scholarly journals Intensity of thrombin formation and myocardial contractility in patients with ischemic heart disease after coronary stenting

2017 ◽  
Vol 16 (2) ◽  
pp. 63-69
Author(s):  
G. A. Berezovskaya ◽  
E. S. Klokova
Keyword(s):  
Myocardial Contractility ◽  
Protein C ◽  
Stress Echocardiography ◽  
Thrombin Generation ◽  
Wall Motion ◽  
Primary Pci ◽  
Before And After ◽  
Wall Motion Abnormalities ◽  
Artery Disease ◽  
Thrombin Formation

Objective. To study the relationship between the intensity of thrombin formation, estimated by thrombin generation test (TGT) in platelet poor plasma, and myocardial contractility in patients with coronary artery disease (CAD) before and after percutaneous coronary intervention (PCI). Methods. The study included 75 patients with coronary artery disease aged between 40 to 75 years, who underwent primary PCI (10 patients) or elective (65 patients) procedure, as well as 35 individuals matched for age and sex with no clinical signs of CAD. We investigated the venous blood obtained before and after 6 and 12 months following PCI. In the same period, stress echocardiography was performed. The intensity of thrombin formation was assessed using a TGT, formed in platelet poor plasma and the modified reaction mixture by adding human recombinant thrombomodulin (rh-TM) to assess the degree of activation of the protein C system. Results. The association between stress echocardiography parameters characterizing myocardial contractile capacity (ejection fraction (EF) of the left ventricle and a wall motion abnormalities (WMAs)) and TGT parameters, reflecting the intensity (ETP and the Peak) of the thrombin formation rate (V), was identified to be more expressed in patients undergoing primary PCI. The presence of the reverse correlation between EF and WMAs and the percentage reduction of V, ETP and Peak after the addition of rh-TM, as well as a significant association of the EF and WMAs with TGT indicators staged with rh-TM demonstrates the role of protein C system in the changes of myocardial contractility. The intensity of thrombin generation was also associated with hypertension. Conclusion. It was determined that TGT parameters were strongly associated with stress echocardiography parameters. The changes in thrombin generation rate were most closely associated with left ventricular ejection fraction, index of wall motion abnormalities and arterial hypertension, including hypertensive reaction to physical activity.

scholarly journals P1555 Delta mapse: an easy-to-use tool to evaluate coronary artery stenosis during dypiridamole pharmacological stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Moderato ◽  
S M Binno ◽  
G Pastorini ◽  
C Dallospedale ◽  
G Benatti ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Receiver Operating Curve ◽  
Circumflex Artery ◽  
Reversible Ischemia ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Background Dypiridamol stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless the results of the test are related to visualization of wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. Aim of our study was to evaluate whether an an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. Methods We prospectively enrolled 300 patients with suspected CAD and perform a DSE; at rest and peak MAPSE was acquired. 59 patients with reversibile ischemia during stress echocardiography (positive) were referred to perform coronary angiography. Patients were divided according to MAPSE behaviour during DSE: group 1 (MAPSE ≤ 0) and group 2 (delta MAPSE > 0 mm). Results The mean age of was 63 ± 11 years, male gender was prevalent (73%); no differences were found in risk factors and left vetnricular ejection fraction (LV-EF) between two groups.Coronary arteries were normal in 14 patients (23%), while significant stenosis (>70%) was found in 45 patients (77%); in 31 patients (53%) left main (LM) or proximal LAD artery were involved, while in 17 (29%) and 22 (37%) right coronary artery and circumflex artery were affected respectively. Patients with CAD showed a lower (blunted or no increase) MAPSE after dypiridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups (0,2 mm vs 2,8 mm p = 0,004) (Figure 1B). By using a Receiver Operating Curve, the Area under the curve was 0,757, with the best cut-off value for CAD prediction at Delta Mapse= +2.5 mm (sensibility 0,667 and specificity 0,809 – p = 0.012 - Figure 1b). In particular, Delta Mapse was able to predict LM/LAD stenosis (Figure 1B AUC = 0.679 ;p = 0.019), rather than right coronary artery and circumflex artery disease, with higher predictivity than delta LV-EF (AUC = 0.577; p = 0.077). Discussion To our knowledge, this is the first study that compared the behaviour of MAPSE during dypiridamole infusion in patient with and withouth coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and have increased sensitivity over traditional methods of systolic performance such as LV-EF; in this context, dypiridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD, mostly driven by LM/LAD disease, on top of other well known markers of ischemia. Incorporating this easy-to-use parameter could improve specificity of DSE and strenghten the suspect of reversibile ischemia when clear wall motion abnormalities are not found. Abstract P1555 Figure 1A and 1B

Simple six-item clinical score improves risk prediction capability of stress echocardiography

Heart ◽  
2017 ◽  
Vol 104 (9) ◽  
pp. 760-766 ◽  
Author(s):  
Lauro Cortigiani ◽  
Clara Carpeggiani ◽  
Rosa Sicari ◽  
Claudio Michelassi ◽  
Francesco Bovenzi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Risk Score ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Clinical Score ◽  
Validation Group ◽  
Sex Risk ◽  
Wall Motion Abnormalities ◽  
Artery Disease

ObjectivesTo assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE).MethodsStudy includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups.ResultsDuring a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001).ConclusionsSimple clinical variables may be able to optimise SE risk stratification.

