1
|
Ahres A, Jablonkai B, Schrancz Á, Balogh Z, Kenessey A, Baranyai T, Őze Á, Szigeti Z, Rubóczky G, Nagybaczoni B, Apor A, Simon J, Szilveszter B, Kolossváry M, Merkely B, Maurovich-Horvat P, Andrássy P. Patients with Moderate Non-Culprit Coronary Lesions of Recent Acute Coronary Syndrome. Int Heart J 2021; 62:952-961. [PMID: 34497167 DOI: 10.1536/ihj.20-760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fractional flow reserve (FFR) measurement was compared to dobutamine stress echocardiography (DSE) instable angina (SA) with stable coronary lesion (s) (SCL (s) ) in a few trials; however, similar comparisons in patients with acute coronary syndrome (ACS) with non-culprit lesion (s) (NCL (s) ) are lacking. Our objectives were to prospectively evaluate the diagnostic performance of FFR with two different cutoff values (< 0.80 and < 0.75) relative to DSE in moderate (30%-70% diameter stenosis) NCLs (ACS group) and to compare these observations with those measured in SCLs (SA group). One hundred seventy-five consecutive patients with SA (n = 86) and ACS (n = 89) with 225 coronary lesions (109 SCLs and 116 NCLs) were enrolled. In contrast to the ACS cohort in SA patients, normal DSE was associated with higher FFR values compared to those with abnormal DSE (P = 0.051 versus P = 0.006). In addition, in the SA group, a significant correlation was observed between DSE (regional wall motion score index at peak stress) and FFR (r = -0.290; P = 0.002), whereas a similar association was absent (r = -0.029; P = 0.760) among ACS patients. In the SA group, decreasing the FFR cutoff value (< 0.80 versus < 0.75) improved the concordance of FFR with DSE (70.6% versus 81.7%) without altering its discriminatory power (area under the curve; 0.68 versus 0.63; P = 0.369), whereas in the ACS group, concordance remained similar (69.0% versus 71.6%) and discriminatory power decreased (0.62 versus 0.51; P = 0.049), respectively. In conclusion, lesion-specific FFR assessment may have different relevance in patients with moderate NCLs than in patients with SCLs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ágnes Őze
- Department of Cardiology, Bajcsy-Zsilinszky Hospital
| | - Zsolt Szigeti
- Department of Cardiology, Bajcsy-Zsilinszky Hospital
| | | | | | - Astrid Apor
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Judit Simon
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Bálint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Béla Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University.,Medical Imaging Center, Semmelweis University
| | | |
Collapse
|
2
|
Kadoglou NPE, Papadopoulos CH, Papadopoulos KG, Karagiannis S, Karabinos I, Loizos S, Theodosis-Georgilas A, Aggeli K, Keramida K, Klettas D, Kounas S, Makavos G, Ninios I, Ntalas I, Ikonomidis I, Sahpekidis V, Stefanidis A, Zaglavara T, Athanasopoulos G, Karatasakis G, Kyrzopoulos S, Kouris N, Patrianakos A, Paraskevaidis I, Rallidis L, Savvatis K, Tsiapras D, Nihoyannopoulos P. Updated knowledge and practical implementations of stress echocardiography in ischemic and non-ischemic cardiac diseases: an expert consensus of the Working Group of Echocardiography of the Hellenic Society of Cardiology. Hellenic J Cardiol 2021; 64:30-57. [PMID: 34329766 DOI: 10.1016/j.hjc.2021.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
Stress echocardiography (SE) is a well-established and valid technique, widely-used for the diagnostic evaluation of patients with ischemic and non-ischemic cardiac diseases. This statement of the Echocardiography Working Group of the Hellenic Society of Cardiology summarizes the consensus of the writing group regarding the applications of SE, based on the expertise of their members and on a critical review of current medical literature. The main objectives of the consensus document include a comprehensive review of SE methodology and training, focusing on the preparation, the protocols used and the analysis of the SE images and an updated, evidence-based knowledge about SE applications on ischemic and non-ischemic heart diseases, such as in cardiomyopathies, heart failure and valvular heart disease.
Collapse
Affiliation(s)
- Nikolaos P E Kadoglou
- Medical School, University of Cyprus, Nicosia, Cyprus; Second Cardiology Department, "Hippokration" Hospital, Aristotle University ofThessaloniki, Greece.
| | | | | | | | | | | | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Kalliopi Keramida
- 2nd Cardiology Department, Attikon University Hospital, Athens, Greece
| | | | | | - George Makavos
- 3rd Cardiology Department, Sotiria University Hospital, Athens, Greece
| | - Ilias Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | | | | | | | | | | | - George Karatasakis
- 1st Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Nikos Kouris
- Cardiology Department, Thriasio Hospital, Elefsina, Greece
| | | | | | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | - Petros Nihoyannopoulos
- Metropolitan Hospital Center, Piraeus, Greece; Imperial College London, Hammersmith Hospital, London, UK
| |
Collapse
|
3
|
Exercise echocardiography demonstrates potential myocardial damage in patients with repaired tetralogy of Fallot using layer-specific strain analysis. Cardiol Young 2020; 30:710-716. [PMID: 32364109 DOI: 10.1017/s1047951120000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Exercise stress echocardiography and layer-specific strains are emerging as important tools for cardiac assessment. This study was aimed to evaluate layer-specific strains and torsion parameters during exercise in order to investigate the characteristics of cardiac dysfunction in patients with repaired tetralogy of Fallot and to detect subclinical left ventricular dysfunction. MATERIALS AND METHODS Thirteen patients with repaired tetralogy of Fallot (median age, 17.3 [interquartile range, 14.5-22.9] years; 6 males) and 13 controls (median age, 28.5 [interquartile range, 27.6-31.6] years; 13 males) underwent echocardiography at rest and during supine exercise. Layer-specific longitudinal strain and circumferential strain of three myocardial layers (endocardium, midmyocardium, and epicardium), torsion, and untwisting rate were measured using two-dimensional speckle-tracking echocardiography. RESULTS Peak endocardial papillary circumferential strain (-21.1 ± 2.6% vs. -25.8 ± 3.8%, p = 0.007), midmyocardial apical circumferential strain (-11.1 ± 4.0% vs. -15.6 ± 3.2%, p = 0.001), epicardial apical circumferential strain (-11.1 ± 4.0% vs. -15.6 ± 3.2%, p = 0.021), and torsion (8.9 ± 6.0 vs. 14.9 ± 4.8 degree, p = 0.021) were significantly lower in the repaired tetralogy of Fallot group than in the control group during exercise, though no significant difference was found between patients and controls at rest. CONCLUSIONS Analysis of layer-specific strains and torsion parameters during exercise could detect subclinical left ventricular dysfunction in patients with repaired tetralogy of Fallot, which might reflect potential myocardial damage, at a stage where these parameters have normal values at rest. This finding provides new insight into the mechanisms of cardiac dysfunction in patients with repaired tetralogy of Fallot.
Collapse
|
4
|
Steeds RP, Wheeler R, Bhattacharyya S, Reiken J, Nihoyannopoulos P, Senior R, Monaghan MJ, Sharma V. Stress echocardiography in coronary artery disease: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2019; 6:G17-G33. [PMID: 30921767 PMCID: PMC6477657 DOI: 10.1530/erp-18-0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
Stress echocardiography is an established technique for assessing coronary artery disease. It has primarily been used for the diagnosis and assessment of patients presenting with chest pain in whom there is an intermediate probability of coronary artery disease. In addition, it is used for risk stratification and to guide revascularisation in patients with known ischaemic heart disease. Although cardiac computed tomography has recently been recommended in the United Kingdom as the first-line investigation in patients presenting for the first time with atypical or typical angina, stress echocardiography continues to have an important role in the assessment of patients with lesions of uncertain functional significance and patients with known ischaemic heart disease who represent with chest pain. In this guideline from the British Society of Echocardiography, the indications and recommended protocols are outlined for the assessment of ischaemic heart disease by stress echocardiography.
Collapse
Affiliation(s)
- Richard P Steeds
- Department of Cardiology, Institute of Cardiovascular Science, University Hospital Birmingham, Birmingham, UK
| | - Richard Wheeler
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | | | - Joseph Reiken
- Department of Cardiology, Kings College Hospital, London, UK
| | - Petros Nihoyannopoulos
- Department of Cardiology, National Heart Lung Institute, Hammersmith Hospital, London, UK
| | - Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Mark J Monaghan
- Department of Cardiology, Kings College Hospital, London, UK
| | - Vishal Sharma
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| |
Collapse
|
5
|
Dasgupta S, Friedman H, Allen N, Stark M, Ferguson E, Sachdeva R, Border WL. Exercise stress echocardiography: Impact on clinical decision-making in pediatric patients. Echocardiography 2019; 36:938-943. [PMID: 30934142 DOI: 10.1111/echo.14326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of exercise stress echocardiography (ESE) in the pediatric population is less well defined as compared to adults. We aimed to determine the utility and impact of ESE on clinical decision-making in pediatric patients. METHODS We identified patients who underwent an ESE at our center from 2011 to 2015. Test indications were categorized into symptoms with exercise; sports/activity clearance; hypertrophic cardiomyopathy (HCM) or suspected HCM; coronary anomalies; or abnormal electrocardiogram (EKG). Change in clinical management was assessed by comparing pre- and post-test activity restrictions, which were categorized into unrestricted from exercise or activity; restricted from exercise or activity; and surgical referral. RESULTS During the study period, 353 ESEs met inclusion criteria. Of all ESEs performed, 263 (75%) were normal. Clinical management changed as a result of ESE in 144 (40%). Of the abnormal ESEs, 44 were restricted from activity, including 25 (56.8%) restricted from competitive or varsity athletics, 14 (31.8%) restricted from recreational sports, and 5 (11.4%) restricted from all activity. Surgical referrals included valve repair/replacement in 7 (50%), ICD placement in 5 (35.8%), coronary re-implantation in 1 (7.1%), and atrial septal defect repair in 1 (7.1%). CONCLUSION Exercise stress echocardiography provides the pediatric cardiologist with useful information that impacts management in a wide variety of cardiac disorders. Clinical management changed in nearly half the patients that were subjected to an ESE at our center. This supports the value of ESE for informing clinical decision-making. Future studies should aim to refine patient selection and examine its impact on patient outcomes.
Collapse
Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Nicole Allen
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Megan Stark
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Eric Ferguson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Ritu Sachdeva
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - William L Border
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| |
Collapse
|
6
|
Xu B, Dobson L, Mottram PM, Nasis A, Cameron J, Moir S. Is exercise stress echocardiography useful in patients with suspected obstructive coronary artery disease who have resting left bundle branch block? Clin Cardiol 2018; 41:360-365. [PMID: 29574887 PMCID: PMC6490042 DOI: 10.1002/clc.22875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/23/2017] [Accepted: 12/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Current guidelines support exercise stress echocardiography (ESE) for evaluation of suspected obstructive coronary artery disease (OCAD) in ambulant patients with left bundle branch block (LBBB). Data regarding the diagnostic utility of ESE in patients with LBBB are limited. HYPOTHESIS We hypothesized that the diagnostic performance of ESE for the assessment of suspected OCAD is reduced in the context of LBBB. METHODS We studied 191 consecutive patients with resting LBBB undergoing ESE for the investigation of suspected OCAD between 2008 and 2015 at our center. The studies were categorized as inconclusive, normal, or abnormal. Patients with an abnormal response were subcategorized as regional ischemic response or globally abnormal. RESULTS Eighty-two patients (43%) demonstrated a normal left ventricular contractile response (LVCR) to exercise; 92 (48%) developed an abnormal LVCR to exercise, including 70 patients with globally abnormal and 22 patients with regional ischemic responses. Of the patients with abnormal responses, 62 patients had anatomic imaging, only 29 of whom had significant OCAD, conferring an overall specificity of ESE for significant OCAD of 21% and accuracy of 52%. Of patients who developed a regionally abnormal response, 89% had significant OCAD. CONCLUSIONS For patients with LBBB who develop a globally abnormal LVCR during ESE, the specificity of ESE for reliably excluding significant OCAD is significantly reduced. ESE appears to be a suboptimal test for the evaluation of OCAD in patients with resting LBBB, as about 50% of patients will have an abnormal response, the majority due to globally abnormal contraction where OCAD cannot be reliably diagnosed. Alternative testing should be considered for the investigation of suspected OCAD in patients with resting LBBB.
