Ultrasound imaging versus morphopathology in cardiovascular diseases. Myocardial cell damage

This review article summarizes the results of histopathological and clinical imaging studies to assess myocardial necrosis in humans. Different histopathological features of myocardial cell necrosis are reviewed. In addition, the present role of echocardiographic techniques in assessing irreversible myocardial damage is briefly summarized

Stress echocardiography for risk stratification of patients following percutaneous coronary intervention

Objectives: To assess the prognostic value of stress echocardiography following percutaneous coronary intervention. Materials and methods: The study group was made by 904 patients (682 men; age 64?10 years) who underwent stress echocardiography with exercise (n=66), dipyridamole (n=677) or dobutamine (n=161) after a median of 7 months from percutaneous coronary intervention. Patients were followed-up for the occurence of hard (death, infarction) and major events [death, infarction, late (>3 months) revascularization]. Results: Ischemia at stress echo was assessed in 272 (30 %) patients. During a median follow-up of 18 months, there were 182 events (43 deaths, 51 myocardial infarctions, and 88 late revascularizations). Additionally 131 patients underwent early (<3 months) revascularization and were censored. Independent predictors of hard events were ischemia at stress echo (HR=2.55; 95 % CI=1.68-3.87; p<0.0001), rest wall motion score index (HR=2.83; 95 % CI=1.66-4.82; p<0.0001), and age (HR=1.02; 95 % CI=1.00-1.04; p=0.04). 4-year hard event rate was 34 % in patients with and 10 % in those without ischemia (p<0.0001) (Figure). Independent predictors of major events were ischemia at stress echo (HR=2.82; 95 % CI=2.10-3.81; p<0.0001), diabetes (HR=1.87; 95 % CI=1.35-2.59; p<0.0001), rest wall motion score index (HR=1.93; 95 % CI=1.27-2.93; p=0.002), and antianginal therapy at the time of test (HR=1.44; 95 % CI=1.07-1.93; p=0.02). 4-year major event rate was 53 % in patients with and 21 % in those without ischemia (p<0.0001) (Figure). Conclusion: Stress echocardiography is effective for risk stratification of patients following percutaneous coronary intervention. In particular, inducible ischemia is a strong and independent predictor of both hard and major events

Stress echocardiography for the risk stratification of patients following coronary bypass surgery

Objectives: The aim of the study was to assess the prognostic value of stress echocardiography after surgical revascularization. Methods: We evaluated 500 (100 women) patients who had undergone exercise or pharmacological SE after a median of 69 months after coronary artery by-pass grafting (CABG). Of these, 351 (70%) complained of symptoms suggestive of ischemic origin while 149 (30%) were tested for asymptomatic progression of the disease. Results: SE was positive for ischemia in 196 (39%) patients. During a median follow-up of 25 months, 61 patients died, 33 had a nonfatal myocardial infarction, and 112 underwent late (N3 months) revascularization. Multivariable Cox\u27 regression analysis indicated age (HR=1.04; 95% CI 1.01-1.06; pb0.003), and peak WMSI (HR=3.07; 95% CI 1.96-4.81; p=0.0001) as independent predictors of hard (total mortality and myocardial infarction) events. SE information provided a significant improvement in predictive power of the statistical model (chi-square increase 34%, pb0.0001 for hard and 91%, pb0.0001 for major events, respectively). Survival analysis showed ischemia at SE to be associated with significantly higher hard and major event rate in both symptomatic and asymptomatic patients. Discussion: SE represents an effective tool for the risk stratification of patients with previous CABG independently of the presence of symptoms suggestive of ischemic origin

Assessment of Multivessel Coronary Artery Disease by Means of Stress‐Recovery ST/HR Index in Postinfarction Patients on Beta‐Blocker Therapy

