Diastolic stress echocardiography and biomarkers in patients with preserved left ventricle ejection fraction and heart failure symptoms.

BACKGROUND: Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice. AIM: Our study aimed to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricular ejection fraction (LVEF) and HF symptoms. METHODS: All the consecutive patients with HF symptoms, preserved LVEF, and suspected DD were examined on transthoracic echocardiography (TTE) and DSE using the protocol according to the American Society of Echocardiography recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro-atrial natriuretic peptide (MR-proANP), and serum soluble ST2 receptor (ST2). RESULTS: The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association classification IIa - 53; IIb - 17; III - 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%), and known coronary artery disease (10%). The rest transthoracic echocardiography (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed a positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P < 0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P < 0.01), E/e' rest (AUC, 0.790; P < 0.01), and baseline NT-proBNP (AUC, 0.713; P < 0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT, or e' were not predictive of DSE results. CONCLUSIONS: DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value for diastolic dysfunction.

Aortic regurgitation and left ventricle remodeling on cardiac magnetic resonance and transthoracic echocardiography.

BACKGROUND: Transthoracic echocardiography (TTE) is the first imaging modality used to assess aortic regurgitation (AR). However, it is not possible to provide precise quantification in all patients. AIM: Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling. METHODS: A total of 51 consecutive patients with AR in TTE (New York Heart Association I/II, 55%/38%) were enrolled into the study and 49 individuals (age, 57.1 [14]; 61% males) underwent a non-contrast CMR (2 patients excluded) obtained on 1.5 T system (GE Optima MR450w). RESULTS: The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed an association with CMR parameters (AR vol: r = 0.75; P <0.001 and RF: r = 0.55; P <0.01). CMR revealed larger LV end-diastolic volumes (EDV) (185.5 [61] vs 158.4 [61] ml; P = 0.03) and a trend towards higher left ventricular ejection fraction (59% [8] vs 56% [8]; P = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; P <0.0001) compared to TTE (r = 0.6; P = 0.001). The inter-modality agreement (TTE-CMR) in AR grading was low (κ = 0.15), with highly concordant grading in mild AR (91%). CONCLUSIONS: CMR provides a comprehensive assessment of AR severity and LV remodeling with a weak or a moderate agreement with TTE.

Carotid artery stenosis and ultrasound vascular indexes predict the coronary revascularization in patients with high cardiovascular risk scheduled for coronary angiography.

BACKGROUND: Carotid artery atherosclerosis is a complex and multifactorial chronic disease. AIMS: We aimed to assess the predictive value of cardiovascular (CV) risk factors, carotid artery stenosis (CAS), and ultrasound vascular indices for coronary revascularization in patients referred for coronary angiography. METHODS: Patients scheduled for elective coronary angiography were enrolled. The following ultrasound indices were obtained: CAS, carotid intima­media thickness (IMT), extra­media thickness (EMT), intra­abdominal thickness (IAT), and the combined PATIMA index. RESULTS: The study included 322 patients (118 women, 204 men) with CV risk factors (mean [SD] number, 5.4 [1.5]) and coronary artery disease (n = 228; 71%) with equal rates of 1-, 2-, and 3-vessel disease (35%, 33%, and 32%, respectively). Indications for percutaneous or surgical coronary revascularization were reported for 158 patients (49%). Patients with and without revascularization had a similar total number of CV risk factors (mean [SD], 5.4 [1.3] vs 5.3 [1.1]; P = 0.9) and IAT (mean [SD], 74 [24] mm vs 77 [28] mm; P = 0.4). The receiver operating characteristic (ROC) curve analysis showed that baseline CAS, carotid IMT, EMT adjusted for body mass index, and PATIMA index have a similar significant predictive value for coronary revascularization (mean [SD] area under the ROC curve, 610 [31] u, 590 [31] u, 610 [32] u, and 630 [30] u, respectively). CONCLUSIONS: The severity of CAS and carotid vascular indices (IMT, EMT, and PATIMA index) may predict coronary revascularization in patients with high or very high CV risk. Clinical assessment and the presence of CV risk factors do not add predictive value in these patients.

Diabetic Patients with an Acute Myocardial Infarction in Terms of Risk Factors and Comorbidities Management: Characteristics of the Highest-Risk Individuals.

BACKGROUND: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are heterogeneous individuals with different clinical status compared to patients without DM. OBJECTIVES: The aim of this study was to analyze the group of diabetic patients with ST-segment elevation MI (STEMI) or non-ST-segment elevation infarction (NSTEMI) including risk factors, medical history, laboratory findings, advancement of coronary vessel atherosclerosis, and diagnostics and therapeutic modalities performed. A comparison of groups according to the type of MI was also made. MATERIAL AND METHODS: The study involved all (n = 130) patients with DM and AMI, hospitalized in the Department of Cardiology, Medical University of Silesia, Katowice, in 2012. Clinical presentation, medical history, laboratory tests, imaging studies and additional tests as well as treatment management data were collected. Statistical analysis of the data obtained was performed using STATISTICA® software. Coronary angiography was performed in 120 subjects (92.3%). RESULTS: NSTEMI almost doubled STEMI occurrence in the study group (65.4% vs. 34.6%). Left main disease (LMD) was more often diagnosed in the NSTEMI subgroup of patients (14.1% vs. 6.7%). There were no significant differences between the compared groups as far as clinical presentation and comorbidities are concerned; more frequent previous PCI in NSTEMI patients was noticed, however (37.7% vs. 17.8%; p = 0.0195). The STEMI subgroup was characterized by higher leukocytosis (13.2 vs. 10.0 × 103/µL; p < 0.001) and serum glucose concentration (217 vs. 182 mg%; p = 0.001); they were also treated with invasive methods more frequently (95.5% vs. 75%; p < 0.001) and the left anterior descending artery was delivered with stents more frequently (63.3% vs. 48.7%; p = 0.0426). CONCLUSIONS: Patients with DM and AMI are burdened with metabolic disorders and numerous risk factors. They require aggressive diagnostics and therapy including new revascularization techniques and optimal medical treatment. Regardless of the type of AMI (STEMI or NSTEMI), the study group was homogeneous in terms of complaints, comorbidities and metabolic profile.