Utility of global longitudinal strain to detect significant coronary artery disease, its extent and severity in patients with stable ischemic heart disease.

BACKGROUND: Early changes in cardiac function due to ischemia may be detected by global longitudinal peak systolic strain (GLS). Till date, no Indian data exist regarding role of GLS in stable ischemic heart disease (SIHD) and data showing correlation of GLS and SYNTAX score (SS) is meager in world literature. Our aim was to ascertain the role of GLS in SIHD. METHODS: One hundred and seventeen subjects with angina and normal transthoracic echocardiogram (TTE) underwent strain echocardiography and coronary angiography (CAG). RESULTS: There was significant correlation between GLS and SS values (R2  = .686, P < .0001). The correlation was weaker yet significant in the low SS (<22) group (R2  = .491, P < .0001) and high SS (≥22) group (R2  = .602, P < .0001). The cutoff value of GLS to detect significant CAD was -16.5 (87.6% sensitivity, 85.7% specificity, P < .0001), to predict high SS was -13.5% (sensitivity 78.3%, specificity 87.9%, P < .0001) and to predict triple vessel disease (TVD) was -14.5 (95.7% sensitivity, 73.4% specificity, P < .0001). The agreement between GLS and CAG for detection of significant CAD was substantial (κ = 0. 676, P < .0001), similar to that between territorial strain and CAG in detecting LAD disease (κ = 0.688, P < .0001) while agreement between strain imaging and CAG for detecting number of vessels diseased was moderate (κ = 0.406, P < .0001). CONCLUSION: Global longitudinal peak systolic strain must be conducted on subjects with angina and inconclusive electrocardiogram (ECG) findings to rule out significant CAD even if conventional TTE was normal. This may facilitate early diagnosis of CAD or sub-clinical left ventricular systolic dysfunction (LVSD), preventive or treatment measures, and overall cost savings.

Prevalence and real-world assessment of central aortic blood pressure in adult patients with essential hypertension uncontrolled on single anti-hypertensive agents.

OBJECTIVE: To assess the prevalence of high central aortic pressure (CAP) in Indian patients with uncontrolled essential hypertension while on anti-hypertensive monotherapy. Also, to determine correlation between brachial blood pressure (BBP) and CAP, and ascertain if it is impacted by anti-hypertensive drug class and patients' age. METHODS: In this real-world, observational, prospective study, patients (30-70 years) with uncontrolled BBP (systolic BP [SBP] ≥140 mmHg or diastolic BP [DBP] ≥90 mmHg) were enrolled. Treatment was adjusted at Visit 1 (baseline), based on BBP and at treating physicians' discretion. Primary endpoint was proportion of patients with uncontrolled central aortic SBP (>125 mmHg) at baseline. Secondary endpoints were comparison of BBP and CAP across drugs classes and age groups at baseline and Visit 2 (End-of-study, ∼8 weeks post-baseline), and proportion of patients with uncontrolled central SBP at end-of-study. RESULTS: Of 2030 patients screened, 1949 patients reported at baseline and 1740 patients completed end-of-study visit. Central SBP was >125 mmHg for 84.3% patients at baseline, and 48% patients at end-of-study. Interestingly, at end-of-study, 6.6% patients still had uncontrolled brachial SBP and controlled central SBP, while 13.6% patients had uncontrolled central SBP and controlled brachial SBP. At both visits, brachial SBP and central SBP showed positive correlation across most drug classes and age groups. At baseline, ACE inhibitors showed better efficacy than other drug classes. At end-of-study, BP control was better with fixed-dose combinations, though free-drug combinations were more frequently prescribed. CONCLUSION: Measurement of CAP along with BBP can be vital in management of hypertension. CTRI REGISTRATION NUMBER: CTRI/2015/10/006302.

Trans-catheter closure of a large aneurysm in coarctation of abdominal aorta.

•Here, we are presenting a very rare case of coarctation of abdominal aorta where a transcatheter closure by a vascular plug of the feeding collateral to a large aneurysm has been done. To the best of our knowledge, this mode of therapy has never been described in persons with coarctation of abdominal aorta.•Aneurysms in patients with an abdominal coarctation are not well recognized. This is probably the only case being reported where transcatheter closure of the feeding vessel to the aneurysm has been successfully performed.•In this case, aneurysm was closed by a vascular plug only to prevent sudden rupture and death, and no attempt was made for stenting or dilatation of the atretic segment as the segment was long and no direct connection could be noted between upper and lower segments. The incidence of coarctation of the abdominal aorta is rare and the possibility of aneurysms in coarctation of the abdominal aorta is very rare compared to coarctation of the descending thoracic aorta. Thus, this case is being reported in view of the extreme rarity of the problem.

Left ventricular diastolic dysfunction in COPD may manifest myocardial ischemia.

BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is observed frequently in advanced COPD and it appears unrelated to the co-presence of its common risk factors as hypertension, diabetes, ischemic heart disease, etc. The patho-physiology of this association is yet unclear. We postulated that ischemia not apparent in the routine clinical evaluation could be the cause of such LVDD. METHOD: Advanced COPD (GOLD III & IV) patients being excluded of concomitant presence of hypertension, diabetes, ischemic heart disease, and hypothyroidism by conventional evaluations were looked for the presence of LVDD by tissue Doppler echocardiography. The subjects having LVDD were further evaluated with 99(m)Tc MIBI stress myocardial perfusion imaging to detect the presence of ischemia. RESULTS: 7 out of 14 patients of advanced COPD sufferers without any known risk factors for LVDD had reversible perfusion defect in the stress perfusion imaging predominantly involving the inferior wall myocardium (71.43%). Most of the defects, though significant, were not picked up by stress ECG. CONCLUSION: Reversible ischemic defects are quite common (50%) in advanced COPD patients with LVDD without the presence of common risk factors. This association needs further evaluation.