10 research outputs found
Impact of Myocardial Viability Assessed by Delayed Enhancement Cardiovascular Magnetic Resonance on Clinical Outcomes in Real World Practice
Background: Delayed enhancement cardiovascular magnetic
resonance imaging (DeCMRI) has become the preferred method for viability assessment. It is well established that viable dysfunctional myocardium has the potential for functional recovery after revascularization.
Objective: Our objective is to evaluate whether viability assessment by DeCMRI affects clinical outcome in daily clinical practice.
Methodology:We retrospectively studied 132 consecutive patients (114 male, mean age 59 ± 10 years) with ischaemic cardiomyopathy (Mean LVEF: 29.1 ± 14%) who underwent CMRI viability testing from 1st Jan-31st Dec 2015 in our centre. Patientswere divided into 3 groups:
Group A: Viable myocardium- optimal medical therapy only (38.6%);
B: Viable myocardium- revascularization done (29.5%); and
C: Nonviable myocardium (29.5%).
Results: Mean age for groups A, B and C were 61.2, 58.3, 56.2 years respectively, p=0.048. The proportion of triple vessel disease in each of the groups were 56.1%, 54.5% and 38.5% (p=0.44); whereas left main involvement was 31.7%, 21.2% and 19.2% respectively (p=0.43). Majority of group C patients did not undergo revascularisation (90%). Group B had statistically significant EF improvement (5.5%, SD 11.9)
compared to Group A (-0.6%, SD 6.7) and Group C (-1.2%, SD 9.8), p value 0.014. Mortality at 1 year was significantly higher in Group A compared to Group Band C (31.4%, 7.7% and 12.8% respectively, p=0.009). MACE rates were also increased in Group A compared to the other two groups (41.2%, 20.5% and 27.0%, p=0.09). Odds Ratio for MACE was 3.01 (95% Cl 1.22 - 7.45) for Group A vs B and 2.8 (95% Cl 1.1 - 6.9) for Group A vs C.
Conclusion: Patients with viable myocardium who did not undergo revascularization (group A) had the worst prognosis, even when compared to those with non-viable myocardium; with significantly higher 1-year mortality. Although not statistically significant, there was also a trend towards higher MACE in these patients. These findings emphasize that patients with poor LV function but viable myocardium need to undergo revascularisation and that optimal medical therapy alone is not sufficient
Reversal of cardiac damage in patients with symptomatic severe aortic stenosis following transcatheter aortic valve implantation: An echocardiographic study
Background: Severe aortic stenosis (AS) results in cardiac damages, such as left ventricular hypertrophy, left atrial enlargement, pulmonary pressure elevation and in advanced stage, right ventricular damage. Généreux and colleagues proposed a staging classification based on these extra-valvular damages in 2017, with increasing stage representing more cardiac damage. While regression of these cardiac damages is expected following aortic valve replacement, the reversal of cardiac damage based on this staging system has not been described.
Purpose: This study aimed to describe and stage the changes in cardiac structure and function at 6 months and 1 year after transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe AS.
Methods: This was a retrospective, single center, longitudinal observational study. Echocardiographic data of patients who underwent TAVI were retrieved and analysed.