Objective: The aim of this study was to evaluate the influence of pharmacological therapy on the assessment of coronary anatomy by means of, respectively, conventional ST depression and comparative heart-rate adjusted ST segment (ST/HR) analysis during exercise and recovery following acute Ml. Background: The withdrawal of therapy before stress testing is controversial. We previously demonstrated that a simple continuous variable (Stress-Recovery Index [SRI] defined as the difference between the areas subtended to baseline and limited by ST trend against HR during exercise and recovery) can substantially improve the post-MI identification of multivessel disease (MVD). Methods: Seventy-five patients underwent maximal exercise ECG test on and off beta-blockers with or without additional therapy, in random sequence, within 2 weeks of infarction. Coronary angiography was done within 1 month. The test was considered positive for increased risk of MVD in case of ST depression 5 mm × beats × min−1, as previously suggested. Results: Off therapy, ST depression was positive in 33 and negative in 42 patients, while SRI was positive in 35 and negative in 40; on therapy, ST depression was positive in 21 and negative in 54 patients, while SRI was positive in 44 and negative in 31. Forty-four subjects had MVD. The sensitivity and specificity of SRI were, respectively, increased and reduced by therapy, while an opposite effect was found on ST depression. SRI on therapy was more sensitive (P > 0.001) and less specific (P > 0.05) than ST depression and was the most sensitive parameter in identifying only 3-vessel. Positive ST depression and negative SRI on therapy were associated, respectively, with the highest and lowest Gensini's score. Conclusions: The SRI is superior to ST depression in identifying complex coronary anatomy in post-Ml patients, especially during beta-blockade therapy. A.N.E. 1999;4(1):60–6

Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

OBJECTIVE—Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetic patients; therefore, their risk stratification is a relevant issue. Because exercise tolerance is frequently impaired in these patients, pharmacological stress echocardiography (SE) has been suggested as a valuable alternative. Our aim was to evaluate the prognostic value of this technique in diabetic patients with known or suspected CAD. RESEARCH DESIGN AND METHODS—A total of 259 consecutive diabetic patients underwent pharmacological SE (dobutamine in 108 patients and dipyridamole in 151 patients) and follow-up for 24 ± 22 months. A comparison between the prognostic value of SE and exercise electrocardiography (ECG) was made in a subgroup of 120 subjects. RESULTS—A total of 13 cardiac deaths and 13 nonfatal infarctions occurred during follow-up, and 58 patients were revascularized. Univariate predictors of outcome were known CAD, positive SE, rest and peak wall motion score index (WMSI), and peak/rest WMSI variation. Peak WMSI was the only significant and independent prognostic indicator (odds ratio 11; 95% CI 4–29, P &lt; 0.0001) on multivariate Cox's analysis. After adjustment for the most predictive clinical and exercise ECG variables, SE provided 43% additional prognostic information (gain in X2 = 7, P &lt; 0.01). Moreover, positive SE was associated with a significantly lower event-free survival. CONCLUSIONS—SE effectively predicts cardiac events in diabetic patients with known or suspected CAD and adds additional prognostic information as compared with exercise ECG

Prognostic value of pharmacologic stress echocardiography in diabetic and nondiabetic chest pain patients with intermediate-to-high threshold positive exercise electrocardiography

Aims: To compare the prognostic value of pharmacologic stress echocardiography in diabetic and nondiabetic patients with chest pain and intermediate-to-high threshold positive exercise electrocardiography. Materials and methods: 935 chest pain patients (131 diabetics) with ST-segment depression &#8805;1 mm on exercise electrocardiography at >75 watt workload underwent dipyridamole (n=786) or dobutamine (n=149) stress echocardiography and were followed-up for the occurence of hard (death, infarction) and major events (death, infarction, late revascularization). Results: During a median follow-up of 26 months, 158 events (51 deaths, 28 myocardial infarctions, and 79 late revascularizations) occurred: 34 in diabetics and 124 in nondiabetics (see Figure). Independent predictors of hard events were age, diabetes, and ischemia at stress echo. 5-year hard event rate was 24 % in patients with and 4 % in those without ischemia (p<0.0001). Independent predictors of major events were age, diabetes, hypercholesterolemia, smoking habit, antianginal therapy at the time of testing, and ischemia at stress echo. 5-year major event rate was 46 % in patients with and 7 % in those without ischemia (p<0.0001). Conclusions: Stress echocardiography is effective in risk stratifying diabetics and nondiabetics with intermediate-to-high threshold ischemic exercise electrocardiography. However, major event rate associated with a non ischemic test is similar in diabetics and nondiabetics during the first year of follow-up, and markedly increased in the former thereafter

Stress echocardiography for risk stratification of patients following coronary bypass surgery

