scholarly journals Clinical Values of Resting Electrocardiography in Patients with Known or Suspected Chronic Coronary Artery Disease: A Stress Perfusion Cardiac MRI Study

2021 ◽  
Author(s):  
Yodying Kaolawanich ◽  
Rawiwan Thongsongsang ◽  
Thammarak Songsangjinda ◽  
Thananya Boonyasirinant
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Multivariable Analysis ◽  
Stress Perfusion ◽  
Cardiac Events ◽  
Chronic Coronary Artery Disease ◽  
Artery Disease ◽  
Ecg Abnormalities

Abstract Background Electrocardiography (ECG) is an essential investigation in patients with chronic coronary artery disease (CAD). However, evidence regarding the diagnostic and prognostic value of ECG in this population is limited. Therefore, we sought to determine whether baseline ECG abnormalities were associated with myocardial ischemia and cardiac events in patients with known or suspected chronic CAD. Methods Consecutive patients with known (n=146) or suspected chronic CAD (n=349) referred for adenosine stress cardiac magnetic resonance (CMR) between 2011 and 2014 were enrolled. Resting ECGs were classified as major, minor and no abnormalities. Predictors of myocardial ischemia on CMR and major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for heart failure and late revascularization (>180 days after CMR) were evaluated.Results Average age was 69±11 years (51% men). One hundred and eighty-five patients (37.4%) had major and 154 (31.1%) had minor ECG abnormalities. In patients with suspected CAD, myocardial ischemia was present in 83 patients (23.8%). Multivariable analysis demonstrated major ECG abnormality as the strongest predictor of myocardial ischemia (HR 2.88; 95% CI 1.69-4.92; p<0.001). Adding ECG to clinical pretest probability models improved the prediction of myocardial ischemia in ROC analyses (p=0.04). In the whole cohort (n=495), 91 MACE occurred during the median follow-up period of 4.8 years. Multivariable analysis showed that diastolic blood pressure, history of heart failure, prior revascularization, ischemia, myocardial scarring, and major ECG abnormality were independent predictors of MACE.Conclusion Abnormal resting ECG is common in patients with known or suspected chronic CAD. ECG had important diagnostic and prognostic values in this population.

scholarly journals Clinical values of resting electrocardiography in patients with known or suspected chronic coronary artery disease: a stress perfusion cardiac MRI study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yodying Kaolawanich ◽  
Rawiwan Thongsongsang ◽  
Thammarak Songsangjinda ◽  
Thananya Boonyasirinant
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Multivariable Analysis ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Chronic Coronary Artery Disease ◽  
Artery Disease ◽  
Ecg Abnormalities

Abstract Background Electrocardiography (ECG) is an essential investigation in patients with chronic coronary artery disease (CAD). However, evidence regarding the diagnostic and prognostic value of ECG in this population is limited. Therefore, we sought to determine whether baseline ECG abnormalities were associated with myocardial ischemia and cardiac events in patients with known or suspected chronic CAD. Methods Consecutive patients with known (n = 146) or suspected chronic CAD (n = 349) referred for adenosine stress cardiac magnetic resonance (CMR) between 2011 and 2014 were enrolled. Resting ECGs were classified as major, minor, and no abnormalities. Predictors of myocardial ischemia on CMR and major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for heart failure and late revascularization (> 180 days after CMR) were evaluated. Results Average age was 69 ± 11 years (51% men). One hundred and eighty-five patients (37.4%) had major and 154 (31.1%) had minor ECG abnormalities. In patients with suspected CAD, myocardial ischemia was presented in 83 patients (23.8%). Multivariable analysis demonstrated major ECG abnormality as the strongest predictor of myocardial ischemia (HR 2.51; 95% CI 1.44–4.36; p = 0.001). Adding ECG to clinical pretest probability models improved the prediction of myocardial ischemia in ROC analyses (p = 0.04). In the whole cohort (n = 495), 91 MACE occurred during the median follow-up period of 4.8 years. Multivariable analysis showed that diabetes mellites, history of heart failure, prior revascularization, left ventricular ejection fraction, ischemia, and major ECG abnormality were independent predictors of MACE. Conclusion Abnormal resting ECG is common in patients with known or suspected chronic CAD. ECG had important diagnostic and prognostic values in this population.

scholarly journals Modifiable Risk Factors and Major Cardiac Events Among Adult Survivors of Childhood Cancer

2013 ◽  
Vol 31 (29) ◽  
pp. 3673-3680 ◽  
Author(s):  
Gregory T. Armstrong ◽  
Kevin C. Oeffinger ◽  
Yan Chen ◽  
Toana Kawashima ◽  
Yutaka Yasui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Childhood Cancer ◽  
Cardiovascular Risk Factors ◽  
Valvular Disease ◽  
Cardiac Events ◽  
Artery Disease

Purpose To evaluate the relative contribution of modifiable cardiovascular risk factors on the development of major cardiac events in aging adult survivors of childhood cancer. Patients and Methods Among 10,724 5-year survivors (median age, 33.7 years) and 3,159 siblings in the Childhood Cancer Survivor Study, the prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity was determined, along with the incidence and severity of major cardiac events such as coronary artery disease, heart failure, valvular disease, and arrhythmia. On longitudinal follow-up, rate ratios (RRs) of subsequent cardiac events associated with cardiovascular risk factors and cardiotoxic therapy were assessed in multivariable Poisson regression models. Results Among survivors, the cumulative incidence of coronary artery disease, heart failure, valvular disease, and arrhythmia by 45 years of age was 5.3%, 4.8%, 1.5%, and 1.3%, respectively. Two or more cardiovascular risk factors were reported by 10.3% of survivors and 7.9% of siblings. The risk for each cardiac event increased with increasing number of cardiovascular risk factors (all Ptrend < .001). Hypertension significantly increased risk for coronary artery disease (RR, 6.1), heart failure (RR, 19.4), valvular disease (RR, 13.6), and arrhythmia (RR, 6.0; all P values < .01). The combined effect of chest-directed radiotherapy plus hypertension resulted in potentiation of risk for each of the major cardiac events beyond that anticipated on the basis of an additive expectation. Hypertension was independently associated with risk of cardiac death (RR, 5.6; 95% CI, 3.2 to 9.7). Conclusion Modifiable cardiovascular risk factors, particularly hypertension, potentiate therapy-associated risk for major cardiac events in this population and should be the focus of future interventional studies.

scholarly journals Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer

2016 ◽  
Vol 34 (23) ◽  
pp. 2743-2749 ◽  
Author(s):  
Lee W. Jones ◽  
Laurel A. Habel ◽  
Erin Weltzien ◽  
Adrienne Castillo ◽  
Dipti Gupta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Menopausal Status ◽  
Multivariable Analysis ◽  
Recreational Physical Activity ◽  
Cvd Risk ◽  
Artery Disease

Purpose Cardiovascular disease (CVD) is a leading cause of death among women with nonmetastatic breast cancer. Whether exercise is associated with reductions in CVD risk in patients with breast cancer with an elevated CVD risk phenotype is not known. Methods Using a prospective design, women (n = 2,973; mean age, 57 years) diagnosed with nonmetastatic breast cancer participating in two registry-based, regional cohort studies, completed a questionnaire that assessed leisure-time recreational physical activity (metabolic equivalent task [MET]-h/wk). The primary end point was the first occurrence of any of the following: new diagnosis of coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, occurring after study enrollment. Results Median follow-up was 8.6 years (range, 0.2 to 14.8 years). In multivariable analysis, the incidence of cardiovascular events decreased across increasing total MET-h/wk categories (Ptrend < .001). Compared with < 2 MET-h/wk, the adjusted hazard ratio was 0.91 (95% CI, 0.76 to 1.09) for 2 to 10.9 MET-h/wk, 0.79 (95% CI, 0.66 to 0.96) for 11 to 24.5 MET-h/wk, and 0.65 (95% CI, 0.53 to 0.80) for ≥ 24.5 MET-h/wk. Similar trends were observed for the incidence of coronary artery disease and heart failure (P values < .05). Adherence to national exercise guidelines for adult patients with cancer (ie, ≥ 9 MET-h/wk) was associated with an adjusted 23% reduction in the risk of cardiovascular events in comparison with not meeting the guidelines (< 9 MET-h/wk; P < .001). The association with exercise did not differ according to age, CVD risk factors, menopausal status, or anticancer treatment. Conclusion Exercise is associated with substantial, graded reductions in the incidence of cardiovascular events in women with nonmetastatic breast cancer.

scholarly journals Association of the Extent of Myocardial Ischemia with Outcomes in Patients with Suspected Coronary Artery Disease

2020 ◽  
Author(s):  
Takao Kato ◽  
Mitsuru Momose ◽  
Yukari Uemura ◽  
Masanao Naya ◽  
Naoya Matsumoto ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Single Photon ◽  
Heart Diseases ◽  
Photon Emission ◽  
Suspected Coronary Artery Disease ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Artery Disease

Abstract Background: There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.Methods: From the data of 2780 patients with stable angina, who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests, 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year. Results: Patients with ≥10% myocardial ischemia (n=173) were older than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (9.1% vs. 1.2%, P<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant (adjusted hazard ratio [95% confidence interval], 2.40 [1.09-5.26], P=0.029).Conclusion: The presence of ≥10% myocardial ischemia was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.

scholarly journals IMPACT OF ANXIETY AND DEPRESSIVE DISORDERS ON THE NEUROPEPTIDE-CYTOKINE STATUS OF IMMUNE SYSTEM IN VARIOUS VARIANTS OF THE CLINICAL COURSE OF CHRONIC ISCHEMIC HEART DISEASE

2019 ◽  
Vol 21 (5) ◽  
pp. 973-980
Author(s):  
A. V. Gertsev ◽  
V. N. Ischuk ◽  
Yu. N. Zakrevskii
Keyword(s):  
Coronary Artery Disease ◽  
Immune System ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Depressive Disorders ◽  
Chronic Ischemic Heart Disease ◽  
Chronic Coronary Artery Disease ◽  
Opiate Peptides ◽  
Artery Disease

Occurrence of coronary artery disease in combination with anxiety-depressive disorders is common in clinical practice. In such patients, affective disorders significantly may cause progression of atherosclerotic processes, thus complicating the course of cardiac pathology and prognosis. Distinct markers of immune inflammation, first of all, cytokines are of particular importance for the pro-atherogenic effects in atherosclerotic foci. Endogenous opiate peptides are considered the main regulators of these processes at the neuroimmune level. Their role for stabilization of cytokine levels in evolving inflammation in atherosclerotic plaque, and during adaptation of heart muscle to stressful effects was previously shown. Despite reliable data on the role of immune inflammatory markers in atherogenesis, the validity of the regulatory role of opiate peptides in this process, questions still exist about the effects of affective disorders upon neuropeptide-cytokine status of the immune system in the patients with chronic ischemic heart disease (IHD). Another issue concerns the ranges of these changes in painful and painless forms of myocardial ischemia.Therefore, the purpose of our study was to assess the impact of severity of anxiety-depressive disorders upon the neuropeptide-cytokine status of immune system in patients with various clinical variants of chronic IHD, as well as comparisons of these changes expressed in painlul and painless myocardial ischemia.Appropriate groups were formed, then being divided into subgroups, according to the percentage of painful and painless episodes of angina pectoris: Group 1 (n = 36) included patients with chronic coronary artery disease occurring and moderate-grade anxiety/depression; Group 2 (n = 34) consisted of patients with chronic coronary artery disease and mild anxiety-depressive disorders; Group 3 (n = 20) included patients with chronic coronary artery disease without anxiety and depressive disorders; Group 4 (n = 22) represented controls (healthy persons). As based on presence of painful and painless episodes of stenocardia, the following subgroups were specified: in the 1 st group of patients, painful form of IHD was detected in 44% of cases (n = 17); painless form of IHD was detected in 56% of patients (n = 19); in the 2 nd group of patients, painful form of IHD is in 52% of the examined persons (n = 18), painless form of IHD was revealed in 48% of cases (n = 16); in the 3 rd group, the painful form of IHD was confirmed in 37% of patients (n = 8), painless form of IHD was observed in 63% of patients (n = 12). In all these groups, the following parameters were evaluated: the state of psychophysiological status determined by psychological testing, the levels of vegetative regulation (β-endorphin), the function of cardiovascular system (SMECG), and the levels of peripheral blood TNFα, IL-1β, IL-6 and IL-4, IL-10 were also measured.As based on the data of clinical and laboratory examination, we have suggested that, in the patients with chronic IHD, anxiety and depressive disorders exert a direct pathological effect on the neuropeptide-cytokine status of immune system expressed as suppression of β-endorphin, increased level of pro-inflammatory cytokines and a decrease in anti-inflammatory factors. Meanwhile, these changes are especially pronounced in the patients with painless myocardial ischemia.

Abstract 4174: Adenosine-Stress CT Myocardial Perfusion Imaging: Comparison with Stress Myocardial Perfusion MRI in Patients with Coronary Artery Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Masaki Ishida ◽  
Hajime Sakuma ◽  
Shingo Kato ◽  
Motonori Nagata ◽  
Nanaka Ishida ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Perfusion Ct ◽  
Perfusion Mri ◽  
Adenosine Stress ◽  
Stress Perfusion ◽  
Stress Myocardial Perfusion ◽  
Artery Disease

Background: CT coronary angiography with vasodilator stress might be of great value in detecting both myocardial ischemia and morphological stenoses of the coronary arteries. Stress myocardial perfusion MRI has been shown to provide accurate assessment of presence and extent of myocardial ischemia in patients with coronary artery disease(CAD). The aim of this study was to determine the value of stress myocardial perfusion CT for the detection of myocardial ischemia by using stress perfusion MRI as a reference method. Methods: The study protocol was approved by the institutional review board and all participants gave written informed consent. Cardiac CT was performed in 12 patients with suspected CAD by using a 64-detector MDCT scanner. Beta-blocker was orally administered prior to CT study. During continuous injection of adenosine, contrast enhanced CT images of the heart were acquired with retrospectively gated helical CT protocol. Adenosine stress myocardial perfusion MRI was performed within 2 weeks from CT perfusion study in all patients. Stress myocardial perfusion MDCT and MR images were qualitatively assessed by two observers using a 16-segment model. Results: All patients completed stress CT study protocol without significant side-effect. Averaged heart rate was 62+/−10 beats/min in the baseline state and 74+/−14 beats/min during adenosine stress. Perfusion abnormality during stress was observed in 83 (43.2%) of 192 segments by MDCT and in 89 (46.4%) of 192 segments by MRI. On a vessel based analysis, stress CT and stress MRI findings are concordant in 30 (83.3%) of 36 territories. The sensitivity, specificity and accuracy of adenosine stress myocardial perfusion CT for the predicting abnormal perfusion on stress perfusion MRI was 84.6%, 80% and 83.3%, respectively. Conclusion: Adenosine stress myocardial perfusion CT can be successfully performed in patients with CAD. Excellent agreement between stress myocardial perfusion CT and MRI observed in this study indicates the value of stress CT approach for comprehensive assessment of morphology and functional significance of CAD.

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