Diagnostic value of left ventricular myocardial deformation imaging to predict hemodynamically significant coronary artery stenoses in patients with moderate probability of coronary artery disease

[...]. Aim of the study. The aim of this study was to evaluate the diagnostic value of global and regional longitudinal, circumferential and radial LV myocardial deformation parameters derived from 2D STE to detect hemodynamically significant coronary artery stenosis in patients with moderate pre-test probability of CAD. Objectives of the study. 1. To evaluate sensitivity and specificity of LV myocardial deformation parameters derived from 2D STE to detect hemodynamically significant coronary artery stenosis in patients with moderate pretest probability of CAD, to detect cut-off values of LV myocardial deformation parameters which could let to distinquish hemodynamically significant coronary artery stenoses from non-significant CA stenoses; 2. To evaluate the diagnostic value of LV myocardial deformation parameters to detect hemodynamically significant severe and moderate CA stenoses and hemodynamically significant coronary artery stenoses in different regions; 3. To evaluate the addictive value of LV myocardial deformation parameters derived from 2D STE to detect hemodynamically significant coronary artery stenoses in patients with moderate pretest probability of CAD. [...]

Positron Emission Tomography in the Diagnosis and Management of Coronary Artery Disease

Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging

Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass

Ankylosing spondyloarthritis (AS) is a chronic inflammatory rheumatic disease, strongly related to human leukocyte antigen (HLA)-B27. Cardiac involvement in AS manifests in 2 to 10% of patients as aortic insufficiency, aortitis, mitral valve fibrosis, or disturbance in the conduction of the heart. In this article, we present a case of a 49-year-old male patient with AS, who was referred to our medical institution for elective aortic valve surgery because of severe aortic regurgitation. The histological findings revealed fibrosing endocarditis of aortic valve and nonspecific aortitis of aortic root. Late postoperatively, we observed exacerbation of AS and narrowing of the main left coronary artery (LAD). Our case highlights the importance of proper treatment of AS before and after cardiac surgery. Furthermore, in this case, we suspect association between cardiopulmonary bypass, activity of AS, and coronary artery disease

Early hemodynamics after aortic valve replacement

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with di erent types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 10.22 years; range, 37–88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), e ective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th–7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly di erent between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest

Left atrial deformation parameters for the assessment of hemodynamically significant coronary artery stenosis in patients with intermmediate pretest probability of coronary artery disease

Introduction: The role of left ventricle (LV) longitudinal deformation parameters in detecting hemodynamically significant coronary artery disease (CAD) have been shown in previuos studies. However, still little is known about the diagnostic value of longitudinal left atrial (LA) strain/strain rate parameters at rest and at peak dobutamine dose in the assessment of CAD, while their role can be substantial. Purpose: To determine the diagnostic value of left atrial (LA) longitudinal deformation parameters at rest and at peak dose of dobutamine stress echocardiography (DSE) to predict significant coronary artery stenosis in patients with intermmediate pretest probability of CAD. Methods: DSE and adenosine stress magnetic resonance imaging (AMRI) were perfomed to 61 patients with intermmediate pretest probability of CAD. CAD was defined as>70% diameter coronary artery stenosis on invasive coronary angiography or in the presence of intermediate stenosis (50-70%) validated as hemodynamically significant by AMRI. Both conventional and LA miocardial deformation parameters, such as LA peak systolic strain (LA S), peak systolic SR (LAs SR), early diastolic SR (LAe SR), late diastolic SR (LAa SR) were analysed using 2D speckle tracking echocardiography (STE) at rest and at peak dobutamine dose. Patients were divided into two groups: non-obstructive CAD (-) n=22 ( 36%) vs obstructive CAD (þ) n=39 ( 64%). Results: There were no significant differences of clinical characteristics, conventional echocardiography LV and LA parameters and longitudinal LA deformation parameters between the two groups at rest. LAe SR and LAs SR were significantly lower in patients with obstructive CAD at peak dobutamine dose (LAe SR 2,076 0,76 s-1 vs 1,686 0,63 s- 1, p=0.04; LAs SR 2,686 1,51 s-1 vs 2,056 0,98 s- 1, p=0.05). There were no significant differences between other LA deformation parameters at peak dobutamine dose. According to .[...

Impact of left ventricular function on health-related quality of life in coronary artery disease patients

Objective: The aim of the study was to investigate the relation between health-related quality of life (HRQoL) and left ventricular systolic and diastolic function parameters in stable coronary artery disease (CAD) patients with mild and moderate heart failure. Materials and methods: This study included 758 CAD patients. Left ventricular ejection fraction (LVEF) and ratio of peak velocities of early (E) and late (A) diastolic mitral inflow, ratio E/A, deceleration time, isovolumic relaxation time were assessed. Patients completed the SF-36 questionnaire. Results: There were no strong and significant associations between echocardiographic measures and HRQoL in NYHA I-II class patients. In NYHA III class in univariate linear regression analyses significant associations were found between LVEF and physical functioning (β = 0.230, P = 0.009) and role limitations due to physical problems (β = 0.230, P = 0.009) and these associations remain significant after adjustment for age, gender, hypertension, angina pectoris class, nitrate, ACE inhibitors and diuretics use. E/A ratio was significantly associated only with mental health domain (β = 0.188, P = 0.048), and this association remains significant after all adjustments. Conclusions: In stable CAD patients with NYHA I-II functional class HRQoL was not strongly associated with left ventricular function; in NYHA III functional class patients\u27 greater systolic function mainly was associated with better physical health and better diastolic function, with better mental health

Left ventricular function by speckle-tracking echocardiography in patients with low-T3 syndrome and acute myocardial infarction

Background and objective: Low-T3 syndrome is common in patients with acute myocardial infarction (AMI). Recent experimental and clinical data have suggested a potential negative impact of low-T3 syndrome on myocardial function in patients with AMI. The aim of this study was to assess left ventricular (LV) myocardial function in patients with low-T3 syndrome and to investigate the association between hormonal profile and the severity of LV dysfunction using speckle-tracking echocardiography (STE). Materials and methods: In 130 patients with first-onset ST-segment elevation acute myocardial infarction (STEMI), conventional 2D and speckle-tracking echocardiography within 48– 72 h after the hospitalization was performed, and blood samples for TSH, fT4, fT3, and anti- TPO levels were obtained to investigate thyroid hormone production within 24 h and on the fourth day after the onset of STEMI symptoms. Results: The patients were divided into two groups according to their serum level of fT3: group 1 with fT3 concentration below 3.2 pmol/L (n = 34) and group 2 with normal fT3 (>3.2 pmol/L) level (n = 96). LV ejection fraction (EF) tended to be lower in the low fT3 group. The systolic longitudinal strain did not differ between the groups, but the late diastolic longitudinal strain rate was lower in group 1 (P = 0.011). The systolic basal LV rotation positively correlated with the level of fT3 (r = 0.4; P < 0.001), while a negative correlation was detected between myocardial rotational parameters – systolic apical rotation (r = 0.2; P < 0.05), torsion (r = 0.3; P < 0.001), and diastolic apical rotation rate (r = 0.3; P < 0.01) – and fT3 levels. Conclusions: The late diastolic longitudinal LV strain rate and LV rotation evaluated by speckle-tracking echocardiography were impaired in patients with low-T3 syndrome after AMI

Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease

Background and objective: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckletracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD. Materials and methods: In 81 patients (mean age, 64 ± 8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n = 41) and pathologic (n = 40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI). Results: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters. Conclusions: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD