scholarly journals The modified protocol of transesophageal atrial pacing in stress echocardiography as an alternative way to increase the information value of the method for detection of ischemic wall motion abnormalities

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 71-76
Author(s):  
M. A. Saidova ◽  
J. V. Botvina ◽  
V. N. Shitov ◽  
L. S. Atabaeva
Keyword(s):  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Information Value ◽  
Atrial Pacing ◽  
Circumflex Artery ◽  
Diagnostic Significance ◽  
Coronary Insufficiency ◽  
Group 2

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). In addition to stress-EchoCG with TEAES, selective coronary angiography was performed for all patients. The development of the new method for evaluating occult coronary insufficiency was based on comparison of SP and MP for TEAES with stress-EchoCG with data of coronary angiography.Results    In both groups, significant differences in values of systolic and diastolic blood pressure were absent. However, the values of achieved heart rate were significantly different: 141±11 (TEAES SP) and 155±10 (TEAES MP) bpm (p=0.01). There was also a difference in the duration of the TEAES protocols: 15±3 and 5±2 min, respectively (p=0.006). The use of the modified TEAES protocol for detecting transient disorders of left ventricular myocardial local contractility increased the sensitivity, specificity and accuracy of the test from 76 %, 87 %, and 80 % to 83 %, 92 %, and 86 %, respectively. The most significant differences were found in the area supplied by the circumflex artery: the SP and MP sensitivities were 63 % and 75 %, respectively (p<0.05) and the SP and MP accuracies were 81 % and 90 %, respectively (p<0.05).Conclusion    Evaluation of occult coronary insufficiency by stress-EchoCG with the TEAES MP as compared to the TEAES SP provides a gentler procedure regimen for the patient due to a shorter duration of the test and at the same time improves the diagnostic significance of this method in IHD patients.

scholarly journals Evaluation of strain parameters during stress-echocardiography with physical exercise may be significant in detecting severe coronary artery disease

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Stepanova ◽  
NF Radova ◽  
MN Alekhin
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Global Longitudinal Strain ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Gensini Score ◽  
The Difference ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Assessment of the left ventricular strain during speckle-tracking stress echocardiography may be significant in diagnosing transient myocardial ischemia. So it is challenging to evaluate left ventricular global longitudinal strain (GLS) and post-systolic shortening indicators during stress-echocardiography and compare their diagnostic value with the data obtained with invasive methods of diagnosing coronary artery disease (CAD). Aim of the study. The aim of this study was to determine the diagnostic capabilities of the left ventricular GLS, delta GLS, left ventricular post-systolic index (PSI) and post-systolic time (PST) obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods. The study included 113 patients (mean age 64.8 ± 9.4 years; 43 females) with known or suspected CAD. All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of left ventricular GLS, left ventricular PSI and PST using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLS values was also counted. The delta of the left ventricular GLS values was counted as the difference of the left ventricular GLS values after the load and at rest. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 41 patients without CAD, 53 patients with moderate CAD (≤34 points on the Gensini score) and 19 patients with severe CAD (&gt;35 points on the Gensini score). Results. In the group of patients with severe CAD, values of left ventricular GLS after the load significantly differed from the group of patients without CAD (16,1 compared with 20,3; p = 0,003) and from the group of patients with moderate CAD (16,1 compared with 19,4; p = 0,003). At rest GLS values didn’t differ significantly between all groups. Left ventricular GLS delta in the group of patients with severe CAD differed significantly with the group of patients without CAD (-1,8 compared with 1,3; p = 0,003) and with the group of patients with moderate CAD (-1,8 compared with 0,6; p = 0,03). Left ventricular PSI differed significantly between the group of patients with severe CAD and the group of  patients without CAD after the load (8,4 compared with 5,1; p = 0,03) and at rest didn’t differ significantly. Left ventricular PST values didn’t differ significantly at rest and after the load in all groups. Conclusions. Strain parameters such as left ventricular GLS, left ventricular GLS delta and left ventricular PSI assessed during stress-echocardiography on the treadmill may be useful in identifying patients with severe CAD. Left ventricular PST didn’t show significance in identifying CAD.

scholarly journals Incremental Value of Left Ventricular Mechanical Dyssynchrony Assessment by Nitrogen-13 Ammonia ECG-Gated PET in Patients With Coronary Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Danzha Zheng ◽  
Yanyun Liu ◽  
Lei Zhang ◽  
Fan Hu ◽  
Xubo Tan ◽  
...  
Keyword(s):  
Myocardial Viability ◽  
Diagnostic Value ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Cardiac Events ◽  
Nitrogen 13 Ammonia ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease

Background: Phase analysis is a technique used to assess left ventricular mechanical dyssynchrony (LVMD) in nuclear myocardial imaging. Previous studies have found an association between LVMD and myocardial ischemia. We aim to assess the potential diagnostic value of LVMD in terms of myocardial viability, and ability to predict major adverse cardiac events (MACE), using Nitrogen-13 ammonia ECG-gated positron emission tomography (gPET).Methods: Patients with coronary artery disease (CAD) who underwent Nitrogen-13 ammonia and Fluorine-18 FDG myocardial gPET were enrolled, and their gPET imaging data were retrospectively analyzed. Patients were followed up and major adverse cardiac events (MACE) were recorded. The Kruskal-Wallis test and Mann-Whitney U test were performed to compare LVMD parameters among the groups. Binary logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and multiple stepwise analysis curves were applied to identify the relationship between LVMD parameters and myocardial viability. Kaplan–Meier survival curves and the log-rank test were used to look for differences in the incidence of MACE.Results: In total, 79 patients were enrolled and divided into three groups: Group 1 (patients with only viable myocardium, n = 7), Group 2 (patients with more viable myocardium than scar, n = 33), and Group 3 (patients with less viable myocardium than scar, n = 39). All LVMD parameters were significantly different among groups. The median values of systolic phase standard deviation (PSD), systolic phase histogram bandwidth (PHB), diastolic PSD, and diastolic PHB between Group 1 and Group 3, and Group 2 and Group 3 were significantly different. A diastolic PHB of 204.5° was the best cut-off value to predict the presence of myocardial scar. In multiple stepwise analysis models, diastolic PSD, ischemic extent, and New York Heart Association (NYHA) classification were independent predictive factors of viable myocardium and myocardial scar. The incidence of MACE in patients with diastolic PHB &gt; 204.5° was 25.0%, higher than patients with diastolic PHB &lt;204.5° (11.8%), but the difference was not significant.Conclusions: LVMD generated from Nitrogen-13 ammonia ECG-gated myocardial perfusion imaging had added diagnostic value for myocardial viability assessment in CAD patients. LVMD did not show a definite prognostic value.

Abstract 2086: Usefulness of Pneumatic Lower Extremity Compression During Dobutamine Stress Echocardiography

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hyung-Kwan Kim ◽  
Sung-A Chang ◽  
Jin-Shik Park ◽  
Yong-Jin Kim ◽  
Joo-Hee Zo ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Positive Response ◽  
Dobutamine Stress Echocardiography ◽  
False Negative ◽  
Lower Extremities ◽  
Wall Stress ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Myocardial Oxygen Demand

Background Afterload is expected to increase with pneumatic compression of the lower extremities. Therefore, left ventricular (LV) wall stress which is the most important factor determining myocardial oxygen demand will also increase, leading to an increase in sensitivity of dobutamine stress echocardiography (DSE) or shortened time to positive response.The purpose of this study was to evaluate the effect of pneumatic compression of lower extremities on the diagnostic accuracy of DSE. Methods In 40 patients who underwent DSE and were anticipating coronary angiography, DSE was repeated with the pneumatic compression (100mmHg) of lower extremities (DSEcomp) prior to coronary angiography. Sensitivity and specificity of DSE and DSEcomp were determined based on the coronary angiographic finding. Results All patients tolerated pneumatic compression of the lower extremities during the tests. LV end-systolic volume (p=0.042) and end-systolic wall stress (p=0.036) were significantly greater in the DSEcomp than DSE. In 3 patients with false negative results in DSE, DSEcomp showed positive responses, demonstrating a significant increase in sensitivity from 75% to 94% (p=0.045). Only 1 patient with true negative result in DSE was interpreted as showing positive response in DSEcomp, resulting in a decrease in specificity from 88% to 83% (p=NS). In 11 of 13 patients with true positive results both in DSE and DSEcomp, positive responses were seen at least 1 stage earlier in DSEcomp compared to DSE. Conclusions Pneumatic compression of lower extremities increases the sensitivity of DSE and shortens the time to positive response.

Assessment of left ventricular function from M‐mode measurement of circumflex artery motion recorded by coronary angiography

2003 ◽  
Vol 37 (5) ◽  
pp. 259-265
Author(s):  
Anders Kähäri ◽  
Per Thunberg ◽  
Kent Emilsson ◽  
Håkan Geijer ◽  
Torbjörn Andersson ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Circumflex Artery

scholarly journals THE DIAGNOSTIC SIGNIFICANCE OF FLUORESCENCE ANGIOGRAPHY FOR THE EARLY DETECTION AND PROGNOSTICATION OF THE DEVELOPMENT OF ACTIVE RETINOPATHY OF PREMATURITY IN THE INFANTS BORN ON THE DEADLINES OF GESTATION

2017 ◽  
Vol 12 (1) ◽  
pp. 17-22 ◽  
Author(s):  
E. I Saidasheva ◽  
V. A Lyubimenko ◽  
S. V Buyanovskaya ◽  
F. V Kovshov
Keyword(s):  
Early Detection ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Diagnostic Value ◽  
Retinal Blood Flow ◽  
Fluorescence Angiography ◽  
Diagnostic Significance ◽  
Extremely Preterm ◽  
Group 2 ◽  
Preterm Born

Aim. The objective of the present study was to elucidate the fluorescent angiographic characteristics, such as the features of retinal and choroidal microcirculation, depending on the duration of the active course of retinopathy of prematurity in the infants born on the deadlines of gestation (the gestational age of 21-26 weeks). Materials and methods. The study included 65 patients presenting with retinopathy of prematurity. A total of 102 sessions of fluorescence angiography (FA) of the retina were carried out, with 40% of the sessions being performed in duplicate. The gestational age of the infants ranged from 22 to 26 (mean 24.9+-1.0) weeks, their body weight at birth varied from 490 to 1,400 (mean BW 774.8+-152.6) g. All the patients were subdivided into 4 groups. Group 1 was comprised of 8 (12.3%) children at the initial stages of retinopathy of prematurity, group 2 consisted of 28 (43.1%) children presenting with threshold retinopathy of prematurity, group 3 was composed of 20 (30.8%) children with the recurring disorder, and group 4 involved 9 (13.8%) children experiencing induced regression of this pathology. The photographs of the fundus and digital video FA images were obtained with the use of the RetCam3 pediatric retinal camera (“Clarity”, USA). The 10% fluorescein solution was administered intravenously in the form of bolus injections at a dose of 7.5 mg/kg. Results. The present study has revealed some characteristic fluorescent and angiographic features of active retinopathy of prematurity in the extremely preterm born infants including instability of the retinal blood flow, variability in the filling of the choroid, various types of pathological branching of the blood vessels at the boundary between vascularized and avascular retina, etc. The comparative analysis of the angiograms and colour images of the fundus obtained with the use of the RetCam3 camera gave evidence of the high diagnostic value of the fluorescence angiography technique that provides the possibility for the early objective visualization and registration of the pathological changes in the retinal vasculature characteristic of the initial and threshold stages of the disease as well as for the reliable detection of the signs of its relapse (the local sites of re-proliferation) and regression of the pathology being considered. Conclusion. The application of the fluorescence angiography technique for the examination of the markedly prematurely born infants provides a safe and efficient tool allowing to greatly optimize both the early detection and prognostication of the development of active retinopathy of prematurity in the infants born on the deadlines of gestation.

scholarly journals P1399 Global longitudinal systolic deformation of the left ventricle during stress echocardiography with physical exercise may identify patients with severe coronary artery disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Stepanova ◽  
M N Alekhin
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Left Ventricle ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Gensini Score ◽  
Treadmill Test ◽  
Artery Disease ◽  
Diagnostic Capabilities

