ABSTRACT
BACKGROUND AND OBJECTIVES: Functional capacity varies significantly among patients with heart failure with reduced ejection fraction (HFrEF), and it remains unclear why functional capacity is severely compromised in some patients with HFrEF while it is preserved in others. In this study, we aimed to evaluate the role of pulmonary artery stiffness (PAS) in the functional status of patients with HFrEF. METHODS: A total of 46 heart failure (HF) patients without overt pulmonary hypertension or right HF and 52 controls were enrolled in the study. PAS was assessed on parasternal short-axis view using pulsed-wave Doppler recording of pulmonary flow one centimeter distal to the pulmonic valve annulus at a speed of 100 mm/sec. PAS was calculated according to the following formula: the ratio of maximum flow velocity shift of pulmonary flow to pulmonary acceleration time. RESULTS: PAS was significantly increased in the HFrEF group compared to the control group (10.53±2.40 vs. 7.41±1.32, p < 0.001). In sub-group analysis of patients with HFrEF, PAS was significantly associated with the functional class of the patients. HFrEF patients with poor New York Heart Association (NYHA) functional capacity had higher PAS compared those with good functional capacity. In multivariate regression analysis, NYHA class was independently correlated with PAS. CONCLUSION: PAS is associated with functional status and should be taken into consideration as an underlying pathophysiological mechanism of dyspnea in patients with HFrEF.
Subject(s)
Humans , Acceleration , Dyspnea , Heart Failure , Heart , Hypertension, Pulmonary , Pulmonary Artery , Stroke Volume , Vascular StiffnessABSTRACT
Objective: The present study was undertaken to investigate the prognostic value of the frontal planar QRS-T angle in patients without angiographically apparent coronary atherosclerosis
Subjects and Methods: Three hundred and seven patients with normal coronary arteries on coronary angiography were included. The absolute difference between the frontal QRS- and T-wave axes was defined as the frontal planar QRS-T angle, and patients were divided into 3 subgroups based on the frontal planar QRS-T angle [<45, 45-90, and >90]. Demographic, clinical, laboratory, and angiographic data were compared between groups. Based on the regression analysis results, patients were recategorized into 4 groups according to their luminal calibers of left main coronary artery [LMCA] and history of hypertension [HT] [nonhypertensive LMCA 4.13 mm, hypertensive LMCA 4.13 mm]
Results: The median value of the frontal planar QRS-T angle of all participants was 38°. Subjects with the widest frontal planar QRS-T angle were older [p = 0.027], were hypertensive [p = 0.001], and had higher corrected QT values [p = 0.001]. Patients with the widest frontal planar QRS-T angle had larger LMCA and left anterior descending coronary artery diameters compared to subjects with a normal and borderline frontal QRS-T angle [p = 0.004 and p = 0.028, respectively]. Corrected QT, HT, and LMCA diameter were found as independent predictors of the frontal planar QRS-T angle. Subjects with HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle
Conclusion: Patients with a history of HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle. Since HT-induced electrophysiological changes are still not well established and we observed that changes in the luminal caliber of coronary arteries are associated with an abnormal frontal QRS-T angle, the frontal QRS-T angle could serve as a marker of ventricular repolarization heterogeneity in hypertensive patients in addition to keeping track of arrhythmic events, even before overt disease
ABSTRACT
Objective: The purpose of this study was to assess the impact of the presence of peripheral arterial disease [PAD] on left ventricular [LV] function in patients with coronary artery disease [CAD] presenting with acute coronary syndrome [ACS]
Subjects and Methods: The medical records of the patients who were referred to Ankara Bayindir Hospital, Ankara, Turkey, due to a first episode of ACS were reviewed. Patients with concomitant PAD and CAD [group 1] were compared with those who had CAD only [group 2]. The Mann-Whitney U and chi[2] tests were used to compare continuous and categorical variables, respectively
Results: Baseline demographic data of 53 patients with PAD + CAD [42 men and 11 women; mean age 62.5 +/- 9.5 years] and a group of 60 patients with CAD only [41 men and 19 women; mean age 59.9 +/- 9.8 years] were similar, except for the serum creatinine level which was higher in group 1 than in group 2 [1.32 +/- 0.34 vs. 1.03 +/- 0.22 mg/dL, p < 0.001]. Patients with CAD + PAD had significantly higher Gensini scores [62.6 +/- 19.7 vs. 41.4 +/- 26.8, p = 0.004] and more 3-vessel disease than patients with CAD alone [62.2 vs. 31.6%, p < 0.045]. There was a significant difference between the 2 groups regarding the LV ejection fraction at the time of the diagnosis [52.0 +/- 8.2% in the CAD + PAD group and 43.7 +/- 13.3% in the CAD-alone group; p = 0.017]
Conclusion: CAD concomitant with PAD was associated with preserved LV function at early stages of diagnosis in patients with ACS
ABSTRACT
BACKGROUND AND OBJECTIVES: The study aimed to evaluate the correlation between electrocardiographic (ECG) parameters and presence and extent of coronary artery disease (CAD) to indicate the usefulness of these parameters as predictors of severity in patients with stable CAD. SUBJECTS AND METHODS: Two hundred fifty patients, without a history of any cardiovascular event were included in the study. The ECG parameters were measured manually by a cardiologist before coronary angiography. The patients were allocated into five groups: those with normal coronary arteries (Group 1), non-critical coronary lesions (Group 2), one, two and three vessel disease (Group 3, Group 4 and Group 5, respectively. RESULTS: Group 1 had the lowest P wave dispersion (PWD) and P wave (Pmax), QT interval (QTmax), QT dispersion (QTd), corrected QT dispersion (QTcd) and QT dispersion ratio (QTdR), while the patients in group 5 had the highest values of these parameters. Gensini score and QTmax, QTd, QTcmax, QTcd, QTdR, Pmax, and PWD were positively correlated. QTdR was the best ECG parameter to differentiate group 1 and 2 from groups with significant stenosis (groups 3, 4, and 5) (area under curve [AUC] 0.846). QTdR was the best ECG parameter to detect coronary arterial narrowing lesser than 50% and greater than 50%, respectively (AUC 0.858). CONCLUSION: Presence and severity of CAD can be determined by using ECG in patients with stable CAD and normal left ventricular function.
Subject(s)
Humans , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Electrocardiography , Ventricular Function, LeftABSTRACT
We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.