Results: From May 2018 to Feb 2021, 31 patients underwent TAVI. 5 patients were excluded due to death <6 months post-procedure (n=2) and incomplete echocardiographic data (n=3). The mean age of the remaining 26 patients was 70.9±9.4 years, 57.7% were male, and 34.6% bicuspid aortic valve. After TAVI, transvalvular aortic mean pressure gradient reduced from 45.2±14.5 mmHg to 8.0±5.4 mmHg (p<0.001), and aortic valve area increased from 0.57±0.21 cm2 to 1.75±0.68 cm2 (p<0.001). At baseline, 6-month and 1-year, the left ventricular mass index (LVMi) were 183.4±60.7g/m2, 150.8±55.3 g/m2 and 126.8±42.1 g/m2 (p<0.001) respectively; left-atrial volume index (LAVI) were 60.4±22.8 ml/m2 , 51.7±23.8ml/m2, and 48.1±23.6ml/m2 (p=0.009) respectively; left ventricular ejection fraction (LVEF) were 52.3±25.4%, 64.2±29.3%, and 62.4±12.1% (p=0.005) respectively. Based on the proposed cardiac damage staging for AS, at baseline 38% of patients were stage 1, 65.4% stage 2, 7.7% stage 3 and 23.1% stage 4. At 1 year, 8.3% were stage 0, 29.2% stage 1, 58.3% stage 2, and 4.2% stage 4. 12 patients (46%) showed improvement in cardiac damage staging, and the other 14 (54%) remained in the same stage.
Conclusion: In patients with symptomatic severe AS, there were overall significant regression in LVMi and LAVI, and improvement in LVEF at 1 year after TAVI. However, improvement in cardiac damage staging was observed in only 46% of patients
Utility of 2-Dimensional Speckle-Tracking Echocardiography to Predict Severity of Coronary Artery Disease in Patients With Non ST-Elevation Acute Coronary Syndrome and Apparent Normal Global and Segmental Systolic Function
Infective Endocarditis at A Tertiary Referral Centre in A Developing Country: Aetiology, Microbology and Risk Factors for Embolic Complications and Mortality
Left Ventricle Function Recovery After Revascularisation in Patients With Acute Myocardial Infarction (Single Vessel Disease): Comparison of 2D Strain Imaging With Standard Echocardiography
Global Longitudinal Strain Predicts Adverse Left Ventricular Remodeling After ST-segment Elevation Myocardial Infarction
Association between Clinical Parameters and CRT Response
Background: CRT is indicated for patients with severely impaired left ventricular systolic function and ventricular dyssynchrony who remain symptomatic despite optimal medical therapy. CRT is an expensive treatment with a significant non-responder rate.
Objective: To ensure appropriate use of this treatment modality, we decided to investigate whether clinical parameters can predict response to CRT in our patients.
Methods: We retrospectively reviewed all CRT patients under responder based on pre-specified ECHO and clinical criteria. An ECHO response would be: relative improvement from baseline left ventricular ejection fraction (EF) of N 15%; and a decrease in End Diastolic Volume index (EDVi) or End Systolic Volume index (ESVi) of N 15%. Clinical response was defined as an improvement of at least 1 NYHA functional class. Patients who fulfil both ECHO and clinical criteria are considered responders
our follow-up since 2014. We classified them as responder or non
The Association between CYP2C19 Genotype and Phenotype and the Impact on 1-year Outcomes Following Phenotype Guided-escalated Antiplatelet Therapy in Myocardial Infarction Patients with Drug Eluting Stents
Preliminary Results of Smartphone Electrocardiogram for Detecting Atrial Fibrillation After A Cerebral Ischemic Event: A Multi-center Randomised Controlled Trial
The Association Between N-Terminal B-Type Natriuretic Peptide and One Year Clinical Outcome in Patients with Acute Myocardial Infarction : A Multicenter Study
Background: NT-proBNP is a useful biomarker in the management of heart failure. However, there is conflicting evidence for the prognostic value of NT-ProBNP in acute myocardial infarction (AMI).
Objectives:
(1) To explore the association between NT-proBNP and 1-year
cardiac related mortality in AMI patients.
(2) To explore the association between NT-proBNP and 1-year risk of sudden cardiac death or ventricular arrhythmia, readmission for heart failure, readmission for acute coronary syndrome (ACS) and stroke.
Methods: We conducted a multicenter, prospective observational study recruiting patients presenting with AMI between 1-August2016 to 31-January-2017, involving 1 cardiology referral center and 4 non-cardiology hospitals. NT-proBNP levels (Alere Triage®, US)
were measured within 24 hours of AMI diagnosis. Patients were followed-up for 1 year