Abstract Background Assessment of longitudinal systolic deformation of the left ventricular myocardium during speckle tracking stress echocardiography can potentially be significant in the diagnosis of transient myocardial ischemia. In this regard, determination of the global longitudinal systolic deformation (GLSD) of the left ventricle during stress echocardiography is challenging and its diagnostic capabilities can be assessed by comparing them with the data obtained with invasive methods for diagnosing coronary artery disease (CAD). Aim of the study The aim of this study was to determine the diagnostic capabilities of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods The study included 80 patients (mean age 68.3 ± 7.8 years; 29 females). All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of the left ventricular GLSD using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLSD values was counted. The delta of the left ventricular GLSD values was counted as the difference of the left ventricular GLSD values at rest and after the exercise. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 21 patients without CAD, 45 patients with moderate CAD (&lt;34 points on the Gensini score) and 14 patients with severe CAD (&gt; 34 points on the Gensini score). Results In the group of patients with severe CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test significantly differed from the groups of patients with moderate CAD and without CAD (-0.56 compared with 2.17; p = 0,009). In the group of patients without CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test did not significantly differ from the group of patients with CAD (0.23 compared to -0.95; p = 0.199). Conclusions The delta of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill showed a reliable significance in determining severe CAD, but did not demonstrate a reliable significance in identifying the absence of CAD.

scholarly journals 704 Stress echocardiography: myocardial work ‘works’

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maurizio Cusma ◽  
Rodolfo Caminiti ◽  
Antonio Parlavecchio ◽  
Giampiero Vizzari ◽  
Nunzio Fichera ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Wall Motion ◽  
Diagnostic Technique ◽  
Subjective Assessment ◽  
Left Ventricular ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
Coronary Syndrome ◽  
2D Strain ◽  
Artery Disease

Abstract Stress echocardiography is a widely employed diagnostic technique relying on subjective assessment of left ventricular wall motion and particular expertise. We report a case of a male patient with chronic coronary syndrome, who underwent dipyridamole echocardiography before planned non cardiac surgery. Despite the absence of symptoms and relevant electrocardiographic and wall motion changes, only 2D strain and, especially, Myocardial Work analysis was able to detect abnormalities suggestive of myocardial ischaemia. Thus, coronary angiography was performed, showing critical stenosis of the proximal Circumflex artery, that was treated with angioplasty and drug-eluting stent implantation. Interestingly, the location of strain and myocardial work abnormalities was consistent with the culprit vessel territory. This case highlights the particular usefulness of advanced echocardiographic techniques, especially for the detection of one-vessel coronary artery disease, during stress echocardiography.

Decreased layer specific longitudinal strain in myocardial segments supplied by stenosed LAD coronary artery: analysis for baseline, peak and recovery phase of stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Kowalczyk ◽  
J.D Kasprzak ◽  
P Hamala ◽  
B Nowak ◽  
R Nowakowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Statistical Significance ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Stress Tests ◽  
Myocardial Layers ◽  
Group 2 ◽  
Group 1

Abstract Background Despite wide utility of global longitudinal strain in the assessment of left ventricular function up to now little is known about layer specific quantification of myocardial function during stress tests and its potential for ischemia detection. Purpose To investigate diagnostic utility of layer specific LS during stress echocardiography using marker segments in patients with established Left Anterior Descending (LAD) coronary artery status. Methods We retrospectively analyzed 63 patients (mean age 62.5±9.9 years, 62% males) with suspected coronary artery disease, who had performed dobutamine stress echocardiography (DSE). Layer specific speckle tracking LS analyses were performed during rest, maximal stress and recovery. As a marker for LAD (segment most probably supplied by this artery) we used mid-anterior left ventricle segments. LAD status were established with coronary angiography or angioCT and consider as significant if ≥70% stenosis was present. Results In our study group 14 patients had significantly stenosed LAD (group 1) and 24 had normal coronaries (group 2). We detected significantly lowered absolute values of strain in endocardial and mid-myocardial layers of segments supplied by stenosed LAD at rest for endocardium −8.6% (group 1) vs −13.4% (group 2); p=0.045; and mid-myocardium −7.3% (group 1) vs −11.2% (group 2); p=0.044. Moreover, we observed similar trend at recovery, however without reaching statistical significance. Conclusions Longitudinal strain analysis focused on segments supplied by assessed coronary artery my provide quantitative data confirming ischemia in the settings of rest and stress echocardiography. Our pilot study suggest that for inotropic agents like dobutamine the potential ischemic dysfunction may be however masked at peak stage of the test. Funding Acknowledgement Type of funding source: None

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