Abstract 2685: Assessment of Myocardial Perfusion With Stress-Contrast Echocardiography in Diabetics

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Constadina Aggeli ◽  
Georgios Giannopoulos ◽  
Georgios Roussakis ◽  
Euaggelia Christoforatou ◽  
Georgios Marinos ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Predictive Value ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Contrast Echocardiography ◽  
Diabetic Patients ◽  
Perfusion Defects ◽  
Wall Motion Abnormalities ◽  
Stress Contrast

Background and purpose: The combination of myocardial contrast echocardiography with dobutamine-atropine stress echocardiography has shown promising results in the diagnostic approach of coronary heart disease (CHD). However, its diagnostic value in specific patient populations has not been clearly specified. The aim of the present study was to assess the value of stress contrast echocardiography (SCE) in diagnosing significant coronary heart disease in diabetic versus non-diabetic patients. Methods: 127 individuals (60 males, 62±9.8 years old) with no known history of CHD, among which 59 patients with Type 2 diabetes mellitus, were submitted to stress echocardiography (four-stage dobutamine protocol 10 – 40 mcg/kg/min, with use of atropine as required to reach 90% of age-adjusted target heart rate), combined with intravenous contrast use to perform myocardial contrast echocardiography. New or worsening wall motion abnormalities during stress or reversible perfusion defects in >2 contiguous segments were considered as signs of ischemia. Significant CHD was defined as >50% stenosis in a major epicardial artery on coronary angiography (CAG). Results: Among the 68 non-diabetic subjects and the 59 diabetics, 58 (85.3%) and 45 (76.3%) were found to have significant CHD on CAG, respectively. There were no significant differences as regards to age, sex and other major risk factors between diabetics and non-diabetics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) in the total of 127 patients were 92%, 63%, 91%, 65% and 87%, respectively. These diagnostic parameters in non-diabetic vs. diabetic subjects were 93% vs. 91% (p= NS ), 90% vs. 43% (p<0.01), 98% vs. 84% (p<0.05) and 69% vs. 60% (p= NS ). Conclusions: Stress contrast echocardiography is an exceptionally reliable technique for CHD diagnosis. However, our findings suggest that in diabetic patients it appears to exhibit inferior specificity and PPV compared to non-diabetics. A possible explanation could be that microcirculation abnormalities, which are common in diabetes, may cause appearance of signs of ischemia (wall-motion abnormalities and/or perfusion defects) on SCE, without presence of angiographically significant CHD.

Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

2019 ◽  
Vol 90 (7) ◽  
pp. 792-795
Author(s):  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Brittany A Ricci ◽  
Brian MacGrory ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Wall Motion ◽  
Cardiac Evaluation ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

scholarly journals Diagnostic Test Squatting Stress Echocardiography and Coronary Angiography in Diagnosing Coronary Heart Disease

2017 ◽  
pp. 190-8
Author(s):  
Andy Rahman ◽  
Mefri Yanni ◽  
Masrul Syafri
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Unstable Angina ◽  
Predictive Value ◽  
Stress Echocardiography ◽  
Coronary Artery Stenosis ◽  
Non Invasive ◽  
Sensitivity Specificity

Background: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.

Contrast echocardiography

ESC CardioMed ◽  
2018 ◽  
pp. 435-438
Author(s):  
Anastasia Vamvakidou ◽  
Roxy Senior
Keyword(s):  
Image Quality ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Contrast Echocardiography ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Artery Disease

The major requirement for optimal echocardiographic image interpretation, reproducibility, and diagnostic accuracy is image quality. Despite the use of harmonics, a significant proportion of patients have challenging images, which has an impact on diagnosis and management. The ultrasound contrast agents (UCAs), which are administered intravenously, have been a significant development in image quality optimization and have proved to be an important aid in the assessment of structural abnormalities, detection of regional wall motion abnormalities, and calculation of left ventricular ejection fraction. The use of UCAs is also of critical importance for the detection of ischaemia and the assessment of significant coronary artery disease through detection of inducible regional wall motion abnormalities during stress echocardiography. UCAs can also assess myocardial perfusion, which improves assessment of myocardial ischaemia during stress echocardiography. Similarly the simultaneous assessment of wall motion and perfusion improves assessment of viable myocardium in patients with left ventricular dysfunction. As the use of UCAs results in increased feasibility, reproducibility, and diagnostic and prognostic accuracy of echocardiography including cost-efficiency, both European and American guidelines endorse its use in clinical cardiology.

scholarly journals The influence of afterload on left ventricular contractility: 2D-strain and dyssynchrony in stress echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Karev ◽  
S Verbilo ◽  
E Malev ◽  
M Prokudina ◽  
A Suvorov
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Wall Motion ◽  
Wall Motion Score Index ◽  
Wall Motion Abnormalities ◽  
Response To Exercise ◽  
Score Index

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertensive response to exercise (HRE) has negative prognostic value but its impact on the  left ventricle (LV) contractility and on stress echocardiography (SE) results remains controversial. The global longitudinal strain (GLS) and LV dyssynchrony changes in response to afterload increase were shown even in patients with narrow QRS at rest, but not on exertion. Purpose We aimed to analyze the relation between the blood pressure (BP) during SE and LV GLS and dyssynchrony changes. Methods We performed exercise SE on treadmill in 96 patients without coronary artery stenosis (invasive or CT coronary angiography). Patients divided into two groups: HRE (n = 41) and normal response to exercise (NRE) (n = 55). We analyzed GLS and standard deviation of time between the onset of QRS and segmental longitudinal strain peaks (STE-TIME SD) using speckle tracking and 3d-ejection fraction (EF) at rest and on exertion. Results 2D-EF increase was higher in patients with NRE, but 3D-EF did not differ between groups. Wall motion abnormalities (WMA) on peak stress were detected more often in patients with HRE who had higher wall motion score index (WMSI). GLS on exertion and its increment were lower in HRE group (Fig. 1 - "Bull’s eye" diagrams of GLS at rest and on exertion in patient with NRE (upper panel) and HRE (lower panel)). Among dyssynchrony markers we revealed higher values of STE-TIME SD on exertion in HRE group (Table 1). Moreover the analysis showed positive correlations between BP level on exertion and peak GLS (r = 0.56, p &lt; 0.0001), GLS increase (r = 0.54, p &lt; 0.0001) and STE-TIME SD on exertion (r = 0.27, p &lt; 0.02) Conclusions HRE is associated with less increment in GLS and 2D-EF on exertion. Besides LV dyssynchrony signs can appear in response to exaggerated afterload increase even in patients with narrow QRS complexes. Patients with HRE more often show stress-induced WMA and have greater WMSI on exertion in absence of coronary artery lesions, thus HRE can alter the specificity of the test in transient ischemia detection. Table 1 HRE NRE p Δ-2D ejection fraction 5.0 (4.0; 7.0) 10.0 (8.0; 12.5) &lt;0.0000001 Δ-3D ejection fraction 8.25 (4.0; 8.25) 8.24 (8.15; 11.65) 0.09 Wall motion abnormalities on exertion 46.34% 1.8% &lt;0.00001 Wall motion score index 1.0 (1.0; 1.18) 1.0 (1.0; 1.0) 0.00013 GLS on exertion -21.0 (-22.0; -19.0) -24.0 (-26.5; -23.0) &lt;0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) &lt;0.0000001 STE-TIME SD-IMPOST 42.0 (35.0; 53.0) 35.0 (27.5; 45.0) 0.012 Left ventricle systolic function and dyssynchrony in two groups. Abstract Figure 1.

scholarly journals Multimodal Diagnostics of Microrheologic Alterations in Blood of Coronary Heart Disease and Diabetic Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 76
Author(s):  
Anastasia Maslianitsyna ◽  
Petr Ermolinskiy ◽  
Andrei Lugovtsov ◽  
Alexandra Pigurenko ◽  
Maria Sasonko ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Optical Methods ◽  
Diabetic Patients ◽  
Aggregation Index ◽  
Significant Difference

Coronary heart disease (CHD) has serious implications for human health and needs to be diagnosed as early as possible. In this article in vivo and in vitro optical methods are used to study blood properties related to the aggregation of red blood cells in patients with CHD and comorbidities such as type 2 diabetes mellitus (T2DM). The results show not only a significant difference of the aggregation in patients compared to healthy people, but also a correspondence between in vivo and in vitro parameters. Red blood cells aggregate in CHD patients faster and more numerously; in particular the aggregation index increases by 20 ± 7%. The presence of T2DM also significantly elevates aggregation in CHD patients. This work demonstrates multimodal diagnostics and monitoring of patients with socially significant pathologies.

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