2016 Left ventricular diastolic function guideline have better prognostic value than 2009 guideline in patients with acute coronary syndrome

BACKGROUND: Cardiovascular disease is the leading cause of death in Brazil and worldwide. In the context of diastolic dysfunction, echocardiography is the best non-invasive diagnostic method. However, the comparison of the two main guidelines for evaluate left ventricular diastolic function in acute coronary syndrome (ACS) is scarce. OBJECTIVE: To compare the prognostic value of both guidelines of American Society of Echocardiography, from 2009 and 2016, in patients with ACS. METHODS: This is a sub-analysis of a prospective cohort observational study with 109 patients admitted to the emergency with ACS. The follow up was performed within 1 year and combined outcome was cardiovascular death or new heart failure. We used the non-parametric Spearman method to assess the correlation between the categories of diastolic function according to the guideline used. The Cox model and the Log rank test with Kaplan-Meier curves were used to compare the prognostic value of categorizing patients according to the guideline used. The results were expressed as hazard ratio with a confidence interval of 95%. RESULTS: The mean age was 63 years ± 11, most male patients (73.4%) and the predominant color of patients was white (60.4%). Among the main risk factors, the most frequent for coronary artery disease was dyslipidemia (78%), followed by systemic arterial hypertension (77.1%) and sedentary lifestyle (65.9%). The study identified a mean borderline ejection fraction, a high E/E' ratio, and LV diastolic and systolic volumes presented means above normal. The most common electrocardiographic change on admission was T-wave inversion (45%), and NSTEMI was the main clinical diagnosis (74%). The categories in which there was a greater disagreement between the guidelines were grade II diastolic dysfunction and normal function. The correlation between the diagnosis of diastolic dysfunction when compared to the use of the 2009 and 2016 guidelines was weak (R = 0.56 by Spearman's method; p<0.001). By the Kaplan-Meier curves, dividing the groups into with or without LA pressure elevation, the distinction between the evolution of the two groups is significant when performed by the 2016 guideline (Log Rank = 8.17; p = 0.04). CONCLUSION: The current guideline (2016) for the assessment of left ventricular diastolic dysfunction showed a higher prognostic value of combined outcome of cardiovascular death or new heart failure within one year, when compared to the guideline of 2009 in patients.

Left atrial minimum volume is better correlate of left atrial dysfunction by two-dimensional strain

BACKGROUND: The analysis of left atrial (LA) function can add important information to the understanding of cardiovascular diseases. Therefore, to assess its functioning the use of volumetric measurements is adopted. The maximum LA volume is the most echocardiography parameter used, however, some studies demonstrated that minimum LA volume is better to correlate with atrial dysfunction. Purpose: The purpose of this study was compare the accuracy of the phasic volumes of the left atrium in determining LA dysfunction identified by the two-dimensional strain. METHODS: This observational, cross-sectional study admitted 109 participants with diagnosis of acute coronary syndrome non-ST-segment elevation. The exams were performed within 72 hours of admission. LA volume was defined by the mean of measurements performed in the four and two-chamber apical windows using Simpson's method. The phasic volumes of the left atrium were measured using an electrocardiogram synchronized with the device. Reservoir LA strain less than 21% was the cut off to LA dysfunction. RESULTS: The phasic LA volume variables analyzed were maximal (LAVMAX), minimal (LAVMIN) and before atrial contraction (LAVBAC) volume, and each variable indexed for body surface (LAVIMAX, LAVIMIN and LAVIBAC). Therefore, a Roc curve was generated for each volume variable to assess which would be more accurate in predicting left atrial dysfunction. The Youden index was used to determine the cutoff point for each one of them. The areas under the Roc curves were: 0.83 (LAVIMIN), 0.81 (LAVMIN), 0.78 (LAVBAC), 0.76 (LAVIMAX), 0.74 (LAVIBAC) and 0.71 (LAVMAX). CONCLUSION: This study concluded that phasic volumes were good determinants of left atrial dysfunction identified by 2D strain. The minimum left atrial volume was the better correlated with left atrial dysfunction.

Left atrial minimum volume is better correlate of left atrial dysfunction by two-dimensional strain

BACKGROUND: The analysis of left atrial (LA) function can add important information to the understanding of cardiovascular diseases. Therefore, to assess its functioning the use of volumetric measurements is adopted. The maximum LA volume is the most echocardiography parameter used, however some studies demonstrated that minimum LA volume is better to correlate with atrial dysfunction. PURPOSE: The purpose of this study was compare the accuracy of the phasic volumes of the left atrium in determining LA dysfunction identified by the two-dimensional strain. METHODS: This observational, cross-sectional study admitted 109 participants with diagnosis of acute coronary syndrome non-ST-segment elevation. The exams were performed within 72 hours of admission. LA volume was defined by the mean of measurements performed in the four and two-chamber apical windows using Simpson's method. The phasic volumes of the left atrium were measured using an electrocardiogram synchronized with the device. Reservoir LA strain less than 21% was the cut off to LA dysfunction. RESULTS: The phasic LA volume variables analyzed were maximal (LAVMAX), minimal (LAVMIN) and before atrial contraction (LAVBAC) volume, and each variable indexed for body surface (LAVIMAX, LAVIMIN and LAVIBAC). Therefore, a Roc curve was generated for each volume variable to assess which would be more accurate in predicting left atrial dysfunction. The Youden index was used to determine the cutoff point for each one of them. The areas under the Roc curves were: 0.83 (LAVIMIN), 0.81 (LAVMIN), 0.78 (LAVBAC), 0.76 (LAVIMAX), 0.74 (LAVIBAC) and 0.71 (LAVMAX). CONCLUSION: This study concluded that phasic volumes were good determinants of left atrial dysfunction identified by 2D strain. The minimum left atrial volume was the better correlate with left atrial dysfunction.

Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome

BACKGROUND: Left ventricular diastolic function is an important prognostic marker in acute coronary syndrome. However, classification of the dysfunction grade using isolated echocardiographic parameters remains difficult. Therefore, it is necessary to combine multiple data in diagnostic algorithms. The purpose of this study was to evaluate the capacity of left atrial strain (LAS) components to classify left ventricular diastolic dysfunction (DD) grade. METHODS: Cross-sectional speckle-tracking echocardiography. Patients were divided according to the diastolic dysfunction grade for later association with the LAS. RESULTS: The three LAS components showed moderate correlation with most diastolic variables(left atrial volume index, E/e' ratio and e' wave). In addition, there was related reduction of the LAS, which was inversely proportional to the DD grade (p < 0.05). LAS was effective for the identification of patients with DD grade III [area under the curve (AUC) for the reservoir = 0.99; conduit AUC = 0.89; contraction AUC = 0.99) and also those with DD grade II or III (reservoir AUC = 0.94; conduit AUC = 0.92; contraction AUC = 0.80]. CONCLUSIONS: LAS alone presented excellent capacity to classify DD in patients with acute coronary syndrome and may represent an additional tool for this purpose. (AU)

Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome.

BACKGROUND: Left ventricular diastolic function is an important prognostic marker in acute coronary syndrome. However, classification of the dysfunction grade using isolated echocardiographic parameters remains difficult. Therefore, it is necessary to combine multiple data in diagnostic algorithms. The purpose of this study was to evaluate the capacity of left atrial strain (LAS) components to classify left ventricular diastolic dysfunction (DD) grade. METHODS: Cross-sectional study with 109 consecutive patients admitted to the emergency room with acute coronary syndrome. Patients were referred for echocardiographic evaluation within 72 h. Mean values of LAS, corresponding to three phases of atrial function (reservoir, conduit and contraction), were obtained by speckle-tracking echocardiography. Patients were divided according to the diastolic dysfunction grade for later association with the LAS. RESULTS: The three LAS components showed moderate correlation with most diastolic variables (left atrial volume index, E/e' ratio and e' wave). In addition, there was related reduction of the LAS, which was inversely proportional to the DD grade (p < 0.05). LAS was effective for the identification of patients with DD grade III [area under the curve (AUC) for the reservoir = 0.99; conduit AUC = 0.89; contraction AUC = 0.99) and also those with DD grade II or III (reservoir AUC = 0.94; conduit AUC = 0.92; contraction AUC = 0.80]. CONCLUSIONS: LAS alone presented excellent capacity to classify DD in patients with acute coronary syndrome and may represent an additional tool for this purpose.

Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome

BACKGROUND: Left ventricular diastolic function is an important prognostic marker in acute coronary syndrome. However, classifcation of the dysfunction grade using isolated echocardiographic parameters remains difcult. Therefore, it is necessary to combine multiple data in diagnostic algorithms. The purpose of this study was to evaluate the capacity of left atrial strain (LAS) components to classify left ventricular diastolic dysfunction (DD) grade. METHODS: Cross-sectional study with 109 consecutive patients admitted to the emergency room with acute coronary syndrome. Patients were referred for echocardiographic evaluation within 72 h. Mean values of LAS, corresponding to three phases of atrial function (reservoir, conduit and contraction), were obtained by speckle-tracking echocardiography. Patients were divided according to the diastolic dysfunction grade for later association with the LAS. RESULTS: The three LAS components showed moderate correlation with most diastolic variables (left atrial volume index, E/e' ratio and e' wave). In addition, there was related reduction of the LAS, which was inversely proportional to the DD grade (p< 0.05). LAS was efective for the identifcation of patients with DD grade III [area under the curve (AUC) for the reservoir=0.99; conduit AUC=0.89; contraction AUC=0.99) and also those with DD grade II or III (reservoir AUC=0.94; conduit AUC=0.92; contraction AUC=0.80]. CONCLUSIONS: LAS alone presented excellent capacity to classify DD in patients with acute coronary syndrome and may represent an additional tool for this purpose.

Novel genes detected by transcriptional profiling from whole-blood cells in patients with early onset of acute coronary syndrome.

BACKGROUND: Genome-wide expression analysis using microarrays has been used as a research strategy to discovery new biomarkers and candidate genes for a number of diseases. We aim to find new biomarkers for the prediction of acute coronary syndrome (ACS) with a differentially expressed mRNA profiling approach using whole genomic expression analysis in a peripheral blood cell model from patients with early ACS. METHODS AND RESULTS: This study was carried out in two phases. On phase 1 a restricted clinical criteria (ACS-Ph1, n=9 and CG-Ph1, n=6) was used in order to select potential mRNA biomarkers candidates. A subsequent phase 2 study was performed using selected phase 1 markers analyzed by RT-qPCR using a larger and independent casuistic (ACS-Ph2, n=74 and CG-Ph2, n=41). A total of 549 genes were found to be differentially expressed in the first 48 h after the ACS-Ph1. Technical and biological validation further confirmed that ALOX15, AREG, BCL2A1, BCL2L1, CA1, COX7B, ECHDC3, IL18R1, IRS2, KCNE1, MMP9, MYL4 and TREML4, are differentially expressed in both phases of this study. CONCLUSIONS: Transcriptomic analysis by microarray technology demonstrated differential expression during a 48 h time course suggesting a potential use of some of these genes as biomarkers for very early stages of ACS, as well as for monitoring early cardiac ischemic recovery.

Novel genes detected by transcriptional profiling from whole-bloodcells in patients with early onset of acute coronary syndrome

Background: Genome-wide expression analysis using microarrays has been sed as a research strategy to discovery new biomarkers and candidate genes for a number of diseases. We aim to find new biomarkers for the prediction of acute coronary syndrome (ACS) with a ifferentially expressed mRNA profiling approach using whole genomic expression analysis in a peripheral blood cell model from patients with early ACS.Methods and results: This study was carried out in two phases. On phase 1 a restricted clinical criteria (ACS-Ph1, n = 9 and CG-Ph1, n = 6) was used in order to select potential mRNA biomarkers candidates. A subsequent phase 2 study was performed using selected phase 1 markers analyzed by RT-qPCR using alarger and independent casuistic (ACS-Ph2, n = 74 and CG-Ph2, n = 41). A total of 549 genes were found to be differentially expressed in the first 48 h after the ACS-Ph1. Technical and biological validation further confirmed that ALOX15, AREG, BCL2A1, BCL2L1, CA1, COX7B, ECHDC3, IL18R1, IRS2, KCNE1, MMP9, MYL4 and TREML4, are differentially expressed in both phases of this study.Conclusions: Transcriptomic analysis by microarray technology demonstrated differential expression during a 48 h time course suggesting a potential use of some of these genes as biomarkers for very early stages of ACS, as well as for monitoring early cardiac ischemic recovery.