Abstract 13917: Post-systolic Shortening in the Ischemic Myocardium is Attenuated in Multivessel Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daisuke Sakurai ◽  
Toshihiko Asanuma ◽  
Kasumi Masuda ◽  
Masamichi Oka ◽  
Koichiro Kotani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Disease Model ◽  
Left Ventricular ◽  
Ischemic Myocardium ◽  
Multivessel Disease ◽  
Vessel Disease ◽  
Single Vessel ◽  
The Difference ◽  
The Relationship ◽  
Single Vessel Disease

Background: Post-systolic shortening (PSS) is myocardial shortening that occurs after end-systole and is considered as a sensitive marker of myocardial ischemia. Empirically, PSS in patients with multivessel disease is smaller than that in those with single vessel disease. Although this seems to be due to a decrease of difference in contraction between the ischemic and the surrounding myocardium, no study has elucidated it. We investigated the relationship between PSS and the difference of contraction between the ischemic and surrounding myocardium in an animal model which underwent left anterior descending coronary artery (LAD) occlusion (single vessel disease model) followed by left circumflex coronary artery (LCx) occlusion (multivessel disease model). Methods: In 7 open-chest dogs, left ventricular short-axis images (GE Vivid E9) and hemodynamic data were acquired at 3 conditions: (1) at baseline, (2) during LAD occlusion, and (3) during both LAD and LCx occlusion. Circumferential strains were analyzed in 6 segments by speckle tracking software. The amplitude of PSS (ε PSS ) and end-systolic strain (ε ES ) were measured and the difference of ε ES between a segment perfused by the LAD and the average of the other 5 segments was calculated (Δε ES ). Results: In the LAD segment, dyskinetic motion and PSS occurred during LAD occlusion but they were paradoxically attenuated during both LAD and LCx occlusion. ε PSS significantly correlated with Δε ES (r=0.95, p<0.05). Although ε PSS significantly decreased during both occlusion compared to LAD occlusion, ε PSS corrected by Δε ES (ε PSS /Δε ES ) did not decrease (figure). Conclusions: PSS in the ischemic myocardium was attenuated when the surrounding myocardium also became ischemic. The difference of contraction between the ischemic and the surrounding myocardium at end-systole seems to be a determinant of the amplitude of PSS. A parameter ε PSS /Δε ES may be useful for assessing ischemia in patients with multivessel disease.

Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seiko IDE ◽  
Satoru Sumitsuji ◽  
Kensuke Yokoi ◽  
Masatoki Yoshida ◽  
Isamu Mizote ◽  
...  
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Heart Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Myocardial Mass ◽  
Non Invasive ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

scholarly journals Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal

2020 ◽  
Vol 11 (6) ◽  
pp. 68-71
Author(s):  
Binay Kumar Rauniyar ◽  
Arun Kadel ◽  
Kiran Prasad Acharya ◽  
Kartikesh Kumar Thakur ◽  
Rakesh Bahadur Adhikari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Tertiary Care ◽  
Significant Coronary Artery Disease ◽  
Young Patients ◽  
Vessel Disease ◽  
Single Vessel ◽  
Triple Vessel Disease ◽  
Artery Disease ◽  
Single Vessel Disease

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country. Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal. Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included. Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%). Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).

scholarly journals Sex-specific outcome after minimally invasive direct coronary artery bypass for single-vessel disease

2019 ◽  
Vol 30 (3) ◽  
pp. 380-387
Author(s):  
Christine Friedrich ◽  
Rouven Berndt ◽  
Assad Haneya ◽  
René Rusch ◽  
Rainer Petzina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Survival Rates ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Abstract OBJECTIVES Female gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB). METHODS From January 1998 to December 2016, a total of 607 consecutive patients with single-vessel disease (31.9% women) underwent MIDCAB at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded during a median follow-up period of 8.0 years. Survival time was estimated for all patients and after applying propensity score matching (138 women vs 138 men). Multivariable Cox regression analysis identified risk factors predicting a long-term mortality rate. RESULTS In women, a longer surgical time (125 vs 113 min; P &lt; 0.001) and a higher transfusion rate were recorded (13.0% vs 5.1%; P = 0.001) with similar rates of in-hospital deaths (1.0% vs 0.5%; P = 0.60) and MACCE (1.5% vs 0.7%; P = 0.39). Survival and MACCE-free survival during the follow-up period did not differ significantly between genders (P = 1.0, P = 0.36). Survival and MACCE-free survival rates after 5 years were 94% and 90% in women compared to 91% and 86% in men. Propensity score matching demonstrated improved long-term survival rates in women (P = 0.029). Insulin-dependent diabetes mellitus, postoperative atrial fibrillation and prolonged intensive care unit stay were associated with long-term deaths for both genders, whereas obesity, former myocardial infarction and preoperative atrial fibrillation were significant risk factors in men. CONCLUSIONS Female patients showed no adverse outcomes after MIDCAB, although risk factors were gender-specific. Overall, MIDCAB demonstrated excellent short- and long-term results as a treatment for single-vessel disease in both genders.

Robotic mammary takedown and off-pump bypass surgery for single-vessel disease of the left anterior descending coronary artery

2003 ◽  
Vol 92 (10) ◽  
pp. 1222-1224 ◽  
Author(s):  
Tomislav Mihaljevic ◽  
Subroto Paul ◽  
John G. Byrne ◽  
Marzia Leacche ◽  
Robert S. Farivar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Bypass Surgery ◽  
Off Pump ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease ◽  
Pump Bypass

scholarly journals Correlation of B-Type Natriuretic Peptide Level with Severity of Coronary Artery Disease in Non St Elevated Acute Coronary Syndrome with Normal Left Ventricular Function

2017 ◽  
Vol 12 (1) ◽  
pp. 17-22
Author(s):  
Sohel Mahmud ◽  
AKM Fazlur Rahman ◽  
SM Ahsan Habib ◽  
Chaudhury Meshkat Ahmed ◽  
SM Mustafa Zaman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Lv Function ◽  
Syntax Score ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Normal Left Ventricular ◽  
Artery Disease ◽  
The Relationship

Background: Coronary artery disease (CAD) is predicted to be the most common cause of death and disability globally by 2020. In Bangladesh, for better management of coronary artery disease and to reduce the burden of acute coronary events patients with non ST elevated acute coronary syndrome (NSTE–ACS) should be focused. B-type natriuretic peptide (BNP) can be suggested as a tool to predict severity of coronary atherosclerotic lesion even with normal left ventricular (LV) function and thus to categorize the patients for appropriate referral and invasive evaluation.Aims: This study is designed to assess the relationship between level of BNP and severity of coronary artery disease assessed with SYNTAX score in NSTE-ACS patients with normal LV function. Methods: This cross sectional observational study was conducted at UCC, BSMMU during the period of May 2014 to April 2015 among the patients with non ST elevated myocardial infarction (NSTEMI) and unstable angina. 116 patients were enrolled by non-random purposive sampling who was admitted for coronary angiogram. All the data were recorded in structured questionnaire including details of medical history, coronary risk factors and physical findings. In NSTE-ACS patients with normal LV function venous blood samples were collected for BNP and later SYNTAX scoring was assessed during coronary angiogram. The relationship between level of BNP and SYNTAX score in patients with both UA and NSTE-MI was assessed statistically to evaluate the validity of BNP as a tool to predict severity of coronary atherosclerotic lesions among the patients with NSTE-ACS.Results: The mean age was 57.84±8.82 years. Among the 116 patients, highest frequency of patients was in the age group 51-60 years 55(47.4%) .In which 88(75.9%) were male. Male:Female ratio is 3.1:1.The percentage of risk factors was higher in NSTEMI group and difference with UA was statistically significant (p <0.05). Serum BNP in UA 64.9±13.07 and in NSTEMI 107.2±11.53. The mean difference of serum BNP between two groups is statistically significant. In UA group the SYNTAX score was found 13.2±11.1 and in NSTEMI 19.9±13.5 which is statistically significant. In UA group maximum patients were found two vessel disease and in NSTEMI maximum patients in three vessel disease. 70.0% of patients of three vessel disease had e” 80pg/ml of BNP. The association is statistically significant (p< 0.05). Higher the level of BNP reflect higher the vessel involvement and SYNTAX score irrespective of UA and NSTEMI.Conclusion: Our study reveals BNP is a candidate for entry into the setting of principal risk scores. Our findings indicate that the level of BNP may reflect the severity of ischemic insult even when irreversible injury and systolic dysfunction have not occurred.University Heart Journal Vol. 12, No. 1, January 2016; 17-22

scholarly journals Risk factors for ST- Elevation Myocardial Infarction in a tertiary hospital in central Nepal

