Frequency and characteristics of myocardial ischemia recorded during stress echocardiography in patients with high coronary risk

Background/Aim. Ischemic heart disease is the major cause of morbidity and mortality in the world as well as in our country. Ischemic heart disease has the multifactorial origin and the presence of several risk factors increases the risk of myocardial ischemia. The aim of the study was to evaluate the frequency and characteristics of myocardial ischemia in asymptomatic subjects with two or more risk factors for coronary artery disease during stress echocardiography. Methods. In 240 high risk asymptomatic subjects (an absolute risk of fatal cardiovascular disease of more than 5%, according to the Systemic Coronary Risk Evaluation Chart), the exercise stress echocardiography test was performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality (WMA). The wall motion score index was calculated before and after the exercise stress echocardiography. Results. During exercise stress echocardiography, in 36 (15%) subjects WMA occurred. Out of 36 subjects with myocardial ischemia, in 10 (27.8%) subjects WMA and ST segment depression were accompanied with the first occurrence of chest pain (the subgroup with symptomatic myocardial ischemia), in 20 (55.6%) subjects WMA and ST segment depression were detected and in 6 (16.6%) subjects only WMA occurred (the subgroup with silent myocardial ischemia). There were no significant differences between the subgroups with symptomatic and silent myocardial ischemia with regard to exercise tolerance, heart rate at the onset of WMA, and time to the onset of WMA, but the wall motion score index was significantly higher in the subjects with symptomatic myocardial ischemia (p < 0.01). In all the individuals with symptomatic myocardial ischemia, significant stenosis of the coronary arteries was found by coronary angiography. Out of 26 subjects with asymptomatic myocardial ischemia, coronary angiography was performed in 18 and significant stenosis of the coronary arteries was diagnosed in all of them. The number and grade of coronary stenosis in subjects with symptomatic and silent myocardial ischemia were similar. Conclusion. The obtained results presented the incidence of myocardial ischemia in 15% of asymptomatic subjects with high coronary risk during stress echocardiography. Silent myocardial ischemia was markedly more frequent than symptomatic one, but in the subjects with symptomatic ischemia, the wall motion score index was significantly higher.

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Prevalence and prognostic significance of silent myocardial ischemia in patients after myocardial infarction

Vojnosanitetski pregled ◽

10.2298/vsp0708519d ◽

2007 ◽

Vol 64 (8) ◽

pp. 519-523 ◽

Cited By ~ 2

Author(s):

Marina Deljanin-Ilic ◽

Stevan Ilic

Keyword(s):

Myocardial Infarction ◽

Coronary Angiography ◽

Exercise Test ◽

Stress Echocardiography ◽

Wall Motion ◽

Prognostic Significance ◽

Silent Myocardial Ischemia ◽

Wall Motion Score Index ◽

St Segment ◽

Score Index

Background/Aim. Silent myocardial ischemia (MI) can be detected in subjects with any symptoms, in patients after myocardial infarction and in coronary patients who have episodes of symptomatic, as well as of silent MI. This study was carried out to evaluate the frequency, characteristics and prognostic significance of silent MI detected in stress echocardiography test in patients after myocardial infarction. Methods. In 210 patients within three months after myocardial infarction exercise test was performed. In those patients with ischemic ST depression on exercise electrocardiogram, in order to confirm MI stress echocardiography was additionally performed. To assess the incidence of major cariovascular events, all the patients were followed at least five years after the first myocardial infraction. Results. Out of 210 patients 88 (42%) had ischemic response during stress echocardiography test. Out of 88 patients with MI 54 (61%) had anginal pain (patients with symptomatic MI), while 34 (39%) were free of symptoms (patients with silent MI). Level of exercise test, heart rate, time to the onset of ST segment depression, and the magnitude of ST segment depression were similar in both subgroups of the patients with MI. Duration of exercise test was longer in patients with silent MI (p < 0.05). Wall motion score index during stress echocardiography was higher in patients with symptomatic MI (p < 0.05). Coronary angiography findings were similar in patients with silent and those with symptomatic MI. During a five- yearsfollow- up period the occurrence of major cardic events (cardiac mortality and recurrent myocardial infarction) was similar in both subgroups of the patients with MI. Conclusion. In more than one third of patients after myocardial infarction silent MI during stress echocardiography was detected. The patients with silent ischemia had longer duration of exercise test and smaller wall motion score index on stress echocardiography. There was no difference in coronary angiography finding between patients with silent and those with symptomatic MI. The incidence of major cardiac events during a five- years- follow-up was similar in the patients with silent and those with symptomatic MI. .

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P1504Impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block

European Heart Journal ◽

10.1093/eurheartj/ehz748.0267 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Stoickov ◽

M Deljanin Ilic ◽

I Tasic ◽

L J Nikolic ◽

D Marinkovic ◽

...

Keyword(s):

Myocardial Ischemia ◽

Left Bundle Branch Block ◽

Wall Motion Abnormality ◽

Stress Echocardiography ◽

Wall Motion ◽

Qt Dispersion ◽

Exercise Stress ◽

Bundle Branch Block ◽

Exercise Stress Echocardiography ◽

The Impact

Abstract Background/Introduction ECG has always provided very useful information that can be used to diagnosis, treatment and prevention of cardiovascular events, but ECG changes is not useful to the detection of myocardial ischemia in patients with left bundle branch block (LBBB). QT dispersion (QTd) is a measure of inhomogeneous repolarization of myocardium. Abnormally high QTd has been correlated with risk of cardiac death in coronary patients. Purpose The aim of this study was to establish the impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block. Methods The study involved 123 patients with LBBB, average age 52.7 years. In all subjects clinical examination, standard ECG and exercise stress echocardiography, were performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality. The first ECG was done before the exercise stress echocardiography and the second one was done immediately after exercise, with calculation of corrected QT dispersion (QTdc). Results During exercise stress echocardiography, in 45 (36.6%) subjects wall motion abnormality occurred (group with myocardial ischemia: MI), and 78 (63.4%) subjects were without ischemia (group without myocardial ischemia: NMI). Before starting the exercise stress echocardiography, MI group patients had significantly higher values of QTdc (61.2±17.6 vs 43.6±15.4 ms; p<0.001) in comparison to NMI group patients. During the exercise stress echocardiography, the QTdc significantly increased in MI group from 61.2±17.6 to 87.4±20.3 ms (p<0.001). In the NMI group there were no significant changes in the values QTdc during exercise stress echocardiography (from 43.6±15.4 to 46.5±19.8 ms (p - NS). Conclusions Significant increase of QT dispersion is associated with the occurrence of myocardial ischemia during exercise stress echocardiography in patients with LBBB. This new diagnostic approach, of using QT dispersion, significantly improves the clinical usefulness of exercise stress echocardiography in detecting myocardial ischemia in patients with LBBB.

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The influence of afterload on left ventricular contractility: 2D-strain and dyssynchrony in stress echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.192 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Karev ◽

S Verbilo ◽

E Malev ◽

M Prokudina ◽

A Suvorov

Keyword(s):

Coronary Artery ◽

Left Ventricle ◽

Ejection Fraction ◽

Stress Echocardiography ◽

Longitudinal Strain ◽

Wall Motion ◽

Wall Motion Score Index ◽

Wall Motion Abnormalities ◽

Response To Exercise ◽

Score Index

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertensive response to exercise (HRE) has negative prognostic value but its impact on the left ventricle (LV) contractility and on stress echocardiography (SE) results remains controversial. The global longitudinal strain (GLS) and LV dyssynchrony changes in response to afterload increase were shown even in patients with narrow QRS at rest, but not on exertion. Purpose We aimed to analyze the relation between the blood pressure (BP) during SE and LV GLS and dyssynchrony changes. Methods We performed exercise SE on treadmill in 96 patients without coronary artery stenosis (invasive or CT coronary angiography). Patients divided into two groups: HRE (n = 41) and normal response to exercise (NRE) (n = 55). We analyzed GLS and standard deviation of time between the onset of QRS and segmental longitudinal strain peaks (STE-TIME SD) using speckle tracking and 3d-ejection fraction (EF) at rest and on exertion. Results 2D-EF increase was higher in patients with NRE, but 3D-EF did not differ between groups. Wall motion abnormalities (WMA) on peak stress were detected more often in patients with HRE who had higher wall motion score index (WMSI). GLS on exertion and its increment were lower in HRE group (Fig. 1 - "Bull’s eye" diagrams of GLS at rest and on exertion in patient with NRE (upper panel) and HRE (lower panel)). Among dyssynchrony markers we revealed higher values of STE-TIME SD on exertion in HRE group (Table 1). Moreover the analysis showed positive correlations between BP level on exertion and peak GLS (r = 0.56, p < 0.0001), GLS increase (r = 0.54, p < 0.0001) and STE-TIME SD on exertion (r = 0.27, p < 0.02) Conclusions HRE is associated with less increment in GLS and 2D-EF on exertion. Besides LV dyssynchrony signs can appear in response to exaggerated afterload increase even in patients with narrow QRS complexes. Patients with HRE more often show stress-induced WMA and have greater WMSI on exertion in absence of coronary artery lesions, thus HRE can alter the specificity of the test in transient ischemia detection. Table 1 HRE NRE p Δ-2D ejection fraction 5.0 (4.0; 7.0) 10.0 (8.0; 12.5) <0.0000001 Δ-3D ejection fraction 8.25 (4.0; 8.25) 8.24 (8.15; 11.65) 0.09 Wall motion abnormalities on exertion 46.34% 1.8% <0.00001 Wall motion score index 1.0 (1.0; 1.18) 1.0 (1.0; 1.0) 0.00013 GLS on exertion -21.0 (-22.0; -19.0) -24.0 (-26.5; -23.0) <0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) <0.0000001 STE-TIME SD-IMPOST 42.0 (35.0; 53.0) 35.0 (27.5; 45.0) 0.012 Left ventricle systolic function and dyssynchrony in two groups. Abstract Figure 1.

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Echocardiographic markers of inducible myocardial ischemia at baseline evaluation preparatory to exercise stress echocardiography

Cardiovascular Ultrasound ◽

10.1186/s12947-016-0064-5 ◽

2015 ◽

Vol 14 (1) ◽

Author(s):

Antonella Cherubini ◽

Giovanni Cioffi ◽

Carmine Mazzone ◽

Giorgio Faganello ◽

Giulia Barbati ◽

...

Keyword(s):

Myocardial Ischemia ◽

Stress Echocardiography ◽

Exercise Stress ◽

Exercise Stress Echocardiography ◽

Baseline Evaluation

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Abstract 16032: Determinants of Exercise Capacity Assessed Using Combined Stress Echocardiography and Cardiopulmonary Exercise Testing in Patients Treated for Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.16032 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Krzysztof Smarz ◽

Tomasz Jaxa-Chamiec ◽

Beata Zaborska ◽

Maciej Tysarowski ◽

Andrzej Budaj

Keyword(s):

Myocardial Infarction ◽

Stress Echocardiography ◽

Wall Motion ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Combined Stress ◽

Wall Motion Score Index ◽

Cardiopulmonary Exercise ◽

Oxygen Difference ◽

Score Index

Introduction: Exercise capacity (EC) after acute myocardial infarction (AMI) influences prognosis, but the causes of its reduction are complex and not sufficiently studied. Methods: We prospectively enrolled consecutive patients who underwent percutaneous coronary intervention for their first AMI without residual coronary stenosis and with left ventricular ejection fraction (LVEF) > 40% more than 4 weeks after the AMI. We performed combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) using a semi-supine cycle ergometer to determine predictors of EC (peak oxygen uptake [VO 2 ]). Results: Among 81 patients (70% male, mean age 58 ± 11 years), 40% suffered AMI with ST-segment elevation (STEMI), and 60% non-STEMI, LVEF was 57 ± 7%; wall motion score index, 1.18 (IQR 1.06 - 1.31); peak VO 2 , 19.5 ± 5.4 mL/kg/min. Multivariate analysis ( Table ) revealed that parameters at peak exercise: heart rate (β = 0.17, p < 0.001), stroke volume (β = 0.09, p < 0.001), and arteriovenous oxygen difference (β = 93.51, p < 0.001) were independently positively correlated with peak VO 2 , with arteriovenous oxygen difference being its strongest contributor. At rest, left ventricular systolic and diastolic function parameters and the extent of myocardial scarring (wall motion score index) did not predict EC (p > 0.05). Conclusions: In patients treated for AMI with normal/mildly reduced LVEF, EC is associated with peak peripheral oxygen extraction as well as peak heart rate and peak stroke volume. CPET-SE is a useful tool to evaluate decreased fitness in this group.

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