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Hamdan M, Kossaify A. Silent Myocardial Ischemia Revisited, Another Silent Killer, Emphasis on the Diagnostic Value of Stress Echocardiography with Focused Update and Review. Adv Biomed Res 2023; 12:245. [PMID: 38073734 PMCID: PMC10699249 DOI: 10.4103/abr.abr_91_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2024] Open
Abstract
Silent myocardial ischemia (SMI) is a relatively common phenomenon in patients with coronary artery disease (CAD). The original description of SMI dates back to the 1970s. We performed an extensive search of the literature starting from 2000, using MEDLINE or PubMed, and 676 documents were analyzed, and only 45 articles found suitable for the study were selected. Data regarding the prevalence and risk factors of SMI were discussed, along with the different mechanistic processes behind it; also, methods for screening and diagnosis are exposed, namely electrocardiographic stress test, stress echocardiography, and single-photon emission computed tomography (SPECT). The silent nature of the condition presumes that patients are diagnosed at a more advanced stage, and screening high-risk patients for early management is essential. Education of patients is necessary, and medical management along with cardiac rehabilitation is valid for mild cases, whereas patients with moderate-to-severe myocardial ischemia might require a more invasive approach. SMI is relatively common, diagnostic approach offers data regarding the presence of ischemia along with its anatomic extent, providing important prognostic value. Given its silent and critical nature, future directions for better screening and management must be searched and implemented extensively.
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Affiliation(s)
- Mira Hamdan
- Cardiology Division, Saint Esprit Kaslik University USEK, Hospital Notre Dame Des Secours, Byblos, Lebanon
| | - Antoine Kossaify
- Cardiology Division, Saint Esprit Kaslik University USEK, Hospital Notre Dame Des Secours, Byblos, Lebanon
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2
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Tsigkriki L, Kleitsioti P, Dimitriadis F, Sidiropoulos G, Alkagiet S, Efstratiou D, Kalaitzoglou M, Charisopoulou D, Siarkos M, Mavrogianni AD, Giannakopoulou P, Zarifis J, Koulaouzidis G. The Utility of Low-Dose-Dobutamine Stress Echocardiography in Patients with Heart Failure with Reduced Ejection Fraction: An Update. Diagnostics (Basel) 2023; 13:2920. [PMID: 37761286 PMCID: PMC10527914 DOI: 10.3390/diagnostics13182920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Despite significant advancements in medical therapy, heart failure with reduced ejection fraction (HFrEF) continues to be a significant cause of death and disability. Reversible ischaemic left ventricular dysfunction due to viable myocardium is one such contributing factor. In these cases, coronary revascularization has shown promise in improving left ventricular function and prognosis. For patients with HFrEF and wide QRS, cardiac resynchronization therapy (CRT) is an effective option to address electromechanical dyssynchrony. However, approximately 30% of patients do not respond positively to CRT, highlighting the need to refine candidate selection for this treatment. In some patients with reduced HFrEF, there is a condition known as classical low-flow, low-gradient aortic stenosis (AS) that may be observed. This condition is characterized by a low transaortic flow, which leads to reductions in both the transaortic mean gradient and aortic valve area. Decision-making regarding revascularization, CRT, and pharmacological treatment play a crucial role in managing HFrEF. Cardiac imaging can be valuable in guiding decision-making processes and assessing the prognosis of patients with HFrEF. Among the imaging modalities, dobutamine stress echocardiography has come a long way in establishing itself as a feasible, safe, effective, relatively cheap non-invasive technique. The aim of this review is to explore the current literature on the utility of low-dose stress echocardiography in diagnosing and prognosticating patients with HFrEF.
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Affiliation(s)
- Lamprini Tsigkriki
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Panagiota Kleitsioti
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Fotis Dimitriadis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - George Sidiropoulos
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Stelina Alkagiet
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Dimitris Efstratiou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Maria Kalaitzoglou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | | | - Michail Siarkos
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Angeliki-Despoina Mavrogianni
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Pinelopi Giannakopoulou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - John Zarifis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland
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O'Driscoll JM, Edwards JJ, Greenhough E, Smith E, May M, Gupta S, Marciniak A, Sharma R. The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end-stage renal disease. Eur J Sport Sci 2023:1-10. [PMID: 36815759 DOI: 10.1080/17461391.2023.2184727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m2) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO2 (9.80 ± 2.10 vs. 15.90 ± 4.30 ml·kg-1·min-1, P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09-8.70; P = 0.03) and peak VO2 (HR 0.73; 95% CI 0.64-0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. HIGHLIGHTSWe aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality.Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality.This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.
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Affiliation(s)
- J M O'Driscoll
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - J J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - E Greenhough
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - E Smith
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - M May
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - S Gupta
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Marciniak
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - R Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
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Popescu (Chair) BA, Stefanidis A, Fox KF, Cosyns B, Delgado V, Di Salvo GD, Donal E, Flachskampf FA, Galderisi M, Lancellotti P, Muraru D, Sade LE, Edvardsen T. Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging Recommendations: update 2020. Eur Heart J Cardiovasc Imaging 2020; 21:1305-1319. [DOI: 10.1093/ehjci/jeaa266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The primary mission of the European Association of Cardiovascular Imaging (EACVI) is ‘to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging’. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.
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Affiliation(s)
- Bogdan A Popescu (Chair)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” - Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania
| | | | - Kevin F Fox
- Department of Cardiology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | | | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Denisa Muraru
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, P.le Brescia 201, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Leyla Elif Sade
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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5
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Kossaify A, Bassil E, Kossaify M. Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review. Cardiol Res 2020; 11:89-96. [PMID: 32256915 PMCID: PMC7092766 DOI: 10.14740/cr851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 01/28/2020] [Indexed: 01/06/2023] Open
Abstract
Stress echocardiography (SEC) is a technique established more than 35 years ago; however, it is still poorly implemented in many countries and institutions, and this reluctance may be related to many obstacles such as operator skills, lack of awareness or institutional policy. Stress echo was initially used for assessing coronary artery disease (CAD), with respect to myocardial viability, using wall motion response; however, current use of stress echo extends beyond CAD, such as valvular heart disease and diastolic stress test. Dobutamine is a commonly used agent when pharmaceutical approach is implemented. With regard to CAD, there are four stress responses: normal, ischemic, viable and necrotic. A low dose dobutamine protocol is recommended in patients with baseline wall motion abnormalities, and a very low dose dobutamine is used in low flow low gradient aortic stenosis in order to check the flow and contractility reserve. Of note, respecting protocols, indications and contraindications are important to avoid or minimize risks of complications during the procedure. This article presents a focused update and review regarding SEC, along with an overview of the different indications, structures and steps, and obstacles and outcomes; also the article aims to highlight more awareness and sensitization on this useful technique.
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Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Elie Bassil
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Mikhael Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
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Whitman M, Jenkins C, Sabapathy S, Adams L. Comparison of Heart Rate Blood Pressure Product Versus Age-Predicted Maximum Heart Rate as Predictors of Cardiovascular Events During Exercise Stress Echocardiography. Am J Cardiol 2019; 124:528-533. [PMID: 31204038 DOI: 10.1016/j.amjcard.2019.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
Exercise stress echocardiograms (ESEs) are a functional cardiovascular (CV) test typically used for the investigation of coronary artery disease. ESEs are often terminated at a predetermined age-predicted maximum heart rate (APMHR) to facilitate timely acquisition of ultrasound images at peak exercise. Although an APMHR of 85% is often used, this has not been validated as a suitable termination end point. Heart rate blood pressure product (HRBPP) as an established measure of myocardial work may provide a more reliable assessment of cardiac workload. The aim of this study was to assess maximal HRBPP (MHRBPP) and APMHR as markers of cardiac workload during ESE, using CV events at mean follow-up as the outcome variable. After exclusions, 712 patients being investigated for ischemic heart disease, performed an ESE to volitional fatigue using the standard Bruce protocol. Patient demographics and test data were collected and patients followed for 4.4 ± 2.1 years. Cut-points for MHRBPP (25,060; area under curve 0.77) and APMHR (93.8% and 97.9%; area under curve 0.71; p = 0.12 for difference) were established from receiver operating characteristic analysis. Those achieving an APMHR >85% but MHRBPP <25,060 had significantly more CV events than achieving an MHRBPP >25,060 regardless of APMHR (p <0.05). In conclusion, the current study demonstrates the superior prognostic power of MHRBPP over APMHR alone for the prediction of future CV events in patients performing an otherwise negative ESE for the detection of myocardial ischemia.
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Pettemerides V, Turner T, Steele C, Macnab A. Does stress echocardiography still have a role in the rapid access chest pain clinic post NICE CG95? Echo Res Pract 2019; 6:17-23. [PMID: 30893640 PMCID: PMC6477652 DOI: 10.1530/erp-18-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment. Methods 1815 patients were referred to rapid access chest pain clinic (RACPC) between June 2013 and March 2015. 802 patients had stress echocardiography as the initial investigation. 446 patients had normal resting left ventricular (LV) systolic function and a negative stress echocardiogram. At least 24 months after discharge, a survey was carried out to detect major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction, admission to hospital for heart failure or angina, coronary artery disease at angiography, revascularisation by angioplasty or coronary artery bypass grafting) within 2 years. Results Overall, 351 patients were successfully followed up. The mean Diamond-Forrester (D-F) score and QRISK2 suggested a high pre-test probability (PTP) of coronary artery disease (CAD). There were nine deaths (eight non-cardiac deaths and one cardiac death). MACE occurred in four patients with a mean time of 17.5 months (11.6–23.7 months). The annual event rate was 0.6%. Conclusion A negative stress echocardiogram can reliably reassure patients and clinicians even in high PTP populations with suspected stable angina. It can continue to be used to assess stable chest pain post CG95.
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Affiliation(s)
- Victoria Pettemerides
- Manchester University Foundation Trust, North West Heart Centre, Wythenshawe Hospital, Manchester, UK
| | - Thomas Turner
- University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Conor Steele
- University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Anita Macnab
- Manchester University Foundation Trust, North West Heart Centre, Wythenshawe Hospital, Manchester, UK
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Clarke WT, Peterzan MA, Rayner JJ, Sayeed RA, Petrou M, Krasopoulos G, Lake HA, Raman B, Watson WD, Cox P, Hundertmark MJ, Apps AP, Lygate CA, Neubauer S, Rider OJ, Rodgers CT. Localized rest and stress human cardiac creatine kinase reaction kinetics at 3 T. NMR IN BIOMEDICINE 2019; 32:e4085. [PMID: 30920054 PMCID: PMC6542687 DOI: 10.1002/nbm.4085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 05/11/2023]
Abstract
Changes in the kinetics of the creatine kinase (CK) shuttle are sensitive markers of cardiac energetics but are typically measured at rest and in the prone position. This study aims to measure CK kinetics during pharmacological stress at 3 T, with measurement in the supine position. A shorter "stressed saturation transfer" (StreST) extension to the triple repetition time saturation transfer (TRiST) method is proposed. We assess scanning in a supine position and validate the MR measurement against biopsy assay of CK activity. We report normal ranges of stress CK forward rate (kfCK ) for healthy volunteers and obese patients. TRiST measures kfCK in 40 min at 3 T. StreST extends the previously developed TRiST to also make a further kfCK measurement during <20 min of dobutamine stress. We test our TRiST implementation in skeletal muscle and myocardium in both prone and supine positions. We evaluate StreST in the myocardium of six healthy volunteers and 34 obese subjects. We validated MR-measured kfCK against biopsy assays of CK activity. TRiST kfCK values matched literature values in skeletal muscle (kfCK = 0.25 ± 0.03 s-1 vs 0.27 ± 0.03 s-1 ) and myocardium when measured in the prone position (0.32 ± 0.15 s-1 ), but a significant difference was found for TRiST kfCK measured supine (0.24 ± 0.12 s-1 ). This difference was because of different respiratory- and cardiac-motion-induced B0 changes in the two positions. Using supine TRiST, cardiac kfCK values for normal-weight subjects were 0.15 ± 0.09 s-1 at rest and 0.17 ± 0.15 s-1 during stress. For obese subjects, kfCK was 0.16 ± 0.07 s-1 at rest and 0.17 ± 0.10 s-1 during stress. Rest myocardial kfCK and CK activity from LV biopsies of the same subjects correlated (R = 0.43, p = 0.03). We present an independent implementation of TRiST on the Siemens platform using a commercially available coil. Our extended StreST protocol enables cardiac kfCK to be measured during dobutamine-induced stress in the supine position.
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Affiliation(s)
- William T. Clarke
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wellcome Centre for Integrative Neuroimaging, FMRIBUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Mark A. Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Jennifer J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Rana A. Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Hannah A. Lake
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - William D. Watson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Pete Cox
- Department of Physiology AnatomyUniversity of OxfordParks Road, Sherrington BuildingOxfordUK
| | - Moritz J. Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Andrew P. Apps
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Craig A. Lygate
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wolfson Brain Imaging CentreUniversity of CambridgeBox 65, Cambridge Biomedical CampusCambridgeUK
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Ellis J, Valkovič L, Purvis LA, Clarke WT, Rodgers CT. Reproducibility of human cardiac phosphorus MRS ( 31 P-MRS) at 7 T. NMR IN BIOMEDICINE 2019; 32:e4095. [PMID: 30924566 PMCID: PMC6546607 DOI: 10.1002/nbm.4095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 05/12/2023]
Abstract
PURPOSE We test the reproducibility of human cardiac phosphorus MRS (31 P-MRS) at ultra-high field strength (7 T) for the first time. The primary motivation of this work was to assess the reproducibility of a 'rapid' 6½ min 31 P three-dimensional chemical shift imaging (3D-CSI) sequence, which if sufficiently reproducible would allow the study of stress-response processes. We compare this with an established 28 min protocol, designed to record high-quality spectra in a clinically feasible scan time. Finally, we use this opportunity to compare the effect of per-subject B0 shimming on data quality and reproducibility in the 6½ min protocol. METHODS 10 healthy subjects were scanned on two occasions: one to test the 28 min 3D-CSI protocol, and one to test the 6½ min protocol. Spectra were fitted using the OXSA MATLAB toolbox. The phosphocreatine to adenosine triphosphate concentration ratio (PCr/ATP) from each scan was analysed for intra- and intersubject variability. The impact of different strategies for voxel selection was assessed. RESULTS There were no significant differences between repeated measurements in the same subject. For the 28 min protocol, PCr/ATP in the midseptal voxel across all scans was 1.91 ± 0.36 (mean ± intersubject SD). For the 6½ min protocol, PCr/ATP in the midseptal voxel was 1.76 ± 0.40. The coefficients of reproducibility (CRs) were 0.49 (28 min) and 0.67 (6½ min). Per-subject B0 shimming improved the fitted PCr/ATP precision (for 6½ min scans), but had negligible effect on the CR (0.67 versus 0.66). CONCLUSIONS Both 7 T protocols show improved reproducibility compared with a previous 3 T study by Tyler et al. Our results will enable informed power calculations and protocol selection for future clinical research studies.
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Affiliation(s)
- Jane Ellis
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
| | - Ladislav Valkovič
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Slovak Academy of SciencesInstitute of Measurement ScienceBratislavaSlovakia
| | | | - William T. Clarke
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - Christopher T. Rodgers
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Wolfson Brain Imaging Centre, Department of Clinical NeurosciencesUniversity of CambridgeUK
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Verma B, Singh A. Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability. Open Access Maced J Med Sci 2019; 7:1287-1292. [PMID: 31110571 PMCID: PMC6514354 DOI: 10.3889/oamjms.2019.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/30/2019] [Accepted: 03/31/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Dobutamine stress echocardiography (DSE) and myocardial perfusion scan are the commonly used modalities to detect viable myocardium. DSE is comparatively cheaper and widely available but has a lower sensitivity. AIM We aimed to compare contrast-enhanced low-dose dobutamine echocardiography (LDDE) and gated 99mTc-sestamibi myocardial perfusion scan (MPS) for the degree of agreement in the detection of myocardial viability. METHODS We studied 850 left ventricular segments from 50 patients (42 men, mean age 55.5 years), with coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 40%), using contrast-enhanced LDDE and 99mTc-Sestamibi gated SPECT. Segments were assessed for the presence of viability by both techniques and head to head comparisons were made. RESULTS Adequate visualisation increased from 80% in unenhanced segments to 96% in contrast-enhanced segments. Of the total 850 segments studied, 290 segments (34.1%) had abnormal contraction (dysfunctional). Among these, 138 were hypokinetic (16.2% of total), 144 were severely hypokinetic or akinetic (16.9% of total), and 8 segments were dyskinetic or aneurismal (0.9% of total). Among 151 segments considered viable by technetium, 137 (90.7%) showed contractile improvement with dobutamine; in contrast, only 8 of the 139 segments (5.7%) considered nonviable by technetium had a positive dobutamine response. The per cent of agreement between technetium uptake and a positive response to dobutamine was 78.6% with kappa = 0.63, suggestive of a substantial degree of agreement between the two modalities. CONCLUSION Use of contrast-enhanced LDDE significantly increased the adequate endocardial border visualisation. Furthermore, this study showed a strong degree of agreement between the modalities in the detection of viable segments. So, contrast-enhanced LDDE appears to be a safe and comparable alternative to MPS in myocardial viability assessment.
