scholarly journals Comparative Characteristics of The Effects of Drug and Mechanical Reperfusion in The Treatment of Acute Coronary Syndrome with ST Elevation in Patients Working in Environmentally Challenging Conditions

2020 ◽  
Vol 8 (6) ◽  
pp. 479-486
Author(s):  
Javadova Tarana Mamedgasanovna ◽  
Mammadgasan Mammadguseynovich Agayev
Keyword(s):  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Combined Application ◽  
St Elevation ◽  
Group 2 ◽  
Comparison Of The Results ◽  
Group 1

Studied clinical and hemodynamic efficacy of complex use  heparin,Сyто-Mас,  propranolol (obzidan), fosinopril (monopril)  with and PCI; PCI conducted separately on hemodynamics on cardiohemodynamics on ekoendotoksikoz (AMP) and the clinical course of patients working in environmentally stressful conditions in the acute phase and follow-up of MI. Comparison of the results of complex mediakamentoz and mechanical revascularization with PCI conducted separately. Investigated  50 patients with   STMI in the age of 30 to 70 years (56,7 ± 1,20 years). Of the  50 patients 25 were treated Cyto-Mac, foznopril, propranolol with heparin and PCI (group 1); 25  patients were treated with PCI alone (group 2). In both groups, blood was determined by the degree ekoendotoksikoza (AMP) by EchoCG and Doppler EchoCG  studied  ESV, EDV,  EF, SI, CI , an  local contractility violation index of left ventricle (LCVI) , with the aid of restenosis koronorografii. A well established dynamics of systolic and diastolic blood pressure, clinical features of MI during follow-up. Patients treatedheparin,Cуто-мас, propranolol, foznopril  and PCIindicators of central hemodynamics stabilizis. The reduced  ЕSV,EDV, LCVI and decreased degree ofekoendotoksikoza (АMP), improves left ventricular systolic function of demand , increases PV. However, in this group, one patient on the third day was recorded AHF and one recurrent MI. İn The group spent only 2 PCI in relapse developed MI, 1 - restenosis,  2 -AHF and 1 patients died. The results show that the combined application of drug therapy with PCI provides a positive result in  comparsionwiththan separately conducted  PCI in ACS  with elevation ST.

4938Left ventricular global longitudinal strain recovery predicts scar size reduction and systolic remodelling post ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Vo ◽  
T Nguyen ◽  
A Chen ◽  
J French ◽  
J Otton ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Scar Size ◽  
Reverse Remodelling ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Lv Systolic Function ◽  
Group 1

Abstract Background Left ventricular (LV) strain has prognostic utility following ST-elevation myocardial infarction (STEMI); however, serial changes in LV strain has not been evaluated post-infarct. We sought to determine the relationship between post-STEMI transthoracic echocardiographic (TTE) LV global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) imaging derived scar size and LV systolic remodelling. Methods Following revascularisation, 172 first STEMI patients (85% male, 56.9±10.7 years) had paired TTE for GLS, and CMR to evaluate scar size and LV systolic function at baseline (2–7 days) and follow-up (8–10 weeks). Patients were divided into 3 groups according to absolute baseline GLS: group 1 (GLS ≥16%), group 2 (12%< GLS <16%), group 3 (GLS ≤12%). GLS recovery was defined as ≥10% increase in GLS at follow-up, excluding patients with normal baseline GLS. LV systolic adverse remodelling was defined as ≥15% increase in LVESV. LV systolic reverse remodelling was defined as ≥15% decrease in LVESV. Scar reduction was defined as ≥30% decrease in scar size. Results Group 1 and 2 had smaller follow-up scar size and higher LVEF compared to group 3 (p<0.0001 for both, see table). There was no difference in scar size reduction or systolic reverse remodeling among the baseline GLS groups (p>0.05 for both). Importantly, no patients from group 1 demonstrated systolic adverse remodelling. Relative change in GLS is significantly correlated with changes in LVEF (r=0.354, p<0.0001) and scar size (r=−0.262, p<0.0001), see figure. On multivariate binary logistic analysis, patients who demonstrated GLS recovery had greater reduction in scar size (OR=2.77 (1.09–7.01), p=0.032) and LV systolic reverse remodelling (OR=9.63 (1.21–76.41), p=0.032). Follow-up parameters within GLS groups All patients (n=172) Group 1 (n=47) Group 2 (n=72) Group 3 (n=53) Follow-up GLS, % 16.02±3.44 19.38±1.90 16.36±2.09 12.57±2.69 GLS recovery, n 110 (64%) 19 (40%) 53 (74%) 38 (72%) Follow-up scar size, % 7.67±5.40 5.01±3.38 6.27±3.73 12.02±6.24 Follow-up LVEF, % 51.80±10.20 57.83±6.95 54.14±8.02 43.26±9.83 Data presented as mean ± SD or n (%). Correlation graphs for change in GLS Conclusion Stratification of STEMI patients by baseline GLS was a determinant of CMR scar size as well as LV systolic function. However, the evaluation of GLS recovery could provide additional insights into reduction in scar size and LV systolic remodelling, both important prognostic markers. Thus, echocardiographic serial GLS evaluation may be a relevant non-invasive parameter, that is cheaper and more widely available for monitoring STEMI patients and guiding therapy.

