99 research outputs found
Long-term survival and predictors of mortality in Coronat)' Heart Disease
Coronruy heart disease (CHD) is by far the most important cause of death, and a
main cause of disability in the Netherlands. Accordingly, coronruy heart disease has
a great impact on society. In 1995 cardiac death occurred in about 40,000 persons
(28% of all monality) and ischemic heart disease was the reason for 170,000
hospital admissions. I Since the 1980s an inunediate benefit is achieved in patients
with acute manifestations of CHD, with pharmacologic therapy such as
thrombolytic therapy in patients with evolving myocru·dial infarction and coronary
interventions such as coronary aorto bypass graft surgery (CABG) and
percutaneous transluminal coronary angioplasty procedure (PTCA). Together with
improved secondalY prevention through diet, reduced smoking and medical
regimens such as antiplatelets, beta-blockers, ace-inhibitors and statins the life
expectancy has been improved. This resulted in an increase of patients with chronic
manifestations of CHD including heart failure and a population of survivors with a
Weekend versus weekday mortality in ST-segment elevation acute myocardial infarction patients between 1985 and 2008
Long-term (>10 years) prognostic value of dobutamine stress echocardiography in a high-risk cohort
The prognostic value of dobutamine stress echocardiography (DSE) at >10-year follow-up is unknown. The aim of this study was to assess the very long-term prognostic value of DSE in a high-risk cohort of patients with known or suspected coronary artery disease. This prospective, single-center study included 3,381 patients who underwent DSE from January 1990 to January 2003. Two-dimensional echocardiographic images were acquired at rest, during dobutamine stress, and during recovery. Follow-up events were collected and included overall mortality, cardiac death, nonfatal myocardial infarction, and revascularization. The incremental value of DSE in the prediction of selected end points was evaluated using multivariate Cox proportional hazard analysis. During a mean follow-up of 13 ± 3.2 years (range 7.3 to 20.5 years), there were 1,725 deaths (51%), of which 1,128 (33%) were attributed to cardiac causes. Patients with an abnormal DSE had a higher mortality rate (44% vs 35% at 15-year follow-up, p <0.001) than those with a normal DSE. When comparing echocardiographic variables at rest to variables at maximum dose dobutamine, the chi-square of the test improved from 842 to 870 (p <0.0001) and from 684 to 740 (p <0.0001) for all-cause mortality and cardiac death, respectively. DSE provided incremental value in predicting all-cause mortality, cardiac death, and hard cardiac events. There seems, however, to be a "warranty period" of approximately 7 years, when the survival curves of a normal and abnormal DSE no longer diverge
Impact of Early Coronary Revascularization on Long-Term Outcomes in Patients With Myocardial Ischemia on Dobutamine Stress Echocardiography
The role of early coronary revascularization in the management of stable coronary artery disease remains controversial. The aim of this study was to evaluate the impact of early coronary revascularization on long-term outcomes (>10Â years) after an ischemic dobutamine stress echocardiography (DSE) in patients with known or suspected coronary artery disease. Patients without stress-induced ischemia on DSE and those who underwent late coronary revascularization (>90Â days after DSE) were excluded. The final study cohort consisted of 905 patients. A DSE with a peak wall motion score index of 1.1 to 1.7 was considered mild
Effect of catheter-based renal denervation on left ventricular function, mass and (un)twist with two-dimensional speckle tracking echocardiography
Background: Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the effect of renal sympathetic denervation (RDN) on functional myocardial parameters, including STE, and to identify potential differences between responders and non-responders.
Methods: The study population consisted of 31 consecutive patients undergoing RDN in the context of treatment for resistant hypertension. Patients were included between December 2012 and June 2014. Transthoracic echocardiography and speckle tracking analysis was performed at baseline and at 6 months follow-up.
Results: The study population consisted of 31 patients with treatment-resistant hypertension treated with RDN (mean age 64 ± 10 years, 15 men). The total study population could be divided into responders (n = 19) and non-responders (n = 12) following RDN. RDN reduced office blood pressure by 18.9 ± 26.8/8.5 ± 13.5 mmHg (p < 0.001). A significant decrease was seen in LV posterior wall thickness (LVPWd) (0.47 ± 1.0 mm; p = 0.020), without a significant change in the LV mass index (LVMI). In the total cohort, only peak late diastolic filling velocity (A-wave velocity) decreased significantly by 5.3 ± 13.2 cm/s (p = 0.044) and peak untwisting velocity decreased significantly by 14.5 ± 28.9°/s (p = 0.025).
Conclusion: RDN reduced blood pressure and significantly improved functional myocardial parameters such as A-wave velocity and peak untwisting velocity in patients with treatment-resistant hypertension, suggesting a potential beneficial effect of RDN on myocardial mechanics
Repeat interventions as a long-term treatment strategy in the management of progressive coronary artery disease.
Objectives. This study investigates whether repeat coronary interventions, applied over an extended time period, can successfully curtail the progression of ischemic symptoms and angiographic lumen narrowing.
Background. Coronary artery disease is a chronic and generally progressive disorder, and potential treatment strategies should be examined and compared with this chronicity in mind. Percutaneous interventional revascularization procedures could theoretically be useful in controlling progression of the disease through repeated use as new coronary lesions arise. However, the outcome of this long-term management concept has not previously been subjected to detailed investigation.
Methods. From a consecutive series of 4,357 interventional cardiac procedures, 544 patients were identified who received two or more interventions during the 13-year study period. These patients were categorized into one of three groups: restenosis (repeat interventions limited to the same target segment, N = 261), new stenosis (all repeat interventions directed to stenoses not previously treated, N
Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery disease
Background: It is not entirely clear whether ischemia burden on stress single-photon emission computed tomography (SPECT) effectively identifies patients who have a long-term benefit from coronary revascularization. Methods: The study population consisted of 719 patients with ischemia on stress SPECT. Early coronary revascularization was defined as percutaneous coronary intervention or coronary artery bypass grafting ≤90 days after SPECT. Patients who underwent late revascularization (>90 days after SPECT) were excluded (n = 164). Results: Of the 538 patients (73% men, mean age 59.8 ± 11 years), 348 patients had low ischemia burden (<3 ischemic segments) and 190 patients had moderate to high ischemia burden (≥3 ischemic segments). A total of 76 patients underwent early revascularization. During a median follow-up of 12 years (range 4-17), 283 patients died of whom 125 due to cardiac causes. Early revascularization was beneficial on all-cause mortality (HR 0.46, 95% CI 0.30-0.46) and cardiac mortality (HR 0.54, 95% CI 0.29-0.99). Conclusions: Patients with myocardial ischemia on stress SPECT who underwent early revascularization had a lower all-cause mortality and cardiac mortality during long-term follow-up as compared to patients who received pharmacological therapy alone. This difference in long-term outcomes was mainly influenced by the survival benefit of early revascularization in the patients with moderate to high ischemia burden
Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT
OBJECTIVES: To compare the accuracy of dobutamine stress echocardiography
(DSE) and simultaneous 99mTc sestamibi (MIBI) single-photon emission CT
(SPECT) imaging for the diagnosis of coronary artery stenosis in women.
PATIENTS: Seventy women with limited exercise capacity referred for
evaluation of myocardial ischemia. METHODS: DSE (up to 40 microg/kg/min)
was performed in conjunction with stress MIBI SPECT. Resting MIBI images
were acquired 24 h after the stress test. Ischemia was defined as new or
worsened wall motion abnormalities confirmed by DSE and as reversible
perfusion defects confirmed by MIBI. Significant coronary artery disease
was defined as > or = 50% luminal diameter stenosis. RESULTS: DSE was
positive for ischemia in 35 of 45 patients with coronary artery stenosis
and in 2 of 25 patients without coronary artery stenosis (sensitivity =
78% CI, 68 to 88; specificity = 92% CI, 85 to 99; and accuracy = 83% CI,
74 to 92). A positive MIBI study for ischemia occurred in 29 patients with
coronary artery stenosis and in 7 patients without coronary artery
stenosis (sensitivity = 64% CI, 53 to 76; specificity = 72% CI, 61 to 83;
and accuracy = 67% CI, 56 to 78 [p < 0.05 vs DSE]). In the 59 vascular
regions with coronary artery stenosis, the regional sensitivity of DSE was
higher than MIBI (69% CI, 62 to 77 vs 51% CI, 42 to 59, p < 0.05), whereas
specificity in the 81 vascular regions without significant stenosis was
similar (89% CI, 84 to 94 vs 88% CI, 82 to 93, respectively). CONCLUSION:
DSE is a useful noninvasive method for the diagnosis of coronary artery
stenosis in women and provides a higher overall and regional diagnostic
accuracy than dobutamine MIBI SPECT in this particular population
Patients who do not complete cardiac rehabilitation have an increased risk of cardiovascular events during long-term follow-up
Background: Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. Methods: We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a ‘standard’ CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events
Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test
OBJECTIVE: Dobutamine stress testing is increasingly used for the
diagnosis and functional evaluation of coronary artery disease. However,
little is known about the safety and feasibility of this stress modality
in diabetic patients. RESEARCH DESIGN AND METHODS: We studied the impact
of diabetes on hemodynamic profile and on the safety and feasibility of
dobutamine (up to 40 microg x kg(-1) x min(-1)) and atropine (up to 1 mg)
stress echocardiography for the diagnosis of coronary artery disease in
1,446 consecutive patients (aged 60+/-12 years, 962 men) with limited
exercise capacity and suspected myocardial ischemia. Of these, 184
patients were known to have IDDM or NIDDM. The test was considered
feasible when 85% of the maximal heart rate and/or an ischemic end point
(new or worsened wall motion abnormalities, ST segment depression, or
angina) was achieved. RESULTS: No myocardial infarction or death occurred
during the test. There was no significant difference between diabetic and
nondiabetic patients with regard to heart rate increase during dobutamine
stress echocardiography (58+/-25 vs. 61+/-24 beats/min), peak rate
pressure product (18,400+/-3,135 vs. 18,048+/-4454), or the prevalence of
hypotension (systolic blood pressure drop of >40 mmHg) (7 vs. 5%),
ventricular tachycardia (5.4 vs. 4.5%), and supraventricular tachycardia
(3 vs. 4%) during the test. Dobutamine stress echocardiography was
feasible in 92% of the diabetic patients and in 90% of the nondiabetic
patients. Coronary angiography was performed in 55 diabetic and 240
nondiabetic patients. Sensitivity, specificity, and accuracy of dobutamine
stress echocardiography for the diagnosis of coronary artery disease in
diabetic patients were 81, 85, and 82%. Those in nondiabetic patients were
74, 87, and 77%, respectively (NS). CONCLUSIONS: Dobutamine stress
echocardiography is a feasible method for the diagnosis of coronary artery
disease in patients with limited exercise capacity with a comparable
safety, feasibility, and accuracy in diabetic and nondiabetic patients
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