Sydämen rasituskaikukuvaus

Vertaisarvioitu.Sydämen rasituskaikukuvaus on pitkään käytössä ollut, monipuolinen sydänsairauksien tutkimusmenetelmä. Rintakipupotilaan hemodynaamisesti merkittävä, ahtauttava sepelvaltimotauti on mahdollista todeta seinämäliikehäiriönä, joka kehittyy rasituksen aiheuttaman sydänlihasiskemian seurauksena. Kaikukuvauksen avulla on mahdollista arvioida sydänlihasiskemian sijaintia ja laajuutta sekä sen yhteyttä potilaan kuormitukseen ja oireisiin. Rasituskaikukuvaus mahdollistaa sydämen rakenteen ja toiminnan monipuolisen tutkimisen, kuten vasemman kammion systolisen ja diastolisen toimintahäiriön toteamisen. Tutkimuksen käyttöaiheet ovat laajentuneet, ja sitä käytetään aiempaa enemmän muun muassa läppävikojen vaikeuden, sydänlihassairauksien ja epäselvän hengenahdistuksen selvittelyssä.Peer reviewe

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post-MI digoxin use effects on AF patient outcomes in a nationwide registry follow-up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004-2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow-up was 7.4 years. Patients using digoxin after MI had a higher cumulative all-cause mortality (77.4% vs. 72.3%; hazard ratio [HR]: 1.19; confidence interval [CI]: 1.07-1.32; p = 0.001) during a 10-year follow-up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF.Peer reviewe

ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes Recommendations for cardiovascular imaging

The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of "clinical likelihood of CAD" was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms

Early statin use and cardiovascular outcomes after myocardial infarction: A population-based case-control study

Background and aimsStatin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). However, many patients do not use statins. We studied the association of not using statin early after MI with adverse outcomes.MethodsConsecutive MI patients admitted to 20 Finnish hospitals (n = 64,401; median age 71) were retrospectively studied. Statin was not used by 17.1% within 90 days after MI discharge (exposure). Differences in baseline features, comorbidities, revascularization, and other evidence-based medications were balanced with propensity score matching, resulting in 10,051 pairs of patients with and without statin. Median follow-up was 5.9 years.ResultsPatients not using statin early after MI had higher all-cause mortality in 1-year (15.8% vs. 11.9%; HR 1.38; CI 1.30–1.46; p ConclusionsLack of statin therapy early after MI is associated with adverse outcomes across the spectrum of MI patients. Results underline the importance of timely statin use after MI.</p

Cardiac autophagic vacuolation in severe X-linked myopathy with excessive autophagy

X-linked myopathy with excessive autophagy (XMEA), caused by mutations of the VMA21 gene, is a strictly skeletal muscle disease. Extensive studies in yeast established VMA21 as the master assembly chaperone of V-ATPase, the complex multisubunit proton pump that acidifies organelles and that is vital to all mammalian tissues. As such, skeletal muscle disease exclusivity in XMEA is highly surprising. We now show that the severest VMA21 mutation, c.164-6t>g, does result in XMEA-typical pathology with autophagic vacuolar changes outside skeletal muscle, namely in the heart. However, even patients with this mutation do not exhibit clinical extramuscular disease, including cardiac disease, despite extreme skeletal muscle wasting to the extent of ventilation dependence. Uncovering the unique skeletal muscle vulnerability to defective organellar acidification, and resultant tissue-destructive excessive autophagy, will be informative to the understanding of muscle physiology. Alternatively, understanding extramuscular resistance to VMA21 mutation might disclose heretofore unknown mammalian V-ATPase assembly chaperones other than VMA21. (C) 2016 Elsevier B.V. All rights reserved.Peer reviewe

Multimodality imaging:Bird's eye view from the European Society of Cardiology Congress 2019 Paris, August 31st-September 4th, 2019

At the European Society of Cardiology (ESC) congress of this year 2019, held in Paris from August 31st to September 4th, 4509 abstracts were presented. Of those, 414 (9%) belonged to an imaging category. Experts in echocardiography (VD), nuclear imaging (AS), cardiac computed tomography (CT) (MD) and cardiovascular magnetic resonance (CMR) (CBD), have selected the abstracts in their areas of expertise that were of most interest to them and are summarized in this bird's eye view from this ESC meeting. These abstracts were integrated by one of the Editors of the Journal (JB).Cardiolog

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post-MI digoxin use effects on AF patient outcomes in a nationwide registry follow-up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004-2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow-up was 7.4 years. Patients using digoxin after MI had a higher cumulative all-cause mortality (77.4% vs. 72.3%; hazard ratio [HR]: 1.19; confidence interval [CI]: 1.07-1.32; p = 0.001) during a 10-year follow-up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF