR] = 2.242; 95% CI 2.291–3.894; p = 0.004) and with increased risk of first cardiac rehospitalization (44% vs. 12%; p = 0.001; HR = 4.694; 95% CI 2.498–8.823; p = 0.001). This worse prognosis of ES compared to AMI–VTA was still evident after multivariable adjustment (long-term all-cause mortality: HR = 2.504; 95% CI 1.093–5.739; p = 0.030; first cardiac rehospitalization: HR = 2.887; 95% CI 1.240–6.720; p = 0.014). In contrast, the rates of MACE (40% vs. 32%; p = 0.326) were comparable in both groups. At long-term follow-up of 3 years, ES was associated with higher rates of all-cause mortality and rehospitalization compared to patients with AMI–VTA.

scholarly journals The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuai Meng ◽  
Yong Zhu ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
Jing Nan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Stress Hyperglycaemia ◽  
St Segment ◽  
Significant Difference ◽  
First Time

Abstract Background Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling. Methods We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively. Results In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p  = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p  = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p  = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p  < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p  = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p  = 0.007). Conclusions In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

Correlation between procollagen propeptides end echocardiography indices in patients with ST segment elevation myocardial infarction (STEMI)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Osokina ◽  
V.N Karetnikova ◽  
O.M Polikutina ◽  
Y.S Slepynina ◽  
T.P Artemova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Contractility ◽  
Imaging System ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Objective To investigate the correlation between Procollagen I C-Terminal Propeptide (PICP), Procollagen III N-Terminal Propeptide (PIIINP), indices of echocardiography and anamnestic data in patients with ST segment elevation myocardial infarction (STEMI) and preserved myocardial contractility. Materials and methods 60 men and 23 women diagnosed with STEMI were examined. Echocardiographic studies were performed using SONOS 2500 Cardiac – Vascular Ultrasound (Hewlett Packard, USA). Myocardial contractility was considered to be preserved with left ventricular ejection fraction (LVEF) ≥50%. In addition to standard indices of echocardiography, mitral flow propagation velocity (FPV) was evaluated to diagnose diastolic dysfunction. Coronary angiography was performed using INNOVA 3100 Cardiovascular Imaging System (USA). All patients, during the first twelve hours of the disease, underwent percutaneous coronary intervention (PCI) with stenting of the occluded culprit infarct-related artery. On the 1st and 12th days of hospitalization, the concentrations of PICP and PIIINP were determined for all patients by enzyme-linked immunosorbent assay (ELISA) using laboratory BCM Diagnostics kits (USA). All patients at the hospital received standard therapy. Results The following marker values were obtained: 1st day: PICP 609 (583; 635) ng/ml, PIIINP 26 (18.9; 34.9) ng/ml; 12th day: PICP 588 (580; 561) ng/ml, PIIINP 24.2 (18.6; 30.3) ng/ml. The following significant correlations were revealed: PICP 1st day / isovolumic contraction time – IVCT (m/s) 12th day, r=−0.68, p=0.042; PICP 1st day / Tei Index 12th day, r=−0.72, p=0.028; PICP 1st day / diastolic rigidity 12th day, r=−0.74, p=0.021; PIIINP 1st day/age, r=0.55, p=0.016; PIIINP 1st day/ body mass index (BMI), r=−0.59, p=0.009; PIIINP 1st day / E (cm/s) 1st day, r=0.72, p=0.018; PIIINP 1st day / Em /FPV 1st day, r=0.78, p=0.007; PIIINP 12th day / Em / FPV 1st day, r=0.65, p=0.041; PIIINP 12th day / E (cm/s) 1st day, r=0.67, p=0.033; PIIINP 12th day / E / Em) 12th day, r=0.70, p=0.023; PIIINP 12th day / Em/FPV 12th day, r=0.73, p=0.014. Conclusions The data obtained indicates the correlation between serum markers of myocardial fibrosis and the indices of echocardiography, as well as age. We conclude that, all the markers listed above, are able to represent myocardial remodeling in patients with STEMI. Funding Acknowledgement Type of funding source: None

