scholarly journals Coronary Disease Risk in Asymptomatic Patients with Left Ventricular Moderate Dilatation

2021 ◽  
Vol 17 (18) ◽  
Author(s):  
Zeikidze Solomon ◽  
Suladze Andro ◽  
Zeikidze Nikolozi
Keyword(s):  
Left Ventricle ◽  
Coronary Disease ◽  
Prognostic Value ◽  
Disease Risk ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Silent Ischemia ◽  
Treadmill Test ◽  
Ischemic Disease ◽  
Asymptomatic Patients

Goal of the Study is to assess the risk of coronary disease of asymptomatic ischemia in patients with left ventricular moderate dilatation. Methods: The work was based on the results of investigation of 185patients with left ventricular moderate dilatation, aged 35-55 years from the “Tbilisi Heart and Vascular Clinic” contingent. Among them, there are 159 men and 26 women. Results: Patients who suffer from left ventricular moderate dilatation and don’t expose typical symptom of ischemia possibly are in risk of carrying damaged coronary artery. the LV moderate dilatation of the left ventricle can be used for primary diagnosing of silent ischemia. Sensitivity - 0.867(95%CI:0.806-0.927); Specificity – 0.800(95%CI:0.703-0.897); Prognostic value of positive results; 0.889(95%CI:0.832-0.946); Prognostic value of negative results - 0.765(95%CI:0.664-0.866); diagnostic value - 0.843(95%CI:0.791-0.896). Conclusions: In patients with silent ischemia, the coronary disease predictors are: left ventricular moderate dilatation, male gender, dyslipidemia, arterial hypertension, smoking, positive treadmill test, ischemic disease in 1st degree relatives, low tolerance to treadmill test. Thus, we can use the moderate dilatation of the left ventricle for the primary diagnosing of silent ischemia. The test is simple and non-invasive. It is characterized by high sensitivity and specificity and can be used for early diagnosing of silent ischemia and the prevention of cardiac cases.

Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
NPD Cunha ◽  
I Aguiar-Ricardo ◽  
T Rodrigues ◽  
P Silverio Antonio ◽  
S Couto Pereira ◽  
...  
Keyword(s):  
Exercise Training ◽  
Left Ventricle ◽  
Cardiac Rehabilitation ◽  
Phase Ii ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ischemic Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive.  Purpose Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram.  Methods Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP. Results 205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%).  After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device.  Conclusions A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

Ischemic and non-ischemic dilated cardiomyopathy

Open Medicine ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Giovanni Fazio ◽  
Federica Vernuccio ◽  
Emanuele Grassedonio ◽  
Giuseppe Grutta ◽  
Giuseppe Lo Re ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Ischemic Disease ◽  
Coronary Imaging ◽  
Diagnostic Potential ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Cmr Imaging

AbstractDilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.

scholarly journals Comparative Study of Prognostic Value for Coronary Disease Risk Between the U.K. Prospective Diabetes Study and Framingham Models

Diabetes Care ◽  
2003 ◽  
Vol 27 (1) ◽  
pp. 277-278 ◽  
Author(s):  
I. D. Protopsaltis ◽  
P. A. Konstantinopoulos ◽  
A. V. Kamaratos ◽  
A. I. Melidonis
Keyword(s):  
Comparative Study ◽  
Coronary Disease ◽  
Prognostic Value ◽  
Disease Risk

scholarly journals Prognostic value of sST2 in heart failure patients with diabetes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Castiglione ◽  
M Chiriaco' ◽  
A Aimo ◽  
J Januzzi ◽  
A.M Richards ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Prognostic Value ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Multivariate Linear Regression Analysis ◽  
Available N ◽  
Inflammatory Status ◽  
Hs Crp

Abstract Background Soluble suppression of tumorigenesis-2 (sST2) is released in response to inflammation and vascular injury, and holds prognostic value in heart failure (HF). Type 2 diabetes (T2D) is characterized by a pro-inflammatory status and is highly prevalent among HF patients, with adverse impact on outcomes. The clinical value of sST2 in HF patients with T2D has never been characterized. Purpose We aimed to assess sST2 clinical correlates and prognostic value in HF patients with T2D. Methods Individual data of 3476 patients with stable chronic HF from 5 cohorts from the BIOS (Biomarkers In Heart Failure Outpatient Study) dataset were analysed, with available N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and sST2 levels. Results Mean age was 65±12 years (75% males). T2D was present in 1386 patients (40%), who had higher body mass index (BMI, 27 [24–30] vs. 26 [23–29] kg/m2, p&lt;0.001), lower estimated glomerular filtration rate (eGFR, 56±22 vs. 60±19 mL/min/1,73 m2, p&lt;0.001), higher sST2 (33 [24–47] vs. 27 [20–40] ng/mL, p&lt;0.001), NT-proBNP (1735 [742–3963] vs. 1450 [514–3299] ng/L, p&lt;0.001), hs-TnT (28 [16.2–51.5] vs. 17 [9–31] ng/L, p&lt;0.001) and high-sensitivity C-reactive protein (hs-CRP, 6 [2–11] vs. 4. [2–9] mg/L, p=0.003) (Figure). Differences between sST2 levels in patients with or without T2D were influenced by hs-CRP (p for interaction=0.010) and hs-TnT (p=0.031), but not by NT-proBNP and eGFR. At multivariate linear regression analysis, NT-proBNP, hs-TnT and hs-CRP were independently associated with sST2 levels in both T2D and non-T2D patients. Compared with patients without T2D, those with T2D showed higher 1-year all-cause mortality (12% vs. 10%, p=0.034), cardiovascular mortality (9% vs. 7%, p=0.011), and HF hospitalization rate (22% vs. 12%, p&lt;0.001). In a prognostic model including age, sex, eGFR, ischemic vs- non-ischemic aetiology, left ventricular ejection fraction class, New York Heart Association class, NT-proBNP, hs-TnT, and hs-CRP, sST2 retained independent prognostic value in both patients with or without T2D for 1-year all-cause and cardiovascular mortality, and 1-year HF hospitalization, with higher optimal cut-offs for mortality prediction in T2D vs. non-T2D (39 and 45 vs. 29 and 29 ng/mL respectively for 1-year all-cause and cardiovascular mortality). Conclusions sST2 is higher in HF patients with T2D and likely linked to a pro-inflammatory status. sST2 maintains its prognostic value both in diabetic and non-diabetic HF patients, independently of NT-proBNP, hs-TnT and hs-CRP. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Segmentally impaired left ventricular longitudinal strain: a new predictive diagnostic parameter for asymptomatic patients with severe aortic stenosis and preserved ejection fraction

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Peggy M Kostakou ◽  
Elsie S Tryfou ◽  
Vassilios S Kostopoulos ◽  
Lambros I Markos ◽  
Dimitrios S Damaskos ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Average Strain ◽  
Asymptomatic Patients ◽  
Significant Difference

Introduction: This study aims to investigate the correlation between severe aortic stenosis (sAS) and impairment of left ventricular global longitudinal strain (LVGLS) in particular segments, using two-dimensional speckle tracking echocardiography in patients with sAS and normal ejection fraction of left ventricle (LVEF). Methods: The study included 53 consecutive patients with asymptomatic sAS and preserved LVEF. The regional longitudinal systolic LV wall strain was evaluated at the area opposite of the aorta as the median strain value of the basal, middle, and apical segments of the lateral and posterior walls and was compared to the average strain value of the interventricular septum (IVS) at the same views. Results: LVGLS was decreased and was not statistically different between three- and four-chamber views (−12.5 ± 3.6 vs −11.4 ± 5.5%, p = 0.2). The average strain values of the lateral and posterior walls were statistically reduced compared to the average value of the IVS (lateral vs IVS: −7.8 ± 3.7 vs −10 ± 5.3%, p = 0.005, posterior vs IVS: −7.7 ± 4.2 vs −10.3 ± 3.8%, p < 0.0001). There was no significant difference between lateral and posterior walls (−7.8 ± 3.7 vs −7.7 ± 4.2%, p = 0.9). Conclusions: The strain of lateral and posterior walls of left ventricle, which lay just opposite to the aortic valve seem to be more reduced compared to other walls in patients with sAS and preserved LVEF possibly due to their anatomical position. This impairment seems to be the reason of the overall LVGLS reduction. Regional strain could be used as an extra tool for the estimation of the severity of AS as well as for prognostic information in asymptomatic patients.

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 Prognostic value of high-sensitivity cardiac troponin I in heart failure patients with mid-range and reduced ejection fraction

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255271
Author(s):  
Petr Lokaj ◽  
Jindrich Spinar ◽  
Lenka Spinarova ◽  
Filip Malek ◽  
Ondrej Ludka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Troponin I ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
Ctni Level

Background The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica®, Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%–49%). Methods and results A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI. Conclusion hs-cTnI levels ≥ 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient’s hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.

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