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Al Nooryani A, Aboushokka W, Beleslin B, Nedeljkovic-Beleslin B. Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data: A case report. World J Clin Cases 2024; 12:2269-2274. [DOI: 10.12998/wjcc.v12.i13.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.
CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications.
CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
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Affiliation(s)
- Arif Al Nooryani
- Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates
| | - Wael Aboushokka
- Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates
| | - Branko Beleslin
- Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade 11000, Serbia
| | - Biljana Nedeljkovic-Beleslin
- Institute of Endocrinology, Diabetes and Metabolic Disorders, Univeristy Clinical Center of Serbia, Belgrade 11000, Serbia
- Department of Internal Medicine/Endocrinology, Medical faculty, University of Belgrade, Belgrade 11000, Serbia
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Aleksandric S, Beleslin B. Editorial comment: SYNTAX score II 2020 as a tool for decision making on revascularization strategy in high-risk patients with complex coronary artery disease. Catheter Cardiovasc Interv 2024; 103:680-681. [PMID: 38374776 DOI: 10.1002/ccd.30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
Key points
SYNTAX Score II 2020 outperforms both the anatomical SYNTAX Score and SYNTAX Score II in terms of predicting all‐cause mortality during long‐term follow‐up among patients with complex coronary artery disease (left main coronary artery disease, three‐vessel disease, or both) and chronic renal insufficiency undergoing percutaneous coronary intervention.
A predicted all‐cause mortality of the SYNTAX Score II 2020 >7% significantly adversely affected the observed all‐cause mortality in patients with complex coronary artery disease and chronic renal insufficiency undergoing percutaneous coronary intervention.
For prospective validation of the SYNTAX score II 2020 model in patients with complex coronary artery disease, particularly those with moderate‐to‐severe chronic renal insufficiency (eGFR <60 mL/min/1.73m2), further adequately powered, randomized trials of percutaneous coronary intervention versus coronary artery bypass graft surgery must be conducted, with long‐term follow‐up.
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Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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3
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Stanojevic D, Apostolovic S, Kostic T, Mitov V, Kutlesic-Kurtovic D, Kovacevic M, Stanojevic J, Milutinovic S, Beleslin B. A review of the risk and precipitating factors for spontaneous coronary artery dissection. Front Cardiovasc Med 2023; 10:1273301. [PMID: 38169687 PMCID: PMC10758453 DOI: 10.3389/fcvm.2023.1273301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Spontaneous coronary artery dissection (SCAD) accounts for 1%-4% of cases of acute coronary syndrome (ACS). SCAD is caused by separation occurring within or between any of the three tunics of the coronary artery wall. This leads to intramural hematoma and/or formation of false lumen in the artery, which leads to ischemic changes or infarction of the myocardium. The incidence of SCAD is higher in women than in men, with a ratio of approximately 9:1. It is estimated that SCAD is responsible for 35% of ACS cases in women under the age of 60. The high frequency is particularly observed during pregnancy and in the peripartum period (first week). Traditional risk factors are rare in patients with SCAD, except for hypertension. Patients diagnosed with SCAD have different combinations of risk factors compared with patients who have atherosclerotic changes in their coronary arteries. We presented the most common so-called "non-traditional" risk factors associated with SCAD patients. Risk factors and precipitating disorders which are associated with SCAD In the literature, there are few diseases frequently associated with SCAD, and they are identified as predisposing factors. The predominant cause is fibromuscular dysplasia, followed by inherited connective tissue disorders, systemic inflammatory diseases, pregnancy, use of sex hormones or steroids, use of cocaine or amphetamines, thyroid disorders, migraine, and tinnitus. In recent years, the genetic predisposition for SCAD is also recognized as a predisposing factor. The precipitating factors are also different in women (emotional stress) compared with those in men (physical stress). Women experiencing SCAD frequently describe symptoms of anxiety and depression. These conditions could increase shear stress on the arterial wall and dissection of the coronary artery wall. Despite the advancement of SCAD, we can find significant differences in the clinical presentation between women and men. Conclusion When evaluating patients with chest pain or other ACS symptoms who have a low cardiovascular risk, particularly female patients, it is important to consider the possibility of ACS due to SCAD, particularly in conditions often associated with SCAD. This will increase the recognition of SCAD and the timely treatment of affected patients.
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Affiliation(s)
| | - Svetlana Apostolovic
- Clinic for Cardiology, University Clinical Center Nis, Nis, Serbia
- Internal Medicine Department, Medical Faculty University of Nis, Nis, Serbia
| | - Tomislav Kostic
- Clinic for Cardiology, University Clinical Center Nis, Nis, Serbia
- Internal Medicine Department, Medical Faculty University of Nis, Nis, Serbia
| | - Vladimir Mitov
- Department for Cardiovascular Diseases, Health Center Zajecar, Zajecar, Serbia
| | | | - Mila Kovacevic
- Clinic for Cardiology, Institute for Cardiovascular Diseases Vojvodina, Novi Sad, Serbia
- Internal Medicine Department, Medical Faculty University of Novi Sad, Novi Sad, Serbia
| | - Jelena Stanojevic
- Internal Medicine Department, Medical Faculty University of Nis, Nis, Serbia
| | - Stefan Milutinovic
- Internal Medicine Residency Program, Florida State University College of Medicine, Cape Coral, FL, United States
| | - Branko Beleslin
- Clinic for Cardiology, University Clinical Centre Serbia, Belgrade, Serbia
- Internal Medicine Department, Medical Faculty Belgrade, Belgrade, Serbia
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Mehmedbegović Z, Ivanov I, Čanković M, Perišić Z, Kostić T, Maričić B, Krljanac G, Beleslin B, Apostolović S. Invasive imaging modalities in a spontaneous coronary artery dissection: when "believing is seeing". Front Cardiovasc Med 2023; 10:1270259. [PMID: 37920180 PMCID: PMC10618678 DOI: 10.3389/fcvm.2023.1270259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome (ACS) with recent advancements in cardiac imaging facilitating its identification. However, SCAD is still often misdiagnosed due to the absence of angiographic hallmarks in a significant number of cases, highlighting the importance of meticulous interpretation of angiographic findings and, when necessary, additional usage of intravascular imaging to verify changes in arterial wall integrity and identify specific pathoanatomical features associated with SCAD. Accurate diagnosis of SCAD is crucial, as the optimal management strategies for patients with SCAD differ from those with atherosclerotic coronary disease. Current treatment strategies favor a conservative approach, wherein intervention is reserved for cases with persistent ischemia, patients with high-risk coronary anatomy, or patients with hemodynamic instability. In this paper, we provide a preview of invasive imaging modalities and classical angiographic and intravascular imaging hallmarks that may facilitate proper SCAD diagnosis.
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Affiliation(s)
- Zlatko Mehmedbegović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Ivanov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Cardiology Clinic, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Cardiology Clinic, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Zoran Perišić
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Tomislav Kostić
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Bojan Maričić
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Beleslin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Apostolović
- Faculty of Medicine, University of Niš, Niš, Serbia
- Division of Interventional Cardiology, University Clinical Center Niš, Niš, Serbia
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Tesic M, Travica L, Giga V, Jovanovic I, Trifunovic Zamaklar D, Popovic D, Mladenovic D, Radomirovic M, Vratonjic J, Boskovic N, Dedic S, Nedeljkovic Arsenovic O, Aleksandric S, Juricic S, Beleslin B, Djordjevic Dikic A. Prognostic Value of Mitral Regurgitation in Patients with Primary Hypertrophic Cardiomyopathy. Medicina (Kaunas) 2023; 59:1798. [PMID: 37893516 PMCID: PMC10608691 DOI: 10.3390/medicina59101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Mitral valve pathology and mitral regurgitation (MR) are very common in patients with hypertrophic cardiomyopathy (HCM), and the evaluation of mitral valve anatomy and degree of MR is important in patients with HCM. The aim of our study was to examine the potential influence of moderate or moderately severe MR on the prognosis, clinical presentation, and structural characteristics of HCM patients. Materials and Methods: A prospective study examined 176 patients diagnosed with primary asymmetric HCM. According to the severity of the MR, the patients were divided into two groups: Group 1 (n = 116) with no/trace or mild MR and Group 2 (n = 60) with moderate or moderately severe MR. All patients had clinical and echocardiographic examinations, as well as a 24 h Holter ECG. Results: Group 2 had significantly more often the presence of the obstructive type of HCM (p < 0.001), syncope (p = 0.030), NYHA II class (p < 0.001), and atrial fibrillation (p = 0.023). Also, Group 2 had an enlarged left atrial dimension (p < 0.001), left atrial volume index (p < 0.001), and indirectly measured systolic pressure in the right ventricle (p < 0.001). Patients with a higher grade of MR had a significantly higher E/e' (p < 0.001) and, as a result, higher values of Nt pro BNP values (p < 0.001) compared to Group 1. Kaplan-Meier analysis demonstrated that the event-free survival rate during a median follow-up of 88 (IQR 40-112) months was significantly higher in Group 1 compared to Group 2 (84% vs. 45% at 8 years; log-rank 20.4, p < 0.001). After adjustment for relevant confounders, the presence of moderate or moderately severe MR remained as an independent predictor of adverse outcomes (HR 2.788; 95% CI 1.221-6.364, p = 0.015). Conclusions: The presence of moderate or moderately severe MR was associated with unfavorable long-term outcomes in HCM patients.
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Affiliation(s)
- Milorad Tesic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Travica
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Vojislav Giga
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ivana Jovanovic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Danijela Trifunovic Zamaklar
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Dejana Popovic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia
| | - Djordje Mladenovic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Marija Radomirovic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Jelena Vratonjic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Nikola Boskovic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Srdjan Dedic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Srdjan Aleksandric
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Stefan Juricic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
| | - Branko Beleslin
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ana Djordjevic Dikic
- Clinic for Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.T.); (V.G.); (D.T.Z.); (M.R.); (S.J.); (A.D.D.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Giga V, Tesic M, Beleslin B, Boskovic N, Sobic-Saranovic D, Jovanovic I, Nedeljkovic I, Paunovic I, Dedic S, Djordjevic-Dikic A. Predictors of diastolic deceleration time of coronary flow velocity of infarct related and reference coronary artery assessed by transthoracic Doppler echocardiography in the chronic phase of successfully reperfused anterior myocardial infarction: relation to infarct size. Front Cardiovasc Med 2023; 10:1196206. [PMID: 37771666 PMCID: PMC10523777 DOI: 10.3389/fcvm.2023.1196206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/31/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction High-frequency transthoracic Doppler echocardiography (TDE) enables the assessment of flow velocity and velocity pattern in different coronary arteries, including the assessment of diastolic deceleration time (DDT) of coronary flow velocity. Short DDT of infarct related artery (IRA) (<600 msec) in the acute phase of anterior myocardial infarction (MI) is the predictor of adverse left ventricular (LV) remodeling and prognosis. The significance of DDT of coronary flow velocity assessment in the chronic phase of anterior MI is not well established. Our study aimed to establish the predictors of DDT of the coronary flow velocity of infarct related (left anterior descendent-DDT of LAD) and reference coronary artery, evaluated by TDE, and to assess their relation to infarct size in the chronic phase of successfully reperfused first anterior MI. Methods Our study included 40 consecutive patients (34 men, mean age 52 ± 12 years) one month after the first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of LV volumes, ejection fraction, and percentage of the myocardium with fixed perfusion abnormalities and echocardiographic examination including the evaluation of DDT of IRA and reference coronary artery TDE. Results DDT of LAD correlated significantly to the WMSI (r = -0.467, p = 0.002), LV end-systolic volume (r = -0.412, p = 0.008), LV ejection fraction (r = 0.427, p = 0.006), while the strongest correlation was observed between DDT of LAD and the extent of fixed perfusion abnormality (r = -0.627, p < 0.0001), Multivariate analysis revealed percentage of fixed perfusion abnormalities along with DDT of reference coronary artery as the independent predictors of DDT of IRA. DDT of IRA shorter than 886 msec predicts large fixed perfusion abnormalities (>20%) with a sensitivity of 89% and specificity of 62% (AUC 0.842). Conclusion DDT of LAD assessed by TDE in the chronic phase of successfully reperfused first anterior MI is a usefull variable for the assessment of microcirculatory function that exclusively reflects the extent of microvascular damage and relates to infarct size.
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Affiliation(s)
- Vojislav Giga
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Sobic-Saranovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Insitute for Nuclear Medicine, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Jovanovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Paunovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Srdjan Dedic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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7
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Giga V, Boskovic N, Djordjevic-Dikic A, Beleslin B, Nedeljkovic I, Stankovic G, Tesic M, Jovanovic I, Paunovic I, Aleksandric S. Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65. Diagnostics (Basel) 2023; 13:2229. [PMID: 37443623 DOI: 10.3390/diagnostics13132229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower intermediate (15-65%) pre-test probability of coronary artery disease (CAD) and to assess the prognostic value of exercise electrocardiography and exercise stress echocardiography in this group of patients. METHODS We identified from our stress test laboratory database 862 patients with chest pain without previously known CAD and with a pre-test probability of CAD ranging from 15 to 65% (mean 41 ± 14%) who underwent exercise testing. Patients were followed for the occurrence of death, non-fatal myocardial infarction (MI) and clinically guided revascularization. RESULTS During the median follow-up of 94 months, 87 patients (10.1%) had an adverse event (AE). A total of 30 patients died (3.5%), 23 patients suffered non-fatal MI (2.7%) and 34 patients (3.9%) had clinically guided revascularization (20 patients percutaneous and 14 patients surgical revascularizations). Male gender, age, the presence of diabetes and a slow heart rate recovery (HRR) in the first minute after exercise were independently related to the occurrence of AEs. Adverse events occurred in 10.3% of patients who were tested by exercise stress echocardiography and in 10.0% of those who underwent stress electrocardiography (p = 0.888). CONCLUSION The risk of AEs after negative exercise testing in patients with a pre-test probability of CAD of 15-65% is low. Male patients with a history of diabetes and slow HRR in the first minute after exercise have an increased risk of an adverse outcome.
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Affiliation(s)
- Vojislav Giga
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Nedeljkovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Goran Stankovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivana Jovanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivana Paunovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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8
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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9
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Pálinkás ED, Re F, Peteiro J, Tesic M, Pálinkás A, Torres MAR, Dikic AD, Beleslin B, Van De Heyning CM, D’Alfonso MG, Mori F, Ciampi Q, de Castro Silva Pretto JL, Simova I, Nagy V, Boda K, Sepp R, Olivotto I, Pellikka PA, Picano E. Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy. Int J Cardiovasc Imaging 2022; 38:2593-2604. [DOI: 10.1007/s10554-022-02620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Background
B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).
Aim
To assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.
Methods
We enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e’; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.
Results
LUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e’ (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e’ (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.
Conclusions
Two-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.
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10
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Boskovic N, Giga V, Dedic S, Ostojic M, Karadzic T, Rakocevic I, Aleksandric S, Petrovic O, Tesic M, Jovanovic I, Nedeljkovic I, Banovic M, Beleslin B, Djordjevic-Dikic A. Additive negative prognostic value of coronary flow reserve in patients with left bundle branch block without inducible ischemia and without known coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left bundle branch block (LBBB) can be isolated thing, but it is also often associated with underlying coronary artery disease (CAD). Stress echocardiography (SECHO) is widely used as an imaging method for the diagnosis of CAD. However, the diagnostic value of stress echocardiography in patients (pts) with LBBB is limited.
Purpose
To evaluate negative prognostic value of coronary flow reserve (CFR) in pts with LBBB without inducible ischemia and without known CAD.
Methods
This retrospective study included 224 pts (98, 43.8% male gender, average age 66±11 years) with LBBB and without known CAD. All the pts had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), Duke treadmill score, functional capacity (Metabolic Equivalents - METs) were recorded in all pts. Out of 224 pts, in 64 (29.5%) coronary flow reserve on the left anterior descending artery was assessed using pulsed Doppler echocardiography with adenosine in a dose of 140μcg/kg/body weight during 3 minutes. As the normal value we took value of CFR ≥2. Median follow up of the pts was 72 months (IQR 56.25–132 months) for the occurrence of MACE (cardiovascular death (CVD), non-fatal myocardial infarction (nfMI), coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI).
Results
Out of 224 pts, 6 (2.7%) had positive SECHO test, 2 pts (0.9%) had died due to non-cardiac causes and 11 pts (4.9%) were lost to follow up so they were excluded from further analysis. The remaining 204 pts were divided in 2 groups: 1. pts with only negative SECHO (n=144, 68.8%); 2. pts with negative SECHO and normal CFR (n=64, 31.2%). During the follow-up period 22 out of 205 pts (10.7%) had an adverse event (6 CVD, 6 nfMI, 5 CABG, 8 PCI). Between the two groups there was no significant difference in risk factors and parameters of the SECHO test. Pts with CFR had significantly lower rate of MACE compared to the pts with only SECHO test (2, 3.1% vs 20, 14.2%, p=0.018, respectively). Using the Cox regression analysis, univariate predictors of MACE were insulin dependent diabetes (HR 10.851 [95% CI 2.095–56.220], p=0.004), Duke score (HR 0.603 [95% CI 0.414–0.878], p=0.008), and MET (HR 0.393 [95% CI 0.209–0.737], p=0.004). In the multivariate analysis only the insulin dependent diabetes remained an independent predictor of MACE (HR 6.906 [95% CI 1.100–43.363], p=0.039). Using the Kaplan-Meier survival curve we see that the pts with SECHO test and CFR had shorter event-free time compared to the pts with SECHO test (136.3±3.6 months vs 149.8±2.9 months, Log Rank 4.022, p=0.045) (Figure 1).
Conclusion
Normal value of CFR has good negative prognostic value in pts with LBBB without inducible ischemia and without known CAD, while pts with insulin dependent diabetes have more pronounced risk for the occurrence of adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Boskovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - V Giga
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - S Dedic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - M Ostojic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - T Karadzic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - I Rakocevic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - S Aleksandric
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - O Petrovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Tesic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - I Jovanovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - I Nedeljkovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Banovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - B Beleslin
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - A Djordjevic-Dikic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
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11
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Ciampi Q, Picano E, Djordjevic Dikic A. Haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise test in patients with ANOCA (SESPASM). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with angina and non-obstructed coronary arteries (ANOCA), functional dysregulation such as epicardial coronary spasm and microvascular dysfunction (microvascular spasm and /or impaired microvascular dilatation) frequently coexist.
The aim was to analyse haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise stress echo test in patients with ANOCA.
Methods
In a prospective study we enrolled 38 patients (56±13 years, 31 females) with ANOCA, proven by normal coronary angiogram. Stress echocardiography protocol with Doppler measurements of coronary flow consisted of hyperventilation test for spasm provocation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise test (HYP+EXE) for assessment of endothelium dependent function. Adenosine test was done (ADO 140 mcg/kg in 1 min) for estimation of endothelium independent vasodilatation. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography at the end of the each stage of the test. Abnormal response to HYP was a CFV ratio (stress/rest) <1.0 (vasoconstrictor response). CFV ratio at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation (<2 blunted response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response).
Results
The double product increased during HYP in comparison to rest (13263 vs 10321, p<0.001), and further increased with EXE (23817 vs HYP, p<0.001). Chest pain was present in 6 pts during HYP, and in additional three pts during HYP+EXE (15.8% vs 23.7%, p=0.25). ST segment depression was present in 6 pts during HYP and 23 during HYP+EXE (15.79% vs 60.52%, p<0.001). Wall motion abnormality was provoked with HYP in three pts (7.89%) and in ten (26.3%) with HYP+EXE (p=0.016). CFV ratio was abnormal for vasoconstriction during HYP in 16 (42.1%) and blunted in 23 (60.52%) pts during HYP+EXE (Fig 1). Vasodilation during ADO was preserved in all patients, but one. There was significant difference between CFV reserve during HYP+EXE vs ADO (1.98±0.49 vs 2.53±0.43 respectively, p<0.001) (Fig. 2).
Conclusion
Our results indicate that HYP induce microvascular dysfunction with vasospastic component which is reflected in reduced CFV ratio. This prevents the normal hyperemic response during EXE in more than a half of patients. Endothelial independent vasodilatation during ADO hyperemia was perserved in all patients, excluding structural microvasculature remodeling. HYP+EXE provocation with noninvasive measurement of coronary flow is a promising test for assessing mechanism of arteriolar dysregulation in ANOCA patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Dedic
- School of Medicine, Belgrade University , Belgrade , Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento , Benevento , Italy
| | - E Picano
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
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12
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Aleksandric S, Al-Lamee R, Djordjevic-Dikic A, Giga V, Tesic M, Banovic M, Zobenica V, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Davies J, Beleslin B. Diagnostic accuracy of instantaneous wave-free ratio at rest and during dobutamine provocation to assess myocardial bridging relevance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diastolic fractional flow reserve (d-FFR) during dobutamine provocation (DOB) was found to be a more reliable physiological index for the functional assessment of myocardial bridging (MB). However, d-FFR calculation is complicated and time-consuming, and therefore several authors have suggested the use of instantaneous wave-free ratio (iFR) to overcome these issues.
Purpose
The aim of our study was to assess diagnostic performance of d-FFR and iFR at rest and during DOB with exercise-induced myocardial ischemia as reference.
Methods
Twenty-four symptomatic patients (17 males, mean age 58±8 years) with MB and systolic compression ≥50% diameter stenosis on the left anterior descending (LAD) artery were included. Exercise stress-echocardiography test (SE), and both d-FFR and iFR in the distal segment of LAD at rest and peak DOB (30–50μg/kg/min), were performed in all patients. Optimal cut-off values and diagnostic performance of resting and hyperemic d-FFR and iFR were assessed using SE.
Results
Exercise-SE was positive for myocardial ischemia in 7/24 patients (29%). The area-under-the-receiver-operating-characteristic curve (ROC-AUC) for exercise-induced myocardial ischemia was 0.64 (95% CI: 0.400–0.885) for resting d-FFR, 0.62 (95% CI: 0.378–0.866) for resting iFR, 1.000 (95% CI: 0.999–1.000) for d-FFR at peak DOB, and 0.96 (95% CI: 0.895–1.000) for iFR at peak DOB. No significant difference in ROC-AUC was observed between d-FFR and iFR at peak DOB (p=0.243). The best cut-off value for both d-FFR and iFR at peak DOB was <0.76 with similar sensitivity and negative predictive values (100 vs. 100% for both), but lower specificity and positive predictive value for iFR in identifying MB associated with exercise-induced ischemia (94% vs. 82%; 88% vs. 70%, respectively). Compared with exercise-induced myocardial ischemia, the diagnostic accuracy of d-FFR and iFR at peak DOB was 96% (kappa=0.903, p<0.001) and 88% (kappa=0.731, p<0.001), respectively.
Conclusions
iFR during DOB provocation showed similar diagnostic accuracy as d-FFR to identify the functionally significant MB when compared with exercise-induced myocardial ischemia.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - R Al-Lamee
- Imperial College London , London , United Kingdom
| | | | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tomasevic
- Clinical Center Kragujevac, Clinic for Cardiology , Kragujevac , Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - J Davies
- Imperial College London , London , United Kingdom
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
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Palinkas ED, Re F, Peteiro J, Tesic M, Palinkas A, Torres MAR, Djordjevic Dikic A, Beleslin B, Van De Heyning CM, D'Alfonso MG, Mori F, Ciampi Q, Sepp R, Olivotto I, Picano E. Heterogeneous mechanisms of pulmonary congestion in hypertrophic cardiomyopathy unmasked by comprehensive exercise stress echocardiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, are present in 1 out of 3 patients with hypertrophic cardiomyopathy (HCM).
Aim
To assess the functional and anatomical correlates of exercise B-lines in HCM.
Methods
We enrolled 191 HCM patients (age 53±15 years, 123 males) consecutively referred for ESE (treadmill in 74, bicycle in 117 patients) in 11 quality-controlled centers from 8 countries. ESE assessment at rest and peak stress included: left ventricular (LV) outflow tract gradient, left atrial (LAVi) and LV end-diastolic volume index (EDVi), mitral regurgitation (MR, score from 0 to 3); E/e'; systolic pulmonary arterial pressure (SPAP) and LV force (LV outflow tract gradient+systolic blood pressure/LV end-systolic volume). B-lines at rest and at peak exercise were assessed by LUS with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥2.
Results
LUS was feasible in all subjects. B-lines were present in 55 (29%) patients during stress. When compared to patients without stress B-lines (n=136), patients with B-lines (n=55) at peak exercise had lower peak EDVi (43±17 vs 52±18 ml/m2, p=0.003) higher peak E/e' (16±6 vs 12±5, p<0.001), increase in MR (34 vs 12%, p=0.001), greater stress LAVi (43±14 vs 37±14 ml/m2, p=0.003) and stress SPAP (56±18 vs 40±12 mm Hg p<0.0001): see Figure. Among baseline parameters, the number of B-lines (OR: 7.53, 95% CI 1.21–46.72 p=0.03), LAVi (OR: 1.05, 95% CI 1.00–1.09 p=0.04), and LV force (OR: 1.36, 95% CI 1.04–1.79 p=0.03) were the independent predictors of exercise pulmonary congestion.
Conclusion
HCM patients with pulmonary congestion on exercise show different, and not mutually exclusive mechanisms of diastolic dysfunction and worsening mitral regurgitation. These different hemodynamic mechanisms may require personalized therapeutic actions beyond a pulmonary decongestion therapy with diuretics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E D Palinkas
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine , Szeged , Hungary
| | - F Re
- San Camillo Forlanini Hospital, Cardiology Department , Rome , Italy
| | - J Peteiro
- CIBER-CV, CHUAC and University of A Coruna , A Coruna , Spain
| | - M Tesic
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School , Belgrade , Serbia
| | - A Palinkas
- Elisabeth Hospital of Csongrad , Hodmezovasarhely , Hungary
| | - M A R Torres
- Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - A Djordjevic Dikic
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School , Belgrade , Serbia
| | - B Beleslin
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School , Belgrade , Serbia
| | - C M Van De Heyning
- Antwerp University Hospital, Department of Cardiology , Edegem , Belgium
| | - M G D'Alfonso
- Careggi University Hospital, Cardiovascular Imaging Division , Florence , Italy
| | - F Mori
- Careggi University Hospital, Cardiovascular Imaging Division , Florence , Italy
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento , Benevento , Italy
| | - R Sepp
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine , Szeged , Hungary
| | - I Olivotto
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - E Picano
- CNR – National Research Council, Institute of Clinical Physiology , Pisa , Italy
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Boskovic N, Giga V, Djordjevic-Dikic A, Beleslin B, Stojkovic S, Nedeljkovic I, Aleksandric S, Tesic M, Dedic S, Burazor I, Karadzic T, Paunovic I, Jovanovic I. Comparison of SCORE and SCORE 2 risk prediction tools in contemporary very high risk european population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
New SCORE 2 algorithm overperformed SCORE algorithm in population with decreasing prevalence of cardiovascular (CV) morbidity and mortality. However, there is limited data in risk stratification with SCORE 2 model in contemporary populations from very high risk countries.
Aim
The aim of this study was to compare risk prediction using SCORE 2 and SCORE model and to compare the proportions of patients requiring statin treatment in primary prevention.
Methods
Our study included 1317 patients (511, 38.8% male gender, average age 54±8) without known CV disease aged 40 to 70 years. Data on CV risk factors were prospectively collected in 20 primary care centers throughout the Serbia from January 2020. to December 2020. Based on the CV risk profile, patients were stratified into 4 categories: low, moderate, high and very high risk according to SCORE model and into 3 categories: low to moderate, high and very high risk according to SCORE 2 model. The number of patients requiring statin treatment was assessed according to the risk category and value of LDL cholesterol in SCORE model and the value of non-HDL cholesterol in SCORE 2 model.
Results
Overall, 589 patients (44.7%) were smokers, mean value of total cholesterol was 6.2±1.1 mmol/L, LDL 3.9±1.1, HDL 1.4±0.5, non HDL 4.8±1.2 mmol/L. Systolic blood pressure was 138.6±19.6, diastolic blood pressure was 85.3±10.4 mmHg and was BMI 26.9±5.2. Based on the SCORE model 166 patients (12.6%) were classified into low risk category, 658 (49.9%) into moderate, 276 (20.9%) into high risk and 217 (16.6%) into very high risk category. Based on the SCORE 2 model 30 (2.8%) patients were classified into low to moderate, 273 (18%) and 1014 (79.2%) into very high risk category. There was significantly less patients in low to moderate group in SCORE 2 model compared to SCORE model (30, 2.8% vs 824, 62.6%, p<0.001 respectively) and significantly more patients with very high risk (1014, 79.2% vs 217, 16.6%, p<0.001), but without significance difference in the high risk group (Figure 1). The use of SCORE 2 model resulted in significantly higher proportion of patients requiring statin treatment 93% vs. 43% using SCORE model (p<0.001).
