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1.
Viola William Keddeas Salwa Mohammed Swelim Ghada Kamel Selim 《The Egyptian Heart Journal》2017,69(2):103-110
Background
A substantial fraction of patients with non ST-elevation acute coronary syndrome have an occluded culprit vessel on coronary angiography. Acute coronary occlusion often results in myocardial infarction and loss of systolic function. Identification of these patients may have considerable impact on treatment and prognosis.Aim
The study aims at investigating role of 2D speckle tracking echocardiography as a non-invasive predictor of acute coronary artery occlusion in patients with non ST-segment elevation myocardial infarction.Patients
This study was carried on 60 patients with first attack non ST segment elevation myocardial infarction who were admitted to coronary care unit of Ain Shams University Hospitals. All patients underwent thorough history taking, full clinical examination, 12 leads surface ECG, full 2D, M-mode and Doppler echocardiographic study, two-dimensional speckle tracking strain study and coronary angiography.Results
2D derived peak global longitudinal strain had a highly significant relationship in prediction of the presence of total occlusion, and also number of segments with reduced strain (functional risk area by strain) had a highly significant relationship in prediction of the presence of total occlusion. In this study, 2D derived peak longitudinal strain sensitivity and specificity were 68.9% and 77.7% respectively at a cutoff value of ?15.5 while number of segments with reduced longitudinal strain sensitivity and specificity were 63.6% and 77.7% respectively at a cutoff value of 5 segments.Conclusion
Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization. 相似文献2.
Siva Subramaniyan Neeraj Pandit Ranjit Kumar Nath Ajay Raj Athar Kamal Deepankar Vatsa 《The Egyptian Heart Journal》2018,70(4)
Background
It is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required.Methods
61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24?h of PPCI and then on day 15, 3?months and 6?months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6?months along with effect of duration of chest pain on diastolic function.Results
54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6?months (p value?<?0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6?months except mitral E/e′ ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value?<?0.001). Patients with TIMI flow?<?III had more diastolic dysfunction (p value?<?0.001).Conclusions
Primary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6?months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction. 相似文献3.
Manal Abd El Baky Mahmoud Menat Allah Ali Shaaban Ali Ali Ramzy 《The Egyptian Heart Journal》2018,70(3):155-159
Objective
To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period.Subjects and methods
This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients’ group); at 3 h and then at 6–9 h from admission time.Results
The first sample revealed a non-significant difference between UA group and AMI group as regards CKMB and troponin, however, high significant difference was found as regards Copeptin (Z?=?5.29, P?<?0.001). Moreover, ROC curve analysis of serum Copeptin for discriminating AMI group from UA group in the first sample showed diagnostic sensitivity and specificity of 100%.In conclusion
Determination of copeptin in early diagnosis of AMI has diagnostic value being superior to a conventional cTn-I within the first three hours after acute chest pain. 相似文献4.
Abdulmalik Abdullah Alyahya Mohammed Abdullah Alghammass Fahad Saleh Aldhahri Abdullah Abdulaziz Alsebti Abdullah Yousef Alfulaij Saleh Hamad Alrashed Husam Al Faleh Mostafa Alshameri Khalid Alhabib Mohammed Arafah Abduellah Moberik Abdulaziz Almulaik Zuhair Al-Aseri Tarek Seifaw Kashour 《Journal of the Saudi Heart Association》2018,30(3):172-179
Objectives
This study was conducted to evaluate the effect of direct emergency department activation of the catheterization lab on door-to-balloon time (D2BT) and outcomes of acute ST-elevation myocardial infarction (STEMI) patients at a major tertiary care hospital in Riyadh, Saudi Arabia.Methods
This was a retrospective cohort study that enrolled 100 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention between June 2010 and January 2015. The patients were divided into two groups of 50 patients each. The first group was treated prior to establishing the Code-STEMI protocol. The other group was treated according to the protocol, which was implemented in June 2013. The Code-STEMI protocol is a comprehensive program implementing direct activation of the catheterization lab team using a single call system, data monitoring and feedback, and standardized order forms.Results
The mean age for both groups was 54?±?12?years. Males represented 86% (43) and 94% (47) of the patients in the two groups, respectively. In both groups, 90% (90) of patients had one or more comorbidities. The Code-STEMI group had a significantly lower D2BT, with 70% of patients treated within the recommended 90?minutes (median, 76.5?minutes; interquartile range, 63–90?minutes). By contrast, only 26% of pre-Code-STEMI patients were treated within this timeframe (median, 107?minutes; interquartile range, 74–149?minutes). In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction (8% vs. 0%, p?=?0.043).Conclusion
Implementation of direct emergency department catheterization lab activation protocol was associated with a significant reduction in D2BT. 相似文献5.
Ki Hong Choi Joo Myung Lee Hyun Kuk Kim Jihoon Kim Jonghanne Park Doyeon Hwang Tae-Min Rhee Taek Kyu Park Jeong Hoon Yang Young Bin Song Eun-Seok Shin Chang-Wook Nam Joon-Hyung Doh Joo-Yong Hahn Jin-Ho Choi Seung-Hyuk Choi Bon-Kwon Koo Hyeon-Cheol Gwon 《JACC: Cardiovascular Interventions》2018,11(18):1848-1858
Objectives
The aim of this study was to compare the changes of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) with severity of epicardial coronary stenosis between nonculprit vessel of acute myocardial infarction (AMI) and stable ischemic heart disease (SIHD).Background
There has been debate regarding the reliability of FFR or iFR for nonculprit stenosis in the acute stage of AMI.Methods
A total of 100 AMI patients underwent comprehensive physiologic assessment including FFR, iFR, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) for nonculprit vessel stenosis after primary percutaneous coronary intervention (PCI) for culprit vessel. The changes in FFR and iFR for diameter stenosis (%DS) of nonculprit vessel stenosis were compared with FFR and iFR measured in 203 patients with SIHD.Results
From 40% to 80% stenosis, FFR and iFR measured in nonculprit vessel of AMI patient showed significant decrease with worsening stenosis severity (all p values < 0.001). Nonculprit vessels of AMI patients showed lower CFR than SIHD; however, IMR was not different between the nonculprit vessel of AMI and SIHD patients. FFR and iFR were not significantly different between the nonculprit vessel of AMI and SIHD patients in all %DS groups from 40% to 80% (all p values > 0.05). In addition, percent difference of FFR and iFR according to the increase in %DS was also not significantly different between nonculprit vessel of AMI or SIHD. There was no significant interaction between clinical presentation and the changes of FFR and iFR for worsening %DS (interaction p value = 0.698 and 0.257, respectively).Conclusions
Changes in FFR and iFR for the nonculprit stenosis of AMI patients were not significantly different from those in SIHD patients. These data support the use of invasive physiological parameters to guide treatment of nonculprit stenoses in the acute stage of successfully revascularized AMI. 相似文献6.
Ali Mohammed Kareem Al-Jabari Ahmed Shawky Elserafy Hossamaldin Zaki Alsayed Abuemara 《The Egyptian Heart Journal》2017,69(3):171-175
Background
No-reflow is an important factor as it predicts a poor outcome in patients undergoing primary angioplasty. In comparison with patients attaining TIMI 3 flow, patients with no-reflow have an increased incidence of ventricular arrhythmias, early congestive cardiac failure, cardiac rupture and cardiac death. As such, it is of paramount importance to consider strategies to prevent the occurrence of no-reflow phenomenon. Previous evidence suggests that Beta (β) blockers have multiple favorable effects on the vascular system not directly related to their effect on blood pressure. However, there are insufficient data regarding the effects of prior Beta blocker use on coronary blood flow after primary PCI in patients with AMI.Aim
The aim of this study was to test the hypothesis that Beta blocker treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after acute myocardial infarction.Methods and results
The study included 107 diabetic patients who had presented with acute STEMI within 12 h from the onset of chest pain. All of them have undergone primary angioplasty at Ain Shams University hospitals or National Heart institute. The incidence of no-reflow phenomenon was 21%. No-reflow phenomenon was significantly lower in patients on chronic B-blocker therapy (12% vs. 28%; P = 0.04). The heart rate was significantly lower in the normal reflow group than in the no-reflow group (P = 0.03). The study also showed that B-blocker pretreatment is an independent protective predictor for the no-reflow phenomenon (P = 0.045).Conclusion
Chronic pre-treatment with B-blocker in diabetic patients presenting with STEMI, is associated with lower rate of occurrence of no-reflow phenomenon after primary PCI. 相似文献7.
Abdulaziz U. Joury Ahmed S. Hersi Hussam Alfaleh Khalid F. Alhabib Tarek Seifaw Kashour 《Journal of the Saudi Heart Association》2018,30(3):233-239
Background and objectives
Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality.Methods
We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients.Results
Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55?years vs. 53?years; p?<?0.001) and had lower risk factors than patients with a history of ACS. Higher laboratory readings of cardiac markers and all aspects of mortality were significantly higher among patients with first presentation AMI. After adjustments for baseline variables, congestive heart failure [odds ratio (OR)?=?1.08; 95% confidence interval (CI), 0.73–1.57], reinfarction (OR?=?1.16; 95% CI, 0.58–2.30), cardiogenic shock (OR?=?1.51; 95% CI, 0.74–3.08), stroke (OR?=?2.30; 95% CI, 0.29–17.99), and overall mortality (OR?=?1.16; 95% CI?=?0.74–1.83) were independent predictive factors for first presentation AMI.Conclusions
First presentation AMI patients tend to be older and to have lower rates of risk factors. Adverse clinical outcomes such as congestive heart failure, reinfarction, cardiogenic shock, and stroke were higher among patients with first presentation AMI compared to patients with a history of ACS. 相似文献8.
Pontus Andell Karolina Berntorp Evald H. Christiansen Ingibjörg J. Gudmundsdottir Lennart Sandhall Dimitrios Venetsanos David Erlinge Ole Fröbert Sasha Koul Christian Reitan Matthias Götberg 《JACC: Cardiovascular Interventions》2018,11(20):2084-2094
Objectives
The authors sought to compare reclassification of treatment strategy following instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR).Background
iFR was noninferior to FFR in 2 large randomized controlled trials in guiding coronary revascularization. Reclassification of treatment strategy by FFR is well-studied, but similar reports on iFR are lacking.Methods
The iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome Trial) study randomized 2,037 participants with stable angina or acute coronary syndrome to treatment guided by iFR or FFR. Interventionalists entered the preferred treatment (optimal medical therapy [OMT], percutaneous coronary intervention [PCI], or coronary artery bypass grafting [CABG]) on the basis of coronary angiograms, and the final treatment decision was mandated by the iFR/FFR measurements.Results
In the iFR/FFR (n = 1,009/n = 1,004) populations, angiogram-based treatment approaches were similar (p = 0.50) with respect to OMT (38%/35%), PCI of 1 (37%/39%), 2 (15%/16%), and 3 vessels (2%/2%) and CABG (8%/8%). iFR and FFR reclassified 40% and 41% of patients, respectively (p = 0.78). The majority of reclassifications were conversion of PCI to OMT in both the iFR/FFR groups (31.4%/29.0%). Reclassification increased with increasing number of lesions evaluated (odds ratio per evaluated lesion for FFR: 1.46 [95% confidence interval: 1.22 to 1.76] vs. iFR 1.37 [95% confidence interval: 1.18 to 1.59]). Reclassification rates for patients with 1, 2, and 3 assessed vessels were 36%, 52%, and 53% (p < 0.01).Conclusions
Reclassification of treatment strategy of intermediate lesions was common and occurred in 40% of patients with iFR or FFR. The most frequent reclassification was conversion from PCI to OMT regardless of physiology modality. Irrespective of the physiological index reclassification of angiogram-based treatment strategy increased with the number of lesions evaluated. 相似文献9.
Ahmed Bendary Mohamed El-Husseiny Tarek Aboul Azm Ahmed Abdoul Moneim 《The Egyptian Heart Journal》2018,70(4):415-419
Background
Coronary no-reflow (NR) is a dreadful complication of primary percutaneous coronary intervention (pPCI) that is seen in nearly 50% of cases. A great effort is being done to discover simple tools that could predict such a complication. We aimed primarily to study the predictive power of R-wave peak time (RWPT) on NR.Methods
From October 2017 to March 2018, we enrolled 123 patients with STEMI treated with pPCI at Benha University Hospital and National Heart Institute. We measured RWPT from infarct-related artery (IRA) leads and assessed the development of NR in all finally included 100 patients (after exclusions).Results
Based on occurrence of NR, patients were divided into 2 groups; Group I (n?=?39) with NR and group II (n?=?61) without NR. Smoking, DM, HTN, longer reperfusion times and higher thrombus burden were significantly associated with NR. Both pre- and postprocedural RWPT were significantly higher in group I than Group II. Preprocedural RWPT?>?46?ms predicted NR with a sensitivity and specificity of 79.5% and 86.9% respectively (AUC 0.891, 95% CI 0.82–0.962, P?<?0.001). In adjusted multivariate analysis, preprocedural RWPT was found to be among independent predictors for NR (OR: 26.2, 95% CI: 6.5–105.1, P?<?0.001). The predictive power of preprocedural RWPT was statistically non-inferior to ST-resolution (STR)% (difference between area under curves?=?0.029, P?=?0.595).Conclusion
RWPT is strongly associated with and significantly predicts the development of NR. This association was statistically non-inferior to the well-known association between STR% and NR. 相似文献10.
Gehan Magdy Mohammed Sadaka Tarek Elzawawy Abdallah Elmaghraby 《The Egyptian Heart Journal》2018,70(2):83-88
Background
Percutaneous coronary intervention (PCI) is a commonly used procedure for revascularization, however the impairment of regional myocardial function in patients with stable coronary artery disease (CAD) has not been well characterized, our study aimed to assess the improvement of left ventricular (LV) systolic function after elective PCI of the left anterior descending artery (LAD) using strain and strain rate imaging techniques.Materials and methods
The study included 30 patients (aged 56.8?±?6.6?years, 66.7% males) presented with stable CAD on optimal medical therapy, and recommended for elective PCI to LAD, all patients included in the study had a normal LV wall motions, and normal LV systolic function. Tissue Doppler imaging (TDI) was done before PCI, immediately, and three months post PCI. The peak systolic longitudinal strain (PSLS), and peak systolic strain rate (PSSR) were measured and averaged for the 6 LAD segments (the basal, mid, and apical segments of the anterior wall, the basal, mid anteroseptal, and the apicoseptal segments), 15 healthy control subjects were included as a control group.Results
The average PSLS and PSSR of the ischemic segments were significantly lower in patients compared to control in the ischemic segments, and significantly increased 3?months post PCI but not immediately post PCI. Using the ROC curve a cutoff value of ?13.69% for PSLS can detect regional ischemia with a sensitivity 93.3% and a specificity of 80%.Conclusions
TDI derived strain and strain rate can detect resting regional myocardial dysfunction in presence of preserved LV systolic function, and can assess the improvement of regional myocardial function after successful elective PCI in patients with stable CAD. 相似文献11.
Nasser Mohammad Taha Hany Taha Asklany Adel Hamdy Mahmoud Laila Hammoda Heba Rady Attallah Adel Mohammad Kamel Mohammad AbdelKader AbdelWahab 《The Egyptian Heart Journal》2018,70(3):167-171
Background
Obstructive coronary artery disease (OCAD) and coronary slow flow (CSF) are frequent angiographic findings for patients that have chest pain and require frequent hospital admission. The retina provides a window for detecting changes in microvasculature relating to the development of cardiovascular diseases such as arterial hypertension or coronary heart disease.Objectives
To assess the coronary and ocular circulations in patients with CSF and those with obstructive coronary artery disease.Methods
A prospective study was conducted over 3.5?years, included a total of 105 subjects classified to 4 groups: Group I (OCAD): Included 30 patients with obstructive coronary artery disease, group II (CSF): Included 30 patients with coronary slow-flow, group III (Control 1): Included 30 healthy control persons and group IV (Control 2): Included 15 patients indicated for coronary angiography that proved normal. All participants were subjected to coronary angiography (except control group 1), ophthalmic artery Doppler for measuring Pulsatility index (PI) and resistivity index (RI) and Fluorescence angiography of retinal vessels.Results
Patients with CSF showed slow flow retinal circulation (microcirculation) evidenced by prolonged fluorescein angiography (Arm-retina time [ART] & Arterio-venous Transit time [AVTT]). Ophthalmic artery Doppler measurements (RI & PI) were significantly delayed in OCAD and CSF patients. There was significant positive correlation between TIMI frame count in all subjects and ART, AVTT, PI, RI and Body Mass Index. Using ART cutoff value of >16?s predicted CSF with sensitivity and specificity of 100%, meanwhile AVTT of >2?s predicted CSF with a sensitivity 96.7% and specificity of 93.3.Conclusion
Both delayed arm-retina time and retinal arterio-venous transit times can accurately predict coronary slow-flow. 相似文献12.
Background
Acute coronary syndrome (ACS) refers to a spectrum of symptoms compatible with acute myocardial ischemia. Plasma markers of inflammation have been recently identified as diagnostic aid and risk predictors. The present study, conducted in Slemani Cardiac Hospital (SCH), Sulaimaniyah, Iraq aimed to recognize some risk factors for ACS in Iraqi adults younger than 40.Methodology
This is a prospective case-control study of 100 patients with ACS vs. a control group of 100 healthy volunteers. The study began at 1st January 2014 and ended at 31st December 2016. All patients were subjected to full history taking, clinical examination including measurement of waist circumference and body mass index (BMI). Investigations included electrocardiography (ECG), echocardiography, full blood count, measurement of lipid profile and C-reactive protein (CRP). The patients were managed by percutaneous coronary intervention (PCI).Results
The mean age of the patients was 36?years (range 28–40). Eighty-five% of patients were male. The mean BMI (29?kg/m2) and waist circumference (98?cm) of the patients were higher than the controls (24?kg/m2 and 72?cm respectively). The leukocytes, lymphocytes and neutrophil counts as well as CRP in both groups were within the normal range. The most prevalent risk factor was obesity (n?=?86). Other risk factors were smoking (n?=?62), hypertension (n?=?26), diabetes mellitus (n?=?22) and positive family history of ACS (n?=?24). Most patients (n?=?83) had multi-vessel coronary artery disease (2–3 vessels).Conclusion
ACS in young adults is an increasing health problem. Obesity was found to be the most prevalent risk factor. 相似文献13.
Osama A. Smettei Sawsan Sayed Rami M. Abazid 《Journal of the Saudi Heart Association》2017,29(2):84-89
Background
Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.Objective
The aim of our work is to estimate the frequency of CAAs in Qassim province among patients underwent cardiac CTA at Prince Sultan Cardiac Center.Methods
Retrospective analysis of the CTA data of 2235 patients between 2009 and 2015.Results
The prevalence of CAAs in our study was 1.029%. Among the 2235 patients, 241 (10.78%) had CAAs or coronary variants, 198 (8.85%) had myocardial bridging, 34 (1.52%) had a variable location of the Coronary Ostia, Twenty two (0.98%) had a separate origin of left anterior descending (LAD) and left circumflex coronary (LCX) arteries, ten (0.447%) had a separate origin of the RCA and the Conus artery. Seventeen (0.76%) had an anomalous origin of the coronaries. Six (0.268%) had a coronary artery fistula, which is connected mainly to the right heart chambers, one of these fistulas was complicated by acute myocardial infarction.Conclusions
The incidence of CAAs in our patient population was similar to the former studies, CTA is an excellent tool for diagnosis and guiding the management of the CAAs. 相似文献14.
Noha Hassanin Hanboly Yasser Mohamed Baghdady Reda Huissen Diab Sameeh Ramadan Lawend Ahmed Abdelazim Kenawy 《Journal of the Saudi Heart Association》2018,30(3):211-221
Background
Limited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI).Objectives
The study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3?months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke.Patients and methods
The study population consisted of 300 consecutive patients (mean age, 57.35?±?13.41?years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3?months follow-up after STEMI.Results
Right dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3?months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system.Conclusion
In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3?months follow-up compared to right and balanced coronary artery dominance. 相似文献15.
Mohammad A. Sadaka Eman M. El-Sharkawy Mohamed A. Sobhy Basma A. Hammad 《The Egyptian Heart Journal》2017,69(1):63-70
Objectives
We aimed to determine the role of multi-detector computed tomography (MDCT) in prognosis of patients with known or suspected coronary artery disease (CAD) by applying plaque characterization and whether obstructive versus non-obstructive plaque volume is a predictor of future cardiac events.Background
Vulnerable plaques may occur across the full spectrum of severity of stenosis, underlining that also non-obstructive lesions may contribute to coronary events.Methods
We included 1000 consecutive patients with intermediate pretest likelihood of CAD who were evaluated by 64-MDCT. Coronary artery calcium scoring, assessment of degree of coronary stenosis and quantitative assessment of plaque composition and volume were performed. The end point was cardiac death, acute coronary syndrome, or symptom-driven revascularization.Results
After a median follow-up of 16 months, 190 patients had suffered cardiac events. In a multivariate regression analysis for events, the total amount of non-calcified plaque (NCP) in non-obstructive lesions was independently associated with an increased hazard ratio for non-fatal MI (1.01–1.9/100-mm3 plaque volume increase, p = 0.039), total amount of obstructive plaque was independently associated with symptoms driven revascularization (p = 0.04) and coronary artery calcium scoring (CACS) was independently associated with cardiac deaths (p = 0.001).Conclusion
MDCT is a non-invasive imaging modality with a prognostic utility in patients with known or suspected coronary artery disease by applying plaque characterization and it could identify vulnerable plaques by measuring the total amount of NCP in non-obstructive lesions which could be useful for detecting patients at risk of acute coronary syndrome (ACS) and guide further preventive therapeutic strategies. CACS was shown to be an independent predictor of mortality, while total amount of obstructive volume was shown to be an independent predictor of symptoms driven revascularization. 相似文献16.
Jahangir Rashid Beig Nisar A. Tramboo Kuldeep Kumar Irfan Yaqoob Imran Hafeez Fayaz A. Rather Tariq R. Shah Hilal A. Rather 《Journal of the Saudi Heart Association》2017,29(1):7-14
Background
Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state.Methods
This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient’s decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified.Results
During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient’s decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60–3.46], absence of prior coronary artery disease (OR, 1.54; 95% CI, 1.00–2.39), and negative family history of coronary artery disease (OR; 2.76; 95% CI, 1.86–4.10), were identified as independent predictors of delayed presentation (p < 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers.Conclusion
The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed. 相似文献17.
Helmy Hassan Elghawaby Mohamed Ashraf Shawky Ahmed Hossam Mowafi Akram Mohamed Abd-elbary Farouk Mostafa Faris 《The Egyptian Heart Journal》2018,70(1):9-14
Background
Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting.Methods
IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter.Results
Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) and DM in 8 (28.6%). Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P < 0.001) while a higher calcific content in lesions of non-culprit vessels (P < 0.001). Higher calcific content of proximal more than distal lesions (P = 0.048). Negative remodeling in 55.7% of lesions.Conclusions
A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well. 相似文献18.
Eisuke Usui Taishi Yonetsu Yoshihisa Kanaji Masahiro Hoshino Masao Yamaguchi Masahiro Hada Tadashi Fukuda Yohei Sumino Hiroaki Ohya Rikuta Hamaya Yoshinori Kanno Haruhito Yuki Tadashi Murai Tetsumin Lee Kenzo Hirao Tsunekazu Kakuta 《JACC: Cardiovascular Interventions》2018,11(20):2058-2068
Objectives
This study sought to investigate the relationship of unstable plaque features with physiological lesion severity and microvascular dysfunction.Background
The functional severity of epicardial lesions and microvascular dysfunction are both related to adverse clinical outcomes.Methods
We investigated 382 de novo intermediate and severe coronary lesions in 340 patients who underwent optical coherence tomography, fractional flow reserve (FFR), and index of microcirculatory resistance (IMR) examinations. Lesions were divided into tertiles based on either FFR or IMR values. The optical coherence tomography findings were compared among the tertiles of FFR and IMR. Each tertile was defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74 ≤ FFR ≤0.81), and FFR-T3 (FFR >0.81); and IMR-T1 (IMR ≥25), IMR-T2 (15 < IMR <25), and IMR-T3 (IMR ≤15).Results
No significant relationship was observed between FFR and IMR. The prevalence of optical coherence tomography–defined thin-cap fibroatheroma (TCFA) was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3. An overall significant difference in the prevalence of TCFAs was detected among FFR tertiles, although no pairwise comparison revealed statistical significance. The prevalence of ruptured plaque was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3, although no significant difference was observed between FFR tertiles. Multivariate analysis showed that FFR and IMR were independent predictors of the prevalence of TCFAs (odds ratio: 0.036; 95% confidence interval: 0.004 to 0342; p = 0.004; and odds ratio: 1.034; 95% confidence interval: 1.014 to 1.054; p = 0.001, respectively).Conclusions
Lower FFR and higher IMR values were independent predictors of the presence of a TCFA in angiographically intermediate-to-severe stable lesions or nonculprit lesions in acute coronary syndrome. 相似文献19.
Amir Ahmadi Jonathon Leipsic Kristian A. Øvrehus Sara Gaur Emilia Bagiella Brian Ko Damini Dey Gina LaRocca Jesper M. Jensen Hans Erik Bøtker Stephan Achenbach Bernard De Bruyne Bjarne L. Nørgaard Jagat Narula 《JACC: Cardiovascular Imaging》2018,11(4):521-530
Objectives
The aims of the present study were: 1) to investigate the contribution of the extent of luminal stenosis and other lesion composition-related factors in predicting invasive fractional flow reserve (FFR); and 2) to explore the distribution of various combinations of morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR.Background
In patients with stable ischemic heart disease, FFR-guided revascularization, as compared with medical therapy alone, is reported to improve outcomes. Because morphological characteristics are the basis of plaque rupture and acute coronary events, a relationship between FFR and lesion characteristics may exist.Methods
This is a subanalysis of NXT (HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography), a prospective, multicenter study of 254 patients (age 64 ± 10 years, 64% male) with suspected stable ischemic heart disease; coronary computed tomography angiography including plaque morphology assessment, invasive angiography, and FFR were obtained for 383 lesions. Ischemia was defined by invasive FFR ≤0.80. Computed tomography angiography–defined morphological characteristics of plaques and their vascular location were used in univariate and multivariate analyses to examine their predictive value for invasive FFR. The distribution of various combinations of plaque morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR were examined.Results
The percentage of luminal stenosis, low-attenuation plaque (LAP) or necrotic core volume, left anterior descending coronary artery territory, and the presence of multiple lesions per vessel were the predictors of FFR. When grouped on the basis of degree of luminal stenosis, FFR-negative lesions had consistently smaller LAP volumes compared with FFR-positive lesions. The distribution of plaque characteristics in lesions with normal and abnormal FFR demonstrated that whereas FFR-negative lesions excluded likelihood of stenotic plaques with moderate to high LAP volumes, only one-third of FFR-positive lesions demonstrated obstructive plaques with moderate to high LAP volumes.Conclusions
In addition to the severity of luminal stenosis, necrotic core volume is an independent predictor of FFR. The distribution of plaque characteristics among lesions with varying luminal stenosis and normal and abnormal FFR may explain the outcomes associated with FFR-guided therapy. 相似文献20.
Amr ElFaramawy Mina Youssef Mohamed Abdel Ghany Khaled Shokry 《The Egyptian Heart Journal》2018,70(2):95-100