Natural History of Patients with Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study

Circulation ◽  
2021 ◽  
Author(s):  
Harmony R. Reynolds ◽  
Michael H. Picard ◽  
John A. Spertus ◽  
Jesus Peteiro ◽  
Jose Luis Lopez-Sendon ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natural History ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease ◽  
One Year

Background: Ischemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA. Methods: CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in ISCHEMIA trial screen failures with INOCA) was an international cohort study conducted from 2014-2019 involving angina assessments (Seattle Angina Questionnaire [SAQ]) and stress echocardiograms 1-year apart. This was an ancillary study that included patients with history of angina who were not randomized in the ISCHEMIA trial. Stress-induced wall motion abnormalities were determined by an echocardiographic core laboratory blinded to symptoms, coronary artery disease (CAD) status and test timing. Medical therapy was at the discretion of treating physicians. The primary outcome was the correlation between changes in SAQ Angina Frequency score and change in echocardiographic ischemia. We also analyzed predictors of 1-year changes in both angina and ischemia, and compared CIAO participants with ISCHEMIA participants with obstructive CAD who had stress echocardiography before enrollment, as CIAO participants did. Results: INOCA participants in CIAO were more often female (66% of 208 vs. 26% of 865 ISCHEMIA participants with obstructive CAD, p<0.001), but the magnitude of ischemia was similar (median 4 ischemic segments [IQR 3-5] both groups). Ischemia and angina were not significantly correlated at enrollment in CIAO (p=0.46) or ISCHEMIA stress echocardiography participants (p=0.35). At 1 year, the stress echocardiogram was normal in half of CIAO participants and 23% had moderate or severe ischemia (≥3 ischemic segments). Angina improved in 43% and worsened in 14%. Change in ischemia over one year was not significantly correlated with change in angina (rho=0.029). Conclusions: Improvement in ischemia and improvement in angina were common in INOCA, but not correlated. Our INOCA cohort had a similar degree of inducible wall motion abnormalities to concurrently enrolled ISCHEMIA participants with obstructive CAD. Our results highlight the complex nature of INOCA pathophysiology and the multifactorial nature of angina. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02347215

scholarly journals Mitral anular plane excursion predicts coronary stenosis during stress echocardiography with dipyridamole

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Moderato ◽  
S Binno ◽  
G Rusticali ◽  
C Dallospedale ◽  
D Aschieri ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Stenosis ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Receiver Operating Curve ◽  
Traditional Methods ◽  
Reversible Ischemia ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Dipyridamole stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless, the results of the test are related to wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity.  Purpose Aim Of our study was to evaluate whether an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE.  Methods We prospectively enrolled 512 patients that underwent DSE for suspected CAD; rest and peak MAPSE was acquired; 148 patients were referred to perform coronary angiography, with evidence of severe coronary stenosis in 91 patients.   The mean age was 66.7 ±11 years, male gender was prevalent (64%).  MAPSE at the peak was significantly different between patients with CAD and patient without (13,4mm vs 16,81 mm , p &lt; 0.001); in fact, patients with CAD showed a blunted or no increase of MAPSE after dipyridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups ( -0.5mm vs 2.8mm) By using a Receiver Operating Curve, the Area under the curve was 0,764 (0.682-0.846), with the best cut-off value of +0.5mm (Sensibility 77%, Specificity 62% - Figure 1), comparabale with traditional methods like LAD reserve, FE reduction or Wall Motion Score Index.  Discussion to our knowledge, this is the first study that compared the behavior of MAPSE during dipyridamole infusion in patients with and without coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and has increased sensitivity over traditional methods of systolic performance such as LV-EF: in this context, dipyridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD. Incorporating this easy-to-use parameter could improve the specificity of DSE and strengthen the suspect of reversible ischemia when clear wall motion abnormalities are not found. Abstract Figure. Mean value of Mapse and ROC curve

Contrast echocardiography

ESC CardioMed ◽  
2018 ◽  
pp. 435-438
Author(s):  
Anastasia Vamvakidou ◽  
Roxy Senior
Keyword(s):  
Image Quality ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Contrast Echocardiography ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Artery Disease

The major requirement for optimal echocardiographic image interpretation, reproducibility, and diagnostic accuracy is image quality. Despite the use of harmonics, a significant proportion of patients have challenging images, which has an impact on diagnosis and management. The ultrasound contrast agents (UCAs), which are administered intravenously, have been a significant development in image quality optimization and have proved to be an important aid in the assessment of structural abnormalities, detection of regional wall motion abnormalities, and calculation of left ventricular ejection fraction. The use of UCAs is also of critical importance for the detection of ischaemia and the assessment of significant coronary artery disease through detection of inducible regional wall motion abnormalities during stress echocardiography. UCAs can also assess myocardial perfusion, which improves assessment of myocardial ischaemia during stress echocardiography. Similarly the simultaneous assessment of wall motion and perfusion improves assessment of viable myocardium in patients with left ventricular dysfunction. As the use of UCAs results in increased feasibility, reproducibility, and diagnostic and prognostic accuracy of echocardiography including cost-efficiency, both European and American guidelines endorse its use in clinical cardiology.

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

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 &lt; 0.0001), GLS increase (r = 0.54, p &lt; 0.0001) and STE-TIME SD on exertion (r = 0.27, p &lt; 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) &lt;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% &lt;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) &lt;0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) &lt;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.

Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

2019 ◽  
Vol 90 (7) ◽  
pp. 792-795
Author(s):  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Brittany A Ricci ◽  
Brian MacGrory ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Wall Motion ◽  
Cardiac Evaluation ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

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