Wearable Devices: A Future Useful Tool for Detection of Silent Ischemia in Patients with Diabetes?

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Vlachakis PK ◽  
◽  
Tentolouris A ◽  
Kanakakis I ◽  
Eleftheriadou I ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Wearable Devices ◽  
Silent Myocardial Ischemia ◽  
Silent Ischemia ◽  
Health Care Technology ◽  
Coronary Syndrome ◽  
St Segment ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Care Technology

As smartphone health care technology continues to evolve, many wearable devices are equipped with Electrocardiographic (ECG) recording. Recently, studies examining the possibility of various wearable devices for continuous ECG recording showed their ability to detect ST-segment alterations. It is known that in almost a quarter of people with diabetes, the presentation of an acute coronary syndrome may be atypical or even asymptomatic (“silent”), and it has been associated with adverse prognosis. The precise mechanisms behind the lack of pain in patients suffering from silent myocardial ischemia remain unknown. The attractive hypothesis that clinicians could use a wearable ECG recording to detect and treat earlier patients suffering from silent myocardial ischemia might change the adverse prognosis of those patients. However, before their clinical application, several obstacles should be overcome in order the physicians to obtain an additional powerful tool in the fight against coronary artery disease in people with diabetes.

scholarly journals Myocardial Ischemia and Diabet. Approaches and Recomendation

2020 ◽  
pp. 67-92
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Vascular Disease ◽  
Therapeutic Approach ◽  
Recent Progress ◽  
Silent Myocardial Ischemia ◽  
Patients With Diabetes ◽  
Vascular Age ◽  
Artery Disease

The outlook epidemiological auguring an increase considerable the number of subjects with diabetes and cardiological problem during diabet, and the recent progress regis- tered in the explorations and the treatment of coronary are nesessery for continiun researche. Since long been recognized as a factor of risk vascular age, the diabetes can be regarded as a genuine vascular disease in because of the frequency and in the severity. The share growing, observed and expected, of the population of diabetics, whose prognosis life is dominated by the complications coronary up the diabet among the priorities of health public in France. The specific features of diabetic coronary artery disease, marked by the often insidious nature of its development, place silent myocardial ischemia (IMS) and possible atheromatous involvement of the epicardial coronary artery trunks at the center of the diagnostic and therapeutic approach. The progress, drug and instrumentals, the treatment of the inadequacy coronary lead naturally to reconsider the treatment, and therefore the screening early to IMS in the aim of reducing the morbidity and the mortality heart of patients with diabetes

scholarly journals Vasospasm or Atherosclerotic Lesion of Coronary Arteries: Case Management

2019 ◽  
pp. 87-90
Author(s):  
V. K. Tashchuk ◽  
I. O. Makoviichuk ◽  
M. V. Al Salama ◽  
O. V. Malinevska-Biliichuk ◽  
S. S. Biletskiy ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Ischemia ◽  
Coronary Arteries ◽  
Atherosclerotic Lesion ◽  
Diagnostic Procedures ◽  
Silent Myocardial Ischemia ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

  Background. Coronary artery vasospasm (CVS) is an important mechanism of myocardial ischemia which can produce any of the manifestations of coronary artery disease from silent myocardial ischemia to acute coronary syndrome including myocardial infarction or sudden cardiac death. One of the main markers of CVS is retrosternal pain not associated with increased myocardial oxygen requirement such as that due to exercise or emotional excitement with frequent attacks in the morning and temporary ST segment elevation. Some patients have variant angina caused by the spasm of coronary arteries (СА) coupled with stable angina provoked by emotional and physical stress. Such patients have decreased exercise tolerance. Aim. To determine the feasibility and subsequence of the appointment of diagnostic procedures such as electrocardiography (ECG), bicycle ergometry (BEM), provocative tests and coronary angiography and left ventriculography (CAG & LVG) in order to visualize СА, to make the choice of patient’s management and to assign an adequate therapeutic program. Materials and methods. The patient who was admitted with complaints about progression of angina and shortness of breath received the full complex of diagnostic manipulations. The purpose was to verify the diagnosis and to prescribe an adequate treatment. Results. This clinical case shows the subsequence of the appointment of diagnostic procedures to the patient who has normal ECG, ST segment elevation on BEM and progression of angina attacks, that is, the necessity of the widespread introduction of coronary angiography. Conclusion. This article shows the necessity of appointment of CAG & LVG. CAG & LVG revealed atherosclerotic lesion of CA which caused chest paint, ST segment elevation, and this result confounded the presence of CVS as a cause of complaints in this patient. The patient underwent stenting of the affected CA which helped to eliminate the cause of pain and is compatible with adequate therapeutic tactics for patients with CA stenosis.

Functional assessment of myocardial ischemia by intracoronary electrocardiogram

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R Bigler ◽  
F Praz ◽  
G.C.M Siontis ◽  
M Stoller ◽  
R Grossenbacher ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Primary Study ◽  
Coronary Perfusion ◽  
Funding Source ◽  
Maximal Heart Rate ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
St Segment ◽  
Coronary Lesions

Abstract Background In patients with chronic coronary syndrome (CCS), percutaneous coronary intervention (PCI) targets hemodynamically significant stenoses, i.e., those thought to cause ischemia. The hemodynamic severity of a coronary stenosis increases with its tightness and with the myocardial mass of viable myocardium downstream of the stenosis. Besides the structural angiographic approach, assessment of functional relevance by pressure measurements (fractional flow reserve, FFR; instantaneous wave-free ratio, iFR) is recommended. However, visual angiographic assessment continues to dominate the treatment decisions for intermediate coronary lesions. Conversely, intracoronary ECG (icECG) potentially provides an inexpensive, sensitive and direct measure of myocardial ischemia. Purpose The goal of this study was to test the accuracy of intracoronary ECG during pharmacologic inotropic stress to determine coronary lesion severity in comparison to established physiologic indices (FFR/iFR) as well as with quantitatively determined percent diameter stenosis (%S) using biplane coronary angiography. Method This was a prospective, open-label study in patients with CCS. The primary study end point was the maximal change in icECG ST-segment shift during pharmacologic inotropic stress induced by dobutamine plus atropine obtained within 1 minute after the point of maximal heart rate (estimated by the formula 220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of a stenosis. For the pressure-derived ratios, i.e. FFR and iFR, the coronary perfusion pressure downstream of a lesion as well as the aortic pressure were continuously recorded. Results One hundred patients were included in the study. Pearson-Correlation coefficient was significant between icECG and all three comparators (%S p<0.001, iFR p<0.001, FFR p<0.001). Using the FFR threshold of 0.80 defining coronary hemodynamic significance, ROC-analysis of the absolute icECG ST-segment shift showed an area under the curve (AUC) of 0.708±0.053 (p=0.0001, n=100, FFR<0.80 n=41). AUC for iFR was 0.919±0.030 (p<0.0001), for percent diameter stenosis it was 0.867±0.036 (p<0.0001). Conclusions During pharmacologic inotropic stress, intracoronary ECG ST-segment shift provides specific evidence for regional myocardial ischemia irrespective of the etiology and thus, provides an additional (patho-)physiologic information for decision making in borderline coronary lesions. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation

Credibility of Risk scores in predicting coronary artery disease severity in non-ST segment elevation acute coronary syndrome patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Elhusseini
Keyword(s):  
Clinical History ◽  
Risk Scores ◽  
Syntax Score ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Early Risk ◽  
Timi Score ◽  
St Segment ◽  
Artery Disease ◽  
Grace Score

Abstract Objectives We aimed to assess the value of Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores (RSs) for predicting coronary artery disease (CAD) severity and prognosis in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Background Patients with NSTE-ACS are at varying risks of death and recurrent cardiac events, early risk stratification plays a central role, different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission. Methods A prospective study was conducted including 100 patients (age, 45–68 years) with NSTE-ACS who were admitted at our hospital from January 2018 to January 2019. The two RSs (TIMI& GRACE) were calculated from the initial clinical history, electrocardiogram, and laboratory values collected and recorded on admission. All patients were subjected to conventional coronary angiography during admission, Patients were divided into two groups: 1) patients with syntax score ≤32 (test group, 80 patients) and 2) patients with syntax score >32 (comparative group, 20 patients). Median follow-up duration was 6 (4–9) days. Results Regarding correlation between coronary angiographic severity based on syntax score and the clinical profile based on the two RSs (TIMI&GRACE) in NSTE-ACS patients, statistically significant correlation were found between GRACE score and syntax score (r=0.789; P=0.001) with GRACE score accuracy: 94% and negative predictive value (NPV): 98.7%, whereas no statistically significant correlation were found between TIMI score and syntax score (r=0.087; P=0.388) with TIMI score accuracy: 32% and NPV: 73.1%. Conclusions In conclusion the GRACE score provides a quick and reliable prediction of CAD severity in NSTE-ACS patients, It allows accurate risk estimation, categorizes patients and consequently can help in making accurate therapeutic decisions either with the use of invasive strategies in high risk selected patients or the use of conservative strategies in low risk patients in presence of limited resources. Funding Acknowledgement Type of funding source: None

scholarly journals Diabetes Mellitus with Silent Myocardial Ischemia: A Single-Center Cross-Sectional Study of Karachi, Pakistan

