scholarly journals What are the prognostic implications and factors relating to exercise induced electrocardiographic ST segment changes in the setting of a non-ischaemic stress echocardiogram?

2022 ◽  
Author(s):  
Benjamin T. Fitzgerald ◽  
Erin Smith ◽  
Gregory Scalia
Keyword(s):  
Exercise Capacity ◽  
Cardiac Events ◽  
Ecg Changes ◽  
Stress Imaging ◽  
Coronary Syndrome ◽  
St Depression ◽  
Metabolic Equivalents ◽  
St Segment ◽  
Increased Risk ◽  
Exercise Induced

Background. Electrocardiographic (ECG) changes during stress testing are a common and perplexing finding during non-ischaemic stress echocardiography (SE). Research has provided conflicting results regarding the implications. Methods. SE was performed after maximal Bruce protocol treadmill exercise. Results. 3020 consecutive patients, mean age 58±12 years, 36% female, were followed-up for up to 9 years (mean 36±21 months) post SE. Time to first cardiac event (composite of heart failure admission, worsening New York Heart Association class, worsening ejection fraction, acute coronary syndrome, revascularization, angina or cardiovascular death) was analyzed and adjusted using Cox proportional hazards regression. Prognostic significance was found with 1.5mm of downsloping or horizontal ST depression. Adjusting for baseline differences, increased risk of composite major adverse cardiac events was shown with at least 1.5mm of exercise induced ST depression (Hazard ratio [HR] of 2.47, 95% Confidence ratio [CI] 1.67-3.72, p<0.0001). Patients achieving high level exercise capacity (≥13 metabolic equivalents or METs) with ST depression lower risk of cardiac events during follow-up Conclusion. Patients with ST segment depression but non-ischaemic stress imaging have poorer prognosis compared to patients with non-ischaemic stress echocardiograms with normal stress ECGs. ST depression of 1.5mm or more was established as a prognostically significance value. High exercise capacity improves prognosis, and ECG changes in that setting can be regarded as false positives. Overall, however, ST depression during non-ischaemic stress imaging is not a benign finding.

Future Cardiac Events in Patients with Ischemic ECG Changes during Adenosine Infusion as a Myocardial Stress Agent and Normal Cardiac Scan

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Myocardial Perfusion ◽  
Stress Test ◽  
Adenosine Infusion ◽  
Cardiac Events ◽  
Ecg Changes ◽  
Spect Myocardial Perfusion ◽  
St Depression ◽  
St Segment ◽  
Increased Risk ◽  
Ischemic Ecg

Background: We sought to determine the prognostic importance of adenosine-induced ischemic ECG changes in patients with normal SPECT myocardial perfusion images. Methods: We performed a retrospective analysis of 765 patients undergoing adenosine MPI between January 2013 and January 2015. Patients with baseline electrocardiographic (ECG) abnormalities and/or abnormal scan were excluded. Results: Overall, 67 patients (8.7%) had ischemic ECG changes during adenosine infusion in the form of ST depression of ≥1mm. Of these, 29 (43% [3.8% of all patients]) had normal MPI (positive (+) ECG group). An ageand sex-matched group of 108 patients with normal MPI without ECG changes served as control subjects (negative (-) ECG group). During a mean follow-up of 33.3 ± 6.1 months, patients in the +ECG group had no significantly more adverse cardiac events than those in the –ECG group. One (0.9%) patient within the negative ECG group had a nonfatal MI (0.7% annual event rate after a negative MPI). A case only was admitted due to heart failure in the (-) ECG group) that proved to be secondary to pulmonary cause and not of CAD. A case in this (+) ECG group admitted as a CAD that ruled out by coronary angiography. Conclusion: Patients with normal myocardial perfusion scintigraphy in whom ST-segment depression develops during adenosine stress test appear to be with no increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia.