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Affiliation(s)
- Bhupendra Verma
- Department of Cardiology, Ujala Hospital, Kashipur, UK, India
| | - Amrita Singh
- Department of Nephrology, Ujala Hospital, Kashipur, UK, India
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Płońska-Gościniak E, Gackowski A, Kukulski T, Kasprzak JD, Szyszka A, Braksator W, Gąsior Z, Lichodziejewska B, Pysz P. Stress echocardiography. Part I: Stress echocardiography in coronary heart disease. J Ultrason 2019; 19:45-48. [PMID: 31088010 PMCID: PMC6750176 DOI: 10.15557/jou.2019.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022] Open
Abstract
Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic image acquisition of left ventricular function and valvular flow, if needed. The technique is a well-recognized, safe and widely available stress test used for the diagnosis and assessment of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease. The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators) and pacing stress, most often with the use of a permanent pacemaker. Two operators should perform the test: a physician experienced in stress echocardiography (at least 100 tests completed under supervision of an expert) and a trained nurse or another doctor. The laboratory should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications to physical stress. Pacing stress echo is recommended for patients with pacemakers, and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with intermediate probability of coronary artery disease, inability to perform physical exercise and non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test is also used in symptomatic patients after revascularization or patients qualified for revascularization for functional assessment of coronary artery stenosis. Low-dose dobutamine test is usually performed in patients after myocardial infarction or with moderate-to-severe left ventricular dysfunction to assess myocardial viability before potential revascularization. Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic image acquisition of left ventricular function and valvular flow, if needed. The technique is a well-recognized, safe and widely available stress test used for the diagnosis and assessment of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease. The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators) and pacing stress, most often with the use of a permanent pacemaker. Two operators should perform the test: a physician experienced in stress echocardiography (at least 100 tests completed under supervision of an expert) and a trained nurse or another doctor. The laboratory should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications to physical stress. Pacing stress echo is recommended for patients with pacemakers, and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with intermediate probability of coronary artery disease, inability to perform physical exercise and non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test is also used in symptomatic patients after revascularization or patients qualified for revascularization for functional assessment of coronary artery stenosis. Low-dose dobutamine test is usually performed in patients after myocardial infarction or with moderate-to-severe left ventricular dysfunction to assess myocardial viability before potential revascularization.
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Affiliation(s)
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure of Jagiellonian University Medical College, Noninvasive Cardiovascular Laboratory, Specialist Hospital in Cracow, Cracow, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, The Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Zabrze, Poland
| | | | - Andrzej Szyszka
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiac Diagnosis, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, School of Medicine in Katowice, Poland
- Cardiac Rehabilitation Department Treatment and Rehabilitation Center, Long-Term Care Hospital, Jaworze, Poland
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Ntoskas T, Ahmad F, Woodmansey P. Safety and efficacy of physiologist-led dobutamine stress echocardiography: experience from a tertiary cardiac centre. Echo Res Pract 2018; 5:105-112. [PMID: 30303679 PMCID: PMC6074818 DOI: 10.1530/erp-18-0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Dobutamine stress echocardiography (DSE) services have traditionally been medically led. In some UK institutions, DSE lists are led by physiologists with medical support. In our tertiary cardiac centre at New Cross Hospital (NCH), the DSE service was established by a consultant echocardiographer. Following intensive training and assessment, the Trust approved drug administration by named senior cardiac physiologists. We believe this is the first report of a cardiac physiologist-managed DSE service, including physiologist drug administration. We have assessed the feasibility, safety and validity of this physiologist-led DSE service. Methods Retrospective analysis of 333 patients undergoing stress echocardiogram for inducible reversible ischaemia, myocardial viability and valvular heart disease over 6 months. Patients’ case notes review after 18–24 months. Results Overall, 92% of all cases (306) were performed by physiologists. In 300 studies, dobutamine was administered. The majority of the referrals were for coronary artery disease (CAD) assessment (281). In 235 cases, the study was uncomplicated. Sixty-seven patients developed dobutamine-related side effects. In 16 cases, complications led to early termination of the study. In two cases, urgent medical review was needed. Of the 281 studies for CAD assessment, 239 were negative for ischaemia, 28 were positive and 14 inconclusive. In 5 out of 28 cases with echocardiogram, evidence of inducible ischaemia, coronary angiography revealed unobstructed coronary arteries. Conclusion This study demonstrates the safety and effectiveness of this practice and provides potential for the expansion of the physiologists’ role and physiologist-led DSE services in other hospitals.
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Affiliation(s)
- Theodoros Ntoskas
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Farhanda Ahmad
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Paul Woodmansey
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
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Khan JN, Griffiths T, Fatima T, Michael L, Mihai A, Mustafa Z, Sandhu K, Butler R, Duckett S, Heatlie G. Feasibility of physiologist-led stress echocardiography for the assessment of coronary artery disease. Echo Res Pract 2017; 4:29-36. [PMID: 28592522 PMCID: PMC5510440 DOI: 10.1530/erp-17-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Physiologist-led stress echocardiography (PLSE) services provide potential for expansion of SE services and increased productivity for cardiologists. There are however no published data on the feasibility of PLSE. We sought to assess the feasibility, safety and robustness of PLSE and cardiologist-led stress echocardiography (CLSE) for coronary artery disease (CAD) assessment. METHODS Retrospective analysis of 898 patients undergoing PLSE or CLSE for CAD assessment using exercise or dobutamine stress over 24 months. PLSE involved 2 cardiac physiologists (exercise) or 1 physiologist plus 1 cardiac nurse (dobutamine). A cardiology registrar was present in the echocardiography department during PLSE in case of medical complications. CLSE involved 1 physiologist and 1 trainee cardiologist who analysed the study and reviewed findings with an imaging cardiologist. Sixteen-segment wall motion scoring (WMS, WMSI) analysis was performed. Feasibility (stressor, image quality, proportion of completed studies, agreement with imaging cardiologist analysis) and safety (complication rate) were compared for PLSE and CLSE. RESULTS The majority of studies were CLSE (56.2%) and used dobutamine (68.7%). PLSE more commonly used exercise (69.2%). Overall, 96% of studies were successfully completed (>14 diagnostic segments in 98%, P = 0.899 PLSE vs CLSE). Commencement of PLSE was associated with an increase in annual SE's performed for CAD assessment. Complication rates were comparably very low for PLSE and CLSE (0.8% vs 1.8%, P = 0.187). There was excellent agreement between PLSE and CLSE WMS interpretation of 480 myocardial segments at rest (κ = 0.87) and stress (κ = 0.70) and WMSI (ICCs and Pearson's r >0.90, zero Bland-Altman mean bias). CONCLUSION This to our knowledge is the first study of the feasibility of PLSE. PLSE performed by well-trained physiologists is feasible and safe in contemporary practice. PLSE and CLSE interpretation of stress echocardiography for CAD agree very closely.
