Usefulness of microvolt T-wave alternans testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmia risk in patients with left ventricular dysfunction

Introduction

Patients with left ventricular ejection fraction (LVEF) ≤ 35% are eligible for implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death. Nevertheless, other risk factors facilitating the selection of individuals with highest mortality are still sought. The aim of the study was to verify the usefulness of microvolt T-wave alternans (MTWA) testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmias (EVENTs) in these patients. Previous data from the literature are inconclusive.

Material and methods

Patients with LVEF ≤ 35% were eligible if they did not have a history of sustained ventricular arrhythmias, and were treated with β-blockers. Participants underwent MTWA testing and were subsequently followed.

Results

The group consisted of 139 patients. MTWA results were classified as non-negative (MTWA_non-neg) in 93 and negative (MTWA_neg) in 46 patients. During the 14.3 ±8.6 months of follow-up, EVENTs were observed in 21 patients. The 1-year EVENT rate was 16.4% among MTWA_non-neg patients, and 2.6% among MTWA_neg patients (p = 0.006). The sensitivity of the MTWA test was 95.24%, the specificity – 38.14%, the positive predictive value – 21.51% and the negative predictive value – 97.83%.

Conclusions

In the group of patients with left ventricular systolic dysfunction, with the exclusion of patients with the history of life-threatening ventricular arrhythmia and individuals not being on chronic β-adrenolytic therapy, the abnormal result of MTWA testing is associated with significantly increased risk of all-cause mortality and life-threatening ventricular arrhythmia during 1 year of follow-up, thus identifying the individuals at the highest risk.     

Association between heart rate at rest and myocardial perfusion in patients with acute myocardial infarction undergoing cardiac rehabilitation – a pilot study

Introduction

This study was conducted to determine if there was a link among heart rate at rest (rHR), muscle volume changes, and single photon emission computed tomography (SPECT) parameters after 6-month cardiac rehabilitation in patients with acute myocardial infarction (AMI).

Material and methods

Twenty-nine consecutive AMI patients (mean age: 63.0 ±9.1 years) who received appropriate percutaneous coronary intervention on admission were enrolled. ^99mTc-Sestamibi myocardial SPECT images were obtained at the early (30 min) and delayed (4 h) phases after tracer injection at 2 weeks (0M) and 6 months (6M) after the onset of AMI. Within a few days of SPECT, all patients underwent cardiopulmonary exercise test for evaluation of cardiac rehabilitation effects. Before the initiation of exercise test, leg muscle volume was measured. All patients were stratified into the ≥ 70 beats per minute (bpm) (n = 15) or < 70 bpm (n = 14) group based on rHR at 6M.

Results

There were no significant differences in the recanalization time, peak cardiac enzyme, or initial left ventricular ejection fraction between the two groups. After the 6-month training, the muscle volume changes in the lower limbs (< 70 bpm, 0.23 ±0.22; ≥ 70 bpm, –0.07 ±0.26, p < 0.05) were significantly greater in the < 70 bpm group than the ≥ 70 bpm group. The decreased rate of rHR had a significant correlation with the improved global severity (r = 0.62, p = 0.001) and extent (r = 0.48, p = 0.017) of left ventricle evaluated by ^99mTc-Sestamibi myocardial SPECT delayed phase.

Conclusions

The result of this preliminary study demonstrated that improved myocardial perfusion was closely related to decreased rHR after cardiac rehabilitation.     

Short-term diabetes attenuates left ventricular dysfunction and mortality rates after myocardial infarction in rodents

OBJECTIVES:

To investigate the effects of hyperglycemia on left ventricular dysfunction, morphometry, myocardial infarction area, hemodynamic parameters, oxidative stress profile, and mortality rate in rats that had undergone seven days of myocardial infarction.

INTRODUCTION:

Previous research has demonstrated that hyperglycemia may protect the heart against ischemic injury.

METHODS:

Male Wistar rats were divided into four groups: control-sham, diabetes-sham, myocardial infarction, and diabetes + myocardial infarction. Myocardial infarction was induced 14 days after diabetes induction. Ventricular function and morphometry, as well as oxidative stress and hemodynamic parameters, were evaluated after seven days of myocardial infarction.

RESULTS:

The myocardial infarction area, which was similar in the infarcted groups at the initial evaluation, was reduced in the diabetes + myocardial infarction animals (23±3%) when compared with the myocardial infarction (42±7%, p<0.001) animals at the final evaluation. The ejection fraction (22%, p = 0.003), velocity of circumferential fiber shortening (30%, p = 0.001), and left ventricular isovolumetric relaxation time (26%, p = 0.002) were increased in the diabetes + myocardial infarction group compared with the myocardial infarction group. The diabetes-sham and diabetes + myocardial infarction groups displayed increased catalase concentrations compared to the control-sham and myocardial infarction groups (diabetes-sham: 32±3; diabetes + myocardial infarction: 35±0.7; control-sham: 12±2; myocardial infarction: 16±0.1 pmol min^-1 mg^-1 protein). The levels of thiobarbituric acid-reactive substances were reduced in the diabetes-sham rats compared to the control-sham rats. These positive adaptations were reflected in a reduced mortality rate in the diabetes + myocardial infarction animals (18.5%) compared with the myocardial infarction animals (40.7%, p = 0.001).

CONCLUSIONS:

These data suggest that short-term hyperglycemia initiates compensatory mechanisms, as demonstrated by increased catalase levels, which culminate in improvements in the ventricular response, infarcted area, and mortality rate in diabetic rats exposed to ischemic injury.     

Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment

OBJECTIVES:

To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment.

METHODS:

This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01791764","term_id":"NCT01791764"}}NCT01791764

RESULTS:

The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality.

CONCLUSIONS:

In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients.     

Expression of angiogenesis-related genes in right atrial appendages from patients with advanced myocardial ischemia – preliminary results

Introduction

The most frequent cause of myocardial ischemia is atherosclerotic lesions which narrow coronary vessels leading to impaired blood flow or their total occlusion.

Material and methods

Using HG-U133A oligonucleotide microarrays (Affymetrix) we studied the expression levels of angiogenesis-related genes in patients with different types of heart failure. We analyzed the RNA from right atrial appendages from patients: 1) with advanced coronary disease and myocardial infarction history, 2) with advanced stable coronary disease and no infarction history, and 3) after surgery due to mitral stenosis, but with no coronary vessel lesions.

Results

Analysis of the data from oligonucleotide microarrays allowed identification of 2 genes (ENG and NPPB) differentiating the examination grups.

Conclusions

Analysis of the expression profile of genes involved in angiogenesis, carried out using data obtained from examined individuals’ samples, suggests that necrosis accompanying myocardial infarction is a significant factor leading to elevated expression levels of genes involved in neoangiogenesis.     

Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study

OBJECTIVE:

Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.

METHODS:

The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.

RESULTS:

The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.

CONCLUSION:

Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate     

ST-segment changes in high-resolution body surface potential maps measured during exercise to assess myocardial ischemia: a pilot study

Introduction

The aim of the study was to assess myocardial ischemia by analysis of ST-segment changes in high-resolution body surface potential maps (HR-BSPM) measured at rest and during an exercise stress test.

Material and methods

The study was carried out on a group of 28 patients with stable coronary artery disease and 15 healthy volunteers. The HR-BSPM were measured at rest and during the exercise stress test on a supine ergometer. The workload was increased in stages by 25 W every 2 min, beginning at 50 W. The maps of ST-segment depression (ST₆₀) were calculated from time averaged recordings at rest and at maximal workload.

Results

The efficiency in detection of myocardial ischemia was higher for HR-BSPM than for standard 12-lead electrocardiography (ECG) when both methods were evaluated by outcomes of coronarography. The sensitivity of HR-BSPM was 82.4% while for the standard 12-lead ECG exercise stress test it was 58.8%. For some patients significant changes in the ST segment were observed at stress HR-BSPM but were not visible in standard 12-lead ECG recorded under the same conditions.

Conclusions

Obtained high values of sensitivity and specificity in myocardial ischemia detection suggest that maps of ST₆₀ calculated from HR-BSPM can improve detection of patients with ischemic heart disease in comparison to the standard electrocardiographic exercise stress test examinations.     

High admission levels of γ-glutamyltransferase predict poor myocardial perfusion after primary percutaneous intervention

OBJECTIVE:

This retrospective study aimed to investigate the relationship between admission levels of serum γ-glutamyltransferase and poor myocardial perfusion after primary percutaneous coronary intervention in patients with acute myocardial infarction.

INTRODUCTION:

Reperfusion injury caused by free radical release and increased oxidative stress is responsible for the pathophysiology of the no-reflow phenomenon in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Serum γ-glutamyltransferase is an established marker of increased oxidative stress.

