Impact of the adjunctive use criteria for intravascular ultrasound-guided percutaneous coronary intervention and clinical outcomes.

The impact of the adherence to the adjunctive use criteria (AUC) for intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) and clinical outcomes in low IVUS volume countries are limited. The current study compared the procedural success and complication rates between used and not used IVUS catheter in the patients who were met (C +) and were not met (C-) the AUC for IVUS-guided PCI. From June 2018 through June 2019, a total of 21,066 patients were included in the Thai PCI registry. Among the study population, 15,966 patients (75.8%) have met the IVUS-AUC. The IVUS-guided PCI rates were 14.5% and 11.3% in the C + and C - groups, respectively. After adjusting for covariables by propensity model, IVUS-guided PCI was identified as an independent predictor of the procedural success rate regardless of whether the AUC were met with the relative risk [RR (95% confidence interval (CI)] of 1.033(1.026-1.040) and 1.012(1.002-1.021) in C + and C- groups, respectively. IVUS-guided PCI increased the procedural complication risks in both groups but were not significant with corresponding RRs of 1.171(0.915-1.426) and 1.693(0.959-2.426). Procedural success was achieved with IVUS-guided PCI regardless of whether the AUC were met. IVUS-guided PCI did not lead to an increase in procedural complications.

Impact of manual thrombectomy on microvascular obstruction in STEMI patients.

OBJECTIVE: To assess the effect of manual thrombectomy (MT) on microvascular obstruction (MVO) using cardiac magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Three hundred and eighty-three patients admitted for STEMI and undergoing CMR fulfilled the inclusion criteria and were categorized into two groups (did or did not undergo MT). The two primary endpoints were the occurrence and extent of MVO, analyzed as a categorical variable and as a semicontinuous variable. Among the 383 patients, 49.1% exhibited MVO. Both the incidence of MVO and the median number of segments presenting with MVO were significantly higher in the MT group than in the no-MT group, (59.5 vs. 38.9%, p < .001) and (1.5 [0;4] vs. 0 [0;2], p < .001). Analysis stratified on coronary thrombus grade showed similar results, only in patients with a high thrombus burden (60.7 vs. 43.5%, p = .004, and 2 [0;4] vs. 0 [0;3], p = .001. When adjusting for baseline differences, MT remained a determinant of MVO occurrence and extent (odds ratio, OR 1.802 [95% confidence interval, CI 1.080-3.009], p = .024) and ß = .137, p = .024) in patients with a high thrombus grade. CONCLUSION: In STEMI patients, MT was associated with the occurrence and extent of MVO, on CMR, especially in patients with a high thrombus burden.

Electrocardiographic predictors of cardiovascular events in patients at high cardiovascular risk: a multicenter study.

BACKGROUND: There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. METHODS: Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. RESULTS: A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS) (21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD) (7.3%), left ventricular hypertrophy (LVH) (12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. CONCLUSIONS: A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.

Accuracy of ECG criteria for the diagnosis of left ventricular hypertrophy: a comparison with magnetic resonance imaging.

BACKGROUND: There are many ECG criteria for the diagnosis of left ventricular hypertrophy (LVH). There are, however limited data on the accuracy of these criteria in comparison with cardiac magnetic resonance (CMR). OBJECTIVE: To determine the accuracy of ECG criteria for the diagnosis of LVH using CMR as the gold standard and to assess gender-specific data. MATERIAL AND METHOD: Patients who were referred for CMR for clinical purposes were studied. ECG and CMR were performed on the same day. Functional CMR protocol was performed for the assessment of cardiac volume, function and mass. CMR variables were indexed by the adjustment of body surface area. The following ECG criteria were used: Romhilt-Estes criteria (score at least 4 or 5 points were used in the present study), Sokolow-Lyon and Sokolow-Lyon-Rappaport, Cornell voltage and Cornell product, and sum of QRS voltage of all 12 leads. CMR of 184 subjects (120females, 64 males) free of cardiovascular disease was used as controls. Patients with left ventricular mass index above 95 percentile of gender specific left ventricular mass in control group were considered LVH. Diagnostic yield of ECG criteria for LVH was calculated for the whole group and each gender RESULTS: There were a total of 1,882 patients, 994 males and 888 females. Average age was 64.6 +/- 11.3 years. LVH was diagnosed by CMR in 23.3% in female and 25.4% in male. ECG criteria for the diagnosis of LVH had a relatively low sensitivity (0.25-0.61), and high specificity (0.75-0.95). Female had a lower sensitivity, higher specificity, higher PPV similar NPV and higher overall accuracy than male. Cornell product, Romhilt-Estes (at least 4 points) and Sokolow-Lyon were the ECG criteria with the best accuracy, sensitivity and specificity, respectively. CONCLUSION: ECG criteria for the diagnosis of LVH had a relatively low sensitivity, and high specificity. The accuracy was in the range of 0.71-0.80. Cornell product had the highest accuracy.

Correlation between aortic stiffness and visceral fat determined by magnetic resonance imaging.

BACKGROUND AND OBJECTIVE: Arterial stiffening is an independent predictor for cardiovascular events. Studies using a variety of different techniques have shown that visceral fat accumulation may be related to aortic stiffening. However, there are limited data available about the study using magnetic resonance imaging (MRI). The aim of the present study is to assess the correlation of visceral fat to the degree of aortic stiffness as determined by MRI. MATERIAL AND METHOD: The present study examined 95 subjects (age 69.14 +/- 9. 76 years, female 50.5%, waist circumference 93 +/- 11 cm) who underwent cardiac MRI examination. Using MRI, aortic stiffness was measured as aortic pulse wave velocity (PWV) by distance divided by time delay between mid-ascending and mid-descending aorta. Body fat measures were evaluated as abdominal visceral fat volume (visceral fat), pericardial fat volume (visceral fat) and abdominal subcutaneous fat volume (subcutaneous fat). Pearson correlation analysis was performed to determine the correlation between aortic stiffness and each measure of the body fat. RESULTS: Mean PWV 11.41 +/- 5.30 m/s, pericardial fat 17.37 +/- 4.60 ml, abdominal visceral fat 470.85 +/- 181.12 ml and abdominal subcutaneous fat 617.57 +/- 214.70 ml. No correlation was found between PWV and each measure of body fat as follows; (1) pericardial fat volume to PWV (r = -0.025, p-value = 0.808), (2) abdominal visceral fat volume to PWV (r = 0.068, p-value = 0.520), (3) abdominal subcutaneous fat volume to PWV (r = -0.001, p-value = 0.992), (4) total abdominal fat volume to PWV (r = 0.038, p-value = 0.719), (5) total visceral fat volume to PWV (r = 0.066, p-value = 0.528). There was also no correlation found between PWV and visceral fat grouped in tertiles. CONCLUSION: There was no significant correlation between visceral fat volumes and aortic stiffness.