scholarly journals Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

2021 ◽  
pp. 15-19
Author(s):  
Tetiana Pylova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Comparative Analysis ◽  
Myocardial Ischemia ◽  
Coronary Arteries ◽  
Holter Monitoring ◽  
Group I ◽  
St Segment ◽  
Stable Coronary Heart Disease ◽  
Group Ii

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries. Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %. Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042). Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

scholarly journals Impact of ranolazine on exercise tolerance and arrhythmias in patients with INOCA

2021 ◽  
pp. 10-15
Author(s):  
Vira Tseluyko ◽  
Tetyana Pylova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Arteries ◽  
Exercise Test ◽  
Exercise Tolerance ◽  
Ventricular Arrhythmias ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Group I ◽  
Group Ii

The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring. Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated. Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18. Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II

scholarly journals ISCHEMIA trial. The relationship between medical and interventional approach to stable ischemic heart disease treatment. Myocardial ischemia with non-obstructive coronary arteries (INOCA)

2021 ◽  
pp. 114-126
Author(s):  
D.A. Yakhontov ◽  
◽  
Yu.O. Ostanina ◽  
Keyword(s):  
Heart Disease ◽  
Myocardial Ischemia ◽  
Coronary Arteries ◽  
Trial Data ◽  
Occurrence Rate ◽  
Conservative Strategy ◽  
Invasive Strategy ◽  
Stable Coronary Heart Disease ◽  
The Relationship ◽  
Severe Ischemia

Introduction. Approaches to the stable coronary heart disease (CHD) treatment have been the subject to debate a long time. One of the fi rst and fundamental studies in the treatment of stable coronary heart disease patients is the COURAGE trial, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, the CHD high prevalence with medical and social signifi cance necessitate the future consideration of the relationship between medical, that is conservative, and invasive approaches in treatment of this disease. It was particularly the focus of the recently completed multicentre ISCHEMIA trial. Another urgent problem of modern cardiology is myocardial ischemia in non-obstructive (<50% luminal occlusion) coronary arteries (INOCA) identifi ed in approximately 70% of patients who underwent coronary angiography. Aim of the research. Analysis of the available data on the management of stable CHD patients based on the ISCHEMIA trial data and review of publications on the INOCA problem. Results. In the ISCHEMIA trial, the occurrence rate of the primary outcome (cardiovascular death, myocardial infarction (MI), resuscitated cardiac arrest, hospitalization for chronic heart failure) was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The occurrence rate of the main secondary outcomes also did not differ between the groups signifi cantly. Quality of life in the invasive group was higher only in patients who had angina at baseline. The study subanalysis demonstrated that borderline left coronary artery stenosis is associated with a poor prognosis, and an invasive strategy relieves the angina symptoms. Women who participated in the ISCHEMIA trial had a higher incidence of angina attacks, despite less extensive coronary arteries (CA) lesions and less severe ischemia manifestations than men. Among patients with stable CHD accompanied with moderate to severe ischemia and severe chronic kidney disease patients, no evidence for the benefi t of the initial invasive strategy in reducing the risk of death or nonfatal myocardial infarction compared to the conservative strategy was found. As for ischemia in non-obstructive coronary arteries (INOCA), it is diagnosed in at least one in five patients who have undergone coronary angiography. This requires the search for new diagnostic methods, verifi cation of risk factors, causes, and optimal treatment approaches. Conclusion. The ISCHEMIA trial data demonstrated the necessity for a more careful selection of patients with stable CHD for invasive treatment, taking into account the angina pectoris severity and modern antianginal therapy possibilities. Management of patients with myocardial ischemia accompanied by non-obstructive CA lesions should be carried out on the basis of the EAPCI Expert Consensus Document on Ischaemia with INOCA (2020) which discusses the genesis of angina, as well as the diagnosis and treatment of this condition.

scholarly journals Comparison of Clinical Efficacy of Ticagrelor and Clopidogrel for Treatment of Coronary Heart Disease with Myocardial Ischemia

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Shuo Huang
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Shear Rate ◽  
Myocardial Ischemia ◽  
Clinical Efficacy ◽  
Control Group ◽  
Study Group ◽  
Clinical Indicators ◽  
Whole Blood Viscosity ◽  
St Segment

Objective: To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment. Methods: Ninety-six coronary heart disease patients with myocardial ischemia admitted to our hospital from July 20 to July 2019 were recruited as subjects. They were randomly divided into study group and control group according to parity of case number, with 48 patients in each group. Control group was given treatment with clopidogrel, while patients in study group were given treatment with ticagrelor. Clinical efficacy was compared between the both groups. Results: Comparison showed that total effective rate of clinical treatment was higher in study group when compared to control group (P<0.05). Frequency of ST segment depression, duration of ST segment depression, systolic blood pressure, diastolic blood pressure, heart rate and other clinical indicators in study group were superior to control group (P<0.05). Whole blood viscosity at low shear rate, whole blood viscosity at high shear rate, plasma viscosity shear rate, total cholesterol, triglyceride and other haemorheological parameters in study group were superior to control group (P<0.05). Conclusion: Application of ticagrelor has higher clinical efficacy than clopidogreal for coronary heart disease patients with myocardial ischemia. Clinical indicators and haemorheological parameters of myocardial ischemia patients were significantly improved. It should be promoted for application.

scholarly journals Different tactics of single-stent endovascular treatment among coronary heart disease patients with coronary artery bifurcation lesions

2012 ◽  
Vol 11 (2) ◽  
pp. 39-43
Author(s):  
Z. Kh. Shugushev ◽  
Yu. V. Tarichko ◽  
Yu. A. Vasyuk
Keyword(s):  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Coronary Artery ◽  
Balloon Angioplasty ◽  
Ecg Changes ◽  
Timi Grade ◽  
Group I ◽  
Bifurcation Lesions ◽  
Group Ii

Aim. To analyze the results of different tactics of single-stent endovascular treatment among patients with coronary heart disease (CHD) and coronary artery bifurcation lesions (CABL). Material and methods. The study included 135 CHD patients with CABL. All participants were divided into 2 groups: Group I (n=77; 58,3 %) consisted of patients who underwent coronary artery (CA) main branch (MB) stenting and subsequent kissing balloon angioplasty of a CA side branch (SB). Group II (n=55) included patients with “genuine” CABL, who underwent only MB stenting with SB protection, but without SB balloon angioplasty. Results. In all 132 CABL patients, drug-eluting stents were successfully implanted, with technical effectiveness of 100 % and in-hospital survival of 100 %. Clinical outcomes were similar in both groups, with no major cardiovascular events registered. At the same time, such an important angiographic index as SB diameter was significantly higher in Group I, compared to Group II. At later stages, Group II patients required SB angioplasty and demonstrated habitual angina symptoms, ischemic electrocardiographic (ECG) changes, and slow SB blood flow (TIMI grade <III) after CA MB stenting. Conclusion. MB stenting of CA bifurcation without SB kissing balloon angioplasty cannot be recommended to all CABL patients. Development of habitual angina symptoms, ischemic ECG changes, and slow SB blood flow (TIMI grade <III) often requires subsequent SB kissing balloon angioplasty.

scholarly journals Effect of Mobile Internet on Attitude and Self-Efficacy of Patients with Coronary Heart Disease Diagnosed by 12-Lead Holter ECG

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Haitao Sun ◽  
Jing Li ◽  
Yue Wang ◽  
Xiaoke Ma
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Data ◽  
Self Efficacy ◽  
Mobile Internet ◽  
Control Group ◽  
Study Group ◽  
Holter Ecg ◽  
Group I ◽  
Group Ii

Objective. To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods. The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results. No obvious difference in general data among groups ( P > 0.05 ). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher ( P < 0.05 ), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups ( P > 0.05 ). Compared with the control group, the scores of CAS-R of the study group were obviously higher ( P < 0.05 ), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better ( P < 0.05 ). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion. Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients’ perceived control attitude and self-efficacy.

Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men

2005 ◽  
Vol 12 (5) ◽  
pp. 478-483 ◽  
Author(s):  
Martin Stagmo ◽  
Steen Juul-Möller ◽  
Bo Israelsson
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Revascularization ◽  
Holter Monitoring ◽  
Middle Aged ◽  
Major Coronary Event ◽  
St Segment ◽  
Increased Risk ◽  
Coronary Events

Background Ambulatory electrocardiogram monitoring (Holter) with ST-analysis as a measure of myocardial ichemia has in populations with coronary heart disease been shown to predict major coronary events: death, myocardial infarction or coronary revascularization. There has, however, been conflicting evidence regarding the usefulness of this technique in identification of healthy subjects with increased risk for coronary heart disease. The aim of this study was to assess if Holter monitoring with ST-analysis could be used to predict future major coronary events in asymptomatic middle-aged men with a defined aggregation of traditional risk factors for coronary heart disease. Methods One hundred and fifty-five asymptomatic participants from the city of Malmö, Sweden, with known levels of conventional cardiovascular risk factors underwent Holter monitoring for analysis of transient ST-segment depression at the age of 55 years. Fifteen years after the Holter monitoring, hospital records, diagnosis and death registries were revisited for major coronary events. Results An ST-segment depression of 1 mm or greater (0.1 mV) was considered significant for myocardial ischemia and was found in 54 of the 155 men. There were no significant differences in risk factors in the two groups at baseline. The 15-year incidence of a first major coronary event was significantly higher in men with ST-segment depression (39%) than in men without ST-segment depression (20%) ( P < 0.015). A Holter electrocardiogram could predict future major coronary events with a positive and negative predictive value of 35 and 80%, respectively. Conclusions Holter monitoring can be used as a complement to conventional risk factor evaluation in deciding whether or not to treat risk factors for CHD in asymptomatic subjects.

scholarly journals Influence of silent myocardial ischemia on the life quality in patients with ischemic heart disease

2021 ◽  
Vol 20 (2) ◽  
pp. 52-58
Author(s):  
I. I. Gorovenko ◽  
T. P. Pronko
Keyword(s):  
Mental Health ◽  
Heart Disease ◽  
Myocardial Ischemia ◽  
Ischemic Heart Disease ◽  
Life Quality ◽  
Ischemic Heart ◽  
Silent Myocardial Ischemia ◽  
Group I ◽  
Group Ii ◽  
Integral Indicator

The aim of the study was to evaluate the effect of silent myocardial ischemia on the life quality and on the frequency of occurrence and severity of depressive disorders in patients with Ischemic Heart Disease. Materials and methods. The study involved 93 persons, including 42 practically healthy individuals and 51 patients with Ischemic Heart Disease: silent myocardial ischemia. The study included males, aged 45 to 60 years old. To assess the life quality, the Russian validated version of the Medical Outcomes Study-Short Form (SF-36) questionnaire developed by the Boston Institute of Health was used. The Hamilton Depression Rating Scale (HDRS) was used to study the psycho-emotional state of the patients. Statistical data analysis was performed using the Statistica 10.0 and Microsoft Excel 2010 software package. Results. Role functioning (RF) was reduced by 32 % (p<0.0001), general health (GH) was reduced by 31 % (p<0.0001), and mental health was reduced (MH) by 32 % (p<0.0001), social functioning (SF) decreased by 30 % (p<0.0001) in patients with silent myocardial ischemia compared to healthy persons. Both integral indicators of life quality were also reduced in the patients with silent myocardial ischemia compared to the control group. The integral indicator «Physical component of health» for group I was 52.24 [37.4; 59.8] and for group II – 48.84 [41.08; 53.01], p<0.001. The integral indicator «Mental health component» for group I was 54.00 [51.45; 56.76] and for group II – 47.09 [30.29; 52.71], p<0.00001. Mild to moderate depression was found in 35.3 % of the patients with silent myocardial ischemia, and 15.68 % was with severe and extremely severe depression.Conclusions. Silent myocardial ischemia decrease the life quality of patients and promotes the development of depressive states.

scholarly journals LIFE QUALITY ASSESSMENT OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE AFTER MYOCARDIAL REVASCULARIZATION

2021 ◽  
Vol 8 (6) ◽  
pp. 465-475
Author(s):  
I. A. Narkevich ◽  
O. D. Nemyatykh ◽  
K. A. Kovaleva ◽  
L. G. Ratova ◽  
I. O. Trushnikova ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Stable Coronary Artery Disease ◽  
Life Quality ◽  
Stable Coronary Heart Disease ◽  
Artery Disease ◽  
Angioplasty And Stenting

The aim of this study is to assess the life quality of patients with stable coronary artery disease after angioplasty and stenting of coronary arteries at the post-hospital stage.Materials and methods. Methods of the sociological analysis (questionnaire surveys) and methods of mathematical statistics (descriptive statistics, time series method, factor and variance analyses) were used at different stages of the prospective observational study. The research materials were as follows:1458 electronic patient records with a stable coronary heart disease (SCHD) after angioplasty and stenting of coronary arteries (ASCA); 620 questionnaires filled in by patients before the surgery, 1, 6, 12 months after discharge. The statistical analysis was performed using the IBM SPSS Statistics software.Results. The results of a comprehensive survey make it possible for us to assert that during the studied period, stable good healths of cardiac surgery patients with ASCA were maintained. Within the framework of the EQ-5D-5L questionnaire, it was revealed that more than 50% of patients have no physiological problems. The results of the SAQ analysis demonstrate that 58% of the patients feel better, and more than 34% of the patients do not have shortness of breath 1 year after the surgery. A statistically significant improvement in their healths was established according to a visual analogue scale relatively to the annual observation mark (62.82 ± 20.95), which corresponds to the high results assessment of the medical technology use. At the same time, 53% of the patients notify that the treatment results meet their own expectations.Conclusion. The proposed calculation of the integrated index of patients’ treatment efficiency demonstrated by the patients with stable coronary heart disease after angioplasty and stenting of the coronary arteries is based on the results of the factor analysis. This calculation can be used to assess the efficiency of pharmacotherapy in the framework of a value-oriented approach to the treatment of a number of other pathologies.

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