Objectives: To assess the prognostic value of stress echocardiography following coronary bypass surgery. Methods: We evaluated 451 patients (360 men; age 65?10 years) who underwent stress echocardiography with exercise (n=33), dipyridamole (n=319) or dobutamine (n=99) after a median of 69 months from coronary bypass surgery. Patients were followed-up for the occurence of hard (death, infarction) and major events (death, infarction, late [>3 months] revascularization). Results: Ischemia at stress echo was assessed in 185 (41%) patients. During a median follow-up of 25 months, there were 119 events (56 deaths, 17 myocardial infarctions, and 46 late revascularizations). Additionally 55 patients underwent early [<3 months] revascularization and were censored. Independent predictors of hard events were age (HR=1.06; 95% CI=1.03-1.10; p<0.0001), and peak wall motion score index (HR=3.36; 95% CI=1.85-6.11; p<0.0001). 4-year major event rate was 26% in patients with and 17% in those without ischemia (p=0.44) (Figure). Independent predictors of major events were age (HR=1.03; 95% CI=1,01-1.06; p=0.002), ischemia at stress echo (HR=1.73; 95% CI=1.20-2.49; p=0.004), and resting wall motion score index (HR=1.82; 95% CI=1.20-2.77; p=0.005). 4-year major event rate was 40% in patients with and 26% in those without ischemia (p=0.02) (Figure). Conclusion: In patients with previous coronary bypass surgery, ischemia at stress echo is a multivariable indicator of future major events. However, it is unable to predict hard events

Stress echocardiography for the risk stratification of patients following coronary bypass surgery

OBJECTIVES: The aim of the study was to assess the prognostic value of stress echocardiography after CABG. METHODS: We evaluated 500 (100 women) patients who had undergone exercise or pharmacological SE after a median of 69 months after CABG. Of these, 351 (70%) complained of symptoms suggestive of ischemic origin while 149 (30%) were tested for asymptomatic progression of the disease. RESULTS: SE was positive for ischemia in 196 (39%) patients. During a median follow-up of 25 months, 61 patients died, 33 had a nonfatal myocardial infarction, and 112 underwent late (>3 months) revascularization. Multivariable Cox\u27 regression analysis indicated age (HR=1.04; 95% CI 1.01-1.06; p<0.003), and peak WMSI (HR=3.07; 95% CI 1.96-4.81; p=0.0001) as independent predictors of hard (total mortality and myocardial infarction) events. SE information provided a significant improvement in predictive power of the statistical model (chi-square increase 34%, p<0.0001 for hard and 91%, p<0.0001 for major events, respectively). Survival analysis showed ischemia at SE to be associated with significantly higher hard and major event rate in both symptomatic and asymptomatic patients. DISCUSSION: SE represents an effective tool for the risk stratification of patients with previous CABG independently of the presence of symptoms suggestive of ischemic origin

The Green Era of Food Packaging: General Considerations and New Trends

Recently, academic research and industries have gained awareness about the economic, environmental, and social impacts of conventional plastic packaging and its disposal. This consciousness has oriented efforts towards more sustainable materials such as biopolymers, paving the way for the “green era” of food packaging. This review provides a schematic overview about polymers and blends of them, which are emerging as promising alternatives to conventional plastics. Focus was dedicated to biopolymers from renewable sources and their applications to produce sustainable, active packaging with antimicrobial and antioxidant properties. In particular, the incorporation of plant extracts, food-waste derivatives, and nano-sized materials to produce bio-based active packaging with enhanced technical performances was investigated. According to recent studies, bio-based active packaging enriched with natural-based compounds has the potential to replace petroleum-derived materials. Based on molecular composition, the natural compounds can diversely interact with the native structure of the packaging materials, modulating their barriers, optical and mechanical performances, and conferring them antioxidant and antimicrobial properties. Overall, the recent academic findings could lead to a breakthrough in the field of food packaging, opening the gates to a new generation of packaging solutions which will be sustainable, customised, and green

Complications during pharmacological stress echocardiography: a video-case series

BACKGROUND: Stress echocardiography is a cost-effective tool for the modern noninvasive diagnosis of coronary artery disease. Several physical and pharmacological stresses are used in combination with echocardiographic imaging, usually exercise, dobutamine and dipyridamole. The safety of a stress is (or should be) a major determinant in the choice of testing. Although large scale single center experiences and multicenter trial information are available for both dobutamine and dipyridamole stress echo testing, complications or side effects still can occur even in the most experienced laboratories with the most skilled operators. CASE PRESENTATION: We decided to present a case collection of severe complications during pharmacological stress echo testing, including a ventricular tachycardia, cardiogenic shock, transient ischemic attack, torsade de pointe, fatal ventricular fibrillation, and free wall rupture. CONCLUSION: We believe that, in this field, every past complication described is a future complication avoided; what happens in your lab is more true of what you read in journals; and Good Clinical Practice is not "not having complications", but to describe the complications you had