scholarly journals Stress Echocardiography with Adenosinethreephosphate and Atrial Pacing in Diagnosis of Late Coronary Shunts Stenosis

2021 ◽  
pp. 57-66
Author(s):  
A. V. Talanova ◽  
D. A. Lezhnev ◽  
N. N. Mikheev
Keyword(s):  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Coronary Arteries ◽  
Coronary Stenosis ◽  
Stress Echocardiography ◽  
Atrial Pacing ◽  
Coronary Lesions

The aim of the study was to evaluate diagnostic accuracy of stress echocardiography (stress echoCG) with combination of high doze АТР and atrial pacing in diagnosis of late coronary shunts stenosis.48 men aged from 45 to 64 (48,4 ± 1,6 years), 36 patients undergone mammarocoronary shunting, 12 patients undergone auto venous shunting. Stress echoCG with combination of high doze ATP and atrial pacing suggested shunts lesions in 44 patients, in 8 cases previously intact coronary arteries, approved with coronary angiography. Coronary angiographies reviled no coronary lesions in 24 patients > 70 % shunts restenosis, in 22 coronary stenosis from 50 up to 70 %. Accuracy, sensitivity and specificity of stress- EchoCG with combination of stress-agents in coronary shunts restenosis, as well as stenosis of previously intact coronary arteries were 100 %.

scholarly journals Comparative efficiency of bicycle stresses-echocardiography and dopplerography of coronary arteries in diagnosis of the latent coronary insufficiency

2015 ◽  
Vol 14 (1) ◽  
pp. 32-40
Author(s):  
A. B. Trivozhenko ◽  
S. A. Iaroshuk ◽  
P. V. Struchkov
Keyword(s):  
Sensitivity And Specificity ◽  
Coronary Arteries ◽  
Stress Echocardiography ◽  
Roc Analysis ◽  
Combined Method ◽  
Coronary Insufficiency ◽  
Significant Stenosis ◽  
Comparative Efficiency ◽  
The Right ◽  
Combined Technique

Modern angiographic and stressful ultrasonic technologies possess the big possibilities in diagnostics of the latent coronary insufficiency. Purpose. To compare sensitivity and specificity of bicycle stress-echocardiography, dopplerography of coronary arteries and combined method in diagnostics of significant stenosis of coronary arteries were used. Design/methodology/approach. Two groups of patients were analyzed: 35 persons from more than 50 % stenosis of coronary arteries and 39 persons without significant stenosis. Dopplerography of coronary arteries and stress-echocardiography were performed in all patients. The ROC-analysis of sensitivity and specificity of each method and the combined technology in diagnostics of the general CAD, left anterior-descending CAD, and the right coronary CAD was spent. Findings. The dopplerography of coronary arteries has shown sensitivity of 77 %, specificity of 97 %, for LAD - 81 and 97 %, for RA - 50 and 98 %. The stress-echocardiography has shown sensitivity of 83 %, specificity of 95 %, for LAD - 89 and 95 %, for RA - 63 and 98 % The combined technique has shown sensitivity of 93 %, specificity - 95 %, for LAD - 96 and 94 %, for RA - 75 and 98 %. Conclusion. The combined technique is characterized by the robust reproducibility at the expense of revealing of loading infringements local contractility of myocardium in patients with not detected stenosis, and also at the expense of revealing of vascular narrowing in persons with well developed indemnification of deficiency of a blood-groove on the changed vessel.

scholarly journals Cardiovascular magnetic resonance in emergency patients with multivessel disease or unobstructed coronary arteries: a cost-effectiveness analysis in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025700 ◽  
Author(s):  
Elizabeth A Stokes ◽  
Brett Doble ◽  
Maria Pufulete ◽  
Barnaby C Reeves ◽  
Chiara Bucciarelli-Ducci ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Coronary Arteries ◽  
Stress Echocardiography ◽  
Multivessel Disease ◽  
Coronary Angiogram ◽  
Key Drivers ◽  
The Uk

ObjectiveTo identify the key drivers of cost-effectiveness for cardiovascular magnetic resonance (CMR) when patients activate the primary percutaneous coronary intervention (PPCI) pathway.DesignEconomic decision models for two patient subgroups populated from secondary sources, each with a 1 year time horizon from the perspective of the National Health Service (NHS) and personal social services in the UK.SettingUsual care (with or without CMR) in the NHS.ParticipantsPatients who activated the PPCI pathway, and for Model 1: underwent an emergency coronary angiogram and PPCI, and were found to have multivessel coronary artery disease. For Model 2: underwent an emergency coronary angiogram and were found to have unobstructed coronary arteries.InterventionsModel 1 (multivessel disease) compared two different ischaemia testing methods, CMR or fractional flow reserve (FFR), versus stress echocardiography. Model 2 (unobstructed arteries) compared CMR with standard echocardiography versus standard echocardiography alone.Main outcome measuresKey drivers of cost-effectiveness for CMR, incremental costs and quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios.ResultsIn both models, the incremental costs and QALYs between CMR (or FFR, Model 1) versus no CMR (stress echocardiography, Model 1 and standard echocardiography, Model 2) were small (CMR: −£64 (95% CI −£232 to £187)/FFR: £360 (95% CI −£116 to £844) and CMR/FFR: 0.0012 QALYs (95% CI −0.0076 to 0.0093)) and (£98 (95% CI −£199 to £488) and 0.0005 QALYs (95% CI −0.0050 to 0.0077)), respectively. The diagnostic accuracy of the tests was the key driver of cost-effectiveness for both patient groups.ConclusionsIf CMR were introduced for all subgroups of patients who activate the PPCI pathway, it is likely that diagnostic accuracy would be a key determinant of its cost-effectiveness. Further research is needed to definitively answer whether revascularisation guided by CMR or FFR leads to different clinical outcomes in acute coronary syndrome patients with multivessel disease.

P873Plasma PCSK9 levels and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Panahi ◽  
M S Ghahrodi ◽  
M S Jamshir ◽  
M A Safarpour ◽  
M Pirro ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Coronary Stenosis ◽  
Coronary Vessels ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Vessel Disease ◽  
Coronary Calcifications ◽  
Triple Vessel Disease

Abstract Background Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute. Purpose To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications. Methods One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD<50% or CAD≥50% in one or more coronary arteries. The burden of coronary calcifications was estimated by angiography visual inspection and classified as absent, mild, moderate or severe. Results Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD (<50%) or normal angiographic findings. Also, calcifications were absent in 65 patients (64.4%), and mild, moderate and severe in 23 (22.8%), 11 (10.9%) and 2 (2%) patients, respectively. Plasma PCSK9 levels were significantly associated with age (rho=0.22, p=0.025) and SBP (rho=0.21, p=0.034), and were almost doubled in patients with chronic kidney disease (CKD) as compared to those without CKD [164.6 ng/mL (104.6–187.0) vs 94.8 ng/mL (86.8–114.9), p=0.006]. Among patients without CKD, those with CAD≥50% had higher plasma PCSK9 levels than those without [97.1 ng/mL (87.8–143.0) vs 83.2 ng/mL (73.4–102.6), p=0.04]. In the overall population, higher plasma PCSK9 levels were found in pts with triple vessel disease [165.7 ng/mL (121.3–180.5)] than in those with double/single vessel involvement [97.9 ng/mL (87.6–99.8) and 88.4 ng/mL (87.3–97.4), p<0.001 for both comparisons] or without CAD [87.5 ng/mL (74.3–114.9), p<0.001]. Also, a trend toward an increase of plasma PCSK9 levels was found with higher CAD severity [no-CAD: 87.5 ng/mL (74.3–114.9), CAD<50%: 89.1 ng/mL (78.9–105.3), CAD≥50%: 97.6 ng/mL (87.9–155.3), p=0.051], which turned significant after exclusion of CKD patients (p=0.042). Adjustment for age, sex, plasma LDL-cholesterol levels, statin use and CKD abolished the association between PCSK9 and CAD severity but not with the number of significantly diseased vessels and the burden of coronary calcifications. Conclusions Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level. Acknowledgement/Funding None

scholarly journals The modified protocol of transesophageal atrial pacing in stress echocardiography as an alternative way to increase the information value of the method for detection of ischemic wall motion abnormalities

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 71-76
Author(s):  
M. A. Saidova ◽  
J. V. Botvina ◽  
V. N. Shitov ◽  
L. S. Atabaeva
Keyword(s):  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Information Value ◽  
Atrial Pacing ◽  
Circumflex Artery ◽  
Diagnostic Significance ◽  
Coronary Insufficiency ◽  
Group 2