scholarly journals Correlation of N-terminal pro-B-type natriuretic peptide with clinical parameters in patients with hypertension

2013 ◽  
Vol 70 (8) ◽  
pp. 728-734
Author(s):  
Janko Pejovic ◽  
Svetlana Ignjatovic ◽  
Marijana Dajak ◽  
Nada Majkic-Singh ◽  
Zarko Vucinic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Nyha Class ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Control Group ◽  
Ventricular Systolic Function ◽  
Function Group ◽  
Group 2 ◽  
Group 1

Background/Aim. Identification of patients with arterial hypertension and a possible onset of heart failure by determining the concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) enables timely intensification of treatment and allows clinicians to prescribe and implement optimal and appropriate care. The aim of this study was to evaluate NT-proBNP in patients with longstanding hypertension and in patients with signs of hypertensive cardiomyopathy. Methods. The study involved 3 groups, with 50 subjects each: ?healthy? persons (control group), patients with hypertension and normal left ventricular systolic function (group 1) and patients with longstanding hypertension and signs of hypertensive cardiomyopathy with impaired left ventricular systolic function (group 2). We measured levels of NT-proBNP, Creactive protein and creatinine according to the manufacturer?s instructions. All the patients were clinically examined including physical examination of the heart with blood pressure, pulse rate, electrocardiogram (ECG) and echocardiogram. Results. Our results showed that the determined parameters generally differed significantly (Student?s t-test) among the groups. The mean (? SD) values of NT-proBNP in the control group, group 1 and group 2 were: 2.794 (? 1.515) pmol/L, 9.575 (? 5.449) pmol/L and 204.60 (84,93) pmol/L, respectively. NTproBNP correlated significantly with the determined parameters both in the group 1 and the group 2. In the group 1, the highest correlation was obtained with Creactive protein (r = 0.8424). In the group 2, the highest correlation was obtained with ejection fraction (r = - 0.9111). NT-proBNP showed progressive increase in proportion to the New York Heart Association (NYHA) classification. The patients in thegroup 2 who belonged to the II and III NYHA class had significantly higher levels of NTproBNP than those in the NYHA class I (ANOVA test, p = 0.001). Conclusion. The obtained results suggest that NTproBNP is a useful biomarker in the treatment of patients with longstanding hypertension who are at risk for heart failure.

scholarly journals Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hui-Hui Liu ◽  
Ye-Xuan Cao ◽  
Jing-Lu Jin ◽  
Yuan-Lin Guo ◽  
Cheng-Gang Zhu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
Normal Left Ventricular ◽  
Glucose Status