Collapse
Affiliation(s)
- Bo Xu
- MonashHeart, Monash HealthClaytonVictoriaAustralia
| | - Laura Dobson
- MonashHeart, Monash HealthClaytonVictoriaAustralia
| | | | - Arthur Nasis
- MonashHeart, Monash HealthClaytonVictoriaAustralia
| | | | - Stuart Moir
- MonashHeart, Monash HealthClaytonVictoriaAustralia
| |
Collapse
|
7
|
Velasco del Castillo S, Antón Ladislao A, Gómez Sánchez V, Onaindia Gandarias JJ, Cacicedo Fernández de Bobadilla Á, Rodríguez Sánchez I, Laraudogoitia Zaldumbide E. Influencia del riesgo cardiovascular en la predicción y el momento de aparición de eventos cardiacos tras ecocardiograma de esfuerzo sin isquemia. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Velasco Del Castillo S, Antón Ladislao A, Gómez Sánchez V, Onaindia Gandarias JJ, Cacicedo Fernández de Bobadilla Á, Rodríguez Sánchez I, Laraudogoitia Zaldumbide E. Influence of Cardiovascular Risk in the Prediction and Timing of Cardiac Events After Exercise Echocardiogram Testing Without Ischemia. ACTA ACUST UNITED AC 2017; 70:736-743. [PMID: 28416165 DOI: 10.1016/j.rec.2016.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES There have been no analyses of the influence of cardiovascular risk as a predictor of events in patients with exercise echocardiography (EE) without ischemia. Our objective was to determine the predictors of cardiac events, paying special attention to cardiovascular risk. METHODS This study included 1640 patients with EE without ischemia. Of these, there were 1206 with no previously known coronary artery disease (CAD), whose risk of a fatal cardiovascular disease event was estimated according to the European SCORE (Systematic COronary Risk Evaluation) risk assessment system, and 434 with known CAD. The primary endpoint was cardiac event-free survival (EFS) (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization). RESULTS After a median follow-up of 35 [23-54] months, no differences were found in cardiac EFS between patients with a SCORE ≥ 10 or diabetes and patients with previous CAD (89.8% vs 87.1%). In the first year, cardiac EFS was high in all groups (99.4% if SCORE < 5; 100% if 5-9; 98% if ≥ 10 or diabetes and 97% in patients with CAD). In the third year, cardiac EFS was similar in the group with SCORE ≥ 10 or diabetes (94.5%) and patients with CAD (91.1%, P = NS). In these patients, the annualized event rate was 2.8% and 2.55%, respectively, and was significantly higher than in groups with SCORE < 5 (0.6%) and SCORE 5-9 (0.12%). The most frequent events were non-ST-segment elevation acute coronary syndrome and late revascularization. Predictors of cardiac events were previous CAD, SCORE ≥ 10 or diabetes mellitus, creatinine clearance, left ventricular ejection fraction, and chest pain during EE. CONCLUSIONS Initial outcome after an EE without ischemia is favorable but is subsequently modulated by cardiovascular risk.
Collapse
|
9
|
Vamvakidou A, Karogiannis N, Tzalamouras V, Parsons G, Young G, Gurunathan S, Senior R. Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome. Eur Heart J Cardiovasc Imaging 2017; 18:415-421. [PMID: 28013281 DOI: 10.1093/ehjci/jew211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/30/2016] [Indexed: 01/09/2023] Open
Abstract
Aims Patients with symptomatic left bundle branch block (LBBB) may have myocardial ischaemia due to both coronary artery disease and/or cardiomyopathy (microcirculatory abnormalities) and may have concomitant left ventricular (LV) dysfunction. We aimed to assess the feasibility and prognostic value of contemporary stress echocardiography (SE), which can uncover both pathophysiologies in LBBB patients in routine clinical practice, and also aimed to assess the additive value of contrast SE. Methods and results Accordingly, 190 consecutive patients (age 70.5 ± 11.3 years, LV ejection fraction = 50.1 ± 10%) with symptomatic LBBB who underwent SE over 6 years were assessed, of which 142 (75%) underwent contrast SE and 176 (92.6%) had diagnostic SE. Inducible ischaemia was present in 25 (14.2%) patients. During follow-up (35.4 ± 20.2 months) there were 32 deaths (18%) and 18 (10.2%) first cardiovascular (CV) events (acute myocardial infarction/mortality) in the 176 patients with diagnostic studies. Wall thickening score index at peak stress (WTSIpeak), which measures combined LV function and inducible ischaemia, was an independent predictor of mortality (HR = 3.78, 95% CI = 1.39-10.31, P = 0.01) and CV events (HR = 3.96, 95% CI = 1.1-14.3, P = 0.036). An abnormal SE (myocardial ischaemia and/or abnormal LV function) predicted an almost three-fold increase in all-cause mortality and CV events compared with normal SE. Amongst the confounders affecting assessment of wall thickening in LBBB and conventional prognostic variables, use of contrast was an independent predictor (P = 0.034) of WTSI1.16 (optimal predictor of mortality/CV outcome). Conclusion SE in patients with LBBB demonstrated high feasibility and the combination of LV systolic function and myocardial ischaemia provided important prognostic information. Contrast-enhanced SE improved the prediction of outcome.
Collapse
Affiliation(s)
- Anastasia Vamvakidou
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Nikos Karogiannis
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Vasilis Tzalamouras
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Guy Parsons
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Grace Young
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Sothinathan Gurunathan
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
10
|
Leischik R, Dworrak B, Sanchis-Gomar F, Lucia A, Buck T, Erbel R. Echocardiographic assessment of myocardial ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:259. [PMID: 27500160 DOI: 10.21037/atm.2016.07.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the last 60 years, echocardiography has emerged as a dominant and indispensable technique for the detection and assessment of coronary heart disease (CHD). In this review, we will describe and discuss this powerful tool of cardiology, especially in the hands of an experienced user, with a focus on myocardial ischemia. Technical development is still on-going, and various new ultrasound techniques have been established in the field of echocardiography in the last several years, including tissue Doppler imaging (TDI), contrast echocardiography, three-dimensional echocardiography (3DE), and speckle tracking echocardiography (i.e., strain/strain rate-echocardiography). High-end equipment with harmonic imaging, high frame rates and the opportunity to adjust mechanical indices has improved imaging quality. Like all new techniques, these techniques must first be subjected to comprehensive scientific assessment, and appropriate training that accounts for physical and physiological limits should be provided. These limits will constantly be redefined as echocardiographic techniques continue to change, which will present new challenges for the further development of ultrasound technology.
Collapse
Affiliation(s)
- Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | - Birgit Dworrak
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | | | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ("i+12"), Madrid, Spain;; European University of Madrid, Madrid, Spain
| | - Thomas Buck
- Clinic of Cardiology, Klinikum Westfalen, Dortmund, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry, Epidemiology, University Clinic Essen, Essen, Germany
| |
Collapse
|
11
|
Peteiro J, Bouzas-Mosquera A, Broullón J, Yañez J, Martinez D, Vazquez JM. Exercise left ventricular ejection fraction predicts events in right bundle branch block. SCAND CARDIOVASC J 2015; 50:108-13. [PMID: 26634337 DOI: 10.3109/14017431.2015.1118529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Interpretation of the electrocardiogram (ECG) during exercise is not easy in patients with right bundle branch block (RBBB). Also, the value of exercise echocardiography (ExE) for predicting outcome in them has not been addressed. We sought to assess its prognostic value in patients with RBBB and known/suspected coronary disease. DESIGN Retrospective analysis of data on 703 patients with RBBB who were submitted to a clinically-indicated ExE. The end points were overall mortality and combined myocardial infarction and cardiovascular mortality. RESULTS During follow-up (4.1 ± 4.5 years) there were 130 deaths and 108 combined events. Independent predictors of combined events were history of coronary artery disease (hazard ratio [HR] = 2.37, 95% Confidence Interval [CI] = 1.24-4.52, p = 0.009) resting wall motion score index (HR = 2.14, 95% CI = 1.12-4.10, p = 0.02), metabolic equivalents (HR = 0.89, 95% CI = 0.93-0.97, p = 0.007), Δ in double product with exercise (HR = 0.96, 95% CI = 0.92-1.00, p = 0.036) and Δ in left ventricular ejection fraction (LVEF) with exercise (HR = 0.97, 95% CI = 0.94-0.99, p = 0.01). Neither positive clinical nor ECG exercise testing was predictive. Combined event rates were 3.3% in patients with ΔLVEF > 5%, 4.7% in those with ΔLVEF between 1-5% and 8.2% in those with no increase (Δ < 1%). CONCLUSIONS A decrease in LVEF during exercise is predictive of serious events in patients with RBBB.
Collapse
Affiliation(s)
- Jesús Peteiro
- a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| | - Alberto Bouzas-Mosquera
- a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| | - Javier Broullón
- b Department of Information Technology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| | - Juan Yañez
- a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| | - Dolores Martinez
- a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| | - Jose Manuel Vazquez
- a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain
| |
Collapse
|
12
|
Exercise Echocardiography Demonstrates Biventricular Systolic Dysfunction and Reveals Decreased Left Ventricular Contractile Reserve in Children After Tetralogy of Fallot Repair. J Am Soc Echocardiogr 2015; 28:294-301. [DOI: 10.1016/j.echo.2014.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/21/2022]
|
13
|
Mordi I, Tzemos N. Non-invasive assessment of coronary artery disease in patients with left bundle branch block. Int J Cardiol 2015; 184:47-55. [PMID: 25697870 DOI: 10.1016/j.ijcard.2015.01.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
There is a high prevalence of coronary artery disease (CAD) in patients with left bundle branch block (LBBB); however there are many other causes for this electrocardiographic abnormality. Non-invasive assessment of these patients remains difficult, and all commonly used modalities exhibit several drawbacks. This often leads to these patients undergoing invasive coronary angiography which may not have been necessary. In this review, we examine the uses and limitations of commonly performed non-invasive tests for diagnosis of CAD in patients with LBBB.
Collapse
Affiliation(s)
- Ify Mordi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Nikolaos Tzemos
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
| |
Collapse
|
14
|
Supariwala AA, Po JRF, Mohareb S, Aslam F, Kaddaha F, Mian ZI, Chaudhry F, Otokiti A, Chaudhry FA. Prevalence and Long-Term Prognosis of Patients with Complete Bundle Branch Block (Right or Left Bundle Branch) with Normal Left Ventricular Ejection Fraction Referred for Stress Echocardiography. Echocardiography 2014; 32:483-9. [DOI: 10.1111/echo.12680] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Azhar A. Supariwala
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Jose Ricardo F. Po
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Sameh Mohareb
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farhan Aslam
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Firas Kaddaha
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Zainab I. Mian
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farhan Chaudhry
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Ahmed Otokiti
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farooq A. Chaudhry
- Mount Sinai Hospital; Icahn School of Medicine at Mount Sinai; New York New York
| |
Collapse
|
15
|
Bouzas-Mosquera A, Peteiro J, Broullón FJ, Méndez E, Barge-Caballero G, López-Pérez M, López-Sainz A, Alvarez-García N, Castro-Beiras A. Impact of electrocardiographic interpretability on outcome in patients referred for stress testing. Eur J Clin Invest 2012; 42:541-7. [PMID: 22050029 DOI: 10.1111/j.1365-2362.2011.02615.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is limited insight into the association of electrocardiographic interpretability with outcome in patients referred for stress testing. METHODS Exercise echocardiography was performed in 8226 patients with known or suspected coronary artery disease. Electrocardiograms were considered uninterpretable in the presence of left bundle-branch block (LBBB), left ventricular hypertrophy (LVH) with strain, repolarization abnormalities because of digitalis therapy, ventricular paced rhythm, preexcitation or ST depression ≥ 0.1 mV because of other causes. End points were all-cause mortality, cardiac death and hard cardiac events (i.e. cardiac death or nonfatal myocardial infarction). RESULTS A total of 2450 patients had uninterpretable electrocardiograms. During a follow-up period of 4.1 ± 3.5 years, there were 1011 deaths (of which 478 were cardiac deaths) and 1069 patients experienced a hard cardiac event. The 5-year rates of death, cardiac death and hard cardiac events were, respectively, 18.7%, 10.9% and 18.8% in patients with uninterpretable ECGs, compared with 9.5%, 4.1% and 10.9% in those with interpretable ECGs (P < 0.001). After covariate adjustment, lack of ECG interpretability remained an independent predictor of all-cause mortality (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.08-1.44, P = 0.002), cardiac death (HR 1.63, 95% CI 1.32-2.01, P < 0.001) and hard cardiac events (HR 1.28, 95% CI 1.11-1.47, P < 0.001). When the specific ECG abnormalities were included as covariates, LBBB, LVH and digitalis therapy remained predictors of cardiac death; LBBB and LVH were predictors of hard cardiac events, and LVH remained predictive of all-cause mortality. CONCLUSION Uninterpretable ECGs portend a worse prognosis in patients referred for stress testing.
Collapse
|
16
|
Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2011; 28:1133-40. [DOI: 10.1007/s10554-011-9931-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/20/2011] [Indexed: 01/19/2023]
|
17
|
Bouzas-Mosquera A, Peteiro J, Broullón FJ, Álvarez-García N, Méndez E, Pérez A, Mosquera VX, Castro-Beiras A. Value of exercise echocardiography for predicting mortality in elderly patients. Eur J Clin Invest 2010; 40:1122-30. [PMID: 20718848 DOI: 10.1111/j.1365-2362.2010.02365.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Elderly patients with suspected or known coronary artery disease are often referred for pharmacological stress testing. Data on the value of exercise echocardiography (ExEcho) for predicting outcome (particularly all-cause mortality) in these patients are scarce. METHODS Peak treadmill ExEcho was performed in 2159 patients ≥ 70 years of age with known or suspected coronary artery disease. Left ventricular wall motion was evaluated at baseline and with exercise, and the increase in wall motion score index from rest to peak exercise (ΔWMSI) was calculated. Ischaemia was diagnosed when new or worsening wall motion abnormalities developed with exercise. The end points were all-cause mortality and major cardiac events (cardiac death or myocardial infarction). RESULTS Ischaemia developed in 844 patients (38·6%) during exercise. Over a mean follow-up of 3·5 ± 3·1 years, 439 deaths occurred. The cumulative 5-year mortality rate was 29·3% in patients with ischaemia versus 16·8% in those without ischaemia (P < 0·001). After covariate adjustment, ΔWMSI remained an independent predictor of mortality [hazard ratio (HR) 2·37, 95% confidence interval (CI) 1·66-3·39, P < 0·001] and major cardiac events (HR 3·48, 95% CI 2·11-5·74, P < 0·001). These results remained significant even in patients with chronotropic incompetence. When added to a model with clinical, resting echocardiographic and exercise electrocardiogram variables, ExEcho results provided incremental value for the prediction of both end points (P < 0·001). CONCLUSIONS ExEcho is feasible in elderly patients with suspected or known coronary artery disease and provides useful information for risk stratification in these patients.