Les facteurs cliniques qui influencent le pronostic post-infarctus à un an

1993 ◽  
Vol 18 (1) ◽  
pp. 63-79
Author(s):  
Sylvie Robichaud-Ekstrand
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
St Segment ◽  
Prognostic Stratification ◽  
History Of ◽  
Exercise Induced

Many clinical factors influence the 1-year prognosis in myocardial infarction (MI) patients. The most important clinical determinants are the left ventricular dysfunction, myocardial ischemia, and complex ventricular arrhythmias. Some authors have found an independent prognostic value of complex ventricular arrhythmias, while others consider that ventricular arrhythmias predict future cardiac events only if associated with low ejection fractions. Other factors that have 1-year prognostic value are the following: a previous MI, a history of angina at least 3 months preceding the infarct, postmyocardial angina, and the criteria that indicate to the practitioner whether MI patients are medically ineligible for stress testing. There still remain controversies in regard to the predictive value of certain variables such as the site, type, and extension of the MI, the presence of complex ventricular arrhythmias, exercise-induced hypotension, ST segment elevation, and the electrical provocation of dangerous arrhythmias. Key words: cardiac rehabilitation, postinfarct mortality and morbidity, cardiac events predictors, postinfarct prognostic stratification

Abstract MP25: Obesity, Heart Failure Risk & Cardiorespiratory Fitness

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Peter F Kokkinos ◽  
Puneet Narayan ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiorespiratory Fitness ◽  
Reference Group ◽  
Normal Weight ◽  
Entire Cohort ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
The Impact

Introduction: Obesity, defined as body mass index (BMI) ≥30 kg/m 2 , is associated with increased incidence of heart failure (HF). Increased cardiorespiratory fitness (CRF), as indicated by increased exercise capacity, is associated with lower risk of cardiovascular disease and HF. However, the CRF-BMI-HF interaction has not been fully explored. Hypothesis: We assessed the hypothesis that the risk of HF associated with increased BMI is moderated by increased CRF. Methods: We identified 19,881 Veterans (mean age: 58.0±11.3 years) who completed an exercise tolerance test (ETT) to assess either CRF status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, CA). None had documented HF at baseline or evidence of ischemia during the ETT. We established four BMI categories: <25 kg/m 2 ; 25-29.9 kg/m 2 ; 30-34.9 kg/m 2 ; and ≥35 kg/m 2 . In addition, we established four CRF categories based on age-stratified quartiles of peak metabolic equivalents (METs) achieved (mean ± SD): Least-Fit (4.5±1.2 METs; n=4,743); Low-Fit (6.6±1.3; n=5,103); Moderate-Fit (8.0±1.3 METs; n=5,084); and High-Fit (11.1±2.4 METs; n=4,951). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of HF across BMI categories for the entire cohort, using BMI 25-29.9 kg/m 2 (lowest HF rate) as the reference group. We then stratified the cohort by the four BMI categories and assessed HF risk across CRF categories within each stratum, using the Least-fit category as the reference group. The models were adjusted for age, race, gender, cardiac risk factors, sleep apnea, alcohol dependence, medications. Results: During follow-up (median=11.8 years), 2,193 developed HF (10.5 per 1,000 person-years of follow-up). The HF risk for normal weight individuals (18.5-24.9 kg/m2) was 10% higher (p=0.93). For obese individuals, the HF risk was 22% higher in those with BMI 30-34.9 kg/m 2 (HR=1.22; 95% CI: 1.09-1.35) and 50% higher (HR=1.50, 95% CI: 1.32-1.72) for those with BMI ≥35 kg/m 2 . When CRF (peak METs achieved) was introduced in the model, the risk for those with BMI 30-34.9 was reduced from 22% to 16% (HR=1.16; 95% CI: 1.04-1.29) and from 50% to 29% (HR=1.29; 95% CI: 1.13-1.48) among those with ≥35 kg/m 2 . For every 1-MET increase in exercise capacity, HF risk was 15% lower (HR=0.85; 95% CI: 0.83-0.87). We then assessed the impact of CRF on the risk of HF within each of the four BMI categories. The HF risk declined progressively (range: 25% to 69%; p<0.01) with increasing fitness within all BMI categories. Conclusions: The obesity-associated increased risk of HF was attenuated by increased CRF. The HF risk was progressively decreased with increased CRF within all BMI categories.

Abstract 2602: Elevated Serum Neopterin Levels and Adverse Cardiac Events in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Juan Carlos Kaski ◽  
Luciano Consuegra-Sanchez ◽  
Daniel J. Fernandez-Berges ◽  
Jose M Cruz-Fernandez ◽  
Xavier Garcia-Moll ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Elevated Serum ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Elevation Acute Coronary Syndrome

Objectives: We sought to assess whether plasma neopterin predicts adverse clinical outcomes in patients with NSTEACS. Background: Circulating C reactive protein (CRP), a marker of inflammation, correlates with events in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). High neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients but their prognostic role in NSTEACS has not been systematically evaluated. Methods: We prospectively assessed 397 patients (74 % men) admitted with NSTEACS: 169 (42.5%) had unstable angina and 228 (57.5%) non-ST-segment elevation myocardial infarction (NSTEMI). Blood samples for neopterin and CRP assessment were obtained at admission. TIMI risk score was also assessed among other clinical and biochemical variables. The study end point was the composite of cardiac death, acute myocardial infarction and recurrent angina at 180-days. Results: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.5–10.6] vs 8.0 [6.2–11.1], p = 0.54). Fifty-nine patients (14.9 %) had events during follow-up (highest third (%) 21.5 vs 1 st and 2 nd thirds 11.5, log rank 7.341, p = 0.007). On multivariable hazard Cox regression, only neopterin (highest vs 1 st and 2 nd thirds, HR 2.15, 95 % CI [1.21–3.81]) was independently associated with the combined endpoint.CRP levels, however, were not significantly different in patients with events compared to those without events (adjusted HR = 0.98, p = 0.89, 95% CI 0.80 –1.21). Conclusion: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in patients with NSTEACS.

Acute coronary syndrome without ST segment elevation: possibilities for predicting the clinical course at the posthospital (6 and 12 months) stage

2016 ◽  
Vol 94 (3) ◽  
pp. 205-210
Author(s):  
Zinaida D. Mikhailova ◽  
M. A. Shalenkova ◽  
P. F. Klimkin
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Course ◽  
Regression Equations ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Logistic Analysis ◽  
St Segment ◽  
Increased Risk ◽  
Hospitalization Period ◽  
Sodium And Potassium

Aim. To measure blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine of patients with acute coronary syndrome without ST segment elevation for the prediction of the clinical course at the posthospital stage. Material and methods. The study included 93patients with complicated (n=46) and uncomplicated (n=47) coronary syndrome without ST segment elevation. Blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine were determined on days 1-3 after hospitalization. 6-hydroxymelatonin was measured by HPLC in urine collected between 23 p.m. and 8 a.m., melatonin i in urine collected between 8 a.m. and 23 p.m. Results. Complicated coronary syndrome was associated with increased levels of melatonin (night), blood IL-10 and Na, salivary Na and Ca while the uncomplicated condition with increased blood melatonin (daytime), IL-6, creatinine, Ca, Na, K, and salivary K. 90 patients were followed up within 12 months after discharge. End-points developed in 36 (40%) of Original investigations them. Logistic analysis yielded variables and 2 logistic regression equations The data on night melatonin +5 and +4 were included in ROC analysis. The night melatonin +5 values over 0.7453 were associated with increased risk of complications in the post-hospital period (6 months) and values of0.7453 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 90%, specificity at -54.39%. The night melatonin +4 values over 0.2903 were associated with increased risk of complications in the post-hospital period (12 months) and values of 0.2903 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 77.8%, specificity at -59.26%. Conclusion. The night melatonin +5 and +4 models can be used to predict the clinical course of acute coronary syndrome during 6 and 12 months of the post-hospitalization period.

Multichannel electrocardiograms obtained by a smartwatch for the diagnosis of acute coronary syndromes: the SMARTAMI TRIAL

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.S Spaccarotella ◽  
A.P Polimeni ◽  
E.P Principe ◽  
A.C Curcio ◽  
S.M Migliarino ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Digital Health ◽  
Coronary Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Depression ◽  
Smart Watch ◽  
St Segment ◽  
Coronary Syndromes ◽  
Good Agreement

Abstract Background Smartwatches are increasingly popular and used for digital health information. A new smart watch introduced an integrated ECG tool, which allows recording a single-lead ECG that has been used for atrial fibrillation detection. The aim of the present study was to prospectively investigate the feasibility and the accuracy of the Apple Watch in patients admitted in the CCU with the diagnosis of Acute Coronary Syndrome compared with a standard 12-lead ECG. Methods A commercially available smart watch series 4 was used and the posterior sensor of the watch was positioned in different standardized body positions to obtain nine bipolar ECGs (corresponding to Einthoven leads I, II and III and Precordial leads V1-V6) that were compared with a simultaneous standard 12-lead ECG. One hundred subjects were included in the study. Fifty-five patients had a STEMI, twenty-seven patients had an NSTEMI all treated with percutaneous coronary revascularization. Eighteen age-matched subjects were included as controls. Results A very good agreement was found between Smartwatch ECG and Standard ECG for the identification of normal ECG, ST segment elevation and NSTE alterations (Cohen's kappa 0.90 [95% CI 0.78 to 1], 0.88 [95% CI 0.78 to 0,97], 0.85 [95% CI 0.74 to 0.96]), respectively. The sensitivity and specificity of Smartwatch ECG for the diagnosis of normal ECG were 84% (95% CI 60 to 97) and 100% (95% CI 95 to 100), STE deviation were 93% (95% CI 82 to 99) and 95% (95% CI 85 to 99), NSTE ECG alterations were 94% (95% CI 81 to 99) and 92% (95% CI 83 to 97), respectively. No significant differences between Smartwatch ECG and Standard ECG for the amplitude of ST changes were reported for each lead (see Figure). Conclusions The Smart Ami Trial demonstrated a very good agreement between the Smartwatch ECG and Standard ECG for the identification of ST-segment elevation and ST depression in patients with acute coronary syndromes opening the possibility of using this tool when a standard ECG is not available. Figure 1 Funding Acknowledgement Type of funding source: None

The effects of exercise capacity and sedentary lifestyle on haemostasis among middle-aged women with coronary heart disease

2008 ◽  
Vol 100 (05) ◽  
pp. 899-904 ◽  
Author(s):  
Imre Janszky ◽  
Margita Eriksson-Berg ◽  
Faris Al-Khalili ◽  
Karin Schenck-Gustafsson ◽  
Edit Nagy
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Exercise Capacity ◽  
Coronary Event ◽  
Factor Vii ◽  
Middle Aged ◽  
Blood Profile ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Haemostatic Factors

SummaryPrevious studies have established a link/relationship between haemostatic factors and increased risk of cardiovascular disease. In addition, physical conditioning is associated with lower coronary heart disease risk. The purpose of this study was to assess the association between physical exercise and haemostatic factors among middle-aged women surviving an acute coronary event. The Stockholm Female Coronary Risk Study included 292 women aged < 65 years, resident in the greater Stockholm area, who were hospitalized for an acute coronary syndrome. Extensive clinical screening including exercise testing, and blood tests were performed 3–6 months after the coronary event. Self-reported physical activity was assessed by a WHO questionnaire. Patients on warfarin treatment were excluded from our analyses. Haemostatic factors were generally higher among physically inactive patients when compared to physically active women in our univariate models. Exercise capacity had a statistically significant relationship with factor VII antigen (p=0.039) and vWFag (p=0.038) even in our multiadjusted analyses. Physical inactivity and poor physical fitness are associated with a potentially prothrombotic blood profile in middle aged women with coronary heart disease.

Variable exercise capacity in variant angina and greater exertional thallium-201 myocardial defect during vasospastic ischemic ST segment elevation than with ST depression

1982 ◽  
Vol 103 (1) ◽  
pp. 142-145 ◽  
Author(s):  
Hiroaki Shimokawa ◽  
Takeyuki Matsuguchi ◽  
Yasushi Koiwaya ◽  
Takaya Fukuyama ◽  
Yasuhiko Orita ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Thallium 201 ◽  
Variant Angina ◽  
St Segment Elevation ◽  
St Depression ◽  
St Segment

P4617Early electrocardiographic changes as markers of coronary microvascular obstruction in acute myocardial infarction with ST segment elevation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C S Garcia Talavera ◽  
A Camblor Blasco ◽  
A L Rivero Monteagudo ◽  
M B Arroyo Rivera ◽  
M Cortes Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analysis ◽  
Poor Prognosis ◽  
Microvascular Obstruction ◽  
Univariate Analysis ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
St Segment ◽  
Increased Risk ◽  
The Mean

Abstract Background Coronary microvascular obstruction (CMVO), occurs frequently even after a quickly epicardial revascularization of the infarct-related artery (IRA), and has been associated with an increased risk of adverse cardiovascular events and poor prognosis in patients with ST-segment myocardial infarction (STEMI). After primary coronary intervention (PCI), incomplete ST-segment elevation (STE) resolution in the ECG has been related to CMVO and worse clinical outcome. However, there is lack of information regarding other ECG changes. The aim of this study is to describe the initial ECG changes in STEMI and evaluate their association with CMVO. Methods From January 2007 to December 2017, all patients with the diagnosis of STEMI that underwent urgent coronary angiography were retrospectively included. Clinical, echocardiographic, and electrocardiographic data were taken from medical records. A univariate and multivariate analysis was performed to evaluate the relationship between initial ECG changes (before PCI) and CMVO defined as final TIMI <3 in the IRA. Results 1022 patients were included; the mean age was 67.8 years (±14), 73.7% were male and 14.4% had previous coronary artery disease. The most frequent IRA was the anterior descending artery in 43.2% of the cases and CMVO was found in 18.3% of the patients. The mean value of STE sum (defined as the sum of STE in V1-V6, I and aVL in anterior STEMI and the sum of II, III, aVF, V5 and V6 in non-anterior STEMI), maximum STE in one lead and number of leads with STE was 11.36mm (± 8.2), 3.65mm (± 2.3) and 4.14mm (± 1.4), respectively. After a univariate analysis, STE sum, maximum STE in one lead and number of leads with STE were associated with CMVO, while only STE sum remained significantly associated with the presence of CMVO after a multivariate analysis (Table). The resolution of STE in the first 2 hours after PCI was a protector factor for CMVO. Univariate and Multivariate Analysis Univariate Multivariate Variables OR 95% CI p OR IC 95% p Sum of STE 1.03 1.01–1.04 0.013 1.03 1.01–1.05 0.005 Number of leads with STE 1.13 1.02–1.26 0.021 1.04 0.87–1.23 0.67 Maximum STE 1.09 1.02–1.16 0.016 1.04 0.92–1.17 0.49 Resolution of STE 0.35 0.25–0.49 <0.001 0.36 0.25–1.18 <0.001 STE, ST-segment elevation. Conclusion Initial ECG changes such as STE sum, number of leads with STE and maximum STE in one lead can be used as early predictors of CMVO and poor prognosis. STE resolution in the first 2 hour was associated with a lower incidence of CMVO as reported in previous studies. Acknowledgement/Funding None

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