Speckle tracking dobutamine stress echocardiography diagnostic accuracy in primary coronary arteries disease diagnosi

The aim of the work was to evaluate STE feasibility as DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-tohigh coronary arteries disease (CAD) risk. Materials and methods: We prospectively examined 140 pts (84 (60.0%) men) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve. Results: Mean LV EF was 54.4±15.8%. All pts had normal BP and HR during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE – 15 (12.9%) cases of different relatively low-grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) pts with negative DSE results CAG revealed 1-vessel insignificant (50 – 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) pts underwent revascularization interventions – 86 (89.6%) PCI’s and (10.4%) CABG surgeries. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive value and very high method overall accuracy (AUC = 0.98) and OR = 627.0 (p<0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2% (р=0.0002) and specificity 80.4% (р=0.0064) with significantly lower integral method accuracy (AUC 0.83, р<0.0001). Conclusions: DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and myocardial viability and coronary reserve evaluation in the pts with CAD suspicion. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant amount of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value

Postoperative cerebrovascular complications in high-risk patients with coronary artery disease in cardiac surgery

Aim: to analyze the frequency and specificity of cerebrovascular complications in patients with coronary artery disease (CAD) after cardiac surgery. Materials and methods: a retrospective analysis of data of 354 randomly selected patients with CAD who were operated on and discharged from the Amosov National Institute of Cardiovascular Surgery, Ukraine from 2009 to 2019. The average age of the patients was 61.9±9.6 years old. In preoperative risk stratification according to the EuroSCORE II scale, patients were classified as high cardiac risk, the predictive risk of death was on average 8.8%. All patients underwent general clinical examinations, ECG, ECHO, coronary angiography and surgical treatment of CAD. Duplex scanningf the brachiocephalic arteries (BCA) was performed in 280 (79.09%) patients. Results: 43 (12.1%) patients had a history of stroke. Among 280 patients who underwent ultrasound examination of BCA, stenosis more than 50% of the internal carotid arteries was diagnosed in 95 (33.9%) cases. For hemodynamically significant (> 70%) BCA stenoses, hemodynamic stability and coronary artery lesions that didn’t require emergency surgery, a neurosurgeon’s consultation is required. The predictive risk of postoperative stroke on the STS scale in average was 1.48±0.98% [range 0.2–6.8%]. In the postoperative period, in 10 (2.8%) patients non-fatal cerebrovascular accidents were developed, among which 5 (1.4%) had an ischemic stroke, and 5 (1.4%) had a transient ischemic attack. The risk of neurological complications in the perioperative period increases in patients with a history of stroke (р = 0,0002), preoperative atrial fibrillation (р = 0,013), aortic calcification (р = 0,003) and more significant decrease of blood pressure on the 1st postoperative day (systolic pressure p = 0.005, diastolic pressure p = 0.0008). Conclusions: strict monitoring of blood pressure and prevention of hypotension are required at all stages of patients management. The cardiac surgeon, whenever possible, limits manipulations on the atheromatous aorta, using the no-touch aorta technique, by performing total arterial revascularization. The work of a multidisciplinary team helps to avoid life-threatening events

Alirocumab and cardiovascular outcomes after acute coronary syndrome

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Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN