Prognosis of Adverse Outcomes in the Research of Coronary Blood Flow During Echocardiography

Aim. The goals of this research are to define the frequency of the coronary arteries visualization possibilities depending on various factors at routine echocardiography and estimate to the relation of coronary flow ultrasound parameters to prognosis of the adverse outcomes in the subsequent year.Material and methods. The study comprises 581 consecutive patients. All patients performed echocardiography following standard method with an additional tab called «Coronary» which was set to visualize coronary arteries. Also all patients underwent a standard examination and debriefing of anamnesis. Observation of patients was the next year after echocardiography. The end points in the study – death from any cause, myocardial infarction (MI), death/ MI, myocardial revascularization operations - stenting and aortocoronary bypass (CABG). The analysis of clinical outcomes was carried out using the study of medical history and outpatient cards, interviewing patients at the time of admission, as well as the method of telephone survey of patients or their next of kin. ROC analysis as well as subgroup survival analysis using the Kaplan-Meier method was performed.Results. The possibility to visualize the segments of coronary arteries and to estimate the coronary flow was in 91% of cases, or 526 patients. Women predominated among the patients (59.7% versus 40.3%). During follow-up, 73 patients recorded endpoints: 23 people died, 4 patients suffered non-fatal MI. 24 patients underwent CABG, 22 patients – myocardial revascularization. Depending on the quartile distribution by body mass index and age, a significant difference in visualization was not identified. Mortality was observed significantly more frequent when the flow velocity in the left coronary artery/proximal left artery descending/circumflex artery was higher than 64 cm/s. Flow velocity in left coronary artery /proximal left artery descending 64 cm/s was the cut-off value predicting MI with 100% sensitivity, 73,4% specificity (p<0.0001). Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events. Key words: coronary flow velocity, echocardiography, coronary artery, adverse events>˂0.0001).Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

NON-INVASIVE ASSESSMENT OF CORONARY BLOOD FLOW IN PATIENTS WITH 2ND TYPE DIABETES DURING EXERCISE TEST

There is absence of data in international publications, on the measurement of coronary flow in 2nd type diabetes patients (DM) during stress-echocardiography (SEchoCG) with physical exertion (PE).Aim. To study the changes of coronary flow in left anterior descending artery (LAD) during SEchoCG with PE in DM patients with and without signs of coronary heart disease (CHD).Material and methods. Totally, 125 patients included, with good visualization of coronary arteries in transthoracic approach. Main group consisted of 68 DM patients, controls were 57 persons comparable by age and gender, without diabetes and CHD signs. All patients underwent SEchoCG on horizontal veloergometer, with Doppler test of blood flow in LAD. Positive stress test patients underwent then coronary angiography.Results. Between the subgroups with DM and CHD and non-CHD, there was highly significant difference in absolute values of velocities on the peak of PE, of velocity increase during PE, and in coronary reserve (CR) in LAD. DM patients without CHD did not significantly differ by the parameters mentioned, from the controls. Threshold value that determine relation of patients to CHD or non-CHD group, was 1,7 for CR. Test precision for subgroup relevance for this level was 86,2%.Conclusion. DM non-CHD patients during PE do not differ from non-DM by the values of coronary flow. CR parameter can be used for CHD diagnostics during SEchoCG with PE in this category of patients

MODELS OF MAJOR ADVERSE CARDIAC EVENT RISK USING RESULTS OF EXERCISE STRESS ECHOCARDIOGRAPHY WITH NONINVASIVE CORONARY ARTERY FLOW ASSESSMENT IN PATIENTS WITH ISCHEMIC HEART DISEASE

Ultrasound non-invasive coronary artery imaging contributes to the diagnosis of ischemic heart disease (IHD) in clinical practice. However, data of the prognostic value obtained from a complex analysis of contractility disorders and coronary blood flow parameters during exercise tests in the world literature are still not available. Aim. To develop risk models for adverse outcomes in patients with probable or definite IHD based on the results of a stress test with a noninvasive coronary blood flow study. Material and methods. Medical data of 689 patients with probable or definite IHD who underwent stress echocardiography with satisfactory visualization of the anterior interventricular artery (AIVA) were included in the analysis. All patients had stress echocardiography on a horizontal bicycle ergometer. Registration of coronary blood flow in the middle third of the AIVA was performed at rest and at the peak of the load with calculation of the coronary reserve value. Further patient follow-up lasted 3 years. Models of further negative outcomes were developed on the basis of the stress echocardiography results and of coronary blood flow parameters. Results. Three models that take into account the factors associated with further mortality, mortality/myocardial infarction and sum of negative outcomes were developed in the study. These models divide a cohort of patients with probable or definite IHD into groups of low, medium and very high risks. Factors associated with the risk of death include: age &gt;56 years, load power &lt;100 W, breach of contractility in the blood supply zone of the circumflex artery initially and during exercise, the difference in blood flow velocities in the AIVA&lt;10 cm/s, coronary reserve of AIVA&lt;2. The risk model of death, taking into account these factors, suggests dividing patients into low-risk group if there are ≤2 factors (mortality 0.6% for 3 years), medium risk – from 2 to 4 factors (mortality 1.8%), high risk – ≥5 factors (mortality 10.3% for 3 years). Conclusion. The study of coronary blood flow during stress echocardiography in addition to the analysis of left ventricular contractility in patients with probable or definite IHD contributes to determine the prognosis of further negative outcomes

DIAGNOSIS AND PREVENTION OF CARDIOTOXICITY IN PATIENTS WITH BREAST CANCER FROM THE STANDPOINT OF AN ONCOLOGIST AND A CARDIOLOGIST

Knowledge of anthracycline antibiotics’ (AAs) pathogenesis and main risk factors allowed to develop various methods of prevention and early detection of cardiotoxicity as well as to create several guidelines on decreasing the risk of its development. Traditional AAs are a crucial option in treatment of metastatic breast cancer including their repeated prescription. However, their application is significantly limited by various manifestations of toxicity, especially cumulative cardiotoxicity. The most promising is use of pegylated liposomal pharmaceutical formulations of AAs. Among these formulations, pegylated liposomal doxorubicin almost fully lacks anthracycline cardiotoxicity because due to its unique formulation it accumulates almost exclusively in tumor tissue

Caffeine and cardiovascular diseases: critical review of current research

Caffeine is a most widely consumed physiological stimulant worldwide, which is consumed via natural sources, such as coffee and tea, and now marketed sources such as energy drinks and other dietary supplements. This wide use has led to concerns regarding the safety of caffeine and its proposed beneficial role in alertness, performance and energy expenditure and side effects in the cardiovascular system. The question remains \u201cWhich dose is safe?\u201d, as the population does not appear to adhere to the strict guidelines listed on caffeine consumption. Studies in humans and animal models yield controversial results, which can be explained by population, type and dose of caffeine and low statistical power. This review will focus on comprehensive and critical review of the current literature and provide an avenue for further study

Left atrial volume changes during exercise stress echocardiography in heart failure and hypertrophic cardiomyopathy

Objective: We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE). Methods: ESE on a bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131). The LAVI stress-rest increase ≥6.8 ml/m2 was defined as dilation. Results: LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs at stress 36 (24-54) ml/m2, P = NS and in HCM at rest 35 (26-48) vs at stress 38 (28-48) ml/m2, P = NS, whereas it decreased in HFpEF from 30 (24-40) to 29 (21-37) ml/m2 at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%), and 55 with HCM (42%) with P &lt; 0.001 for HFrEF and HCM vs HFpEF. A multivariate analysis revealed as the predictors for LAVI dilation E/e' &gt; 14 at rest with odds ratio (OR) 4.4, LVEF &lt;50% with OR 2.9, and LAVI at rest &lt;35 ml/m2 with OR 2.7. Conclusion: The LAVI assessment during ESE was highly feasible and dilation equally frequent with a treadmill or bike. LA dilation was three-fold more frequent in HCM and HFrEF and could be predicted by increased resting E/e' and impaired EF as well as smaller baseline LAVI. Keywords: E/e’ ratio; exercise stress echocardiography; left atrial volume index; left ventricular ejection fraction; mitral regurgitation

Prognostic value of stress echocardiography assessed by the ABCDE protocol

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 &lt; 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