METHODS:

The study population consisted of 80 patients (64 men and 16 women, mean age = 67.5±6.6 years) with thrombolysis in myocardial infarction 0/1 flow pre-procedurally. The patients were divided into two groups according to thrombolysis in myocardial perfusion grades that were assessed immediately following primary percutaneous coronary intervention. The two groups (group 1 and group 2) each consisted of 40 patients with thrombolysis in myocardial perfusion grades 0-1 and thrombolysis in myocardial perfusion grades 2-3, respectively.

RESULTS:

Admission pain to balloon time, γ-glutamyltransferase and creatine kinase-MB isoenzyme levels of group 1 patients were significantly higher than those of group 2 patients. Pain to balloon time, γ-glutamyltransferase, peak creatine kinase-MB isoenzyme, low left ventricular ejection fraction and poor pre-procedural thrombolysis in myocardial infarction grade were significantly associated with poor myocardial perfusion by univariate analysis. However, only pain to balloon time and γ-glutamyltransferase levels showed a significant independent association with poor myocardial perfusion by backward logistic regression analysis. Adjusted odds ratios were calculated as 4.92 for pain to balloon time and 1.13 for γ-glutamyltransferase.

CONCLUSION:

High admission γ-glutamyltransferase levels are associated with poor myocardial perfusion in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention, particularly in patients with prolonged pain to balloon time.     

Surgical Myocardial Revascularization of Patients with Ischemic Cardiomyopathy and Severe Left Ventricular Disfunction

OBJECTIVE:

To determine long-term survival, identify preoperative factors predictive of a favorable outcome, and assess functional improvement after coronary artery bypass grafting in patients with advanced left ventricular dysfunction.

METHODS:

Between 1995 and 2001, 244 patients who underwent coronary artery bypass grafting and had a preoperative left ventricular ejection fraction less than or equal to 35% were included. left ventricular ejection fraction was determined by uniplanar or biplanar ventriculography during left heart catheterization. Indication for surgery was predominance of tissue viability. Functional improvement was evaluated through echocardiography and gated scintigraphy at exercise/rest. Survival was determined by Kaplan-Meier analysis.

RESULTS:

Mean left ventricular ejection fraction was 29±4% (ranged from 9% to 35%). An average of 3.01 coronary bypass grafts per patient were performed. In-hospital mortality was 3.7% (9 patients). The 4-year survival rate was 89.7%. Multivariate correlates of favorable short- and long-term outcome were preoperative New York Heart Association Funcional classification for congestive heart failure class I/II, lower PAsP, higher left ventricular ejection fraction and gated left ventricular ejection fraction Ex/Rest ratio >5%. Left ventricular ejection fraction rise from 32±5% to 39±5%, p <0.001. Gated left ventricular ejection fraction at exercise/rest increased markedly after surgery: from 27±8%/23±7% to 37±5%/31±6%, p <0.001.

CONCLUSIONS:

In selected patients with severe ischemic left ventricular dysfunction and predominance of tissue viability, coronary artery bypass grafting may be capable of implement preoperative clinical/functional parameters in predicting outcome as left ventricular ejection fraction and gated left ventricular ejection fraction at exercise/rest.     

Changes in left ventricular ejection fraction and coronary flow reserve after coronary microembolization

Introduction

Although coronary microembolization (CME) is a frequent phenomenon in patients undergoing percutaneous coronary intervention, few data are available on the changes in left ventricular ejection fraction (LVEF) and coronary flow reserve (CFR) after CME.

Material and methods

In this study, six miniature swine of either sex (body weight 21-25 kg) were used to prepare a CME model. After coronary angiography, 1.2 × 10⁵ microspheres (42 µm) were selectively infused into the left anterior descending artery via an infusion catheter. Left ventricular ejection fraction was evaluated using transthoracic echocardiography; myocardial blood flow was measured using coloured microspheres; and CFR and coronary pressure were measured using Doppler and a pressure wire.

Results

Left ventricular ejection fraction was 0.77 ±0.08 at baseline, 0.69 ±0.08 at 2 h, 0.68 ±0.08 at 6 h, and 0.76 ±0.06 at 1 week (2 h vs. baseline p < 0.05; 6 h vs. baseline p < 0.01). After CME, left ventricular end systolic volume (LVESV) and end diastolic volume (LVEDV) were significant larger 1 week later (p < 0.01 for both), while CFR was significantly reduced at 6 h (1.24 ±0.10 at 6 h vs. 1.77 ±0.30 at baseline, p < 0.01) and myocardial blood flow remained unchanged. Serum ET-1 level was significantly higher only at 6 h after CME (6 h vs. baseline p < 0.05).

Conclusions

Reduction of CFR and LVEF is significant at 6 h after CME and recovers 1 week later with left ventricular dilation.     

B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial infarction

OBJECTIVE:

Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory.

METHODS:

This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed.

RESULTS:

The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 – 8.53); P = 0.002] in non-ST-elevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 – 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 – 3.04); P = 0.032].

CONCLUSIONS:

B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.     

Perfusion assessed by real-time contrast echocardiography correlates with clinical and echocardiographic parameters in patients with first STEMI treated with PCI – 6-month follow-up

Introduction

Angiographic flow in an epicardial artery does not define perfusion at a microvascular level in patients with acute myocardial infarction (AMI). The aim of the study was assessing microvascular reperfusion by myocardial contrast echocardiography (MCE) and left ventricular (LV) functional recovery by echocardiographic methods in patients treated with primary PTCA.

Material and methods

100 consecutive patients with first ST-elevation AMI with single vessel disease treated successfully with primary PCI were enrolled. Regional contrast score index (RCSI), ejection fraction (EF), wall motion score index (WMSI), and end-systolic and end-diastolic volume (ESV, EDV) were evaluated during hospitalization and at 6-month follow-up. The patients were divided into 2 groups according to the absence (Group 1) or presence (Group 2) of perfusion defects on MCE.

Results

Group 1 had lower WMSI (p = 0.0009), higher EF than Group 2 (44.7 and 55.9% respectively, p = 0.000067), and lower ESV (66.0 and 52.6 ml respectively, p = 0.003185). In Group 1 LVEF increased significantly on 6-month follow-up (p = 0.026), while in Group 2 it decreased (p = 0.0175). Both EDV and ESV were significantly lower in Group 1 (p = 0.0106 and p = 0.002882, respectively). There was a correlation between the presence of perfusion defects in the initial contrast echo and unfavourable change in ejection fraction during the follow-up (ANOVA for repeated measures, F[1.91] = 5.85, p = 0.0175). The combined clinical end-point (death and reinfarction) was significantly lower in patients without perfusion defect (p = 0.039).

Conclusions

Myocardial contrast echocardiography results correlated with clinical outcome and recovery of systolic left ventricular function at 6-month follow-up.     

B-type Natriuretic Peptide as Predictor of Heart Failure in Patients with Acute ST Elevation Myocardial Infarction,Single-vessel Disease,and Complete Revascularization: Follow-up Study

Aim

To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization.

Methods

Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (≥50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year.

Results

Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (≥80 pg/mL) at 24 hours (P = 0.001) and 7 days (P = 0.020) after STEMI and successful reperfusion. Patients who had BNP levels ≥80 pg/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P = 0.008).

Conclusion

BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.Natriuretic peptides are peptides that are released from the heart in situations of pressure and volume overload of the ventricles. There are 3 types of natriuretic peptides: atrial natriuretic peptide, B-type natriuretic peptide (BNP), and C-type natriuretic peptide. Atrial natriuretic peptide is released predominantly from the atria, BNP from the ventricles, and C-type natriuretic peptide from the endothelium (1-4). BNP is a 32-amino acid neurohormone synthesized in the form of pre-proBNP, which is first cleaved to proBNP and then to active BNP and inactive fragment NT-proBNP. Its serum levels are increased in left ventricular dysfunction, atrial fibrillation, acute myocardial ischemia (acute coronary syndromes, acute myocardial infarction), pulmonary embolism, advanced age, renal dysfunction, etc (4). The actions of BNP include natriuresis, vasodilatation, inhibition of renin-angiotensin-aldosterone axis, and inhibition of sympathetic nerve activity.In the first hours of acute myocardial infarction, BNP is released as a result of ischemia and necrosis of myocardial cells. BNP then rises as a result of systolic and diastolic dysfunction and increased wall stress of the left ventricle (5).Patients with acute ST elevation myocardial infarction (STEMI) who had higher levels of BNP have been shown to have worse prognosis (death, congestive heart failure, myocardial infarction, and no-reflow phenomenon) (5). Also, patients who died after the STEMI had significantly higher values of BNP (5).We assessed the predictive value of BNP for heart failure in patients who underwent primary percutaneous coronary intervention (PCI) for acute STEMI with single-vessel disease and the optimal timing for the measurement of BNP. We included only patients with no previous known heart failure and normal or near-normal global left ventricular systolic function at admission (LV≥50%). To our knowledge, none of the previous studies evaluated BNP as predictor of heart failure in STEMI patients with previously normal LVEF who underwent successful reperfusion.     

Prevalence of transthoracic echocardiographic abnormalities in patients with ischemic stroke,intracerebral hemorrhage,and subarachnoid hemorrhage

Introduction

This study investigated the prevalence of transthoracic echocardiographic abnormalities in patients with ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH) in sinus rhythm.

Material and methods

The patients included 120 with IS, 30 with SAH, and 41 with ICH. All diagnoses were confirmed by magnetic resonance imaging or brain computed tomography. Two-dimensional echocardiograms were taken at the time stroke was diagnosed. All echocardiograms were interpreted by an experienced echocardiographer.

Results

Of 120 IS patients, 1 (1%) had a left ventricular (LV) thrombus, 1 (1%) had mitral valve vegetations, 30 (25%) had LV hypertrophy, 26 (22%) had abnormal LV ejection fraction, 4 (3%) had mitral valve prolapse, 33 (28%) had mitral annular calcium (MAC), 40 (33%) had aortic valve calcium (AVC), 3 (3%) had a bioprosthetic aortic valve, 10 (8%) had aortic stenosis (AS), 6 (5%) had atrial septal aneurysm, 2 (2%) had patent foramen ovale, and 40 (33%) had no abnormalities. Of 30 SAH patients, 5 (17%) had LV hypertrophy, 1 (3%) had abnormal LV ejection fraction, 1 (3%) had AS, 4 (13%) had MAC, 5 (17%) had AVC, and 20 (67%) had no abnormalities. Of 41 ICH patients, 9 (22%) had LVH, 1 (2%) had abnormal LV ejection fraction, 1 (3%) had AS, 6 (15%) had MAC, 8 (20%) had AVC, and 22 (54%) had no abnormalities.

Conclusions

Transthoracic echocardiographic abnormalities are more prevalent in patients with IS than in patients with SAH or ICH.     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

Mild carbon monoxide poisoning impairs left ventricular diastolic function

Rationale:

Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure.

Objectives:

Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning.

Results:

The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function.

Conclusions:

In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.     

Outcome and predictors of cardiopulmonary resuscitation among patients admitted in Medical Intensive Care Unit in North India

Background:

Outcome and predictors of survival after cardiopulmonary resuscitation (CPR) in Intensive Care Units (ICUs) have been extensively studied in western world, but data from developing countries is sparse.

Objectives:

To study the outcome and predictors of survival after CPR in a Medical ICU (MICU) of a tertiary level teaching hospital in North India.

Materials and Methods:

A 1-year prospective cohort study.

Results:

Of 105 in-MICU CPRs, forty patients (38.1%) achieved return of spontaneous circulation (ROSC). Only one patient (0.9%) survived up to hospital discharge. The predictors of ROSC were ventricular tachycardia/ventricular fibrillation as first monitored rhythm, intubation during CPR and CPR duration ≤ 10 min. CPR duration > 10 min was a significant factor for resuscitation failure.

Conclusions:

The rate of survival to hospital discharge after in-MICU CPRs is extremely poor. Our data may aid treating physicians, resuscitation teams, and families in understanding the likely outcome of patients after in-MICU CPRs.     

Does Quantitative Left Ventricular Regional Wall Motion Change after Fibrous Tissue Resection in Endomyocardial Fibrosis?

OBJECTIVES:

We compared left ventricular regional wall motion, the global left ventricular ejection fraction, and the New York Heart Association functional class pre- and postoperatively.

INTRODUCTION:

Endomyocardial fibrosis is characterized by fibrous tissue deposition in the endomyocardium of the apex and/or inflow tract of one or both ventricles. Although left ventricular global systolic function is preserved, patients exhibit wall motion abnormalities in the apical and inferoapical regions. Fibrous tissue resection in New York Heart Association FC III and IV endomyocardial fibrosis patients has been shown to decrease morbidity and mortality.

METHODS:

We prospectively studied 30 patients (20 female, 30±10 years) before and 5±8 months after surgery. The left ventricular ejection fraction was determined using the area-length method. Regional left ventricular motion was measured by the centerline method. Five left ventricular segments were analyzed pre- and postoperatively. Abnormality was expressed in units of standard deviation from the mean motion in a normal reference population.

RESULTS:

Left ventricular wall motion in the five regions did not differ between pre- and postoperative measurements. Additionally, the left ventricular ejection fraction did not change after surgery (0.45±0.13% x 0.43±0.12% pre- and postoperatively, respectively). The New York Heart Association functional class improved to class I in 40% and class II in 43% of patients postoperatively (p<0.05).

CONCLUSIONS:

Although endomyocardial fibrosis patients have improved clinical symptoms after surgery, the global left ventricular ejection fraction and regional wall motion in these patients do not change. This finding suggests that other explanations, such as improvements in diastolic function, may be operational.     

Is plasma urotensin II concentration an indicator of myocardial damage in patients with acute coronary syndrome?

Introduction

Urotensin II (UII) is a vasoactive peptide secreted by endothelial cells. Increased plasma UII concentration was observed in patients with heart failure, liver cirrhosis, diabetic nephropathy and renal insufficiency. In patients with myocardial infarction both increased and decreased plasma UII concentrations were demonstrated. The aim of this study was to analyze whether plasma UII concentration reflects the severity of acute coronary syndrome (ACS).

Material and methods

One hundred and forty-nine consecutive patients with ACS, without age limit, were enrolled in the study. In all patients plasma concentration of creatinine, creatine kinase isoenzyme MB (CK-MB), troponin C, N-terminal prohormone of brain natriuretic peptide (NT-pro BNP), and UII were assessed, and echocardiography was performed in order to assess the degree of left ventricular hypertrophy, ejection fraction (EF) and mass (LVM).

Results

In patients with the highest risk (TIMI 5-7) plasma UII concentration was significantly lower than in those with low risk (TIMI 1-2): 2.61±1.47 ng/ml vs. 3.60±2.20 ng/ml. Significantly lower plasma UII concentration was found in patients with increased concentration of troponin C (2.60±1.52 ng/ml vs. 3.41±2.09 ng/ml). There was a significant negative correlation between plasma UII concentration and TIMI score or concentration of troponin C, but not CK-MB. Borderline correlation between plasma UII and ejection fraction (R = 0.157; p=0.063) or NT-proBNP (R = − 0.156; p=0.058) was found.

Conclusions

Decreased plasma urotensin II concentration in patients with ACS could be associated with more severe injury of myocardium.     

Effects of Intracoronary Administration of Autologous Adipose Tissue-Derived Stem Cells on Acute Myocardial Infarction in a Porcine Model

Purpose

Adipose-derived stem cells (ADSCs) are known to be potentially effective in regeneration of damaged tissue. We aimed to assess the effectiveness of intracoronary administration of ADSCs in reducing the infarction area and improving function after acute transmural myocardial infarction (MI) in a porcine model.

Materials and Methods

ADSCs were obtained from each pig''s abdominal subcutaneous fat tissue by simple liposuction. After 3 passages of 14-days culture, 2 million ADSCs were injected into the coronary artery 30 min after acute transmural MI. At baseline and 4 weeks after the ADSC injection, 99mTc methoxyisobutylisonitrile-single photon emission computed tomography (MIBI-SPECT) was performed to evaluate the left ventricular volume, left ventricular ejection fraction (LVEF; %), and perfusion defects as well as the myocardial salvage (%) and salvage index. At 4 weeks, each pig was sacrificed, and the heart was extracted and dissected. Gross and microscopic analyses with specific immunohistochemistry staining were then performed.

Results

Analysis showed improvement in the perfusion defect, but not in the LVEF in the ADSC group (n=14), compared with the control group (n=14) (perfusion defect, -13.0±10.0 vs. -2.6±12.0, p=0.019; LVEF, -8.0±15.4 vs. -15.9±14.8, p=0.181). There was a tendency of reducing left ventricular volume in ADSC group. The ADSCs identified by stromal cell-derived factor-1 (SDF-1) staining were well co-localized by von Willebrand factor and Troponin T staining.

Conclusion

Intracoronary injection of cultured ADSCs improved myocardial perfusion in this porcine acute transmural MI model.