Conclusion
The use SCORE 2 risk prediction tool, in comparison to SCORE model, results in significant higher proportion of patients being classified as very high risk category with the increase number of patients requiring statin treatment in primary prevention.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Krka Farma
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School , Belgrade , Serbia
| | - V Giga
- University Belgrade Medical School , Belgrade , Serbia
| | | | - B Beleslin
- University Belgrade Medical School , Belgrade , Serbia
| | - S Stojkovic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Nedeljkovic
- University Belgrade Medical School , Belgrade , Serbia
| | - S Aleksandric
- University Belgrade Medical School , Belgrade , Serbia
| | - M Tesic
- University Belgrade Medical School , Belgrade , Serbia
| | - S Dedic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Burazor
- University Belgrade Medical School , Belgrade , Serbia
| | - T Karadzic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Paunovic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Jovanovic
- University Belgrade Medical School , Belgrade , Serbia
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15
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Jovanovic I, Tesic M, Djordjevic-Dikic A, Giga V, Beleslin B, Aleksandric S, Boskovic N, Petrovic O, Marjanovic M, Vratonjic J, Paunovic I, Ivanovic B, Trifunovic-Zamaklar D. Role of different echocardiographic modalities in the assessment of microvascular function in women with ischemia and no obstructive coronary arteries. J Clin Ultrasound 2022; 50:1134-1142. [PMID: 36218210 DOI: 10.1002/jcu.23313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
This review summarizes current knowledge about echocardiographic modalities used to assess microvascular function and left ventricular (LV) systolic function in women with ischemia and no obstructive coronary arteries (INOCA). Although the entire pathophysiological background of this clinical entity still remains elusive, it is primarily linked to microvascular dysfunction which can be assessed by coronary flow velocity reserve. Subtle impairments of LV systolic function in women with INOCA are difficult to assess by interpretation of wall motion abnormalities. LV longitudinal function impairment is considered to be an early marker of subclinical systolic dysfunction and can be assessed by global longitudinal strain quantification.
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Affiliation(s)
- Ivana Jovanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Milorad Tesic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Giga
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srdjan Aleksandric
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Olga Petrovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Marjanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Jelena Vratonjic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Ivana Paunovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Branislava Ivanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic-Zamaklar
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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16
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Žarković M, Perros P, Ćirić J, Beleslin B, Stojanović M, Stojković M, Miletić M, Janić T. Health care access of thyroid disease patients in Serbia during the COVID-19 pandemic. J Endocrinol Invest 2022; 45:1521-1526. [PMID: 35325447 PMCID: PMC8944403 DOI: 10.1007/s40618-022-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of repurposing health care facilities in response to COVID-19 on the access of patients with thyroid disease to health care. METHODS This study consisted of a web-based survey. The survey was anonymous and consisted of forty questions. RESULTS This survey included 206 respondents. 91.3% of the respondents had health insurance through the Republic Fund of Health Insurance, 9.7% had private or both health insurances, and 3.4% did not have any health insurance. A significant proportion of respondents (60.4%) had to switch from public to private health care to reach a physician and 73.8% had to switch from public to private laboratories. For the 91.9%, this was perceived as a financial burden. Before the pandemic, 83.1% of respondents reported regular follow-up by physicians, which decreased to 44.9% during the pandemic (p < 0.01). 76.3% of the respondents regarded that their thyroid disease was managed optimally before the pandemic, while this figure declined to only 48% during the pandemic (p < 0.01). CONCLUSIONS The COVID-19 pandemic disrupted the medical care of thyroid patients in Serbia. For the patients treated in the public health care system, access to general practice was hindered, while access to specialist care was disrupted. It led to a switch from public to private health care, which was perceived as a financial burden for almost all the respondents. However, private health care proved to be an important safety net when the public system was overwhelmed.
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Affiliation(s)
- M Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia.
| | - P Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Ćirić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - B Beleslin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Miletić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - T Janić
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
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Al Nooryani A, Aboushokka W, AlBaba B, Kerfes J, Abudaqa L, Bhatia A, Mansoor A, Nageeb R, Aleksandric S, Beleslin B. Long-Term Performance of the Magmaris Drug-Eluting Bioresorbable Metallic Scaffold in All-Comers Patients’ Population. J Clin Med 2022; 11:jcm11133726. [PMID: 35807011 PMCID: PMC9267727 DOI: 10.3390/jcm11133726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background: The long-term efficacy and safety of bioresorbable vascular scaffolds (BVS) in real world clinical practice including Magmaris need to be elucidated to better understand performance of this new and evolutive technology. The aim of this study was to evaluate long-term performance of Magmaris, drug-eluting bioresorbable metallic scaffold, in all-comers patients’ population. Methods: We included in this prospective registry first 54 patients (54 ± 11 years; male 46) treated with Magmaris, with at least 30 months of follow-up. Diabetes mellitus and acute coronary syndrome were present in 33 (61%) and 30 (56%) of the patients, respectively. Patients were followed for device- and patient-oriented cardiac events during a median follow-up of 47 months (DOCE–cardiac death, target vessel myocardial infarction, and target lesion revascularization; POCE–all cause death, any myocardial infarction, any revascularization). Results: Event-free survivals for DOCE and POCE were 86.8% and 79.2%, respectively. The rate of DOCE was 7/54 (13%), including in total target vessel myocardial infarction in two patients (4%), target lesion revascularization in six patients (11%), and no cardiac deaths. The rate of POCE was 11/54 (21%), including in total any myocardial infarctions in 3 patients (6%), any revascularization in 11 patients (20%), and no deaths. Definite Magmaris thrombosis occurred in two patients (3.7%), and in-scaffold restenosis developed in five patients (9.3%). Variables associated with DOCE were implantation of ≥2 Magmaris BVS (HR: 5.4; 95%CI: 1.21–24.456; p = 0.027) and total length of Magmaris BVS ≥ 40 mm (HR: 6.4; 95%CI: 1.419–28.855; p = 0.016), whereas previous PCI was the only independent predictor of POCE (HR: 7.4; 95%CI: 2.216–24.613; p = 0.001). Conclusions: The results of the long-term clinical outcome following Magmaris implantation in patients with complex clinical and angiographic features were acceptable and promising. Patients with multi-BVS and longer multi-BVS in lesion implantation were associated with worse clinical outcome.
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Affiliation(s)
- Arif Al Nooryani
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Wael Aboushokka
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Bassam AlBaba
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Jalal Kerfes
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Loai Abudaqa
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Amit Bhatia
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Anoop Mansoor
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | - Ruwaide Nageeb
- Al Qassimi Hospital, Sharjah 3500, United Arab Emirates; (A.A.N.); (W.A.); (B.A.); (J.K.); (L.A.); (A.B.); (A.M.); (R.N.)
| | | | - Branko Beleslin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Correspondence:
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18
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Aleksandric S, Banovic M, Beleslin B. Challenges in Diagnosis and Functional Assessment of Coronary Artery Disease in Patients With Severe Aortic Stenosis. Front Cardiovasc Med 2022; 9:849032. [PMID: 35360024 PMCID: PMC8961810 DOI: 10.3389/fcvm.2022.849032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
More than half of patients with severe aortic stenosis (AS) over 70 years old have coronary artery disease (CAD). Exertional angina is often present in AS-patients, even in the absence of significant CAD, as a result of oxygen supply/demand mismatch and exercise-induced myocardial ischemia. Moreover, persistent myocardial ischemia leads to extensive myocardial fibrosis and subsequent coronary microvascular dysfunction (CMD) which is defined as reduced coronary vasodilatory capacity below ischemic threshold. Therefore, angina, as well as noninvasive stress tests, have a low specificity and positive predictive value (PPV) for the assessment of epicardial coronary stenosis severity in AS-patients. Moreover, in symptomatic patients with severe AS exercise testing is even contraindicated. Given the limitations of noninvasive stress tests, coronary angiography remains the standard examination for determining the presence and severity of CAD in AS-patients, although angiography alone has poor accuracy in the evaluation of its functional severity. To overcome this limitation, the well-established invasive indices for the assessment of coronary stenosis severity, such as fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), are now in focus, especially in the contemporary era with the rapid increment of transcatheter aortic valve replacement (TAVR) for the treatment of AS-patients. TAVR induces an immediate decrease in hyperemic microcirculatory resistance and a concomitant increase in hyperemic flow velocity, whereas resting coronary hemodynamics remain unaltered. These findings suggest that FFR may underestimate coronary stenosis severity in AS-patients, whereas iFR as the non-hyperemic index is independent of the AS severity. However, because resting coronary hemodynamics do not improve immediately after TAVR, the coronary vasodilatory capacity in AS-patients treated by TAVR remain impaired, and thus the iFR may overestimate coronary stenosis severity in these patients. The optimal method for evaluating myocardial ischemia in patients with AS and co-existing CAD has not yet been fully established, and this important issue is under further investigation. This review is focused on challenges, limitations, and future perspectives in the functional assessment of coronary stenosis severity in these patients, bearing in mind the complexity of coronary physiology in the presence of this valvular heart disease.
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Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- *Correspondence: Srdjan Aleksandric
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Ciampi Q, Picano E, Djordjevic Dikic A. Assessment of left ventricular contractile reserve during hyperventilation and exercise in patients with ANOCA. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction. Mechanism of ischemia in patients with angina and no obstructive coronary artery disease (ANOCA), is often unrecognized since invasive tests are seldom done and proper noninvasive test is not established yet.
The aim of our study was to assess changes in ventricular function during hyperventilation test (HYP) designed to provoke vasoconstriction, immediately followed by supine bicycle exercise to increase ischemic stimuli in patients with ANOCA (HYP + EXE).
Methods. : In a prospective study, we enrolled 29 ANOCA patients (age 59.6 ±11 years, 27 females) with previously normal angiograms. All patients underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5"), immediately followed by supine bicycle exercise (HYP + EXE). Ventricular function was assessed based on left ventricular contractile reserve (LVCR), calculated by ratio of the ventricular force at the peak of the each stress level and rest. Force was assessed as the quotient between systolic arterial pressure and end-systolic volume determined by two-dimensional echocardiography. Values range from normal (> 2.0) to mild (1.5–2.0), moderate (1.01–1.49), and severe (≤1.0) dysfunction. For LVCR HYP values are shifted towards lower values (abnormal < 1.1).
Results. Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP + EXE (13.8% vs 24.1 %, p = 0.001). Three patients showed wall motion abnormalities with hyperventilation and additional two patients with HYP + EXE. LVCR HYP response was normal in 19/29 (65.5%) pts and abnormal in 10/29 (34.5%) pts. LVCR HYP + EXE response was normal in 9/29 (31%) pts, 4/29 (13.8%) pts had mild, 11/29 (37.9%) pts had moderate and 5/29 (17.3%) pts had severe dysfunction.
Conclusion. In patients with ANOCA subtle changes in LV function occurred with HYP and EXE stress more often than wall motion abnormality. Measurement of contractile reserve might be a useful tool in assessment of ischemia and ventricular dysfunction in patients with ANOCA. Abstract Figure 1. Abstract Figure 2.
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Division of cardiology, Benevento, Italy
| | - E Picano
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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Palinkas ED, Ciampi Q, Tesic M, Palinkas A, Torres MAR, Djordievic-Dikic A, Beleslin B, Sepp R, Mori F, Picano E. Comprehensive stress echocardiography in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging
Background
Stress echocardiography (SE) in hypertrophic cardiomyopathy (HCM) has more to offer beyond dynamic left ventricular outflow obstruction (LVOTO) to capture the functional heterogeneity of the disease.
Objectives
To determine the feasibility of comprehensive SE in HCM.
Methods
We prospectively enrolled 235 HCM patients (age = 48 ± 15 years, 113 men) assessed with exercise stress echocardiography (ESE) in 4 centers. ESE modality was semi-supine bicycle in 29 patients in one center, and treadmill in 206 (followed by same-day, same session, adenosine for step D) in another centers. During SE, we assessed stress-induced new regional wall motion abnormalities (RWMA, step A), coronary flow velocity reserve (CFVR) in left anterior descending coronary artery with Doppler (step D) by semi-supine exercise or adenosine, heart rate reserve (peak/rest heart rate) for EKG-based step E, mitral regurgitation (MR) flow for step F, and LVOTO (step G for gradient). A comprehensive SE score was generated from 0 (all parameters normal) to 5 (all abnormal).
Results
Technical success rate was 100% for all steps, except step D (80% with semi-supine, 100% with adenosine after treadmill) and F (232/235, 99%). Extra-analysis time was < 3 minutes for steps A + D + E + F + G. Rate of abnormal results ranged from 73% for step E (peak/rest heart rate reserve < 1.80) to 1% for step A (inducible RWMA), with intermediate values for step D (CFVR < 2.0, 44%), step F (at least moderate MR, 32%) and step G (LVOTG > 50 mm Hg, 26%): see figure. SE score was 0 in 14 pts (6%), 1 or 2 in 202 patients (86%) and ≥ 3 in 19 patients (8%).
Conclusions
Comprehensive SE is feasible in HCM with single stress (semi-supine exercise) or hybrid treadmill exercise followed by adenosine for step D. Phenotyping of the multiform manifestations of HCM with a personalized functional blueprint is now possible. Abstract Figure.
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Affiliation(s)
- ED Palinkas
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine, Albert Szent-Györgyi Clinical, Szeged, Hungary
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | - M Tesic
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School, Belgrade, Serbia
| | - A Palinkas
- Elisabeth Hospital of Csongrad, Hodmezovasarhely, Hungary
| | - MAR Torres
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A Djordievic-Dikic
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School, Belgrade, Serbia
| | - B Beleslin
- University of Belgrade, Cardiology Clinic, University Center Serbia, Medical School, Belgrade, Serbia
| | - R Sepp
- University of Szeged, Division of Non-Invasive Cardiology, Department of Internal Medicine, Albert Szent-Györgyi Clinical, Szeged, Hungary
| | - F Mori
- Careggi University Hospital, Cardiovascular Imaging Division, Florence, Italy
| | - E Picano
- CNR – National Research Council, Institute of Clinical Physiology, Pisa, Italy
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Stojković M, Nedeljković-Beleslin B, Tešić M, Bukumirić Z, Ćirić J, Stojanović M, Miletić M, Đorđević-Dikić A, Giga V, Beleslin B, Žarković M. Specific impact of cardiovascular risk factors on coronary microcirculation in patients with subclinical hypothyroidism. J Med Biochem 2021; 41:299-305. [PMID: 36042900 PMCID: PMC9375533 DOI: 10.5937/jomb0-34545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve (CFR) in patients with subclinical hypothyroidism. Methods Thirty two subjects with SCH and eighteen control subjects with normal serum thyroid hormones and thyroid-stimulating hormone (TSH) levels were included in the study. TSH, free thyroxine, free triiodothyronine, glucose, insulin, HbA1c, cholesterol, triglyceride and plasma levels of C-reactive protein were measured. Coronary diastolic peak flow velocities in left anterior descending coronary artery were measured at baseline and after adenosine infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity. Results CFR values were not significantly different between the two groups (SCH 2.76±0.35 vs controls 2.76±0.42). There was a significant correlation of CFR with waist to hip ratio, hypertension, smoking habits, markers of glucose status (glucose level, HbA1c, insulin level, HOMA IR), cholesterol, LDL-cholesterol and triglyceride levels in SCH group, whereas only cholesterol level showed significant correlation with CFR in controls. There was no correlation between CFR and thyroid hormones. Conclusions We concluded that there is a different impact of cardiovascular risk factors on CFR in SCH patients compared to healthy control and that these two groups behave differently in the same circumstances under the same risk factors. The basis for this difference could be that the altered thyroid axis "set point" changes the sensitivity of the microvasculature in patients with SCH to known risk factors.
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Affiliation(s)
| | | | - Milorad Tešić
- University of Belgrade, Faculty of Medicine, Belgrade
| | | | - Jasmina Ćirić
- University of Belgrade, Faculty of Medicine, Belgrade
| | | | | | | | - Vojislav Giga
- University of Belgrade, Faculty of Medicine, Belgrade
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Petrovic M, Dotlic J, Boskovic N, Giga V, Aleksandric S, Dedic S, Beleslin B, Djordjevic Dikic A. The Value of Stress Echocardiography Imaging and Functional Parameters in Patients with aVR Lead ST-Segment Elevation during an Exercise Stress Test to Detect Significant Left Main Stenosis. Acta Med Acad 2021; 50:358-364. [PMID: 35164511 DOI: 10.5644/ama2006-124.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE To evaluate the role of functional and imaging parameters during exercise stress echocardiography (SE) in the presence of ST-segment elevation (ST-E) in aVR leads to predict significant left main/left main equivalent/or ostial left anterior descending (LAD) stenosis (LM+). METHODS The study population included 548 patients with ECG and echo markers of myocardial ischemia, in whom diagnostic coronary angiography was performed. We analyzed the patients' clinical characteristics, ECG changes, wall motion score index (WMSI) by stress echocardiography (SE), as well as functional capacity during exercise (METs) and Duke treadmill score. RESULTS aVR ST-segment elevation was found in 60/548 (11%) patients, whereas aVR ST-E was found in 23/57 patients with left main LM stenosis (Sn 40%, Sp 92%, PPV 38%, NPV 93%). When aVR ST-E was combined with other functional/imaging parameters, patients with aVR ST-E and LM+ had significantly worse functional capacity in METs (5.0±2.2 vs. 6.7±2.3, P=0.005), lower Duke score (-6.8±6.8 vs. -3.6±4.1, P=0.049), and higher deterioration of WMSI (0.51±0.24 vs. 0.39±0.24, P=0.046). Significant multivariable predictors of the left main (LM) stenosis were aVR ST-E and positive SE in LAD territory in the whole group of patients, and Delta WMSI, Duke score and METs achieved in patients presented with aVR ST-E during exercise. CONCLUSION The aVR ST-segment alone has intermediate sensitivity in detecting significant LM stenosis in patients referred to SE testing for chest pain. When combined with other functional and imaging parameters, including poor exercise functional capacity in METs, lower Duke score or greater WMA in the territory of LAD, its diagnostic power to detect LM significantly increases.
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Affiliation(s)
- Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, US.
| | - Jelena Dotlic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Srdjan Dedic
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
| | - Ana Djordjevic Dikic
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
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Tesic M, Beleslin B, Giga V, Jovanovic I, Marinkovic J, Trifunovic D, Petrovic O, Dobric M, Aleksandric S, Juricic S, Boskovic N, Tomasevic M, Ristic A, Orlic D, Stojkovic S, Vukcevic V, Stankovic G, Ostojic M, Djordjevic Dikic A. Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients With Asymmetric Hypertrophic Cardiomyopathy. J Am Heart Assoc 2021; 10:e021936. [PMID: 34634920 PMCID: PMC8751885 DOI: 10.1161/jaha.120.021936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Microvascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with hypertrophic cardiomyopathy (HCM). However, long‐term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on clinical outcome is uncertain in HCM patients. Therefore, the aim of our study was to assess long‐term prognostic value of CFVR on clinical outcome in HCM population. Methods and Results We prospectively included 150 HCM patients (82 women; mean age 48±15 years). Patients’ clinical characteristics, echocardiographic and CFVR findings (both for left anterior descending [LAD] and posterior descending artery [PD]), were assessed in all patients. The primary outcome was a composite of: HCM related death, heart failure requiring hospitalization, sustained ventricular tachycardia and ischemic stroke. Patients were stratified into 2 subgroups depending on CFVR LAD value: Group 1 (CFVR LAD>2, [n=87]) and Group 2 (CFVR LAD≤2, [n=63]). During a median follow‐up of 88 months, 41/150 (27.3%) patients had adverse cardiac events. In Group 1, there were 8/87 (9.2%), whereas in Group 2 there were 33/63 (52.4%, P<0.001 vs. Group 1) adverse cardiac events. By Kaplan‐Meier analysis, patients with preserved CFVR LAD had significantly higher cumulative event‐free survival rate compared to patients with impaired CFVR LAD (96.4% and 90.9% versus 66.9% and 40.0%, at 5 and 8 years, respectively: log‐rank 37.2, P<0.001). Multivariable analysis identified only CFVR LAD≤2 as an independent predictor for adverse cardiac outcome (HR 6.54; 95% CI 2.83–16.30, P<0.001), while CFVR PD was not significantly associated with outcome. Conclusions In patients with HCM, impaired CFVR LAD (≤2) is a strong, independent predictor of adverse cardiac outcome. When the aim of testing is HCM risk stratification and CFVR LAD data are available, the evaluation of CFVR PD is redundant.
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Affiliation(s)
- Milorad Tesic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Branko Beleslin
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Vojislav Giga
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Ivana Jovanovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena Marinkovic
- Institute for Medical Statistics and Informatics School of Medicine University of Belgrade
| | - Danijela Trifunovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Olga Petrovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Milan Dobric
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Srdjan Aleksandric
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Stefan Juricic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia
| | - Nikola Boskovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia
| | - Miloje Tomasevic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Kragujevac Kragujevac Serbia
| | - Arsen Ristic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Dejan Orlic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Sinisa Stojkovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Vladan Vukcevic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
| | - Goran Stankovic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia.,Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Miodrag Ostojic
- School of Medicine University of Belgrade Belgrade Serbia.,Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Ana Djordjevic Dikic
- Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.,School of Medicine University of Belgrade Belgrade Serbia
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25
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Aleksandric S, Djordjevic-Dikic A, Tesic M, Giga V, Dobric M, Banovic M, Boskovic N, Juricic S, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Beleslin B. Cut-off value of coronary flow velocity reserve obtained by transthoracic Doppler echocardiography during intravenous infusion of dobutamine for diagnosis of functional significant myocardial bridging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies showed that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during inotropic stimulation with dobutamine (DOB), in comparison to vasodilation with adenosine, provides more reliable functional evaluation of myocardial bridging (MB). However, the adequate cut-off value of CFVR during DOB for diagnosing functional significant MB has not been fully established.
Purpose
The purpose of the study was to evaluate the adequate cut-off value of TTDE- CFVR during DOB for diagnosis of functional significant MB.
Methods
This prospective study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery (LAD) and systolic compression ≥50% diameter stenosis. Exercise stress-echocardiography test (ExSE) and TTDE-CFVR in the distal segment of LAD during DOB infusion (DOB: 10–40μg/kg/min) were performed in all patients. Percent diameter stenosis (DS) of MB at end-systole and end-diastole were analyzed using quantitative coronary angiography.
Results
Exercise-SE was positive for myocardial ischemia in 22/79 (28%). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (1.94±0.16 vs. 2.78±0.53, p<0.001). ROC analysis identifies the optimal CFVR during peak DOB cut-off value <2.1 (AUC 0.985, 95% CI: 0.965–1.000, p<0.001), with a sensitivity of 96% and specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%, for identifying functionally significant MB associated with stress-induced myocardial ischemia. The categorical agreement between TTDE-CFVR at peak DOB and ExSE was high (kappa value = 0.877, p<0.001). Multivariate logistic regression analysis showed that percent DS at end-diastole was the only independent predictor of ischemic CFVR value <2.1 (OR: 1.136, 95% CI: 1.045–1.235, p=0.003).
Conclusion
A cut-off value <2.1 of CFVR during DOB infusion obtained by TTDE may adequate discriminate functional significant MB that induce myocardial ischemia which is caused by an incomplete diastolic MB-decompression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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26
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Tesic M, Nemes A, Ciampi Q, Rigo F, Cortigiani L, Beleslin B, Djordjevic-Dikic A, Picano E. Additive prognostic value of coronary flow and heart rate reserve during vasodilator stress echocardiography in hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary flow velocity reserve (CFVR) and heart rate reserve (HRR) during vasodilator stress echocardiography (SE) assess coronary microvascular function and cardiac sympathetic reserve respectively. Both CFVR and HRR can be impaired in hypertrophic cardiomyopathy (HCM).
Objectives
To evaluate the prognostic value of CFVR and HRR during vasodilator SE in HCM.
Methods
We enrolled 244 HCM patients (age=51±15 years, 116 men) studied with vasodilator SE from 1999 to 2019 in 5 certified centers. Stress modality was either adenosine (Ado, 0.14 mg/kg/min in 2', n=171) or dipyridamole (Dip, 0.84 mg/kg in 6', n=73). Left ventricular outflow tract obstruction was present at rest in 80 patients (33%). We assessed CFVR in left anterior descending coronary artery (by TTE in 225, and TEE in 19 patients) and HRR (peak/rest heart rate). Abnormal values of HRR were based on receiver operating characteristics for Ado and Dip separately calculated. All patients completed the follow-up.
Results
CFVR was 2.17±0.46 for Dip and 2.13±0.43 for Ado (p=ns); HRR was 1.36±0.19 for Dip and 1.10±0.16 for Ado (p<0.001). An abnormal CFVR (<2.0 for both Ado and Dip) was present in 28 patients for Dip and 73 for Ado (38% vs 43%, p=ns). An abnormal HRR (≤1.34 for Dip and ≤1.03 for Ado) was present in 39 patients for Dip and in 70 patients for Ado (53% vs 41%, p=ns). During a median follow-up of 67 months (interquartile range: 29–103 months), 97 spontaneous events occurred in 71 patients: 29 all-cause deaths, 32 new hospital admission for acute heart failure, 3 sustained ventricular tachycardias, 32 atrial fibrillations and 1 heart transplantation. Event rate was 2.5%/year in patients with normal CFVR and HRR, 4.7%/year in patients with only one abnormal criterion and 10.9%/year in patients with abnormal responses of both criteria (see figure). At multivariate analysis, abnormality of both CFVR and HRR (Hazard ratio 4.033, 95% CI 1.863–8.729, p<0.001) was independent predictor of events.
Conclusions
A reduced CFVR and blunted HRR during vasodilator SE identify distinct phenotypes and show independent value in predicting outcome in HCM patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier spontaneous event-free survival curves based on HRR and CFVR. Kaplan-Meier survival curves (considering spontaneous events) in patients stratified with the abnormal HRR and/or CFVR. Number of patients at risk per year is shown.
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Affiliation(s)
- M Tesic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - A Nemes
- Albert Szent-Györgyi Clinical Center, 2nd Department of Internal Medicine and Cardiology Center, Szeged, Hungary
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | - F Rigo
- Dolo Hospital, Department of Cardiology, Venice, Italy
| | - L Cortigiani
- SAN LUCA Hospital, Department of Cardiology, Lucca, Italy
| | - B Beleslin
- University Clinical Center of Serbia, Belgrade, Serbia
| | | | - E Picano
- Institute of Clinical Physiology, CNR, Biomedicine Department, Pisa, Italy
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27
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Picano E, Djordjevic Dikic A. Noninvasive functional testing in ANOCA: hyperventilation-exercise study for spasm (SESPASM). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In patients with angina and no obstructive coronary artery disease (ANOCA), different mechanisms of ischaemia, epicardial spasm, microvascular spasm, and impaired microvascular dilatation frequently coexist.
The aim was to assess CFVR changes during coronary vasoconstrictor and vasodilator stimuli in patients with ANOCA.
Methods
In a prospective single center study, we enrolled 29 ANOCA patients (age 59.6±11 years, 27 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO 140 mcg/kg in 1 min) on the other day. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio <1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.
Results
The double product increased during HYP, in comparison to rest (13213 vs 10517, p<0.01), and further increased with EXE (23387 vs HYP, p<0.001). Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP+EXE (13.8% vs 24.1%, p=0.001). ST segment depression (≥1mm) was present in 7/29 patients during HYP, and 14/29 during HYP+EXE (24.13% vs 48.3%, p<0.01). Five patients (17%) showed regional wall motion abnormalities with HYP+EXE. CFVR response was abnormal in 19/29 (65%) patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 13 (44%). Vasodilation during ADO was preserved in all patients.There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.35 vs 2.47±0.42 respectively, p<0.01), and between CFVR HYP and ADO (1.28±0.29 vs 2.47±0.42, p<0.001).
Conclusion
In patients with ANOCA, HYP+EXE is a more powerful ischemic stress than HYP alone. In over one-half of patients HYP+EXE unmasks abnormalities in CFVR response and/or regional wall motion, likely unmasking the underlying endothelium dependent microcirculatory dysfunction with enhanced vasoconstriction in 44% of the patients and mixed vasoconstriction and reduced relaxation in 65%.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Clinical Centre of Serbia, Faculty of Medicine
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - E Picano
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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28
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Ciampi Q, Zagatina A, Cortigiani L, Wierzbowska-Drabik K, Kasprzak JD, Haberka M, Djordjevic-Dikic A, Beleslin B, Boshchenko A, Ryabova T, Gaibazzi N, Rigo F, Dodi C, Simova I, Samardjieva M, Barbieri A, Morrone D, Lorenzoni V, Prota C, Villari B, Antonini-Canterin F, Pepi M, Carpeggiani C, Pellikka PA, Picano E. Prognostic value of stress echocardiography assessed by the ABCDE protocol. Eur Heart J 2021; 42:3869-3878. [PMID: 34449837 PMCID: PMC8486488 DOI: 10.1093/eurheartj/ehab493] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
AIM The aim of this study was to assess the prognostic value of ABCDE-SE in a prospective, large scale, multicentre, international, effectiveness study. Stress echocardiography (SE) was recently upgraded to the ABCDE protocol: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. METHODS AND RESULTS From July 2016 to November 2020, we enrolled 3574 all-comers (age 65 ± 11 years, 2070 males, 58%; ejection fraction 60 ± 10%) with known or suspected chronic coronary syndromes referred from 13 certified laboratories. All patients underwent clinically indicated ABCDE-SE. The employed stress modality was exercise (n = 952, with semi-supine bike, n = 887, or treadmill, n = 65 with adenosine for step D) or pharmacological stress (n = 2622, with vasodilator, n = 2151; or dobutamine, n = 471). SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). All-cause death was the only endpoint. Rate of abnormal results was 16% for A, 30% for B, 36% for C, 28% for D, and 37% for E steps. During a median follow-up of 21 months (interquartile range: 13-36), 73 deaths occurred. Global X2 was 49.5 considering clinical variables, 50.7 after step A only (P = NS (not significant)) and 80.6 after B-E steps (P < 0.001 vs. step A). Annual mortality rate ranged from 0.4% person-year for score 0 up to 2.7% person-year for score 5. CONCLUSION ABCDE-SE allows an effective prediction of survival in patients with chronic coronary syndromes.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, Russian Federation
| | | | | | | | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale di Dolo-Venice, Venice, Italy
| | - Claudio Dodi
- Cardiology Department, Ospedale di Cremona, Cremona, Italy
| | - Iana Simova
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Sofia, Bulgaria
| | - Martina Samardjieva
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Sofia, Bulgaria
| | | | | | | | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Francesco Antonini-Canterin
- Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, Treviso, Italy.,Italian Society of Echocardiography and Cardiovascular Imaging, Milano, Italy
| | - Mauro Pepi
- Italian Society of Echocardiography and Cardiovascular Imaging, Milano, Italy.,Cardiology Division, Fondazione Cardiologica Monzino, Milano, Italy
| | - Clara Carpeggiani
- Biomedicine Department, CNR, Institute of Clinical Physiology, Via Moruzzi 1, Building C- Room 130, 56124 Pisa, Italy
| | | | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Via Moruzzi 1, Building C- Room 130, 56124 Pisa, Italy
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29
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Nedeljkovic IP, Giga V, Ostojic M, Djordjevic-Dikic A, Stojmenovic T, Nikolic I, Dikic N, Nedeljkovic-Arsenovic O, Maksimovic R, Dobric M, Mujovic N, Beleslin B. Focal Myocarditis after Mild COVID-19 Infection in Athletes. Diagnostics (Basel) 2021; 11:diagnostics11081519. [PMID: 34441453 PMCID: PMC8392699 DOI: 10.3390/diagnostics11081519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022] Open
Abstract
COVID-19 infection in athletes usually has a milder course, but in the case of complications, myocarditis and even sudden cardiac death may occur. We examined an athlete who felt symptoms upon returning to training after asymptomatic COVID-19 infection. Physical, laboratory, and echocardiography findings were normal. The cardiopulmonary exercise test was interrupted at submaximal effort due to severe dyspnea in the presence of reduced functional capacity in comparison to previous tests. Cardiac magnetic resonance (CMR) detected the focal myocarditis. After three months of recovery, CMR still revealed the presence of focal myocarditis and the persistence of decreased functional capacity. This case raises the question of screening athletes even after asymptomatic forms of COVID-19 infection.
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Affiliation(s)
- Ivana P. Nedeljkovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Correspondence: ; Tel.: +381-632-326-96
| | - Vojislav Giga
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Marina Ostojic
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ana Djordjevic-Dikic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Tamara Stojmenovic
- Private Practice for Sports Medicine “Vita Maxima”, 11030 Belgrade, Serbia; (T.S.); (I.N.); (N.D.)
- Faculty of Physical Culture and Sports Management, Singidunum University, 11000 Belgrade, Serbia
| | - Ivan Nikolic
- Private Practice for Sports Medicine “Vita Maxima”, 11030 Belgrade, Serbia; (T.S.); (I.N.); (N.D.)
| | - Nenad Dikic
- Private Practice for Sports Medicine “Vita Maxima”, 11030 Belgrade, Serbia; (T.S.); (I.N.); (N.D.)
- Faculty of Physical Culture and Sports Management, Singidunum University, 11000 Belgrade, Serbia
| | - Olga Nedeljkovic-Arsenovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Radiology and MRI Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Radiology and MRI Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Dobric
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nebojsa Mujovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branko Beleslin
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.G.); (A.D.-D.); (O.N.-A.); (R.M.); (M.D.); (N.M.); (B.B.)
- Cardiology Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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30
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Bombardini T, Zagatina A, Ciampi Q, Arbucci R, Merlo PM, Haber DML, Morrone D, D’Andrea A, Djordjevic-Dikic A, Beleslin B, Tesic M, Boskovic N, Giga V, de Castro e Silva Pretto JL, Daros CB, Amor M, Mosto H, Salamè M, Monte I, Citro R, Simova I, Samardjieva M, Wierzbowska-Drabik K, Kasprzak JD, Gaibazzi N, Cortigiani L, Scali MC, Pepi M, Antonini-Canterin F, Torres MAR, Nes MD, Ostojic M, Carpeggiani C, Kovačević-Preradović T, Lowenstein J, Arruda-Olson AM, Pellikka PA, Picano E. Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography. J Clin Med 2021; 10:jcm10132906. [PMID: 34209955 PMCID: PMC8267648 DOI: 10.3390/jcm10132906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
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Affiliation(s)
- Tonino Bombardini
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, 199034 St Petersburg, Russia;
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
- Correspondence:
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Pablo Martin Merlo
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Diego M. Lowenstein Haber
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy;
| | - Antonello D’Andrea
- Department of Cardiology-Umberto I° Hospital Nocera Inferiore (Salerno)-L. Vanvitelli University of Campania, 84014 Nocera Inferiore, Italy;
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | | | | | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Michael Salamè
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Ines Monte
- Cardio-Thorax-Vascular Department, Echocardiography Lab, Policlinico Vittorio Emanuele, Catania University, 95124 Catania, Italy;
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular-Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Iana Simova
- Heart and Brain Center of Excellence, University Hospital, 5800 Sofia, Bulgaria; (I.S.); (M.S.)
| | - Martina Samardjieva
- Heart and Brain Center of Excellence, University Hospital, 5800 Sofia, Bulgaria; (I.S.); (M.S.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 93-487 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 93-487 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy;
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy;
| | - Francesco Antonini-Canterin
- Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, 31045 Treviso, Italy;
| | - Marco A. R. Torres
- Department of Cardiology, Federal University of Rio Grande do Sul, 90040-060 Porto Alegre, Brazil;
| | - Michele De Nes
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
| | - Miodrag Ostojic
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Clara Carpeggiani
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
| | - Tamara Kovačević-Preradović
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA; (A.M.A.-O.); (P.A.P.)
| | - Patricia A. Pellikka
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA; (A.M.A.-O.); (P.A.P.)
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
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Tesic M, Travica L, Giga V, Trifunovic D, Jovanovic I, Boskovic N, Dobric M, Aleksandric S, Juricic S, Radomirovic M, Petrovic O, Vratonjic J, Stankovic G, Beleslin B, Djordjevic-Dikic A. Prognostic value of mitral regurgitation in patients with asymmetric hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Since mitral regurgitation (MR) is a very common finding in patients with hypertrophic cardiomyopathy (HCM), the evaluation of the mitral valve anatomy and the degree of MR is of utmost importance in this population. However, data regarding the prognostic value of different degrees of MR in HCM remains scarce.
Purpose
The aim of this study was to determine whether the presence of a higher degree of MR affects: 1) long term prognosis; 2) clinical and echocardiographic presentation of HCM patients.
Material and Methods
We included prospectively 102 patients, diagnosed with primary asymmetric HCM. The degree of MR was determined echocardiographicaly according to current recommendations of the American Association of Echocardiography. According to the MR severity, patients were divided into 2 groups: Group 1 (n = 52) with no/trace or mild MR and Group 2 with moderate or moderate to severe MR. All patients had clinical and echocardiographic examination, 24-hour Holter ECG and NT pro BNP analysis performed. The primary outcome was a composite of: 1) HCM related death or sudden death; 2) hospitalization due to acute heart failure; 3) sustained ventricular tachycardia; 4) ischemic stroke.
Results
Patients with higher MR degree had more frequent chest pain (p = 0.039), syncope (p = 0.041) and NYHA II functional class (p < 0.001). Group 2 patients had mostly obstructive form of HCM (p < 0.001) with more frequent presence of previous atrial fibrillation (AF) (p = 0.032), as well as the new onset of AF (p = 0.014) compared to patients in Group 1. Patients with higher MR degree had significantly more SAM (p < 0.001) resulting in a more frequent eccentric MR jet (p < 0.001), along with calcified mitral annulus (p = 0.007), enlarged left atrial volume index (p < 0.001), and elevated right ventricular pressure (p = 0.001). As a result of higher MR grade, Group 2 had higher E/e" values (p < 0.001), elevated LV filling pressure (lateral E/e’ >10), as well as higher levels of NT pro BNP (p = 0.001). By Kaplan-Meier analysis we demonstrated that the event free survival rate during follow up of median 75 (IQR 48-103) months was significantly higher in Group 1 compared to the Group 2 (79% vs. 46%, p < 0.001), Figure 1. After adjustment for relevant confounders, moderate/moderate to severe MR remained as an independent predictor of adverse outcome (hazard ratio 2.58, 95% CI: 1.08-6.13, p < 0.001).
Conclusion
Presence of moderate, or moderate to severe MR was associated with poor long-term outcome of HCM patients. These results indicate the importance of an adequate MR assessment and detailed evaluation of the mitral valve anatomy in the prediction of complications and adequate treatment of patients with HCM.
Abstract Figure.
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Affiliation(s)
- M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - L Travica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Trifunovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Jovanovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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Žarković M, Wiersinga W, Perros P, Bartalena L, Donati S, Okosieme O, Morris D, Fichter N, Lareida J, Daumerie C, Burlacu MC, Kahaly GJ, Pitz S, Beleslin B, Ćirić J, Ayvaz G, Konuk O, Törüner FB, Salvi M, Covelli D, Curro N, Hegedüs L, Brix T. Antithyroid drugs in Graves' hyperthyroidism: differences between "block and replace" and "titration" regimes in frequency of euthyroidism and Graves' orbitopathy during treatment. J Endocrinol Invest 2021; 44:371-378. [PMID: 32524368 DOI: 10.1007/s40618-020-01320-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Whereas antithyroid drugs (ATD) are the preferred treatment modality for Graves' hyperthyroidism (GH), there is still controversy about the optimal regimen for delivering ATD. To evaluate whether 'Block and Replace' (B + R) and 'Titration' (T) regimes are equivalent in terms of frequency of euthyroidism and Graves' Orbitopathy (GO) during ATD therapy. METHODS A prospective multicentre observational cohort study of 344 patients with GH but no GO at baseline. Patients were treated with ATD for 18 months according to B + R or T regimen in line with their institution's policy. RESULTS Baseline characteristics were similar in both groups. In the treatment period between 6 and 18 months thyrotropin (TSH) slightly increased in both groups, but TSH was on average 0.59 mU/L (95% CI 0.27-0.85) lower in the B + R group at all time points (p = 0.026). Serum free thyroxine (FT4) remained stable during the same interval, with a tendency to higher values in the B + R group. The point-prevalence of euthyroidism (TSH and FT4 within their reference ranges) increased with longer duration of ATD in both groups; it was always higher in the T group than in the B + R group: 48 and 24%, respectively, at 6 months, 81 and 58% at 12 months, and 87 and 63% at 18 months (p < 0.002). There were no significant differences between the B + R and T regimens with respect to the fall in thyrotropin binding inhibiting immunoglobulins (TBII) or thyroid peroxidase antibodies (TPO-Ab). GO developed in 15.9% of all patients: 9.1 and 17.8% in B + R group and T group, respectively, (p = 0.096). GO was mild in 13% and moderate-to-severe in 2%. CONCLUSION The prevalence of biochemical euthyroidism during treatment with antithyroid drugs is higher during T compared to B + R regimen. De novo development of GO did not differ significantly between the two regimens, although it tended to be higher in the T group. Whether one regimen is clinically more advantageous than the other remains unclear.
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Affiliation(s)
- M Žarković
- School of Medicine, University of Belgrade, Belgrade, Serbia.
- Clinic of Endocrinology Clinical Centre of Serbia, Belgrade, Serbia.
| | - W Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - P Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - L Bartalena
- School of Medicine, University of Insubria, Varese, Italy
| | - S Donati
- School of Medicine, University of Insubria, Varese, Italy
| | - O Okosieme
- Department of Endocrinology, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - D Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
| | - N Fichter
- Interdisciplinary Centre for Graves' Orbitopathy, Olten and University Eye Hospital, Basel, Switzerland
| | - J Lareida
- Interdisciplinary Centre for Graves' Orbitopathy, Olten and University Eye Hospital, Basel, Switzerland
| | - C Daumerie
- Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - M-C Burlacu
- Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - G J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - S Pitz
- Orbital Center, Ophthalmic Clinic, Buergerhospital, Frankfurt, Germany
| | - B Beleslin
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology Clinical Centre of Serbia, Belgrade, Serbia
| | - J Ćirić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology Clinical Centre of Serbia, Belgrade, Serbia
| | - G Ayvaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - O Konuk
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - F B Törüner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Salvi
- Graves' Orbitopathy Unit, Department of Clinical Science and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, Milan, Italy
| | - D Covelli
- Graves' Orbitopathy Unit, Department of Clinical Science and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, Milan, Italy
| | - N Curro
- Department of Ophthalmology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - T Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Al‐Nooryani A, Aboushokka W, Mehmedbegovic Z, Beleslin B. A case of mild-to-intermediate left-main lesion with high-risk plaque features: "Blindness of physiology" for PCI guidance? Clin Case Rep 2020; 8:2813-2817. [PMID: 33363828 PMCID: PMC7752358 DOI: 10.1002/ccr3.3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 11/09/2022] Open
Abstract
In patients presenting with acute coronary syndrome without ST elevation, both FFR and OCT imaging may be necessary to adequately interrogate patients with intermediate and ambiguous left-main coronary stenosis.
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Affiliation(s)
| | | | - Zlatko Mehmedbegovic
- Clinic for CardiologyClinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Branko Beleslin
- Clinic for CardiologyClinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
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Dedic S, Boskovic N, Giga V, Tesic M, Aleksandric S, Jovanovic I, Hadzi Tanovic L, Mihajlovic Varbusova I, Stojicic M, Beleslin B, Djordjevic Dikic A. Long term perspective with LBBB: role of stress echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies have shown that left bundle branch block (LBBB), as a relatively common electrocardiographic (ECG) abnormality, represents the condition with often non benign and sometimes adverse outcome.
Purpose
The Aim of our study was to determine the predictive value of a stress echocardiography test in patients with LBBB.
Methods
Our study population included 189 patients (88 male, 46.6%, mean age 63.08±9.65) with diagnosed left bundle branch block who performed stress echocardiography (SECHO) according to Bruce protocol. Median follow-up of the patients was 56 months (IQR 48–71 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction, repeat revascularization (coronary artery bypass grafting-CABG or percutaneous coronary intervention-PCI).
Results
Out of 189 patients, 32 (16.9%) patients had positive, while 157 (83.1%) patients had negative SECHO test. During the follow up period 28 patients had major adverse cardiac event: 1 nonfatal myocardial infarction, 6 heart failure hospitalizations, 5 CABGs, 8 PCIs, while 8 patients had cardiac death. Using the Cox regression analysis, univariate predictors of adverse cardiac events were diabetes mellitus (HR 4.530 [95% CI 1.355–15.141], p=0.014), PCI (HR 4.288 [95% [95% CI 2.010–9.144], p<0.001) and positive SECHO test (HR 2.289 [95% CI 1.006–5207], p=0.048). In the multivariate analysis only previous PCI remained independent predictor of adverse events (HR 3.650 [95% CI 1.665–8.003], p=0.001). p=0.048). Using the Kaplan-Meier survival curve the patients with negative SECHO had better outcome compared to patients with positive SECHO (140/160; 87,5% vs 21/29; 72.4%, p=0.035) and much longer event-free time (77.4±1.6 months vs 67.1±5.4 months, Log Rank 4.136, p=0.042)
Conclusion
Patients with LBBB and negative SEHO test have good prognosis. Patients with history of CAD and diabetes mellitus and LBBB are at increased risk for future events and need periodical reassessment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Belgrade Medical School, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | | | | | - M Stojicic
- General Hospital “Dr Djordje Joanovic”, Zrenjanin, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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Juricic S, Petrovic O, Tesic M, Dobric M, Dikic M, Mehmedbegovic Z, Zivkovic M, Vukcevic V, Aleksandric S, Milasinovic D, Tomasevic M, Orlic D, Stankovic G, Beleslin B, Stojkovic S. A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility.
Purpose
Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function.
Methods
We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity
Results
Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1).
Conclusion
Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dikic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Zivkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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Bombardini T, Zagatina A, Ciampi Q, Cortigiani L, D'Andrea A, Borguezan Daros C, Zhuravskaya N, Wierzbowska-Drabik K, Kasprzak J, De Castro E Silva Pretto J, Djordjevic-Dikic A, Beleslin B, Ostojic M, Kovacevic-Preradovic T, Picano E. Hemodynamic heterogeneity of inadequate cardiac output increase identified by 2-dimensional volumetric exercise echocardiography: slow, stiff or weak heart? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Two-dimensional (2-D) volumetric exercise stress echocardiography (ESE) provides an integrated view of preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) through end-systolic volume (ESV) changes.
Purpose
To assess the dependence of stroke volume (SV) and cardiac output (CO) upon LVCR EDV changes and heart rate (HR) during ESE.
Methods
We prospectively performed semi-supine bicycle or treadmill ESE in 1,344 patients (age 59.8±11.4 years; 550 female; ejection fraction = 62.5±8%) referred for known or suspected coronary artery disease in 20 quality controlled laboratories of 16 countries from 2016 to 2019. SV was calculated at rest and peak stress from raw measurement of LV EDV and ESV by biplane Simpson rule, 2-D echo. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values <2.0 identify a “weak” heart). Preload reserve was defined by an increase in LV EDV. Abnormal values (lack of EDV increase, peak EDV ≤ rest EDV) identify a “stiff” heart. Cardiac output was calculated as SV * HR (measured with standard EKG). HR reserve (stress/rest ratio) <1.85 identifies a “slow” heart with chronotropic incompetence.
Results
By selection, all patients had negative SE by wall motion criteria. Of the 1,344 patients included in the study, 448 belonged to the lowest tertile of CO increase. Of them 326 (73%) achieved HR reserve <1.85; 220 (49%) had a blunted LVCR and 374 (83%) a reduction of preload reserve, with 348 patients (78%) showing ≥2 abnormalities. The more the abnormal criteria, the worse the CO response, which was lowest in slow, stiff and weak hearts: see figure.
Conclusion
Patients with normal CO reserve during exercise usually have a fast, compliant and strong heart. Abnormal CO reserve is associated with heterogeneous hemodynamic responses, with slow, stiff and/or weak hearts. The clarification of underlying hemodynamic heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from a standard 2-D volumetric SE. Hearts with normal CO are all alike; every heart with abnormal CO is abnormal in its own way.
CO % changes in subsets (*p<0.001)
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Bombardini
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - A Zagatina
- State University Hospital, St. Petersburg, Russian Federation
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Cardioloy Division, Benevento, Italy
| | - L Cortigiani
- SAN LUCA Hospital, Cardioloy Division, Lucca, Italy
| | - A D'Andrea
- Monaldi Hospital, Second University of Naples, Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Napoli, Italy
| | | | - N Zhuravskaya
- State University Hospital, St. Petersburg, Russian Federation
| | | | | | | | | | - B Beleslin
- Clinical center of Serbia, Belgrade, Serbia
| | - M Ostojic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - T Kovacevic-Preradovic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - E Picano
- National Council of Research, Biomedicine Department, Pisa, Italy
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Dobric M, Beleslin B, Tesic M, Djordjevic Dikic A, Stojkovic S, Giga V, Tomasevic M, Jovanovic I, Petrovic O, Rakocevic J, Boskovic N, Stankovic G, Vukcevic V, Nedeljkovic M, Ostojic M. Time-dependent improvement in coronary flow reserve in collateral donor artery following successful recanalization of the Coronary Chronic Total Occlusion. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment.
Purpose
Study aim was to assess time-dependent changes in coronary flow reserve (CFR) in collateral donor artery after CTO recanalization and identify factors that influence these changes.
Methods
Our study enrolled 31 patients with CTO scheduled for percutaneous coronary intervention (PCI). Non-invasive CFR was measured before PCI in collateral donor artery, and 24h and 6 months post-PCI in CTO and collateral donor artery. Gated SPECT MIBI was performed before PCI, while quality of life was assessed by Seattle angina questionnaire (SAQ) pre-PCI, and 6 months after PCI.
Results
Collateral donor artery showed significant increase in CFR 24h after CTO recanalization compared to pre-PCI values (2.30±0.49 vs. 2.71±0.45, p=0.005), which remained unchanged after 6 months (2.68±0.24). Maximum baseline blood flow velocity of the collateral donor artery showed significant decrease measured 24h post-PCI compared to pre-PCI values (0.28±0.06 vs. 0.24±0.04m/s), and remained similar after 6-months. There was no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24h and 6 months post-PCI. CFR change of the collateral donor artery 24h post-PCI compared to pre-PCI values showed inverse correlation with left ventricle ejection fraction (LVEF) measured on SPECT. CFR changes showed no correlation with the changes in quality of life assessed by SAQ post-PCI compared to pre-PCI.
Conclusions
Significant increase in CFR of the collateral donor artery was observed within 24h after successful recanalization of CTO artery, which maintained constant after the 6 months follow-up. This increase was largely driven by the significant reduction in the maximum baseline blood flow velocity within 24h after CTO recanalization compared to pre-PCI values. Our results suggest that possible benefit of CTO recanalization could be the improvement in physiology of the collateral donor artery.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Jovanovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Rakocevic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - N Boskovic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M.A Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Ostojic
- University of Belgrade, School of Medicine, Belgrade, Serbia
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Boskovic N, Djordjevic-Dikic A, Dedic S, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Picano E. Hyperventilation echocardiography in INOCA: the HEROIC study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with ischemia and no obstructive coronary artery disease (INOCA) are a heterogeneous group and an unmet diagnostic challenge. Noninvasive Doppler is a feasible tool to assess coronary flow velocity (CFV) in left anterior descending coronary artery (LAD) during stress echocardiography (SE).
Aim
To assess CFV response during coronary vasoconstrictor and vasodilator stimuli in INOCA patients.
Methods
In a prospective single center study, we enrolled 16 INOCA patients (age 60±12 years, 15 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO, 0.84 mg/kg in 1 min) on the other day. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio <1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.
Results
The double product increased during HYP, in comparison to rest (13 337 vs 9858, p<0.001), and further increase with EXE (21 118 vs HYP, p<0.001). Chest pain or dyspnea were present in 2/16 pts during HYP, and in 5/16 patients during HYP+EXE (12.5% vs 31.25%, p=0.083). ST segment depression (≥1mm) was present in 1/16 patients during HYP, and 3/16 during HYP+EXE. Two patients showed regional wall motion abnormalities with HYP+EXE. CFVR response was blunted in 9/16 patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 6. Vasodilation during ADO was preserved in all patients. There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.5 vs 2.4±0.4 respectively, p=0.039), and between CFVR HYP and ADO (1.2±0.3 vs 2.4±0.4, p<0.001).
Conclusion
In INOCA patients, HYP+EXE is a more powerful ischemic stress than HYP alone and unmasks abnormalities in regional wall motion and/or CFV response in over one- half of patients, likely unmasking the underlying abnormal coronary vasomotor response of large epicardial and/ or small coronary vessels. INOCA patients show profound heterogeneity of coronary vasomotor responses which can be detected with a combined vasodilator - vasoconstrictor SE approach with CFV assessment. The clarification of underlying coronary microcirculatory heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from CFV-SE. Normal INOCA hearts are all alike, every abnormal heart is abnormal in its own way.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Jovanovic
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - E Picano
- University of Pisa, CNR Institute of Clinical Physiology, Pisa, Italy
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Kotevska Angjushev M, Dedic S, Boskovic N, Giga V, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Djordjevic Dikic A. The prognostic value of coronary flow reserve of left anterior descending artery in non-diagnostic or inconclusive stress echocardiography tests. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Relevant number of all stress echocardiography results are non-diagnostic or inconclusive. Such importance cannot be ignored as previous studies have shown that these patients have higher risk for adverse events. Non-invasive transthoracic Doppler derived coronary flow reserve (CFR) of left anterior descending (LAD) artery, as additional test, is an effective tool to predict adverse cardiac events in various clinical settings.
Purpose
The aim of this study was to investigate the value of CFR of LAD in predicting outcome.
Methods
122 patients, (35,8% with previous MI) with nondiagnostic stress echocardiography results (target heart rate not reached, chest pain without ECG and echo changes) and with inconclusive stress echocardiography results (target heart rate reached, chest pain with ECG changes and without echo changes) were referred for transthoracic
Doppler echocardiographic CFR assessment of LAD. CFR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. CFR ≤2 was considered abnormal. All patients were followed for major adverse cardiac events (MACE): nonfatal myocardial infarction, hospitalization, revascularization (CABG or PCI) and death.
Results
Measured values of CFR LAD were in the range 1,52- 4,00 (mean: 2,4±0.44). CFR LAD was abnormal in 22 (18%), and preserved in 100 patients (82%). During median follow-up of 23 months (interquartile range 9–35), 14 patients underwent revascularization (2 had CABG, 12 had PCI). There were no myocardial infarctions, hospitalizations or cardiovascular deaths in the follow-up period. Patients with lower CFR values (CFR≤2) had a higher event rate and shorter event free survival time compared to those with CFR>2, event rate (9/22, 40,9% vs 5/98 5,1%; p<0.0001) and event free time (22±3 vs 33±1 months; p<0.0001) by Kaplan Maier analyses, (Log Rank 24.42; p<0.001).
Conclusions
Preserved CFR of LAD (>2.0) predicts excellent survival in patients with non-diagnostic and inconclusive stress echocardiography.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Kotevska Angjushev
- City General Hospital 8 September, Department of Cardiology, Skopje, North Macedonia
| | - S Dedic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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40
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Fountas E, Djordjevic-Dikic A, Beleslin B, Voudris V, Athanassopoulos G. Meta-analysis for cardiovascular risk stratification based on noninvasive left anterior descending velocity reserve. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left anterior descending velocity reserve (LADVR) by transthoracic echocardiography (TTE) has been proposed for cardiovascular risk stratification in observational prospective studies. Aim of the current study was to interrogate the prognostic consistency and coherence of the existing LADVR data by the means of meta-analysis of relevant studies.
Methods
A systematic research through electronic databases was performed for prospective studies with patients with known or suspected coronary artery disease (CAD) who had LADVR data.
The exposure was abnormal values of LADVR as defined in each study and the outcome was the occurrence of cardiovascular event or death (CE-D). Statistical index considered were the risk ratio (RR) for CE-D of patients with abnormal vs. normal LADVR, as obtained from Cox proportional hazard models.
A meta-analysis of these studies using random-effects model was performed to evaluate the pooled prognostic value of abnormal LADVR.
Results
Fifteen studies with 13050 patients (59.7% male; mean age 64.2 years; mean follow-up 25.1 months) were included in this meta-analysis. Every study used adjustments for every established risk factor for CE-D (age, hypertension, diabetes, dyslipidemia, smoking habits, wall motion abnormalities during stress echo). The abnormal value of LADVR was associated with an increased risk of CE-D (RR=3.33, 95% CI: 2.54–4.37, p-value <0.001). Moderate heterogeneity was observed between studies (Q=35.83, p-value=0.001, I2=60.9%) which was further investigated with sensitivity analysis, subgroup analysis and meta-regression.
Conclusions
Meta-analytic data for the cardiovascular risk stratification based on dichotomous LADVR data provide robust evidence for efficient prognostic yield.
The current results support the broader clinical application of the LADVR.
LADVR meta-analysis forestplot
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Fountas
- Onassis Cardiac Surgery Center, Athens, Greece
| | | | - B Beleslin
- University Clinical Center of Serbia, Belgrade, Serbia
| | - V Voudris
- Onassis Cardiac Surgery Center, Athens, Greece
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41
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Tesic M, Ciampi Q, Djordjevic-Dikic A, Beleslin B, Cortigiani L, Palinkas A, Palinkas E, Nemes A, Rigo F, Borguezan-Daros C, Varga A, Agoston G, Villari B, Carpeggiani C, Picano E. Prognostic role of coronary flow velocity reserve in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A reduction in coronary flow velocity reserve (CFVR) related to coronary microvascular dysfunction is a major mechanism for ischemia in hypertrophic cardiomyopathy (HCM).
Hypothesis
To assess the functional correlates and prognostic value of CFVR during stress echocardiography (SE) in HCM.
Methods
We enrolled 201 HCM patients (age 51±14 years, 105 male, 52%; maximal wall thickness: 18±3 mm) studied with CFVR during exercise (n=33, 16.4%), dipyridamole (n=89, 44.3%) or adenosine (n=79, 39.3%) SE in 6 certified centers. CFVR was assessed using pulsed wave Doppler sampling in left anterior descending coronary artery. All patients completed the clinical follow-up.
Results
During SE mean value of CFVR was 2.11±0.46. No patients showed regional wall motion abnormalities during stress. LV outflow tract obstruction (LVOTO) was present in 34 (16.9%) patients at rest and in 47 (23.4%) at peak stress. CFVR was inversely related to age (r=−0.229, p=0.001) and maximal wall thickness (r=−0.197, p=0.031). During a median follow-up of 26 months (IQ range: 12–48 months), 75 events in 63 patients occurred: 10 deaths, 33 new hospital admission for acute heart failure, 8 sustained ventricular tachycardias and 24 atrial fibrillations. Patients in the lowest tertile (≤1.88) showed the worse prognosis with higher incidence of follow-up events compared to median tertile (1.89–2.29) and highest tertile (≥2.30) (see figure). At multivariable analysis, NYHA functional class (HR: 2.234, 95% CI: 1.398–3.517, p=0.001), presence of LVOTO at rest (HR: 2.958, 95% CI: 1.074–3.570, p=0.028) and lowest tertile of CFVR (HR: 2.144, 95% CI: 1.126–4.081, p=0.011) were the independent predictors of follow-up events.
Conclusions
In HCM patients, reduction in CFVR is associated to a clearly worse outcome. The spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Tesic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - Q Ciampi
- Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy
| | | | - B Beleslin
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | | | - A Palinkas
- Elisabeth Hospital of Csongrad, Internal Medicine, Hodmezovasarhely, Hungary
| | - E Palinkas
- University of Szeged, Internal Medicine, Szeged, Hungary
| | - A Nemes
- University of Szeged, Internal Medicine, Szeged, Hungary
| | - F Rigo
- Hospital dell'Angelo, Cardiology, Mestre-Venice, Italy
| | | | - A Varga
- Institute of Family Medicine, Cardiology, Szeged, Hungary
| | - G Agoston
- Institute of Family Medicine, Cardiology, Szeged, Hungary
| | - B Villari
- Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy
| | - C Carpeggiani
- National Council of Research, Cardiology, Pisa, Italy
| | - E Picano
- National Council of Research, Cardiology, Pisa, Italy
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42
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Morrone D, Arbucci R, Wierzbowska-Drabik K, Ciampi Q, Peteiro J, Agoston G, Varga A, Camarozano AC, Boshchenko A, Ryabova T, Dekleva M, Simova I, Lowenstein Haber DM, Tesic M, Boskovic N, Djordjevic-Dikic A, Beleslin B, D'Alfonso MG, Mori F, Rodrìguez-Zanella H, Kasprzak JD, Cortigiani L, Lattanzi F, Scali MC, Torres MAR, Daros CB, de Castro E Silva Pretto JL, Gaibazzi N, Zagatina A, Zhuravskaya N, Amor M, Mieles PEV, Merlo PM, Monte I, D'Andrea A, Re F, Di Salvo G, Merli E, Lorenzoni V, De Nes M, Paterni M, Limongelli G, Prota C, Citro R, Colonna P, Villari B, Antonini-Canterin F, Carpeggiani C, Lowenstein J, Picano E. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes. Int J Cardiovasc Imaging 2020; 37:953-964. [PMID: 33057991 DOI: 10.1007/s10554-020-02071-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = - 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
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Affiliation(s)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Jesus Peteiro
- CHUAC- Complexo Hospitalario Universitario A Coruna- University of A Coruna, La Coruna, Spain
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Ana Cristina Camarozano
- Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia
| | - Iana Simova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | | | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Maria Grazia D'Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Firenze, Italy
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Fabio Lattanzi
- Cardiothoracic Department, University of Pisa, Pisa, Italy
| | | | - Marco A R Torres
- Hospital de Clinicas de Porto Alegre - Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | | | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, St Petersburg, Russian Federation
| | - Nadezhda Zhuravskaya
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, St Petersburg, Russian Federation
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | | | - Ines Monte
- Echocardiography Lab, Cardio-Thorax-Vascular Department, "Policlinico Vittorio Emanuele", Catania University, Catania, Italy
| | | | - Federica Re
- Cardiology Division, Ospedale San Camillo, Rome, Italy
| | - Giovanni Di Salvo
- Cardiology Division, Pediatric Cardiology Department, Brompton Hospital, Imperial College of London, London, UK
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Ravenna, Italy
| | | | - Michele De Nes
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Marco Paterni
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | | | - Costantina Prota
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital "San Giovanni Di Dio e Ruggi D'Aragona", Salerno, Italy.,Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy
| | - Paolo Colonna
- Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy.,Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Francesco Antonini-Canterin
- Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy.,Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta Di Livenza, Treviso, Italy
| | - Clara Carpeggiani
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Eugenio Picano
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy.
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Dobric M, Beleslin B, Tesic M, Djordjevic Dikic A, Stojkovic S, Giga V, Tomasevic M, Jovanovic I, Petrovic O, Rakocevic J, Boskovic N, Sobic Saranovic D, Stankovic G, Vukcevic V, Orlic D, Simic D, Nedeljkovic MA, Aleksandric S, Juricic S, Ostojic M. Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium. Cardiovasc Ultrasound 2020; 18:29. [PMID: 32693812 PMCID: PMC7374915 DOI: 10.1186/s12947-020-00211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography in collateral donor and recanalized artery following successful opening of coronary CTO. Methods Our study enrolled 31 patients (60 ± 9 years; 22 male) with CTO and viable myocardium by SPECT scheduled for percutaneous coronary intervention (PCI). Non-invasive CFVR was measured in collateral donor artery before PCI, 24 h and 6 months post-PCI, and 24 h and 6 months in recanalized artery following successful PCI of CTO. Results Collateral donor artery showed significant increase in CFVR 24 h after CTO recanalization compared to pre-PCI values (2.30 ± 0.49 vs. 2.71 ± 0.45, p = 0.005), which remained unchanged after 6-months (2.68 ± 0.24). Baseline blood flow velocity of the collateral donor artery significantly decreased 24 h post-PCI compared to pre-PCI (0.28 ± 0.06 vs. 0.24 ± 0.04 m/s), and remained similar after 6 months, with no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24 h and 6 months post-PCI. CFVR of the recanalized coronary artery 24 h post-PCI was 2.55 ± 0.35, and remained similar 6 months later (2.62 ± 0.26, p = NS). Conclusions In patients with viable myocardium, prompt and significant CFVR increase in both recanalized and collateral donor artery, was observed within 24 h after successful recanalization of CTO artery, which maintained constant during the 6 months. Trial registration ClinicalTrials.gov (Number NCT04060615).
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Affiliation(s)
- Milan Dobric
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia. .,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia.
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Ana Djordjevic Dikic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Sinisa Stojkovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Miloje Tomasevic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozara Markovica Street, Kragujevac, 34000, Serbia
| | - Ivana Jovanovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Olga Petrovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia
| | - Jelena Rakocevic
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Nikola Boskovic
- Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dragana Sobic Saranovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Goran Stankovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dejan Orlic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dragan Simic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Milan A Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Stefan Juricic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia
| | - Miodrag Ostojic
- Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
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44
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Scali MC, Zagatina A, Ciampi Q, Cortigiani L, D'Andrea A, Daros CB, Zhuravskaya N, Kasprzak JD, Wierzbowska-Drabik K, Luis de Castro E Silva Pretto J, Djordjevic-Dikic A, Beleslin B, Petrovic M, Boskovic N, Tesic M, Monte I, Simova I, Vladova M, Boshchenko A, Vrublevsky A, Citro R, Amor M, Vargas Mieles PE, Arbucci R, Merlo PM, Lowenstein Haber DM, Dodi C, Rigo F, Gligorova S, Dekleva M, Severino S, Lattanzi F, Morrone D, Galderisi M, Torres MAR, Salustri A, Rodrìguez-Zanella H, Costantino FM, Varga A, Agoston G, Bossone E, Ferrara F, Gaibazzi N, Celutkiene J, Haberka M, Mori F, D'Alfonso MG, Reisenhofer B, Camarozano AC, Miglioranza MH, Szymczyk E, Wejner-Mik P, Wdowiak-Okrojek K, Preradovic-Kovacevic T, Bombardini T, Ostojic M, Nikolic A, Re F, Barbieri A, Di Salvo G, Merli E, Colonna P, Lorenzoni V, De Nes M, Paterni M, Carpeggiani C, Lowenstein J, Picano E. Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography. JACC Cardiovasc Imaging 2020; 13:2085-2095. [PMID: 32682714 DOI: 10.1016/j.jcmg.2020.04.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. RESULTS According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. CONCLUSIONS Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).
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Affiliation(s)
- Maria Chiara Scali
- Cardiothoracic Department, University of Pisa, and Nottola Cardiology Division, Montepulciano, Siena, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg, Russian Federation
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Antonello D'Andrea
- Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Nadezhda Zhuravskaya
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg, Russian Federation
| | | | | | | | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ines Monte
- Cardio-Thorax-Vascular Department, Echocardiography lab, "Policlinico Vittorio Emanuele", Catania University, Catania, Italy
| | - Iana Simova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Martina Vladova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Alexander Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | | | | | - Claudio Dodi
- Casa di Cura Figlie di San Camillo, Cremona, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy
| | | | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia
| | - Sergio Severino
- Cardiology Department, Coronary Care Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Fabio Lattanzi
- Cardiothoracic Department, University of Pisa, and Nottola Cardiology Division, Montepulciano, Siena, Italy
| | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, and Nottola Cardiology Division, Montepulciano, Siena, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Marco A R Torres
- Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro Salustri
- Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Eduardo Bossone
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
| | - Francesco Ferrara
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Maria Grazia D'Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Barbara Reisenhofer
- Cardiology Division, Pontedera-Volterra Hospital, ASL Toscana Nord-Ovest, Italy
| | - Ana Cristina Camarozano
- Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil
| | | | - Ewa Szymczyk
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Paulina Wejner-Mik
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | | | | | - Tonino Bombardini
- School of Medicine, University Clinical Center of The Republic of Srpska, Banja-Luka, Bosnia-Herzegovina
| | - Miodrag Ostojic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Aleksandra Nikolic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Federica Re
- Ospedale San Camillo, Cardiology Division, Rome, Italy
| | - Andrea Barbieri
- Cardiology Division, Policlinico University Hospital of Modena, Modena, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Department, Cardiology Division, Brompton Hospital, Imperial College of London, London, United Kingdom
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Ravenna, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | | | - Michele De Nes
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Marco Paterni
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Clara Carpeggiani
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy.
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45
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Bombardini T, Zagatina A, Ciampi Q, Cortigiani L, D'Andrea A, Borguezan Daros C, Zhuravskaya N, Kasprzak JD, Wierzbowska-Drabik K, de Castro E Silva Pretto JL, Djordjevic-Dikic A, Beleslin B, Petrovic M, Boskovic N, Tesic M, Monte IP, Simova I, Vladova M, Boshchenko A, Ryabova T, Citro R, Amor M, Vargas Mieles PE, Arbucci R, Dodi C, Rigo F, Gligorova S, Dekleva M, Severino S, Torres MA, Salustri A, Rodrìguez-Zanella H, Costantino FM, Varga A, Agoston G, Bossone E, Ferrara F, Gaibazzi N, Rabia G, Celutkiene J, Haberka M, Mori F, D'Alfonso MG, Reisenhofer B, Camarozano AC, Salamé M, Szymczyk E, Wejner-Mik P, Wdowiak-Okrojek K, Kovacevic Preradovic T, Lattanzi F, Morrone D, Scali MC, Ostojic M, Nikolic A, Re F, Barbieri A, DI Salvo G, Colonna P, DE Nes M, Paterni M, Merlo PM, Lowenstein J, Carpeggiani C, Gregori D, Picano E. Feasibility and value of two-dimensional volumetric stress echocardiography. Minerva Cardiol Angiol 2020; 70:148-159. [PMID: 32657562 DOI: 10.23736/s2724-5683.20.05304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV). METHODS We enrolled 4735 patients (age 63.6±11.3 years, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (N.=1992 patients) and adenosine (N.=18); ≤2.0 for exercise (N.=2087) or dobutamine (N.=638). RESULTS Force-based LVCR was obtained in all 4735 patients. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57% of patients with abnormal LVCR nevertheless showed increase in stroke volume. CONCLUSIONS Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.
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Affiliation(s)
- Tonino Bombardini
- Faculty of Medicine, University of Banja-Luka, Clinical Center of The Republic of Srpska, Banja-Luka, Bosnia-Herzegovina
| | - Angela Zagatina
- Department of Cardiology, Saint Petersburg University Clinic, Saint Petersburg University, Russia
| | - Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Antonello D'Andrea
- Department of Cardiology, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Nadezhda Zhuravskaya
- Department of Cardiology, Saint Petersburg University Clinic, Saint Petersburg University, Russia
| | | | | | | | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ines P Monte
- Echocardiography Lab, Department of Cardiothoracic and Vascular Medicine, A.O.U. Policlinic Rodolico, University of Catania, Catania, Italy
| | - Iana Simova
- Department of Cardiology, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Martina Vladova
- Department of Cardiology, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - Rodolfo Citro
- Echocardiography Lab, Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Miguel Amor
- Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | - Rosina Arbucci
- Service of Heart Diagnostics, Investigaciones Medicas, Buenos Aires, Argentina
| | - Claudio Dodi
- Casa di Cura Figlie di San Camillo, Cremona, Italy
| | - Fausto Rigo
- Department of Cardiology, Ospedale dell'Angelo, Mestre, Venice, Italy
| | | | | | - Sergio Severino
- Coronary Care Unit, Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Marco A Torres
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro Salustri
- Department of Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | | | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Granit Rabia
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Jelena Celutkiene
- Center of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Hospital, Vilnius, Lithuania
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | - Fabio Mori
- Section of Cardiovascular Diagnostics, Department of Cardiothoracic and Vascular Medicine, Careggi University Hospital, Florence, Italy
| | - Maria G D'Alfonso
- Section of Cardiovascular Diagnostics, Department of Cardiothoracic and Vascular Medicine, Careggi University Hospital, Florence, Italy
| | - Barbara Reisenhofer
- Division of Cardiology, Pontedera-Volterra Hospital, ASL Toscana3 Nord-Ovest, Pontedera, Pisa, Italy
| | - Ana C Camarozano
- Hospital de Clinicas UFPR, Department of Medicine, Federal University of Paranà, Curitiba, Brazil
| | | | - Ewa Szymczyk
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Paulina Wejner-Mik
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | | | - Tamara Kovacevic Preradovic
- Faculty of Medicine, University of Banja-Luka, Clinical Center of The Republic of Srpska, Banja-Luka, Bosnia-Herzegovina
| | - Fabio Lattanzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, Section of Cardiovascular Diseases, University of Pisa, Pisa, Italy
| | - Doralisa Morrone
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, Section of Cardiovascular Diseases, University of Pisa, Pisa, Italy
| | - Maria C Scali
- Nottola-Montepulciano Hospital, Division of Cardiology, ASL Toscana Centro, Siena, Italy
| | - Miodrag Ostojic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Aleksandra Nikolic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Federica Re
- San Camillo Hospital, Division of Cardiology, Rome, Italy
| | - Andrea Barbieri
- Division of Cardiology, Policlinico University Hospital, Modena, Italy
| | - Giovanni DI Salvo
- Division of Cardiology, Department of Pediatric Cardiology, Brompton Hospital, Imperial College of London, London, UK
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital, Bari, Italy
| | - Michele DE Nes
- Department of Biomedicine, Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Marco Paterni
- Department of Biomedicine, Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Pablo M Merlo
- Service of Heart Diagnostics, Investigaciones Medicas, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Service of Heart Diagnostics, Investigaciones Medicas, Buenos Aires, Argentina
| | - Clara Carpeggiani
- Department of Biomedicine, Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Padua University, Padua, Italy
| | - Eugenio Picano
- Department of Biomedicine, Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy -
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Bombardini T, Zagatina A, Ciampi Q, Cortigiani L, D'andrea A, Borguezan Daros C, Zhuravskaya N, Kasprzak JD, Wierzbowska-Drabik K, De Castro E Silva Pretto JL, Djordjevic-Dikic A, Beleslin B, Petrovic M, Boskovic N, Tesic M, Monte IP, Simova I, Vladova M, Boshchenko A, Ryabova T, Citro R, Amor M, Vargas Mieles PE, Arbucci R, Dodi C, Rigo F, Gligorova S, Dekleva M, Severino S, Torres MA, Salustri A, Rodrìguez-Zanella H, Costantino FM, Varga A, Agoston G, Bossone E, Ferrara F, Gaibazzi N, Rabia G, Celutkiene J, Haberka M, Mori F, D'alfonso MG, Reisenhofer B, Camarozano AC, Salamé M, Szymczyk E, Wejner-Mik P, Wdowiak-Okrojek K, Kovacevic Preradovic T, Lattanzi F, Morrone D, Scali MC, Ostojic M, Nikolic A, Re F, Barbieri A, Di Salvo G, Colonna P, De Nes M, Paterni M, Merlo PM, Lowenstein J, Carpeggiani C, Gregori D, Picano E. Feasibility and value of two-dimensional volumetric stress echocardiography. Minerva Cardioangiol 2020. [PMID: 32657562 DOI: 10.23736/s0026-4725.20.05304-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV). METHODS We enrolled 4,735 patients (age 63.6 ± 11.3 yrs, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (n=1,992 patients) and adenosine (n=18); ≤2.0 for exercise (n=2,087) or dobutamine (n=638). RESULTS Force-based LVCR was obtained in all 4,735 pts. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57 % of patients with abnormal LVCR nevertheless showed increase in stroke volume. CONCLUSIONS Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.
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Affiliation(s)
- Tonino Bombardini
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, Saint Petersburg, Russian Federation
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Antonello D'andrea
- Echocardiography Lab and Rehabilitation Unit, Cardiology Department, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Nadezhda Zhuravskaya
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, Saint Petersburg, Russian Federation
| | | | | | | | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ines P Monte
- Cardio-Thorax-Vascular Department, Echocardiography lab, A.O.U. Policlinic Rodolico, Catania University, Catania, Italy
| | - Iana Simova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Martina Vladova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Miguel Amor
- Ramos Mejia Hospital, CABA, Buenos Aires, Argentina
| | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Claudio Dodi
- Casa di Cura Figlie di San Camillo, Cremona, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale dell'Angelo, Mestre, Venice, Italy
| | | | | | - Sergio Severino
- Coronary Care Unit, Cardiology Department, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Marco A Torres
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Alessandro Salustri
- Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Eduardo Bossone
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
| | - Francesco Ferrara
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Granit Rabia
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Jelena Celutkiene
- Centre of Cardiac and Vascular Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Hospital, Vilnius, Lithuania
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Maria Grazia D'alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Barbara Reisenhofer
- Cardiology Division, Pontedera-Volterra Hospital, ASL Toscana3 Nord-Ovest, Volterra, Pisa, Italy
| | - Ana C Camarozano
- Medicine Department, Hospital de Clinicas UFPR, Federal University of Paranà, Curitiba, Brasil
| | | | - Ewa Szymczyk
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Paulina Wejner-Mik
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | | | - Tamara Kovacevic Preradovic
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Fabio Lattanzi
- Molecular Pathology and Critical Area Medicine-Cardiovascular Disease Section, Department of Surgical, Medical, University of Pisa, Pisa, Italy
| | - Doralisa Morrone
- Molecular Pathology and Critical Area Medicine-Cardiovascular Disease Section, Department of Surgical, Medical, University of Pisa, Pisa, Italy
| | - Maria Chiara Scali
- Cardiology Division, Ospedale Nottola-Montepulciano, Siena-ASL Toscana Centro, Montepulciano, Florence, Italy
| | - Miodrag Ostojic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Aleksandra Nikolic
- School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
| | - Federica Re
- Cardiology Division, Ospedale San Camillo, Rome, Italy
| | - Andrea Barbieri
- Cardiology Division, Policlinico University Hospital of Modena, Modena, Italy
| | - Giovanni Di Salvo
- Cardiology Division, Pediatric Cardiology Department, Brompton Hospital, Imperial College of London, London, UK
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Michele De Nes
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Marco Paterni
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Pablo M Merlo
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Clara Carpeggiani
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Padova University, Padua, Italy
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy -
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Jovanovic I, Tesic M, Giga V, Dobric M, Boskovic N, Vratonjic J, Orlic D, Gudelj O, Tomasevic M, Dikic M, Nedeljkovic I, Trifunovic D, Nedeljkovic MA, Dedic S, Beleslin B, Djordjevic-Dikic A. Impairment of coronary flow velocity reserve and global longitudinal strain in women with cardiac syndrome X and slow coronary flow. J Cardiol 2020; 76:1-8. [PMID: 32387219 DOI: 10.1016/j.jjcc.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/19/2020] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Microvascular dysfunction (MVD) is associated with adverse prognosis and may account for abnormal stress tests and angina symptoms in women with cardiac syndrome X (CSX). The aim of our study was to assess MVD by coronary flow velocity reserve (CFVR) and left ventricular (LV) contractile function by LV global longitudinal strain (LVGLS) in CSX patients with respect to presence of slow coronary flow (SCF). It was of additional importance to evaluate clinical status of CSX patients using Seattle Angina Questionnaire. METHODS AND RESULTS Study population included 70 women with CSX (mean age 61 ± 7 years) and 34 age-matched controls. CSX group was stratified into two subgroups depending on SCF presence: CSX-Thrombolysis In Myocardial Infarction (TIMI) 3- normal flow subgroup (n = 38) and CSX-TIMI 2- SCF subgroup (n = 32) as defined by coronary angiography. LVGLS measurements and CFVR of left anterior descending (LAD) and posterior descending (PD) artery were performed. CFVR-LAD and PD were markedly impaired in CSX group compared to controls (2.34 ± 0.25 vs 3.05 ± 0.21, p < 0.001; 2.32 ± 0.24 vs 3.01 ± 0.13, p < 0.001), and furthermore decreased in CSX-TIMI 2 patients. Resting, peak, and ΔLVGLS were all significantly impaired in CSX group compared to controls (for all p < 0.001), and furthermore reduced in CSX-TIMI 2 subgroup. Strongest correlation was found between peak LVGLS and CFVR LAD (r = -0.784, p < 0.001) and PD (r = -0.772, p < 0.001). CSX-TIMI 2 subgroup had more frequent angina symptoms and more impaired quality of life. CONCLUSIONS MVD in CSX patients is demonstrated by reduction in CFVR and LVGLS values. SCF implies more profound impairment of microvascular and LV systolic function along with worse clinical presentation.
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Affiliation(s)
- Ivana Jovanovic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Milorad Tesic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Giga
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Dobric
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Vratonjic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Orlic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ognjen Gudelj
- Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Miloje Tomasevic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Miodrag Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan A Nedeljkovic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srdjan Dedic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Beleslin
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
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48
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Petrovic MT, Djordjevic-Dikic A, Giga V, Boskovic N, Vukcevic V, Cvetic V, Mladenovic A, Radmili O, Markovic Z, Dobric M, Aleksandric S, Tesic M, Juricic S, Nedeljkovic Beleslin B, Stojkovic S, Ostojic MC, Beleslin B, Picano E. The Coronary ARteriogenesis with combined Heparin and EXercise therapy in chronic refractory Angina (CARHEXA) trial: A double-blind, randomized, placebo-controlled stress echocardiographic study. Eur J Prev Cardiol 2020; 28:1452-1459. [PMID: 33611455 DOI: 10.1177/2047487320915661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary collateral circulation exerts protective effects on myocardial ischaemia due to coronary artery disease and can be promoted by exercise with heparin co-administration. Whether this arteriogenetic effect is accompanied by functional improvement of left ventricle during stress and lessening of angina symptoms remains unknown. AIMS To evaluate the anti-ischaemic efficacy of heparin plus exercise in coronary artery disease. METHODS In a prospective, single-centre, randomized, double-blind study we recruited 32 'no-option' patients (27 males; mean age 61 ± 8 years) with stable angina, exercise-induced ischaemia and coronary artery disease not suitable for revascularization. All underwent a two-week cycle of exercise (two exercise sessions per day, five days per week) and were randomized (n = 16 per group) to intravenous placebo (0.9% saline) versus unfractionated heparin (5.000 IU intravenously), 10 min prior to exercise. We assessed Canadian Cardiovascular Society angina class, stress electrocardiogram and echo parameters (wall motion score index) and computed tomography angiography for collaterals. RESULTS After two-week cycle, Canadian Cardiovascular Society class statistically decreased in both groups (heparin plus exercise group: 2.6 ± 0.7 to 1.9 ± 0.7, p < 0.001, exercise group: 2.4 ± 0.7 to 2.1 ± 0.9, p = 0.046). Only the heparin plus exercise group improved time-to-ST segment depression (before 270, 228-327 s vs. after 339, 280-360 s, p = 0.012) and wall motion score index (before 1.38 ± 0.25 vs. after 1.28 ± 0.18, p = 0.005). By multi-slice computed tomography angiography, collaterals improved in 12/15 (80%) in the heparin plus exercise group versus 2/16 (12.5%) in the exercise group (p < 0.001). CONCLUSION A two-week, 10-test cycle of heparin plus exercise is better than exercise in improving angina class, myocardial ischaemia and collaterals by computed tomography angiography.
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Affiliation(s)
- Marija T Petrovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vladimir Cvetic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ana Mladenovic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Oliver Radmili
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Zeljko Markovic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Stefan Juricic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Biljana Nedeljkovic Beleslin
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Sinisa Stojkovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | | | - Branko Beleslin
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Eugenio Picano
- Institute of Clinical Physiology, CNR - Consiglio Nazionale Ricerche, Italy
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Petrovic O, Juricic S, Trifunovic-Zamaklar D, Paunovic I, Rakocevic I, Gavrilovic N, Jovanovic I, Boskovic N, Aleksandric S, Ivanovic B, Djordjevic-Dikic A, Beleslin B, Vukcevic V, Stankovic G, Stojkovic S. P278 Does recanalization of chronic total occlusion reflect on myocardial function? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention for chronic total occlusion (PCI CTO) is still high risk procedure and it is doubtful will it become standard of care. There is evidence that it can reduce angina but even silent ischemia represent ischemic burden that ultimately lead to left ventricle remodeling and electrical instability.
Purpose
Our aim was to access effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) on myocardial function.
Methods
We compared two groups of pts. First patients with percutaneous coronary intervention of chronic total occlusion with optimal medical therapy and second group - patients with only optimal medical therapy (control group). Echocardiographic exam was performed before randomization and after 6 months of follow-up. Doppler intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured. MPI (Myocardial performance index) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral wave (E) was divided by average peak early diastolic annular velocity (e"). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time intervals from 17 segments, reflecting myocardial contraction heterogeneity.
Results
A total of 94 age matched CTO patients (48 in PCI + OMT group and 46 in OMT) were analyzed. Changes in ejection fraction (EF), diastolic function represented by E/e", global cardiac function represented by MPI, global longitudinal strain (GLS) and myocardial dispersion changes were compared between groups. At follow up between groups in there was no significant change in ejection fraction (EF), diastolic function, GLS and mechanical dispersion, but there was improvement in MPI.
Conclusion
Myocardial performance index is sensitive marker which can detect subtle improvement in global myocardial function after recanalization of chronic total occlusion..
Variable PCI + OMT (n = 46) OMT (n = 48) ΔOMT vs. ΔPCI + OMT p value baseline At 6month follow up P value baseline At 6month follow up P value EF (%) 55.69 ± 8.56 54.83 ± 8.44 0.10 50.22 ± 11.71 51.42 ± 10.45 0.06 0.71 MPI 0.676 ± 0.99 0.632 ± 0.96 <0.01* 0.593 ± 0.14 0.604 ± 0.12 0.22 <0.01* E/e" 13.10 ± 6.90 12.05 ± 5,08 <0.05* 14,12 ± 5.70 13.02 ± 5.62 <0.05* 0.23 GLS (%) -14,38 ± 3,38 -15,22 ± 3,68 <0.05* -13.33 ± 3.43 -13.29 ± 3.42 0.87 0.07 Mechanical dispersion (ms) 63.89 ± 26.22 57.35 ± 27.33 <0.01* 53.30 ± 21.68 50.00 ± 22.40 0.05 0.06 Δ- percentage changes between baseline and at 6 month follow up
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Affiliation(s)
- O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - I Paunovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Rakocevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Gavrilovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Jovanovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Ivanovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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50
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Boskovic N, Popovic A, Petrovic MT, Dedic S, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Giga V. P328 Relation between CHA2DS2-VASc and impaired heart rate recovery in patients without inducible myocardial ischemia. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart rate recovery (HRR) has been shown to predict cardiovascular and all-cause morbidity and mortality in different populations. Recent studies have indicated the CHA2DS2-VASc score can be used as predictor of mortality in patients with coronary artery disease, without atrial fibrillation. However, the relation between these two parameters has not yet been documented.
The Aim: The aim of this study was to determine the relation between CHA2DS2-VASc score and impaired heart rate recovery in patients without inducible myocardial ischemia.
Methods
Our study comprised of 2699 consecutive patients (1319 male, 42.8%, average age 60 ± 11 years) who underwent treadmill exercise testing (stress echocardiography or stress echocardiography) according to Bruce protocol for the assessment of myocardial ischemia. We excluded patients with the systolic heart failure (left ventricle ejection fraction <45%) and those with inducible ischemia. CHA2DS2-VASc score was calculated according to the guidelines. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), chronotropic competence (CC), body mass index (BMI) were calculated in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min.
Results
Out of 2699 patients, 378 (12.3%) had a positive test and they were excluded from further analysis. Of the remaining 2321 patients, 251 (10.8%) had an impaired HRR, whereas 2070 (89.2%) had normal HRR. Previously known coronary artery disease (previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery) had 78 (3.4%) patients. Patients with impaired HRR had significantly higher CHA2DS2-VASc score (3.1 ± 1.3 vs 2.3 ± 1.2, p < 0.001), higher resting heart rate (76.9 ± 16.1 vs 73.3 ± 12.3bpm, p < 0.001), higher systolic blood pressure at rest (122.1 ± 13.9 vs 117.2 ± 13.4mmHg, p < 0.001), higher diastolic blood pressure at rest (73.7 ± 7.5 vs 72.3 ± 7.2mmHg, p < 0.001), higher rate of hyperlipproteinemia (176/251, 70.1% vs 1294/2070, 62.5%, p < 0.001), higher BMI (27.3 ± 3.6 vs 26.4± 3.6kg/m2, p < 0.001), shorter duration of the test (5.2 ± 1.8 vs 6.4 ± 1.9 minutes, p < 0.001). lower Duke score (4.6 ± 2.4 vs 6.1 ± 2.4 minutes, p < 0.001). lower MET (6.3 ± 1.8 vs 7.5 ± 1.9, p < 0.001) and higher rate of chronotropic incompetence (173/251, 68.9% vs 1036/2070, 50%, p < 0.001) compares to the patients with normal HRR. Multivariate predictors of impaired HRR were higher CHA2DS2-VASc score (p < 0.001), not achieved THR (p < 0.001), higher heart rate at rest (p = 0.001), higher systolic blood pressure at rest (p = 0.001) and shorter duration of test (p = 0.046).
Conclusion
CHA2DS2-VASc score is an independent predictor of impaired HRR in patients without inducible ischemia.
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Popovic
- University Belgrade Medical School, Belgrade, Serbia
| | - M T Petrovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Dobric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
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