The impact of the left ventricular pacing polarity and localization during cardiac resynchronization therapy on depolarization and repolarization parameters.

OBJECTIVE: Reversal of myocardial activation sequence during cardiac resynchronization therapy (CRT) may increase the transmural dispersion of repolarization (TDR), which may lead to ventricular arrhythmias. Quadripolar left ventricular (LV) leads offer 10 different pacing configurations. However, little is known about the role of pacing polarity on repolarization patterns. Our study aimed to investigate the impact of LV pacing polarity on depolarization and repolarization parameters in the same substrate in the same patient group. METHODS: This study prospectively analyzed 20 patients who were consecutively admitted and underwent CRT-D implantation with quadripolar LV leads. Two bipolar pacing vectors and two unipolar vectors, also called extended bipolar pacing vectors, from the same pacing sites were selected for comparison. Electrocardiogram markers of depolarization and repolarization were measured and compared. RESULTS: Bipolar LV pacing was associated with a significantly shorter QRS duration (basal, unipolar vs. bipolar, 135.1±17.8 vs. 119.3±14.5, p<0.01; non-basal, unipolar vs. bipolar, 134.4±15.7 vs. 121.9±10.3, p<0.01) and Tp-Te value (Basal, unipolar vs. bipolar, 119.1±36.7 vs. 97.6±27.9, p<0.05; non-basal, unipolar vs. bipolar, 117.9±36.3 vs. 98.6±20.4, p<0.05) than those in unipolar pacing. LV pacing from basal and non-basal segments had no differential effect on the repolarization parameters. CONCLUSION: The LV pacing polarity significantly affects QRS duration but not repolarization patterns regardless of the pacing site in the same substrate. From the perspective of basal and non-basal segments, the LV pacing site has no differential effect on the repolarization parameters.

Evaluation of anabolic steroid induced renal damage with sonography in bodybuilders.

BACKGROUND: The aim of this study was to investigate the effect of anabolic steroids on kidneys in bodybuilders. METHODS: Twenty-two bodybuilders were included in the study. Participants were divided into three groups according to the scheme of steroid usage: group 1 (N.=8, intramuscular 500 mg testosterone enanthate, intramuscular 400 mg nandrolone decanoate and oral 40 mg methandrostenolone for 12 weeks), group 2 (N.=7, intramuscular 500 mg testosterone enanthate, intramuscular 300 mg nandrolone decanoate and intramuscular 300 mg boldenone undecylenate for 16 weeks), and group 3 (N.=7, no steroid intake). Blood urea nitrogen (BUN), creatinine (Cr), urine micro-albumin and electrolyte levels were measured. Renal volume, cortical thickness and echogenicity were obtained in ultrasonographic scans. RESULTS: Renal volume, cortical thickness, echogenicity and protein intake value were significantly higher in group 2 than group 1 and 3. Plasma levels of BUN and Cr in group 2 were significantly higher than other groups (P˂0.001). Urine microalbumin and electrolyte levels were normal in all groups. CONCLUSIONS: The results of this study indicate that high protein intake, steroid usage, particularly the schemes, including boldenone undecylenate increases cortical echogenicity, thickness of renal parenchyma and renal volume in bodybuilders.

Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy.

In the absence of left ventricular hypertrophy, importance of fragmented QRS complex (fQRS) in individuals with hypertension is unknown. The authors aimed to evaluate the relationship between blood pressure levels and fQRS in the absence of left ventricular hypertrophy. A total of 548 never-treated patients who underwent 24-hour ambulatory blood pressure monitoring were enrolled. The frequency of fQRS was significantly higher in patients with hypertension than normotension (36.4% vs 17.6%, P<.05). Multivariate logistic regression analysis revealed that systolic blood pressure is significantly associated with presence of fQRS on electrocardiography (odds ratio, 0.931; 95% CI, 0.910-0.9521 [P<.001]) even after adjusting for other confounding factors. Receiver operating characteristic analysis revealed a cutoff value of 147.65 mm Hg for systolic blood pressure to predict presence of fQRS (sensitivity: 51%, specificity: 99%, area under the curve=0.764; 95% CI, 0.717-0.811 [P<.001]). fQRS may be a sign of increased blood pressure and may predict higher fibrotic burden in patients with hypertension.

Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity.

INTRODUCTION: Fragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography. METHODS: We enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore). RESULTS: Eighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009). CONCLUSION: The presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

Left ventricular haematoma mimicking lateral wall myocardial infarction secondary to percutaneous coronary intervention.

Dissecting intra-myocardial haematoma is a rare disease and a potentially fatal complication after cardiac surgery. Patients with previous heart surgery have more risk for dissecting intra-myocardial haematoma after percutaneous coronary intervention. Management of this issue is challenging. We describe a rare case of a 63-year-old woman with a left ventricular wall-dissecting intra-myocardial haematoma, which developed 30 minutes after percutaneous coronary intervention. The patient was treated conservatively, with a successful outcome.

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography.

BACKGROUND: Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. OBJECTIVE: To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. METHODS: We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. RESULTS: Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22. CONCLUSIONS: Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography.

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography / QRS Fragmentado para Estratificação de Risco em Pacientes Submetidos à Primeira Angiografia Diagnóstica

Abstract Background: Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. Objective: To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. Methods: We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. Results: Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22. Conclusions: Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography

Resumo Fundamento: Somente uma pequena proporção dos pacientes com suspeita de doença arterial coronariana (DAC), encaminhados para realizarem angiografia coronária, tem o diagnóstico de DAC obstrutiva confirmado pelo exame. Por isso, outras estratégias de estratificação de risco são necessárias. Objetivo: Investigar a relação da presença de QRS fragmentado (QRSf) no eletrocardiograma na admissão com DAC detectada por angiografia e gravidade da DAC em pacientes sem diagnóstico de doenças vasculares, ou fibrose miocárdica, submetidos à primeira angiografia coronária de diagnóstico. Métodos: Recrutamos 336 pacientes consecutivos que se submeteram à angiografia coronária por suspeita de DAC. Os pacientes foram divididos em dois grupos de acordo com a presença ou ausência de QRSf na admissão. Nós comparamos os grupos quanto à presença e gravidade de DAC. Resultados: Setenta e nove (23,5%) pacientes apresentaram QRSf na admissão. Não houve diferença estatisticamente significativa entre pacientes com QRSf (41.8%) e sem QRSf (30,4%) (p = 0,059) quanto à presença de DAC. No entanto, houve uma diferença estatisticamente significativa entre pacientes com e sem QRSf quanto à presença de DAC (40.5% vs. 10.5%, p < 0,001) e de doença de múltiplos vasos (25,3% vs. 5,1%, p < 0,001). A frequência de QRSf foi significativamente maior em pacientes com escore SYNTAX > 22 em comparação a pacientes com escore SYNTAX ≤ 22. Conclusões: Nossos achados sugerem que o QRSf pode ser um indicador de danos iniciais no miocárdio antecedendo o aparecimento de fibrose e cicatrização, e pode ser usado para estratificação de risco em pacientes submetidos à primeira angiografia coronária de diagnóstico.

Volume Plaquetário Médio está Associado com Reperfusão Inadequada Detectada por Angiografia em Pacientes com Terapia Fibrinolítica Bem Sucedida / Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy

Fundamento: Volume plaquetário médio (VPM) elevado está associado com falha na fibrinólise e eventos adversos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). No entanto, não há dados sobre os efeitos do VPM sobre o fluxo sanguíneo coronariano anterógrado e o grau de reperfusão em pacientes com fibrinólise bem sucedida. Objetivo: O objetivo deste estudo foi investigar o papel do VMP sobre a circulação coronariana via contagem de quadros angiográficos (TFC) na trombólise no infarto do miocárdio (TIMI) após terapia fibrinolítica bem sucedida. Métodos: Entre 145 pacientes tratados com agentes fibrinolíticos, 123 (84,8%) pacientes consecutivos com fibrinólise bem sucedida, determinados por eletrocardiografia, foram incluídos. Os pacientes foram divididos em dois grupos de acordo com TFC. Um TCF > 40 foi considerado como um marcador de reperfusão inadequada, e um TCF ≤ 40 aceito como um indicador de reperfusão completa. Resultados: Após a angiografia coronária, 57 pacientes apresentaram TFC ≤ 40 e 66 pacientes apresentaram TFC > 40. O VPM foi significativamente mais alto no grupo com reperfusão inadequada (8,93 ± 0,87 fl vs. 7,92 ± 0,80 fl, p < 0,001). Um VPM elevado foi identificado como um indicador de reperfusão inadequada, e coordenadas da curva ROC indicaram um ponto de corte de 8,3 fl para VPM. Conclusão: VPM elevado na admissão em pacientes com IAMCSST tratados com terapia fibrinolítica bem sucedida associou-se com reperfusão inadequada detectada por TFC

Background: Higher Mean platelet volume (MPV) is associated with fibrinolysis failure and adverse outcomes in patients with ST elevation myocardial infarction (STEMI). However, there are no data about the effects of MPV on antegrade coronary blood flow and the degree of reperfusion in patients with successful fibrinolysis. Objective: The aim of our study was to investigate the role of MPV on coronary circulation via thrombolysis in myocardial infarction (TIMI) frame count (TFC) after successful fibrinolytic therapy. Methods: Among 145 patients treated with fibrinolytics, 123 (84.8%) consecutive patients with successful fibrinolysis determined by electrocardiography criteria were included. The patients were divided into two groups according to TFC. TFC > 40 was accepted as a marker for inadequate reperfusion and TFC ≤ 40 was accepted as an indicator of complete reperfusion. Results: After coronary angiography, 57 patients had TFC ≤ 40 and 66 patients had TFC > 40. MPV was significantly higher in the inadequate reperfusion group (8.93 ± 0.87 fl vs 7.92 ± 0.80 fl, p < 0.001). Higher MPV was found to be an indicator of inadequate reperfusion and coordinates of the ROC curve indicated a cutoff value of 8.3 fl for MPV. Conclusion: Higher MPV on admission in STEMI patients treated with successful fibrinolytic therapy was found to be associated with inadequate reperfusion detected by TFC

Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?

BACKGROUND: Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient's height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography. METHODS: The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group). RESULTS: BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1-26.6 vs 25.2 ± 1.1, 95% CI: 25.0-25.4, respectively; p = 0.007]. Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) gt; 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively) CONCLUSIONS: EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.

What is better for predilatation in bioresorbable vascular scaffold implantation: a non-compliant or a compliant balloon?

OBJECTIVE: The bioresorbable vascular scaffold system (BVS) is a fully absorbable vascular treatment system. In this study, we aimed to compare the periprocedural effectiveness and long term results of non-compliant balloon (NCB) and compliant balloon (CB) systems, which are used for predilatation before BVS implantation. METHODS: One hundred forty-six BVS-treated lesions from 119 patients were retrospectively analyzed in the study. Patients with acute coronary syndrome, stable angina and silent ischemia were included in the study. Lesions and patients were categorized into the NCB and CB groups according to the type of balloon used for predilatation. NCB was implemented on 72 lesions (59 patients) and CB was implemented on 74 lesions (60 patients). The two groups were compared on terms of procedural features and both in-hospital and 1-year clinical follow-up results. Chi-square and independent sample t test were performed for statistical analysis. RESULTS: There was no significant difference between the two groups in terms of patient characteristics and lesion properties. The number of postdilated lesions was significantly higher in the CB group. Procedure time, fluoroscopy time, and contrast volume were significantly lower in the NCB group. At follow-up, one patient had myocardial infarction in the CB group because of scaffold thrombosis and no mortality was observed. CONCLUSION: Predilatation with NCB before BVS implantation reduces the need for postdilatation. In addition, use of NCB reduces the procedure time, fluoroscopy time, and contrast volume but had no effect on 1 year clinical follow-up results compared with CB.

Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results.

OBJECTIVE: The floating wire technique is a special technique for solving interventional problems in aorta- ostial lesions. There are no long-term data in the literature for the floating wire technique in right aorto-ostial lesions. METHODS: One hundred twenty six patients were retrospectively analyzed in this study. All of these patients had a critical right coronary aorto-ostial lesion. The floating wire technique was performed on 64 patients, and the single wire technique was performed on 62 patients. The two groups were compared with each other in terms of lesional and procedural properties. Additionally, 1-year clinical follow-up results were compared between the two groups. RESULTS: There was no significant difference in terms of lesion properties between the groups. In the floating wire group, mean stent length, number of stents, mean procedure time, mean contrast volume, and mean fluoroscopy time were significantly lower than in the single wire group. At 1 year, 1 patient from each group had myocardial infarction, and no mortality was observed. In the floating wire group, the number of patients who experienced angina and the target lesion revascularization rate were both significantly lower than in the single wire group. CONCLUSION: The floating wire technique in right coronary ostial lesions provides a significant advantage over the single wire technique according to procedural and clinical follow-up results.

Multiple coronary fistulae to left ventricle, with acute myocardial infarction.

A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect.

Evaluation of systemic levels of neutrophilic enzymes in patients with hypertension and chronic periodontitis.

BACKGROUND: Inflammation stimulates neutrophils to release their enzymes into the extracellular matrix. The aim of the present study is to investigate the serum levels of matrix metalloproteinase (MMP)-8, MMP-9, tissue inhibitor of MMP (TIMP)-1, myeloperoxidase (MPO), and neutrophil elastase (NE) in patients with hypertension and chronic periodontitis (CP). METHODS: A total of 95 patients were included in the study. Patients were categorized into three groups: healthy control (n = 29), hypertensive control (n = 32), and hypertensive CP (n = 34). Periodontal parameters were recorded, and serum samples were collected from each participant. Serum MMP-8, MMP-9, TIMP-1, MPO, and NE levels in circulation were assessed by enzyme-linked immunosorbent assay. RESULTS: The hypertensive CP group had significantly higher serum MMP-8, MMP-9, and NE levels than the healthy control group (P <0.05). All study groups had similar serum TIMP-1 levels (P >0.05). Significantly higher serum MPO levels were detected in patients with hypertension and CP than healthy controls and hypertensive controls (P <0.05); however, the difference in serum MPO levels was not significant between the healthy controls and hypertensive controls (P >0.05). There was no significant difference in MMP-8/TIMP-1 ratio among the study groups (P >0.05). MMP-9/TIMP-1 ratio was significantly higher in patients with hypertension and CP than healthy controls (P <0.05). CONCLUSIONS: The presence of hypertension along with CP has a considerable effect on serum neutrophilic enzyme levels, except TIMP-1. However, the levels of these enzymes do not seem to be affected by the presence of hypertension only. Further studies including patients who have only CP might help illuminate the effect of CP on these enzymes in patients with hypertension.

Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery.

PATIENT: Male, 73 FINAL DIAGNOSIS: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath MEDICATION: - Clinical Procedure: CABG Specialty: Cardiology. OBJECTIVE: Management of emergency care. BACKGROUND: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. CASE REPORT: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. CONCLUSIONS: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.

Serum γ-glutamyltransferase activity in patients with nonvalvular atrial fibrillation.

Procoagulant and prothrombotic states in patients with chronic atrial fibrillation (AF) are higher than those in patients with normal sinus rhythm. We assessed and compared serum γ-glutamyltranferase (GGT) activity in elderly patients with nonvalvular AF and control participants with normal sinus rhythm. Consecutive patients (n = 81) with nonvalvular chronic AF and 210 age- and gender-matched control participants with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Presence of coronary artery disease, hypertension, gender, hyperlipidemia, diabetes mellitus, smoking status, glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ejection fraction were comparable between the 2 groups (P > .05 for all). However, serum γ-GGT activity was significantly higher (P = .003) in patients with AF compared with those without AF. We have shown that serum γ-GGT activity is independently associated with chronic nonvalvular AF.

Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease.

BACKGROUND: Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD. METHODS: 168 patients (102 men, 66 women, mean age 66.3 ± 9.9 years) with stable angina and multivessel disease (MVD) were included in the study. According to the LV ejection fraction (LVEF) in echocardiography, patients were divided into two groups, the preserved group (LVEF > 50%), and the impaired group (LVEF < 50%). The preserved group consisted of 94 patients and the impaired group consisted of 74 patients. Emotional status was evaluated using the Hamilton Depression (HAM-D), Hamilton Anxiety (HAM-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. RESULTS: The prevalence of diabetes mellitus (DM) was significantly higher in the impaired group than in the preserved group (29.8% vs 56.8%, p < 0.01). The HAM-D, HAM-A, BAI and BDI scores were higher in the impaired group compared to the preserved group (HAM-D: 12.1 ± 3.3 vs 14.5 ± 2.3, p = 0.03; HAM-A: 12.7 ± 3.4 vs 14.3 ± 2.2, p = 0.01; BAI: 18.6 ± ± 6.4 vs 22.1 ± 6.6, p = 0.01 and BDI: 13.9 ± 2.5 vs 17.2 ± 2.0, p = 0.002, respectively). In multivariate analysis, BDI scores (odds ratio [OR]: 2.197, < 95% confidence interval [CI] 1.101-4.387; p = 0.026), HAM-A scores (OR: 1.912, < 95% Cl 1.092-2.974; p = 0.041) and DM (OR: 2.610, < 95% Cl 1.313-5.183; p = 0.006) were important risk factors for LV dysfunction in stable patients with MVD. CONCLUSIONS: This study demonstrated that emotional status and DM are factors associated with impaired LV systolic function in patients with stable CAD.