scholarly journals Relationship between the ST-Segment Resolution and Microvascular Dysfunction in Patients Who Underwent Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Byung Gyu Kim ◽  
Sung Woo Cho ◽  
Jeong-Ha Ha ◽  
Hyo Seung Ahn ◽  
Hye Young Lee ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Microvascular Dysfunction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Objectives. Incomplete ST-segment elevation resolution (STR) occasionally occurs despite successful revascularization of epicardial coronary artery after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the relationship between the degree of STR and the severity of microvascular dysfunction. Methods. A total of 73 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful PPCI were evaluated. Serial 12-lead electrocardiography was performed at baseline and at 90 minutes after PPCI. Microvascular dysfunction was assessed by index of microvascular resistance (IMR) immediately after PPCI. Results. Patients were classified into 2 groups: 50 patients with complete STR (STR ≥50%) and 23 patients with incomplete STR (STR <50%). The incomplete STR group had a higher IMR value and lower left ventricular ejection fraction (LVEF), compared with the complete STR group. The degree of STR was significantly correlated with IMR (r = −0.416, P=0.002) and LVEF (r = 0.300, P=0.011). These correlations were only observed in patients with left anterior descending artery (LAD) infarction but not observed in patients with non-LAD infarction. A cutoff IMR value was 27.3 for predicting incomplete STR after PPCI. Conclusion. Incomplete STR after PPCI in patients with STEMI reflects the presence of microvascular and left ventricular dysfunction, especially in patients with LAD infarction.

Acute and short-term efficacy of sauna treatment on cardiovascular function: A meta-analysis

2020 ◽  
pp. 147451512094458
Author(s):  
Zhongyou Li ◽  
Wentao Jiang ◽  
Yu Chen ◽  
Guanshi Wang ◽  
Fei Yan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Meta Analysis ◽  
Cardiovascular Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Short Term ◽  
Ventricular Ejection Fraction ◽  
Term Efficacy ◽  
Cardiovascular Nursing

Objective: The role of sauna bathing in cardiovascular function treatment has been increasingly explored, but insufficient attention has been paid to its efficacy. We performed a meta-analysis to provide more evidence for the efficacy of sauna treatment in cardiovascular nursing. Methods: Sixteen peer-reviewed journal articles were screened to summarize the efficacy of the sauna on cardiovascular function. Both acute (0–30 min after the sauna) and short-term (2–4 weeks following the sauna treatment) efficacies were investigated. Results: For pooled acute efficacy, body temperature and heart rate significantly ( p<0.001) grew by 0.94℃ and 17.86 beats/min, respectively; reductions of 5.55 mmHg ( p<0.001) and 6.50 mmHg ( p<0.001) were also observed in systolic blood pressure and diastole blood pressure, respectively. For combined short-term efficacy, left ventricular ejection fraction (LVEF), 6-min walk distance, and flow-mediated dilation ( p<0.001) increased by 3.27%, 48.11 m, and 1.71%, respectively; greater amelioration in LVEF was observed in participants with lower LVEF. The proportion of patients with New York Heart Association class III and IV decreased by 10.9% and 12.2%, respectively. Systolic blood pressure, diastolic blood pressure, brain natriuretic peptide concentration, left ventricular end-diastolic dimension, cardiothoracic ratio, and left atrial dimension reduced by 5.26 mmHg ( p<0.001), 4.14 mmHg ( p<0.001), 116.66 pg/mL ( p<0.001), 2.79 mm ( p<0.001), 2.628% ( p<0.05), and 1.88 mm ( p<0.05), respectively, while the concentration of norepinephrine in the plasma remained unchanged. Conclusion: Sauna treatment was found to play a positive role in improving cardiovascular function and physical activity levels, especially in patients with low cardiovascular function. These findings reveal that thermal intervention may be a promising means for cardiovascular nursing.

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