Collapse
|
18
|
Prognostic value of exercise echocardiography in patients with left ventricular systolic dysfunction and known or suspected coronary artery disease. Am Heart J 2010; 160:301-7. [PMID: 20691836 DOI: 10.1016/j.ahj.2010.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 05/08/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prognostic value of exercise echocardiography (ExE) in patients with left ventricular systolic dysfunction (LVSD) has not been characterized. We sought to assess the value of ExE for predicting outcome in patients with LVSD and known/suspected coronary artery disease. METHODS This study is a retrospective analysis of a prospectively collected database of 1,107 patients who underwent treadmill ExE and had resting LVSD (left ventricular ejection fraction <50%). Ischemia was defined as an increase in wall motion score index from rest to exercise. The end points were all-cause mortality and major cardiac events (MACE). RESULTS Overall, 494 patients (44.6%) developed new or worsening wall motion abnormalities. During a mean follow-up of 4.1 +/- 3.4 years, 301 patients died and 166 had a MACE. In patients with mild LVSD, the 5-year mortality rate was 8.8% in those without ischemia and 21% in those with ischemia (P < .001). For patients with moderate LVSD without ischemia, the 5-year mortality rate was 18.3%, whereas it was 29.2% when ischemia was present (P = .009). In those with severe LVSD, the 5-year mortality rate was 23.9% without ischemia and 35.7% with ischemia (P = .03). In the multivariate analysis, increase in wall motion score index was an independent predictor of mortality (hazard ratio 2.25, 95% CI 1.26-2.06, P = .001) and MACE (hazard ratio 2.60, 98% CI 1.34-5.04, P = .005). The addition of the ExE results to clinical, resting echocardiography and exercise variables provided significant incremental prognostic information for predicting mortality (P = .001) and MACE (P = .005). CONCLUSIONS The ExE provides significant information for predicting outcome in patients with LVSD and known/suspected coronary artery disease.
Collapse
|
19
|
Bouzas-Mosquera A, Peteiro J, Broullón FJ, Alvarez-García N, Mosquera VX, Rodríguez-Vilela A, Casas S, Castro-Beiras A. Prognostic value of exercise echocardiography in patients with atrial fibrillation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:346-51. [PMID: 20164089 DOI: 10.1093/ejechocard/jep212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Non-invasive imaging techniques for the detection of coronary artery disease (CAD) may have technical problems in patients with atrial fibrillation (AF). Although the prognostic value of exercise echocardiography (ExEcho) has been well established in several subgroups of patients, it has not yet been specifically evaluated in these patients. METHODS AND RESULTS From a population of 8095 patients with known or suspected CAD referred for ExEcho, 419 had AF at the time of the tests. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Endpoints were hard cardiac events (i.e. cardiac death or non-fatal myocardial infarction). Mean age was 68.4 +/- 8.5 years, and 256 patients (61.1%) were men. Ischaemia was detected in 92 patients (22%). Over a mean follow-up of 3.10 +/- 2.98 years, 59 hard cardiac events occurred. The 5-year hard cardiac event rate was 37.3% in patients with ischaemia, when compared with 14.5% in patients without ischaemia (P < 0.001). In multivariate analysis, ischaemia on ExEcho remained an independent predictor of hard cardiac events (hazard ratio 1.99, 95% confidence interval 1.06-3.74, P = 0.03), and also provided incremental value over clinical, resting echocardiographic and treadmill exercise data for the prediction of hard cardiac events (P = 0.04). CONCLUSION ExEcho provides significant prognostic information for predicting hard cardiac events in patients with AF.
Collapse
Affiliation(s)
- Alberto Bouzas-Mosquera
- Department of Cardiology, Hospital Universitario A Coruña, As Xubias, 84, 15006 A Coruña, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Aguilar-Torres R, Gómez de Diego JJ, Forteza-Albert JF, Vivancos-Delgado R. Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada. Rev Esp Cardiol 2010; 63 Suppl 1:116-31. [DOI: 10.1016/s0300-8932(10)70145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
21
|
Sicari R. Risk Stratification by Stress Echocardiography Beyond Wall Motion Analysis. JACC Cardiovasc Imaging 2009; 2:260-2. [DOI: 10.1016/j.jcmg.2008.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
|