2021 ◽  
pp. 56-60
Author(s):  
Muhammad Zohaib Siddiq ◽  
Shahid Hussain Memon ◽  
Anwar Ali ◽  
Tabassum Almas ◽  
Atiya Razzaq ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Ischemia ◽  
Cross Sectional Study ◽  
Silent Myocardial Ischemia ◽  
Study Patient ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
St Segment ◽  
History Of

Background: Previous studies have established the fact that diabetic patients are predominantly inclined towards silent myocardial infarction (SMI). The objective of the present study is to determine the incidence of SMI in diabetes mellitus (DM) patients. Methodology: In this cross-sectional study, patient data was gathered on a predesigned proforma regarding the detailed history of dyspnea, DM and its duration, chest pain either present or not. Those patients who had normal ECG labeled negative for SMI, while those who had either ST-segment elevation or ST-segment deviation on resting ECG were positive for SMI. Study was conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi- Pakistan. Results: The mean age of the enrolled patients was 54.21±8.65 (40-70) years. Out of 210, majority were female (51.90%).Overall, 94(44.76%) patients were obese, 122(58.09%) were hypertensive, 90(42.85%) had dyslipidemia and 98(46.66%) diabetic patients were smokers. There were 93 (44.3%) DM patients who had SMI. Moreover, 109(51.90%) patients had a family history of myocardial ischemia. Conclusion:  The SMI incidence among diabetic patients was found higher in local population. It is proposed that diabetic patients with demonstrated cardiovascular autonomic neuropathy must be screened for the manifestation of SMI.

Symptomatic and silent myocardial ischemia during exercise testing in coronary artery disease

1986 ◽  
Vol 58 (4) ◽  
pp. B43-B46 ◽  
Author(s):  
Ezra A. Amsterdam ◽  
Robert Martschinske ◽  
Lawrence J. Laslett ◽  
John C. Rutledge ◽  
Zakauddin Vera
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Exercise Testing ◽  
Silent Myocardial Ischemia ◽  
Artery Disease

scholarly journals The Triglyceride-Glucose Index Predicts Coronary Artery Disease Severity and Cardiovascular Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Qi Mao ◽  
Denglu Zhou ◽  
Youmei Li ◽  
Yuqing Wang ◽  
Shang-Cheng Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Independent Predictor ◽  
Syntax Score ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Tyg Index ◽  
Coronary Artery Disease Severity ◽  
St Segment ◽  
Artery Disease

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is the leading cause of morbidity and mortality from cardiovascular disease worldwide. Several recent studies have shown the relationship between the triglyceride-glucose (TyG) index and vascular disease; however, the role of the TyG index in NSTE-ACS has not been extensively assessed. Thus, we aimed to investigate the association of the TyG index with cardiovascular risk factors and outcomes in NSTE-ACS. Overall, 438 patients with NSTE-ACS were enrolled to examine the association of the TyG index with the SYNTAX score and major adverse cardiovascular events (MACEs). The TyG index was calculated as ln fasting triglyceride mg/dL×fasting glucose mg/dL/2. The severity of coronary lesions was quantified by the SYNTAX score. MACEs included cardiac death, nonfatal myocardial infarction, target vessel revascularization, congestive heart failure, and nonfatal stroke. All the patients underwent a 12-month follow-up for MACEs after admission. Multivariate regression analysis identified metabolic risk factors as independent parameters correlated with the TyG index. The prevalence of glucose metabolism disorder, metabolic syndrome, and MACEs increased with increasing TyG index. The TyG index showed a strong diagnostic performance for cardiovascular risk factors and was independently associated with the SYNTAX score (OR 6.055, 95% CI 2.915–12.579, P<0.001). The risk of MACEs (12.8% and 22.8% for the low TyG index and high TyG index groups, respectively; adjusted HR=1.791, 95% CI 1.045–3.068, P=0.034) significantly increased in the high TyG index group as compared with the low TyG index group. The multivariate Cox regression analysis further revealed that the TyG index was an independent predictor of MACEs (HR 1.878, 95% CI 1.130–3.121, P=0.015). In conclusion, the TyG index might be an independent predictor of coronary artery disease severity and cardiovascular outcomes in NSTE-ACS.

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