929-63 Dobutamine Stress Cine Magnetic Resonance Imaging versus PET for Detection of Myocardial Viability

To identify viable myocardium before coronary revascularization, we prospectively submitted eleven patients (60±7 yrs; 11 M) with previous Q-wave myocardial infarction to 18FDG-Positon Emission Tomography and low-dose (5 to 10 μg/kg/min) dobutamine cine-MRI. 18FDG uptake > 60% was considered indicative of viable tissue. Ouantitation of systolic wall thickening/thinning (SW) was performed by use of a computer software allowing automatic detection of epicardial and endocardial outlines, at rest and under 5, 7.5 and 10 μg/kg/min of dobutamine. Heart slices of both 18FDG-PET scans and dobutamine cine-MRI were divided in 8 segments, matched and analyzed byobservers blinded to clinical data. Sixty-five segments were considered viable by 18FDG-PET; in this subgroup, rest SW thickening averaged 47±5% and improved by 43±8% under low-dose dobutamine. In the remaining 23 segments considered non viable by PET. rest SW thickening averaged 14±7%*(*p<0.05 vs viable segment group) and further worsened by –13±8%*during low-dose dobutamine stress (*p<0.05 versus viable segment group). Positive predictive value of low-dose dobutamine stress cine-MRI for assessment of myocardial viability was 84%. These data suggest that quantitative assessment of regional wall motion by dobutamine cine-MRI may help discriminate viable from non viable myocardium as defined by 18FDG-Positon Emission Tomography

Value of resting myocardial deformation assessment by two dimensional speckle tracking echocardiography to predict the presence, extent and localization of coronary artery affection in patients with suspected stable coronary artery disease

Background: Myocardial deformation assessed by two dimensional speckle tracking echocardiography (2D-STE) allows accurate evaluation of regional and global left ventricular (LV) function and is sensitive to detect abnormalities induced by ischemia. Aim: To examine the value of LV strain (S) and strain rate (SR) assessed by STE to detect the presence, and extent of coronary artery affection in patients with suspected stable coronary artery disease (SCAD). Methods: 81 patients with suspected SCAD and normal resting echocardiography were subjected to 2D-STE and coronary angiography. The peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and PS global radial strain (GRS)/strain rate (GRSR) were calculated as the average of S/SR of the 18 LV segments of the 3 apical views. The PS mid circumferential strain (MCS)/strain rate (MCSR) was calculated as the average of S/SR of the 6 LV segments of the mid LV cavity short axis view. Results: 20 patients (24.7%) represented the normal coronaries group (NCG), and 27 patients (33.3%) with one/two vessel-CAD represented the low risk group (LRG) while 34 patients (42%) with three vessel/left main-CAD represented the high risk group (HRG). GLS, GLSR, GRS, GRSR, MCS and MCSR were significantly lower in patients with significant CAD compared to NCG (all p = 0.000). GLS, GLSR, GRSR, MCS and MCSR were significantly lower in HRG compared to LRG (p = 0.030, p = 0.009, p = 0.000, p = 0.000, and p = 0.004 respectively). Conclusion: Myocardial deformation analysis by STE is not only useful to diagnose CAD, but also predicts the extent of CAD affection in patients with suspected SCAD

Assessment of left ventricular function in young type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: Relation to duration and control of diabetes

Background: The effect of type 1 diabetes mellitus (T1DM) on myocardial function is still controversial. Aim: To examine the usefulness of speckle tracking echocardiography (STE) in detecting subclinical left ventricular (LV) dysfunction in asymptomatic T1DM patients and detect whether any LV abnormalities are related to duration or control of DM. Methods: Sixty young T1DM patients and 30 controls were subjected to conventional echocardiography and STE. The left ventricular (LV) peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and diastolic global strain rate during the isovolumic relaxation period (GSRivr), early diastole (GSRe) and late diastole (GSRa) were calculated as the average of the 12 myocardial segments of the four and two-chamber views while the mid circumferential strain (MCS) was calculated as the average of strains of the 6 LV segments of the mid LV cavity. Results: In diabetic patients, the LV end diastolic dimension (LVEDD) was significantly lower (p = 0.000) while the LV myocardial performance index (LVMPI) and E/lateral E′ ratio were significantly higher (p = 0.000 and p = 0.02 respectively) compared to controls. By STE, only the GLS was significantly lower in diabetic patients compared to controls (p = 0.000). A significant negative correlation was detected between LDL-C and GLS (r = −0.4; p = 0.002). Multivariate logistic regression analysis identified HbA1c as the only independent predictor of GLS in patients (beta = −0.34, 95% CI: −0.67 to −0.19; p = 0.001). Conclusion: STE is useful to detect subclinical LV dysfunction in asymptomatic patients with T1DM. Control of DM but not duration of disease was an independent predictor of LV systolic dysfunction

Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

AbstractIntroductionHigh quality cardiopulmonary resuscitation (CPR) performed according to international guidelines has a vital impact on survival of cardiac arrest.ObjectiveTo investigate different variables affecting return of spontaneous circulation (ROSC) and survival to discharge (STD) after in-hospital cardiac arrest (IHCA) and evaluate adherence to CPR guidelines using a modified Utstein-style template.MethodsA prospective observational study of 126 IHCA out of 5479 admissions to cardiology units of 3 Cairo University hospitals.ResultsCPR was not attempted in 7 futile cases. ROSC was achieved in 50.4%, while STD was achieved in only 7.6% of 119 attempted resuscitations. CPR was started by a physician in 114 cases (95.8%) and by the on duty nurse in only 5 cases. The initial rhythm was shockable rhythm (SR) in 19 cases; 13 (68.4%) of whom achieved ROSC and 6 (31.6%) STD and non SR (pulseless electric activity/asystole) in 100 cases; 47 (47%) of whom achieved ROSC and 3 (3%) STD. Chest compressions were observed appropriate ⩾100/min, ⩾2 inches deep and interrupted <10s in 99.2%, 92.4% and 48.7% of cases respectively. Initial SR and duration of CPR were independently associated with ROSC (both P=0.01) and STD (P=0.008 and 0.02 respectively). A cut-off value for CPR duration of 22.5min had a sensitivity of 86.7% and a specificity of 81.4% in predicting ROSC by receiver-operator characteristics analysis.ConclusionThe poor STD despite a relatively good ROSC calls for improvement of CPR education and training for hospital personnel and better post CA care

Impact of waist circumference on hospital outcome and coronary angiographic findings of patients with acute ST-segment elevation myocardial infarction

Background: Several studies showed that ST-segment elevation myocardial infarction (STEMI) patients with high body mass index (BMI) have better in-hospital outcomes. Aim: This study examined the impact of waist circumference (WC) on the hospital outcome and coronary angiographic extent of STEMI patients. Methods: We evaluated 142 consecutive patients with STEMI. Patients were classified into 2 groups according to WC. Group A (n = 72) had increased WC (WC > 88/102 cm for women/men). Group B (n = 70) had normal WC. A primary composite outcome of in-hospital mortality and cardiovascular complications namely heart failure, cardiogenic shock, serious arrhythmias, re-infarction, post infarction angina, a secondary outcome of in-hospital mortality and coronary angiographic findings were compared between the 2 groups. Results: Group A patients were significantly older, had a significantly higher prevalence of hypertension (HTN), diabetes mellitus (DM) and were significantly less likely to be smokers compared to group B. There was no statistically significant difference in the primary outcome between the 2 groups. WC as a categorical or as a continuous variable did not have any significant influence on the secondary outcome of in-hospital mortality even after adjustment for other predictors of death. Age was the only statistically significant predictor for mortality (p = 0.01). Coronary angiography revealed no statistically significant difference in the number of diseased coronary vessels, number of coronary lesions or Gensini score between the 2 groups. Conclusion: A high WC, had no favorable impact on in-hospital mortality, cardiovascular complications or coronary angiographic extent in STEMI patients

Feasibility of percutaneous closure of atrial septal defects in adults under transthoracic echocardiography guidance using the Figulla atrial septal defect occluder device

Background: Closure of atrial septal defect (ASD) among adults under transthoracic echocardiography (TTE) guidance using devices other than the Amplatzer Septal Occluder has not been extensively tested. Aim of work: Assessment of the safety and efficiency of secundum ASD closure using the Occlutech Figulla ASD Occluder under TTE guidance in adult patients with hemodynamically significant secundum ASD. Methods: Twenty patients (mean age, 32.9 ± 9.7, 75% of them females) were enrolled in the study. All patients underwent TTE and transoesophageal echocardiography (TEE) to assess the characteristics of the ASD prior to percutaneous closure. Procedures were performed using the Figulla Occluder device under both fluoroscopic and TTE guidance. Follow-up clinical and TTE examinations were done at 1, 3, and 6 months following the procedure. Results: TTE estimated mean ASD size was 21.7 ± 7.3 mm with adequate rims except for the aortic rim (deficient in one third of cases). Mean device size was 28.1 ± 8.6 mm with mean procedure and fluoroscopic times of 46.2 ± 16.4 and 15.7 ± 5.4 minutes respectively. ASD was successfully closed in all patients. Two patients showed a small residual shunt immediately after the device placement that disappeared by the end of the 2nd followup TTE examination. Transient complications were detected in 2 patients. All patients were asymptomatic during the follow-up period. Conclusion: Transcatheter closure of secundum ASD in adults under TTE guidance using the Occlutech Figulla ASD occluder device is safe and effective when performed in a tertiary center and by expert echocardiographers and interventional cardiologists