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). In addition to stress-EchoCG with TEAES, selective coronary angiography was performed for all patients. The development of the new method for evaluating occult coronary insufficiency was based on comparison of SP and MP for TEAES with stress-EchoCG with data of coronary angiography.Results    In both groups, significant differences in values of systolic and diastolic blood pressure were absent. However, the values of achieved heart rate were significantly different: 141±11 (TEAES SP) and 155±10 (TEAES MP) bpm (p=0.01). There was also a difference in the duration of the TEAES protocols: 15±3 and 5±2 min, respectively (p=0.006). The use of the modified TEAES protocol for detecting transient disorders of left ventricular myocardial local contractility increased the sensitivity, specificity and accuracy of the test from 76 %, 87 %, and 80 % to 83 %, 92 %, and 86 %, respectively. The most significant differences were found in the area supplied by the circumflex artery: the SP and MP sensitivities were 63 % and 75 %, respectively (p<0.05) and the SP and MP accuracies were 81 % and 90 %, respectively (p<0.05).Conclusion    Evaluation of occult coronary insufficiency by stress-EchoCG with the TEAES MP as compared to the TEAES SP provides a gentler procedure regimen for the patient due to a shorter duration of the test and at the same time improves the diagnostic significance of this method in IHD patients.

scholarly journals Lesion Length Improves Diagnostic Accuracy of Intravascular Ultrasound for Detecting Functional Intermediate Coronary Stenosis Evaluated With Coronary Angiography-Derived Fractional Flow Reserve in Non-left Main Artery

2021 ◽  
Vol 8 ◽  
Author(s):  
Menghuan Li ◽  
Iokfai Cheang ◽  
Yuan He ◽  
Shengen Liao ◽  
Hui Wang ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Intravascular Ultrasound ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Lesion Length ◽  
Left Main ◽  
Fractional Flow ◽  
Main Artery ◽  
Flow Reserve

Objective: Intravascular ultrasound (IVUS) parameters, for example, minimal lumen area (MLA) and area stenosis (AS), poorly identified functional intermediate coronary stenosis (ICS). For detecting functional ICS defined by coronary angiography-derived fractional flow reserve (caFFR), our study aims to determine whether IVUS parameters integrated with lesion length (LL) by three-dimensional quantitative coronary analysis (3D-QCA) could improve diagnostic value.Methods: A total of 111 patients with 122 ICS lesions in the non-left main artery were enrolled. MLA and AS were calculated in all lesions by IVUS. Diameter stenosis (DS%) and LL were measured by 3D-QCA. caFFR was computed by the proprietary fluid dynamic algorithm, a caFFR ≤ 0.8 was considered as functional stenosis. Receiver-operating curve analyses were used to compare the diagnostic accuracy among indices to predict functional stenoses.Results: Mean caFFR values in all lesions were 0.86 ± 0.09. Lesions with caFFR ≤ 0.8 showed lower MLA and higher AS (MLA: 3.3 ± 0.8 vs. 4.1 ± 1.2, P = 0.002; AS: 71.3 ± 9.6% vs. 63.5 ± 1.3%, P = 0.007). DS% and LL were more severe in lesions with caFFR ≤ 0.8 (DS%: 45.5 ± 9.6% vs. 35.5 ± 8.2%, P &lt; 0.001; LL: 31.6 ± 12.9 vs. 21.0 ± 12.8, P &lt; 0.001). caFFR were correlated with MLA, AS, and LL (MLA: r = 0.36, P &lt; 0.001; AS: r = −0.36, P &lt; 0.001; LL: r = −0.41, P &lt; 0.001). Moreover, a multiple linear regression analysis demonstrated that MLA (β = 0.218, P = 0.013), AS (β = −0.197, P = 0.029), and LL (β = −0.306, P &gt; 0.001) contributed significantly to the variation in caFFR. The best cutoff value of MLA, AS, and LL for predicting caFFR ≤ 0.8 were 3.6 mm2, 73%, and 26 mm, with area under the curve (AUC) of 0.714, 0.688, and 0.767, respectively. Combined with MLA, AS, and LL for identifying functional ICS, the accuracy was the highest among study methods (AUC: 0.845, P &lt; 0.001), and was significantly higher than each single method (All P &lt; 0.05).Conclusion: Lesion length can improve the diagnostic accuracy of IVUS-derived parameters for detecting functional ICS.

scholarly journals Trans-coronary Pacing via Rota Wire Prevents Bradycardia During Rotational Atherectomy: A Case Report

2022 ◽  
Author(s):  
Hirofumi Kusumoto ◽  
Kasumi Ishibuchi ◽  
Katsuyuki Hasegawa ◽  
Satoru Otsuji
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Calcified Lesion ◽  
Temporary Pacemaker ◽  
Coronary Lesions ◽  
Pacemaker Insertion ◽  
Calcified Coronary Lesions ◽  
Significant Coronary Stenosis ◽  
Severe Calcification

Abstract Back ground Rotational atherectomy (RA) is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion. In this report, we present a case of trans-coronary pacing via a Rota wire to prevent bradycardia during RA in the proximal right coronary artery (RCA). Case summary A 72-year-old woman with a one month history of worsening effort angina was admitted to our hospital. Computed tomography coronary angiography disclosed significant coronary stenosis with severe calcification in proximal RCA. Coronary angiography revealed significant coronary stenosis with severe calcification in the proximal RCA. Subsequently, percutaneous coronary artery intervention was performed under the guidance of intravascular ultrasound(IVUS). The pull-back IVUS showed a circumferential calcified lesion in the proximal RCA, that was treated using RA, which induced significant bradycardia requiring temporary pacemaker insertion. Immediately, trans-coronary pacing was provided via a Rota wire placed in the far distal RCA; this was used for back-up pacing during RA. RA was completed by safely modifying the calcified lesion. After successful debulking of the calcified lesion, we dilated with a balloon, and a drug-eluting stent was implanted at the proximal RCA. Final IVUS and angiography showed good stent apposition and expansion. we did not observe any serious intraprocedural complications. Discussion RA is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion via the transvenous route. This method could be an effective method to prevent bradycardia during RA.

scholarly journals Diagnostic performance of virtual fractional flow reserve derived from routine coronary angiography using segmentation free reduced order (1-dimensional) flow modelling

2020 ◽  
Vol 9 ◽  
pp. 204800402096757
Author(s):  
Kevin Mohee ◽  
Jonathan P Mynard ◽  
Gauravsingh Dhunnoo ◽  
Rhodri Davies ◽  
Perumal Nithiarasu ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Fractional Flow ◽  
Conventional Angiography ◽  
Reduced Order ◽  
Flow Modelling ◽  
Flow Reserve ◽  
Coronary Lesions

Introduction Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model. Methods Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC). Results QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = −0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity – 58% and specificity – 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity – 92% and specificity - 29% at a 1D-vFFR of 0.7). Conclusions 1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation.

scholarly journals Diagnostic Accuracy of 128-Slice Dual Source CT Coronary Angiography with Invasive Catheter Coronary Angiography in a Tertiary Care Teaching Hospital

2021 ◽  
Vol 15 (6) ◽  
pp. 2057-2062
Author(s):  
Vishram Singh ◽  
Suresh Babu Kottapalli ◽  
Rakesh Gupta ◽  
Nitin Agarwal ◽  
Yogesh Yadav
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Coronary Arteries ◽  
Ct Coronary Angiography ◽  
Dual Source Ct ◽  
Ct Scanner ◽  
Dual Source ◽  
Artery Disease

Background: Coronary artery disease (CAD) morbidity and mortality increasing day by day in India as well as worldwide. Coronary arteries visualization by using invasive catheterization angiography is still using as a front-line diagnostic tool to evaluate the patients with CAD. 128 slice dual source CT improves the cardiac imaging such as high scanning speed, good temporal resolution and low radiation dose. Objective: To assess the diagnostic accuracy of 128-slice dual source CT cardiac angiography with conventional catheter angiography to find common arteries involved in CAD. Methods: This is a prospective, comparative, cross sectional study conducted at cardiology OPD. Patients with complaint of chest pain and suspected CAD were evaluated by CT and conventional coronary angiography and results were compared. Serum creatinine and ECG status were analyzed before the angiography. SIEMENS 128-slice Dual Source Flash Definition CT Scanner was used as a CT coronary angiography. Severity distribution of coronary artery disease, artery wise distribution of non-significant, significant lesions and coronary artery dominance pattern were analyzed and compared. Results: A total of 70 suspected CAD patients were selected and analyzed. American Heart Association (AHA) model of 17-segment was used to assess the coronary arteries. Normal angiograms reported in 15.71% patients and 58.57% had significant disease. A total of 356 lesions were identified from 690 out of 720 segments. Right coronary artery (RCA) is the most common location of significant lesions which contributes 33.5% (n=55/164). Coronary circulation of right-sided dominance was most commonly reported (70.0%). CT angiography showed 96.13% of an overall sensitivity, 96.28% specificity, 89.72% positive predictive value and 98.49% negative predictive value. Conclusion: 128-slice dual source CT scanner has showed high accuracy and act as non-invasive assessment of coronary arteries in patients with CAD Keywords: Cardiac angiography, Catheter coronary angiography, CT coronary angiography, 128-slice MDCT, Conventional angiography

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