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

Analysis of Cardiovascular Risk Factors in Patients with Coronary Heart Disease Qualified for Off-Pump Coronary Bypass

The aim. To analyze the prevalence of cardiovascular risk factors for circulatory diseases in patients with coronary heart disease (CHD) after coronary bypass surgery (off-pump coronary artery bypass grafting). Material and methods. The study included 991 subjects (786 men, 205 women), mean age 64.3 ± 1.4 years. All the study participants underwent off-pump coronary bypass surgery. Results. Based on modern ideas about risk factors for circulatory diseases and CHD, it is impossible to ignore the influence of cardiovascular factors, both modifiable and non-modifiable. The analysis of medical and social risk factors for CHD, which include age, body weight, eating habits and smoking, showed that these medical and social factors are common among patients with CHD. It was found that the prevalence of excess body weight among men with CHD was significantly higher in patients with multivessel lesions than in those with 1-vessel lesions (p=0.05, χ2=3.69). Among women with CHD, excess body weight was significantly higher in the clinical group with multivessel lesions compared to 2-vessel lesions (p=0.002, χ2=9.06). It was also found that the prevalence of excess body weight was significantly higher in clinical groups with 1-vessel lesions among men compared to women (p=0.04, χ2=3.95). It was established that the frequency of obesity was significantly more common in women of different clinical groups compared to men: with 1-vascular lesions (p=0.04, χ2=3.95); with 2-vessel lesions (p=0.0001, χ2=24); with multivessel lesions (p=0.0001, χ2=186.57). It was established that men smoke significantly more often than women (p=0.0001, χ2=31.22). The obtained results complement the scientific data of the world epidemiological studies regarding the determination of the role of medical and social factors in the development of CHD. The article analyzes excess body weight, obesity and smoking as the leading etiological factors for CHD. It was established that the risk of developing CHD is reliably associated with excess body weight, obesity and smoking, among different clinical groups of male and female patients, both with single-vessel lesions and with multivessel lesions in CHD. Conclusions. Analysis of cardiovascular risk factors for the development of CHD, which include age, body weight, eating habits, and smoking, showed that their further study is relevant, as these are common among patients with CHD. It was established that frequency of excess body weight in patients with CHD, both in men and women, was significantly higher among individuals with multivessel lesions. The prevalence of obesity among patients with CHD presented for off-pump coronary artery bypass grafting was significantly higher among women in groups with different numbers of affected coronary vessels. As for smoking, it was established that this behaviorally associated habit is significantly more common among men with CHD. The reliable patterns of prevalence of excess body weight, obesity and smoking in patients with CHD established as a result of the study of cardiovascular factors prove that these factors have high etiological contribution to the development, course and number of affected vessels in CHD

Climate, Ticks and Disease

This book brings together expert opinions from scientists to consider the evidence for climate change and its impacts on ticks and tick-borne infections. It considers what is meant by 'climate change', how effective climate models are in relation to ecosystems, and provides predictions for changes in climate at global, regional and local scales relevant for ticks and tick-borne infections. It examines changes to tick distribution and the evidence that climate change is responsible. The effect of climate on the physiology and behaviour of ticks is stressed, including potentially critical impacts on the tick microbiome. Given that the notoriety of ticks derives from pathogens they transmit, the book considers whether changes in climate affect vector capacity. Ticks transmit a remarkable range of micro- and macro-parasites many of which are pathogens of humans and domesticated animals. The intimacy between a tick-borne agent and a tick vector means that any impacts of climate on a tick vector will impact tick-borne pathogens. Most obviously, such impacts will be apparent as changes in disease incidence and prevalence. The evidence that climate change is affecting diseases caused by tick-borne pathogens is considered, along with the potential to make robust predictions of future events. This book contains: Expert opinions and predictions. Global coverage of trends in ticks and disease. In-depth examination of climate change and tick distribution links.This book is suitable for researchers and students studying zoology, biological sciences, medical entomology, animal health, veterinary medicine, epidemiology, parasitology, and climate change impacts; and for those concerned with public health planning or livestock management where ticks and tick-borne pathogens pose a threat