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Affiliation(s)
- Jamal N Khan
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Timothy Griffiths
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Tamseel Fatima
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Leah Michael
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Andreea Mihai
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Zeeshan Mustafa
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Kully Sandhu
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Robert Butler
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Simon Duckett
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Grant Heatlie
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
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Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.5812/rijm.42876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Li L, Wang F, Xu T, Chen J, Wang C, Wang X, Li D. The detection of viable myocardium by low-dose dobutamine stress speckle tracking echocardiography in patients with old myocardial infarction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:545-554. [PMID: 27155252 DOI: 10.1002/jcu.22366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 04/01/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To explore the significance and value of speckle-tracking echocardiography (STE) associated with low-dose dobutamine stress echocardiography (LDDSE) for the detection of viable myocardium (VM) in patients with old myocardial infarction (OMI). METHODS We performed STE with LDDSE in 33 hospitalized patients with OMI and left ventricular systolic dysfunction. QLAB software was used to analyze strain (S) and strain rate (Sr). Percutaneous coronary intervention (PCI) was subsequently performed. The movement of each wall segment was observed by routine echocardiography before and after 1, 3, and 6 months of PCI, and improvement was regarded as the gold standard for diagnosing VM. RESULTS Compared with semi-quantitative wall-motion analysis combined with LDDSE, the sensitivity, specificity, and accuracy of c-STE (combining the three directions of S and Sr) at LDDSE were 91.6%, 79.5%, and 87.5%, respectively (p < 0.02). Among the deformation parameters, longitudinal strain (LS) and longitudinal strain rate (LSr) had the highest sensitivity, specificity, and accuracy. Upon combining LS and LSr at LDDSE to parallel tests, the sensitivity, specificity, and accuracy were 91.7%, 90%, and 90.6%, respectively. Compared with baseline, LVEF after PCI increased from 43.3% ± 2.6% to 47.3% ± 2.9% (p < 0.001). CONCLUSIONS Global strain at LDDSE is superior to semi-quantitative wall-motion analysis with LDDSE for the assessment of VM. When the multivariable analysis and the parallel tests are combined, LS combined with LSr can be considered an independent predictor of VM. LVEF is improved after PCI in patients with VM and OMI. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:545-554, 2016.
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Affiliation(s)
- Liang Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Jiangsu Province, P.R. China
| | - Fengli Wang
- Cardiology of Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, P.R. China
| | - Tongda Xu
- Cardiology of Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, P.R. China.
| | - Junhong Chen
- Cardiology of Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, P.R. China
| | - Chaofan Wang
- Cardiology of Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, P.R. China
| | - Xiaoping Wang
- Cardiology of Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, P.R. China
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Jiangsu Province, P.R. China.
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Kumarathurai P, Anholm C, Nielsen OW, Kristiansen OP, Mølvig J, Madsbad S, Haugaard SB, Sajadieh A. Effects of the glucagon-like peptide-1 receptor agonist liraglutide on systolic function in patients with coronary artery disease and type 2 diabetes: a randomized double-blind placebo-controlled crossover study. Cardiovasc Diabetol 2016; 15:105. [PMID: 27455835 PMCID: PMC4960858 DOI: 10.1186/s12933-016-0425-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/19/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) and coronary artery disease (CAD) have increased risk of cardiac dysfunction. The diabetic heart is characterized by increased fatty acid oxidation and reduced glucose uptake resulting in reduced cardiac efficiency. Glucagon-like peptide-1 (GLP-1) has shown to increase myocardial glucose uptake and to improve myocardial function. We examined the effect of the GLP-1 receptor agonist, liraglutide, on the systolic function of the left ventricle (LV) in patients with T2D and stable CAD. METHODS In this placebo-controlled crossover study, 41 subjects with T2D and stable CAD were randomized to liraglutide or placebo and underwent dobutamine stress echocardiography (DSE) and exercise tolerance test at beginning and end of each intervention. The primary endpoint was changes in LV ejection fraction. Secondary endpoints were exercise capacity and other measures of systolic function: wall motion score index (WMSI), global longitudinal strain (GLS) and strain rate (GLSR). RESULTS Liraglutide, when compared to placebo, did not improve LV ejection fraction at rest (+0.54 %; 95 % CI 2.38-3.45), at low stress (+0.03 %; 95 % CI 3.25-3.32), at peak stress (+1.12 %; 95 % CI 3.45-5.69), or at recovery (+4.06 %; 95 % CI 0.81-8.93). No significant changes in WMSI were observed at any stress levels. GLS and GLSR at rest did not improve. The maximal exercise capacity estimated by metabolic equivalents was not affected by liraglutide. CONCLUSION In conclusion, liraglutide did not improve the systolic function of the left ventricle during DSE or the exercise capacity in patients with T2D and stable CAD. Clinical Trial Registration http://www.clinicaltrials.gov (unique identifier: NCT01595789).
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Affiliation(s)
- Preman Kumarathurai
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christian Anholm
- Department of Internal Medicine, Copenhagen University Hospital of Amager, Copenhagen, Denmark
| | - Olav W. Nielsen
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Ole P. Kristiansen
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jens Mølvig
- Department of Internal Medicine, Copenhagen University Hospital of Amager, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital of Hvidovre, Copenhagen, Denmark
| | - Steen B. Haugaard
- Department of Internal Medicine, Copenhagen University Hospital of Amager, Copenhagen, Denmark
- Clinical Research Center, Copenhagen University Hospital of Hvidovre, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Keller K, Stelzer K, Munzel T, Ostad MA. Hypertension is strongly associated with false-positive bicycle exercise stress echocardiography testing results. Blood Press 2016; 25:351-359. [PMID: 27163258 DOI: 10.1080/08037051.2016.1182419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Exercise echocardiography is a reliable routine test in patients with known or suspected coronary artery disease. However, in ∼15% of all patients, stress echocardiography leads to false-positive stress echocardiography results. We aimed to investigate the impact of hypertension on stress echocardiographic results. METHODS We performed a retrospective study of patients with suspected or known stable coronary artery disease who underwent a bicycle exercise stress echocardiography. Patients with false-positive stress results were compared with those with appropriate results. RESULTS 126 patients with suspected or known coronary artery disease were included in this retrospective study. 23 patients showed false-positive stress echocardiography results. Beside comparable age, gender distribution and coronary artery status, hypertension was more prevalent in patients with false-positive stress results (95.7% vs. 67.0%, p = 0.0410). Exercise peak load revealed a borderline-significance with lower loads in patients with false-positive results (100.0 (IQR 75.0/137.5) vs. 125.0 (100.0/150.0) W, p = 0.0601). Patients with false-positive stress results showed higher systolic (2.05 ± 0.69 vs. 1.67 ± 0.39 mmHg/W, p = 0.0193) and diastolic (1.03 ± 0.38 vs. 0.80 ± 0.28 mmHg/W, p = 0.0165) peak blood pressure (BP) per wattage. In a multivariate logistic regression test, hypertension (OR 17.6 [CI 95% 1.9-162.2], p = 0.0115), and systolic (OR 4.12 [1.56-10.89], p = 0.00430) and diastolic (OR 13.74 [2.46-76.83], p = 0.00285) peak BP per wattage, were associated with false-positive exercise results. ROC analysis for systolic and diastolic peak BP levels per wattage showed optimal cut-off values of 1.935mmHg/W and 0.823mmHg/W, indicating false-positive exercise echocardiographic results with AUCs of 0.660 and 0.664, respectively. CONCLUSIONS Hypertension is a risk factor for false-positive stress exercise echocardiographic results in patients with known or suspected coronary artery disease. Presence of hypertension was associated with 17.6-fold elevated risk of false-positive results.
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Affiliation(s)
- Karsten Keller
- a Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany.,b Department of Cardiology I , Center of Cardiology, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany
| | - Kathrin Stelzer
- b Department of Cardiology I , Center of Cardiology, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany
| | - Thomas Munzel
- a Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany.,b Department of Cardiology I , Center of Cardiology, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany.,c German Center for Cardiovascular Research, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany
| | - Mir Abolfazl Ostad
- b Department of Cardiology I , Center of Cardiology, University Medical Center of the Johannes Gutenberg-University of Mainz , Mainz , Germany
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Stress-echocardiography is underused in clinical practice: a nationwide survey in Austria. Wien Klin Wochenschr 2015; 127:514-20. [PMID: 26162465 DOI: 10.1007/s00508-015-0828-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The wide area of application, including coronary artery disease, valvular heart disease, or pulmonary hypertension makes stress echocardiography (SE) a powerful, cost-effective imaging modality in cardiology. The role of this technique in clinical practice in Austria is unknown. METHODS A nationwide survey included all departments for cardiology and/or internal medicine in the years 2008 and 2013. By electronic questionnaire demographics, indication for the test, the numbers of examined cases per year, operators, and various applied techniques of SE were interrogated and completed by telephone interviews. RESULTS Data could be obtained from all 117 departments. In the year 2007 in 58 (50%) and in 2012 57 (49%) departments SE was available in Austrian hospitals. More than 100 SEs per year were performed by only four (7%) units in the year 2007 and by five (8%) in 2012. Physical exercise, dobutamine, and dipyridamole SE were available in 27 (46%), 52 (90%), and six (10%) units in 2007, and in 15 (27%), 52 (91%), and five (9%) units in 2012, respectively. In 2007 41 (71%) and in 2012 26 (46%) echo-labs administered contrast agents during SE. Transesophageal SE and 3D-echo was performed in one (2%) and three (5%) units in 2007, and in six (10%) and four (7%) echo-labs in 2012. CONCLUSIONS This representative survey demonstrates the underuse of SE in clinical practice in Austria. Even in established application fields performance is low, examination frequencies as recommended by the cardiology societies are fulfilled only by a minority of institutions.
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The medium term prognostic value of dobutamine stress echocardiogram in patients with high risk scores of coronary artery disease according to NICE Clinical Guideline 95. Int J Cardiol 2014; 176:1190-1. [DOI: 10.1016/j.ijcard.2014.07.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 07/27/2014] [Indexed: 11/22/2022]
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Anholm C, Kumarathurai P, Klit MS, Kristiansen OP, Nielsen OW, Ladelund S, Madsbad S, Sajadieh A, Haugaard SB. Adding liraglutide to the backbone therapy of biguanide in patients with coronary artery disease and newly diagnosed type-2 diabetes (the AddHope2 study): a randomised controlled study protocol. BMJ Open 2014; 4:e005942. [PMID: 25031198 PMCID: PMC4401817 DOI: 10.1136/bmjopen-2014-005942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Newly diagnosed type 2 diabetes mellitus (T2DM) in patients with coronary artery disease (CAD) more than doubles the risk of death compared with otherwise matched glucose tolerant patients. The biguanide metformin is the drug of choice in treatment of T2DM and has shown to ameliorate cardiovascular morbidity in patients with T2DM and myocardial infarction (MI). The incretin hormone, glucagon-like peptide-1 (GLP-1) improves β-cell function, insulin sensitivity and causes weight loss and has been suggested to have beneficial effects on cardiac function. The GLP-1 receptor agonist (GLP-1RA), liraglutide, is currently used for treatment of T2DM but its potential effect on cardiac function has not been investigated in detail. We hypothesised that liraglutide added to metformin backbone therapy in patients with CAD and newly diagnosed T2DM will improve β-cell function and left ventricular systolic function during dobutamine stress. METHODS AND ANALYSES 40 patients with CAD and newly diagnosed T2DM will receive the intervention liraglutide+metformin and placebo+metformin in this investigator-initiated, double blind, randomised, placebo-controlled, cross-over 12 plus 12 weeks intervention study with a 2-week washout period. The primary cardiovascular end point is changes in left ventricular ejection fraction during stress echocardiography. The primary endocrine end point is β-cell function evaluated during a frequently sampled intravenous glucose tolerance test. Secondary end points include heart rate variability, diurnal blood pressure, glucagon suppression and inflammatory response (urine, blood and adipose tissue). ETHICS AND DISSEMINATION This study is approved by the Danish Medicines Agency, the Danish Dataprotection Agency and the Regional Committee on Biomedical Research Ethics of the Capital Region of Denmark. The trial will be carried out under the guidance from the GCP unit at Copenhagen University Hospital of Bispebjerg and in accordance with the ICH-GCP guidelines and the Helsinki Declaration. TRIAL REGISTRATIONS NUMBER Clinicaltrials.gov ID: NCT01595789, EudraCT: 2011-005405-78.