2017 ◽  
Vol 13 (4) ◽  
pp. 416-419
Author(s):  
Sachin Dhungel ◽  
Shankar Laudari ◽  
Laxman Dubey ◽  
Rajesh Panjiyar ◽  
Hari Upadhyay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Medical Science ◽  
Left Circumflex Artery ◽  
Vessel Disease ◽  
Single Vessel ◽  
Triple Vessel Disease ◽  
The Mean ◽  
Single Vessel Disease

Background & Objectives: Coronary artery disease is the common cardiac disease in Nepal. The objective of the study is to explore different risk factors for coronary artery disease.Materials & Methods: This was cross sectional  hospital based study studying the baseline clinical and angiographic characters in ST Myocardial infarction who had Primary Percutaneous coronary intervention (PPCI) in College of Medical Science Teaching Hospital (CMSTH).Results: There were 95 cases with male 77 (82.1%)   and female 18 (17.9%). The mean age overall was 60.05 ± 12.2. The mean age of male was 59.9 ± 12.5 and of female was 60.5 ± 11.2 years. Apart from chest pain, common clinical symptoms were sweating in 60 (63.2%) cases, dyspnea in 41 (43.2%), nausea/vomiting in 38 (40%), dizziness in 17 (17.9%) and epigastric pain in nine (9.5%) cases. Common risk factors were smoking in 83 (87.7%) cases, hypertension 59 in (51.6 %), diabetes in 24 (25.3%), dyslipidemia in 24 (25.3%) and family history in six (6.3%) cases. Common angiographic variables were single vessel disease (SVD) in 45 (47.4%), double vessel disease (DVD) in 20 (21.1%) and triple vessel disease (TVD) in 30 (31.6%) cases. Infarct related artery were Right coronary artery (RCA) in 43 (45.3%), Left circumflex artery (LCx) in seven (7.4 %) and Left anterior descending artery (LAD) in 45 (47.4 %) cases.Conclusion: Patients visiting CMSTH had classical symptoms and risk factors of myocardial infarction. Single vessel disease and Left anterior descending infarction was the most common vessel involved.

scholarly journals CORONARY ARTERY DISEASE

2015 ◽  
Vol 22 (05) ◽  
pp. 532-535
Author(s):  
Usman Javed Iqbal ◽  
Majid Kaleem ◽  
Muhammad Imran Hanif
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Family History ◽  
Positive Family History ◽  
Causative Factor ◽  
Cross Sectional ◽  
Male Predominance ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Background: Development of heart failure is always secondary to presenceof risk factors like diabetes mellitus, hypertension, age, smoking and underlying coronaryartery disease. Objective: The objective of this study was to find the frequency of risk factorsand coronary artery involvement in patients of heart failure after myocardial infarction. StudyDesign: A non-randomized cross sectional study. Setting: Gulab Devi Chest Hospital. Period:Six months. Methods: 100 patients was done. Using non probability (purposive) samplingtechnique; all patients with ages between 20 to 80 years, irrespective of gender, diagnosedwith heart failure (with ejection fraction ≤ 40%) secondary to STEMI were included in thestudy. Patients that were not having heart failure secondary to STEMI and those that hadn’ttheir coronary angiography done were excluded from the study. The data were analyzed usingSPSS Version 20. Descriptive statistics was used to see analyze the data. Results: Mean ageof patients was 52.61±10.2years. There was an overall male predominance (81%). Commonrisk factors that we observed were smoking (65%), hypertension (62%), diabetes (58%) andpositive family history (38%). In this study 51% patients had triple vessels disease, 15% patientshad double vessels disease and 34% patients had single vessel disease. Most common lesionwas of LAD following LCX, RCA and LMS. Conclusion: Our study conclude that coronaryartery disease is the main causative factor for the development of heart failure in patients ofmyocardial infarction and even a single vessel disease can lead to heart failure with severesystolic dysfunction. Most common associated risk factor was smoking, hypertension being thesecond most common following diabetes and positive family history.

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