Abstract Background The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with coronary artery disease (CAD) with different glucose status has not been established. This study sought to evaluate the significance of NT-proBNP in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) and normal left-ventricular systolic function (LVSF) according to different glucose status, especially in those with abnormal glucose metabolism. Methods A total of 8062 patients with CCS and normal LVSF were consecutively enrolled in this prospective study. Baseline plasma NT-proBNP levels were measured. The follow-up data of all patients were collected. Kaplan-Meier and Cox regression analyses were used to assess the risk of MACEs according to NT-proBNP tertiles stratified by glucose status. Results Over an average follow-up of 59.13 ± 18.23 months, 569 patients (7.1 %) suffered from MACEs, including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Kaplan-Meier analysis showed that high NT-proBNP levels had a significant association with MACEs in subjects with prediabetes mellitus (pre-DM) or DM, but not in patients with normoglycemia. Multivariate Cox regression analysis revealed that NT-proBNP remained an independent predictor of MACEs in patients with pre-DM [hazard ratio (HR): 2.56, 95% confidence interval (CI): 1.34–4.91] or DM (HR: 2.34, 95% CI: 1.32–4.16). Moreover, adding NT-proBNP to the original Cox model including traditional risk factors significantly increased the C-statistic by 0.035 in pre-DM and DM, respectively. Conclusions The present study indicated that NT-proBNP could well predict worse outcomes in dysglycemic patients with CCS and normal LVSF, suggesting that NT-proBNP may help with risk stratification in this population.

scholarly journals N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Hypertensive Heart Disease

2011 ◽  
Vol 30 (3) ◽  
pp. 244-249 ◽  
Author(s):  
Janko Pejović ◽  
Svetlana Ignjatović ◽  
Marijana Dajak ◽  
Nada Majkić-Singh ◽  
Žarko Vučinić
Keyword(s):  
Heart Disease ◽  
Natriuretic Peptide ◽  
Systolic Function ◽  
Nyha Class ◽  
Hypertensive Heart Disease ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Control Group ◽  
Group 2 ◽  
Group 1

N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Hypertensive Heart DiseasePatients with hypertensive heart disease have elevated concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The aim of our study was to evaluate NT-proBNP in patients with long-standing hypertension and in patients with signs of hypertensive cardiomyopathy. The study included three groups of 50 subjects: healthy persons (Control Group), patients with hypertension and normal left ventricular systolic function (Group 1) and patients with longstanding hypertension and signs of hyper tensive cardiomyopathy with impaired left ventricular systolic function (Group 2). Our results show a very good correlation (Pearson's test) between NT-proBNP in Group 1 and Group 2 and C-reactive protein (Group 1: r = 0.8424; Group 2: r = 0.6650), systolic blood pressure (Group 1: r = 0.7213; Group 2: r = 0.4856), diastolic blood pressure (Group 1: r = 0.4282; Group 2: r = 0.3989) and ejection fraction (Group 1: r = -0.7390; Group 2: r = 0.9111). ROC analysis revealed that the AUC between the Control Group and Group 1 for NT-proBNP (0.912) was not significantly different (p>0.05) from the AUC for systolic (0.924) and diastolic pressure (0.937). A cut-off value for NT-proBNP of 5.89 pmol/L can be used to reliably distinguish patients of Group 1 from the Control Group, and a cut-off value of 21.67 pmol/L reliably separates patients from Group 1 and Group 2 (in both cases, the AUC is 1.000). Patients in Group 2 who belonged to the II and III New York Heart Association (NYHA) class had significantly higher levels of NT-proBNP than those in NYHA class I (ANOVA test, p=0.001). These data suggest that NT-proBNP is a useful biomarker for distin guishing patients with long-standing hypertension who are at risk of heart failure, allowing optimization and proper treatment of these patients.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

2019 ◽  
Vol 10 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Chi Sum Yuen ◽  
Kwok Fai Lucius Lee ◽  
Inderjeet Bhatia ◽  
Nicholson Yam ◽  
Barnabe Antonio Rocha ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Congenital Cardiac Surgery ◽  
Group 2 ◽  
Bioprosthetic Valves ◽  
Group 1

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

scholarly journals Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

2020 ◽  
Vol 9 (4) ◽  
pp. 1043 ◽  
Author(s):  
Pei-Hsun Sung ◽  
Yi-Chen Li ◽  
Mel S. Lee ◽  
Hao-Yi Hsiao ◽  
Ming-Chun Ma ◽  
...  
Keyword(s):  
Systolic Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Diffuse Coronary Artery Disease ◽  
Cd34 Cells ◽  
Group 2 ◽  
Artery Disease ◽  
One Year ◽  
Lv Systolic Function ◽  
Group 1

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

scholarly journals Different lead locations guided by fluoroscopy and ECG parameters and their effect on patients functional status

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Mohamed MesbahTahaHassanin ◽  
Ahmad ShafieAmmar ◽  
Radwa M. Abdullah ◽  
Mohammad Hassan Khedr
Keyword(s):  
Functional Capacity ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Qrs Complex ◽  
Significant Difference ◽  
Septal Pacing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Right ventricular apical pacing with the resultant left ventricular dyssynchrony often leads to depressed systolic function and heart failure. This study aimed at investigating the relation between various septal locations guided by ECG and fluoroscopy and the intermediate term functional capacity of the patients. Results Fifty patients who received a single lead pacemaker with assumed > 90% pacemaker dependency. Patients were randomized according to RV pacing site RV into group 1 “high septum” (n = 15), group 2 “mid septum” (n = 25), and group 3 “low septum” (n = 10) using QRS vector and duration as well as fluoroscopic parameters. Their clinical status was assessed 6 months after device implementation using 6-min walk test (6MWT). The study showed that paced QRS complex duration itself has no significant difference between the different septal pacing locations (P-value 0.675), although its combination with the paced QRS complex vector can signify the optimal pacing site and 6MWT showed a significant difference among the groups in favor of group 1; group 1 (413.3 ± 148.5), group 2 (359.8 ± 124.6), and group 3 (276.0 ± 98.5) P value 0.04. Conclusion There was a significant difference found between the three septal pacing sites concerning the patient functional capacity with superiority of high septal location. By contrast, different septal sites showed no significant difference of the paced QRS complex duration. To optimize the pacing site in the septum, assessment of the paced QRS vector in leads I and III is of a great benefit especially when combined with paced QRS complex duration assessment.

Abstract 9947: Predictors of Left Ventricular Dysfunction After Aortic Valve Replacement in Patients With Mixed Aortic Valve Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Egbe ◽  
Joeseph Poterucha ◽  
Carole Warnes
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular Dysfunction ◽  
Aortic Valve Disease ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

Objectives: Predictors of left ventricular dysfunction (LVD) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) have not been studied. Objective was to determine prevalence and predictors of early and late LVD at 1 and 5 years post-AVR. Methods: Retrospective review of 247 patients (Age 63±8 years, males 81%) with moderate/severe MAVD who underwent AVR at the Mayo Clinic from 1994-2013. Only patients with follow-up data at 1 year post AVR were included (n=239). Cohort divided into 3 groups based on data collected prior to AVR, 1 and 5 years post AVR. LVD was defined as ejection fraction <50%. Results: LVD was present in 11/239 at baseline. At 1-year post AVR, 181 had normal EF (group 1) while 58/239 (24%) had early LVD (group 2). Predictors of LVD were atrial fibrillation (hazard ratio [HR] 1.83 confidence interval [CI] 1.59-1.98, p=0.001), age >70 years (HR: 3.12, CI: 2.33-4.18, p= <0.0001), CABG (HR: 2.17, CI: 2.24-5.93, p= <0.0001), and severe MAVD pre-operatively (HR: 2.87, CI: 2.33-3.17, p= 0.01), and hypertension (HR: 1.83, CI: 1.35-2.46, p= <0.0001). Prevalence of late LVD was 24% (47/197-group 3) and LVMI at 1 year post AVR was predictive of late LVD (HR 1.65, CI 1.11-3.8 per 10 g/ m 2 increment, p= 0.04)). Group 2 had less reverse LV remodeling compared to group 1 at 1 year post AVR (142±39 vs 129±42 g/ m 2 , p=0.02). Conclusions: Risk of LVD was significant even in subset of patients with moderate MAVD. Risk stratification of MAVD should be based on both clinical and echocardiographic parameters. Our data suggest earlier surgical intervention may be required in the MAVD population to prevent postoperative LVD but further studies are needed. Figure legend: FU: follow up

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