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Affiliation(s)
- Christian Anholm
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
- Department of Internal Medicine, Copenhagen University Hospital, Amager, Denmark
| | - Preman Kumarathurai
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Malene S Klit
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Ole P Kristiansen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Steen Ladelund
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Steen B Haugaard
- Department of Internal Medicine, Copenhagen University Hospital, Amager, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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Wang Ji J, Ye S, Haythe J, Schulze PC, Shimbo D. The risk of adverse events associated with atropine administration during dobutamine stress echocardiography in cardiac transplant patients: a 28-year single-center experience. J Card Fail 2013; 19:762-7. [PMID: 24263121 PMCID: PMC4041661 DOI: 10.1016/j.cardfail.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/19/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although dobutamine stress echocardiography (DSE) is performed in heart transplant patients, the safety profile of atropine administration in DSE in this setting is unclear. METHODS AND RESULTS We identified heart transplant patients who received atropine during DSE from January 1984 to August 2011 at our institution and compared them with a propensity-scored matched control group of heart transplant patients who underwent DSE without atropine. Adverse events were defined as significant arrhythmias (sinus arrest, Mobitz type II heart block, complete heart block, ventricular tachycardia, or ventricular fibrillation), hypotension requiring hospitalization, syncope or presyncope, myocardial infarction, and death. Forty-five heart transplant patients (median age 62 years, 82% male) received 0.2-1 mg atropine during DSE. Of these, 1 patient (2.2%) developed temporary complete heart block. No adverse events were identified in the control group of 154 patients who received dobutamine without atropine. CONCLUSIONS Our findings suggest that complete heart block can occur infrequently with the administration of atropine in heart transplant patients undergoing DSE. Therefore, patients should be appropriately monitored for these adverse events during and after DSE.
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Affiliation(s)
- James Wang Ji
- Division of Cardiology, Columbia University Medical Center, New York, New York
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22
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Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound 2008; 6:30. [PMID: 18565214 PMCID: PMC2443362 DOI: 10.1186/1476-7120-6-30] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 06/19/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent American Heart Association/American College of Cardiology guidelines state that "dobutamine stress echo has substantially higher sensitivity than vasodilator stress echo for detection of coronary artery stenosis" while the European Society of Cardiology guidelines and the European Association of Echocardiography recommendations conclude that "the two tests have very similar applications". Who is right? AIM To evaluate the diagnostic accuracy of dobutamine versus dipyridamole stress echocardiography through an evidence-based approach. METHODS From PubMed search, we identified all papers with coronary angiographic verification and head-to-head comparison of dobutamine stress echo (40 mcg/kg/min +/- atropine) versus dipyridamole stress echo performed with state-of-the art protocols (either 0.84 mg/kg in 10' plus atropine, or 0.84 mg/kg in 6' without atropine). A total of 5 papers have been found. Pooled weight meta-analysis was performed. RESULTS the 5 analyzed papers recruited 435 patients, 299 with and 136 without angiographically assessed coronary artery disease (quantitatively assessed stenosis > 50%). Dipyridamole and dobutamine showed similar accuracy (87%, 95% confidence intervals, CI, 83-90, vs. 84%, CI, 80-88, p = 0.48), sensitivity (85%, CI 80-89, vs. 86%, CI 78-91, p = 0.81) and specificity (89%, CI 82-94 vs. 86%, CI 75-89, p = 0.15). CONCLUSION When state-of-the art protocols are considered, dipyridamole and dobutamine stress echo have similar accuracy, specificity and - most importantly - sensitivity for detection of CAD. European recommendations concluding that "dobutamine and vasodilators (at appropriately high doses) are equally potent ischemic stressors for inducing wall motion abnormalities in presence of a critical coronary artery stenosis" are evidence-based.
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Tomlinson DR, Becher H, Selvanayagam JB. Assessment of myocardial viability: comparison of echocardiography versus cardiac magnetic resonance imaging in the current era. Heart Lung Circ 2008; 17:173-85. [PMID: 18222726 DOI: 10.1016/j.hlc.2007.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/30/2007] [Accepted: 10/29/2007] [Indexed: 12/16/2022]
Abstract
Detecting viable myocardium, whether hibernating or stunned, is of clinical significance in patients with coronary artery disease and left ventricular dysfunction. Echocardiographic assessments of myocardial thickening and endocardial excursion during dobutamine infusion provide a highly specific marker for myocardial viability, but with relatively less sensitivity. The additional modalities of myocardial contrast echocardiography and tissue Doppler have recently been proposed to provide further, quantitative measures of myocardial viability assessment. Cardiac magnetic resonance (CMR) has become popular for the assessment of myocardial viability as it can assess cardiac function, volumes, myocardial scar, and perfusion with high-spatial resolution. Both 'delayed enhancement' CMR and dobutamine stress CMR have important roles in the assessment of patients with ischaemic cardiomyopathy. This article reviews the recent advances in both echocardiography and CMR for the clinical assessment of myocardial viability. It attempts to provide a pragmatic approach toward the patient-specific assessment of this important clinical problem.
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Affiliation(s)
- David R Tomlinson
- Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, UK
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ADULT CONGENITAL DISEASE. Echocardiography 2007. [DOI: 10.3109/9781435628120-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murakami H, Muto H, Asano Y, Miyamoto K, Omoto Y, Yamaguchi Y, Hirokami M, Hanawa N, Tanaka S. Efficacy and Safety of Atropine Administered Prior to Dobutamine Stress Echocardiography. J Echocardiogr 2007. [DOI: 10.2303/jecho.5.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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26
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Aggeli C, Giannopoulos G, Misovoulos P, Roussakis G, Christoforatou E, Kokkinakis C, Brili S, Stefanadis C. Real-time three-dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography. Heart 2006; 93:672-5. [PMID: 17085530 PMCID: PMC1955206 DOI: 10.1136/hrt.2006.101220] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare real-time three-dimensional echocardiography (RT3DE) with two-dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischaemia, with angiographic validation of the results. METHODS 56 patients (mean (SD) age 64.5 (6.2) years, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol. RESULTS All 56 patients completed the stress protocol uneventfully. The mean (SD) acquisition time for the necessary views to evaluate all segments was 26.3 (2.5) s for RT3DE and 58.8 (3.7) s for 2DE (p<0.001). At peak stress, RT3DE had a higher wall-motion score index (1.25 (0.24) by 2DE, 1.30 (0.27) by RT3DE; p = 0.014). The regional wall-motion score for the four apical segments at peak stress was compared; it was 1.35 (0.55) by 2DE and 1.52 (0.69) by RT3DE (p = 0.003). The diagnostic parameters of 2DE versus RT3DE were: sensitivity 73% vs 78%, specificity 93% vs 89% and overall accuracy 86% vs 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE had higher regional wall-motion scores, it showed a tendency towards higher sensitivity (85% vs 78%), although this difference did not achieve statistical significance. CONCLUSION RT3DE identifies wall-motion abnormalities more readily in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. RT3DE results were validated using angiography as reference and findings indicate diagnostic equivalence to 2DE, with the advantage of considerable shorter acquisition times.
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Affiliation(s)
- Constadina Aggeli
- 1st Cardiology Department, University of Athens School of Medicine, Hippokration Hospital, Athens, Greece.
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Moyssakis I, Papadopoulos DP, Kelepeshis G, Gialafos E, Votteas V, Triposkiadis F. Left atrial systolic reserve in idiopathic vs. ischaemic-dilated cardiomyopathy. Eur J Clin Invest 2005; 35:355-61. [PMID: 15948895 DOI: 10.1111/j.1365-2362.2005.01505.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE There are studies indicating more pronounced left atrial (LA) systolic dysfunction at rest in idiopathic (IDDC) than in ischaemic-dilated cardiomyopathy (ISDC). It was hypothesized that the findings would be similar with regards LA systolic reserve. METHODS Twenty-six patients with IDDC, 28 with ISDC and 25 normal controls underwent low-dose dobutamine stress echocardiography (5-10 microg kg(-1) min(-1) IV). Left atrial volumes were echocardiographically determined at rest and during stress at the mitral valve opening (maximal, Vmax), electrocardiographic P wave (onset of atrial systole, Vp) and mitral valve closure (minimal, Vmin) from the apical 4- and 2-chamber views (biplane area-length method). Left atrial systolic function was assessed with the LA-active emptying volume (ACTEV) = Vp-Vmin and fraction (ACTEF) = ACTEV/Vp. RESULTS Vmax at rest was similar in IDDC and ISDC and greater than in the controls (54.2 +/- 12 vs. 48.5 +/- 18 vs. 27.1 +/- 6.3 cm(3) m(-2), respectively, P < 0.001) and did not change with stress (53.9 +/- 13.8 vs. 46.9 +/- 16.2 vs. 25.8 +/- 5.9 cm(3) m(-2), P < 0.001). The ACTEV at rest was similar in IDDC and ISDC and greater than in the controls (8.6 +/- 3.5 vs. 9.7 +/- 2.9 vs. 6.1 +/- 2.2 cm(3) m(-2) P < 0.01), whereas during the dobutamine infusion it remained unaltered in IDDC (10.8 +/- 4.6 cm(3) m(-2), P = NS vs. rest) and increased in ISDC (11.8 +/- 3.3 cm(3) m(-2), P < 0.05) and the controls (13.1 +/- 3.2 cm(3) m(-2), P < 0.01). The ACTEF was lower in IDDC than ISDC and the controls at rest (20 +/- 10% vs. 33 +/- 8% vs. 36 +/- 10%, P < 0.01). Dobutamine infusion was associated with no significant increase in ACTEF in IDDC (25 +/- 12%, P = NS vs. rest), and with an increase in this variable in ISDC (39 +/- 10%, P < 0.05) and the controls (49 +/- 12%, P < 0.01). CONCLUSIONS Dobutamine infusion is associated with an increase in LA ACTEV and fraction in ISDC and no significant change in these indices in IDDC. These findings indicate a reduced LA systolic reserve in IDDC.
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Affiliation(s)
- I Moyssakis
- Laico General Hospital of Athens, Athens, Greece
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Tsutsui JM, Lario FC, Fernandes DR, Kowatsch I, Sbano JC, Franchini Ramires JA, Mathias W. Safety and cardiac chronotropic responsiveness to the early injection of atropine during dobutamine stress echocardiography in the elderly. Heart 2005; 91:1563-7. [PMID: 15797935 PMCID: PMC1769246 DOI: 10.1136/hrt.2004.054445] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the safety and cardiac chronotropic responsiveness to early atropine dobutamine stress echocardiography (DSE) in the elderly. DESIGN Retrospective study of 258 patients >or= 70 years who underwent early atropine DSE and 290 patients >or= 70 years who underwent conventional DSE. In the early atropine protocol, atropine was started at 20 microg/kg/min of dobutamine if heart rate was < 100 beats/min, up to 2 mg. The cardiac chronotropic responsiveness in the elderly was compared with a control group of patients < 70 years matched for sex, myocardial infarction, diabetes, and treatment with beta blockers and calcium channel blockers. RESULTS The dose of dobutamine given to elderly patients was lower during early atropine than during conventional DSE (mean (SD) 29 (7) v 38 (4) microg/kg/min, p = 0.001). Early atropine DSE resulted in diminished incidence of ventricular extrasystoles, non-sustained ventricular tachycardia, bradycardia, and hypotension compared with conventional DSE. In comparison with patients < 70 years, elderly patients required lower doses of dobutamine and atropine and achieved a higher percentage of predicted maximum heart rate (92 (9)% v 88 (10)%, p = 0.0001). Except for more common hypotension (16% v 10%, p = 0.004), no other difference in adverse effects was observed between patients >or= 70 and < 70 years. CONCLUSIONS Early atropine DSE is a safe strategy in the elderly resulting in lower incidence of minor adverse effects than with the conventional protocol. Elderly patients presented adequate cardiac chronotropic responsiveness to early injections of atropine, requiring lower doses of drugs to reach test end points.
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Affiliation(s)
- J M Tsutsui
- Echocardiography Laboratory, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
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Chambers J, Fox K, Fraser A. Recent advances in non-invasive cardiology: article does not mention echocardiography. BMJ 2005; 330:731. [PMID: 15790651 PMCID: PMC555646 DOI: 10.1136/bmj.330.7493.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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