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BACKGROUND: Reduced estimated glomerular filtration rate (eGFR) is associated with lower use of invasive management and increased mortality after acute coronary syndrome (ACS). The reasons for this are unclear. METHODS: A retrospective clinical cohort study was performed using data from the English National Institute for Health Research Health Informatics Collaborative (2010-2017). Multivariable logistic regression was used to investigate whether eGFR<90 mL/min/1.73 m2 was associated with conservative ACS management and test whether (a) differences in care could be related to frailty and (b) associations between eGFR and mortality could be related to variation in revascularisation rates. RESULTS: Among 10 205 people with ACS, an eGFR of <60 mL/min/1.73m2 was found in 25%. Strong inverse linear associations were found between worsening eGFR category and receipt of invasive management, on a relative and absolute scale. People with an eGFR <30 mL compared with ≥90 mL/min/1.73 m2 were half as likely to receive coronary angiography (OR 0.50, 95% CI 0.40 to 0.64) after non-ST-elevation (NSTE)-ACS and one-third as likely after STEMI (OR 0.30, 95% CI 0.19 to 0.46), resulting in 15 and 17 per 100 fewer procedures, respectively. Following multivariable adjustment, the ORs for receipt of angiography following NSTE-ACS were 1.05 (95% CI 0.88 to 1.27), 0.98 (95% CI 0.77 to 1.26), 0.76 (95% CI 0.57 to 1.01) and 0.58 (95% CI 0.44 to 0.77) in eGFR categories 60-89, 45-59, 30-44 and <30, respectively. After STEMI, the respective ORs were 1.20 (95% CI 0.84 to 1.71), 0.77 (95% CI 0.47 to 1.24), 0.33 (95% CI 0.20 to 0.56) and 0.28 (95% CI 0.16 to 0.48) (p<0.001 for linear trends). ORs were unchanged following adjustment for frailty. A positive association between the worse eGFR category and 30-day mortality was found (test for trend p<0.001), which was unaffected by adjustment for frailty. CONCLUSIONS: In people with ACS, lower eGFR was associated with reduced receipt of invasive coronary management and increased mortality. Adjustment for frailty failed to change these observations. Further research is required to explain these disparities and determine whether treatment variation reflects optimal care for people with low eGFR. TRIAL REGISTRATION NUMBER: NCT03507309.
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Síndrome Coronario Agudo , Fragilidad , Tasa de Filtración Glomerular , Riñón , Humanos , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Anciano , Fragilidad/diagnóstico , Fragilidad/epidemiología , Fragilidad/fisiopatología , Fragilidad/complicaciones , Persona de Mediana Edad , Riñón/fisiopatología , Factores de Riesgo , Angiografía Coronaria , Anciano de 80 o más Años , Intervención Coronaria Percutánea , Medición de Riesgo/métodos , Inglaterra/epidemiología , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Estudios de SeguimientoRESUMEN
Eighteen-lead electrocardiography (18-ECG) includes, in addition to those in standard 12-lead ECG (12-ECG), six additional chest leads: V7-V9 and V3RV5R. Leads V7-V9 require the patient to be in a lateral decubitus position for the electrodes to be attached to the back. Synthesized 18-ECG (syn18-ECG) is a method that only records 12-ECG and uses computational logic to record the posterior wall (V7-V9) and right-sided (V3R-V5R) leads. We review the clinical utility of syn18-ECG in conditions including acute coronary syndromes, arrhythmias, acute pulmonary embolism, and Duchenne muscular dystrophy. The syn18-ECG waveform correlates well with the actual 18-ECG waveform, indicating that syn18-ECG is an excellent substitute for 18-ECG, excluding negative T waves. ST elevation in leads V7-V9 has the effect of reducing missed acute coronary syndromes in the posterior wall. In cases of arrhythmia, syn18-ECG can accurately estimate the target site of radiofrequency catheter ablation using a simple algorithm. The use of additional leads in Duchenne muscular dystrophy is expected to provide new insights. To facilitate gaining more knowledge regarding diseases that have not yet been investigated, it is imperative that the cost of syn18-ECG is reduced in the future.
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Arritmias Cardíacas , Electrocardiografía , Humanos , Electrocardiografía/métodos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/fisiopatología , Algoritmos , Electrodos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Procesamiento de Señales Asistido por ComputadorRESUMEN
Objective: To investigate the changes in cardiopulmonary exercise testing (CPET) characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: This is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023. Based on the timeline of the COVID-19 pandemic, patients were divided into two groups: the pre-pandemic group and the during-pandemic group, with January 2020 as the dividing line. Clinical data were collected from both groups, and a comparative analysis was performed on their postoperative CPET outcomes, including peak oxygen uptake (peak VO2), peak metabolic equivalents (peak MET), and other indicators. Weber's classification was used to assess cardiac function. In addition, the 7-tiem generalized anxiety disorder scale (GAD-7) and the patient health questionnaire-9 (PHQ-9) were used to assess the patients' psychological anxiety and depression states, respectively. Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI. Results: A total of 4 310 post-PCI ACS patients were included, with an average age of (58.7±9.1) years, and 3 464 (80.37%) were male. There were 1 698 patients in the pre-pandemic group and 2 612 patients in the during-pandemic group. The main indicator of the CPET, peak VO2 (15.04±3.93) ml·min-1·kg-1 in the during-pandemic group, was lower than that in the pre-pandemic group (15.52±3.68) ml·min-1·kg-1, and the difference was statistically significant (P<0.001). Multivariate logistic regression analysis showed that advanced age, female gender, high body mass index, elevated high-sensitivity C-reactive protein, reduced high-density lipoprotein cholesterol, smoking history, history of myocardial infarction, more severe ACS classification, and mild to moderate degree of depression were related to poor cardiopulmonary outcomes (P<0.05). Conclusion: The COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI. Reduced physical activity, and increased psychological stress should be given consideration and attention regarding their impact on patients' cardiopulmonary function.
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Síndrome Coronario Agudo , COVID-19 , Prueba de Esfuerzo , Intervención Coronaria Percutánea , Humanos , COVID-19/epidemiología , Persona de Mediana Edad , Síndrome Coronario Agudo/fisiopatología , Masculino , Femenino , Estudios Transversales , SARS-CoV-2 , Anciano , Ansiedad , Depresión/etiología , Depresión/epidemiología , Consumo de Oxígeno , PandemiasRESUMEN
OBJECTIVE: To assess long-term clinical outcomes and factors associated with target vessel revascularisation in patients with deferred revascularisation based on negative fractional flow reserve and negative instantaneous wave-free ratio. METHODS: The longitudinal, retrospective study was conducted from July 1, 2020, to January 1, 2022, at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2012 to January 2020 of patients with deferred revascularisation having intermediate to severe coronary lesions on coronary angiogram and had negative fractional flow reserve >0.80 or instantaneous wave-free ratio >0.89 and had not undergone immediate or planned revascularisation on the basis of negative physiological assessment. Data was collected from the institutional records, while final follow-up was taken by reviewing the medical records or telephonic interviews regarding any major adverse cardiac event after the index procedure. Data was analysed using Stata 14.2. RESULTS: Of the 345 patients, 245(71%) were males. The overall mean age was 62±11 years. There were 194(56%) patients who presented with stable angina and 151(44%) presented with acute coronary syndrome. Mean fractional flow reserve was 0.87±0.04 and mean instantaneous wave-free ratio was 0.93±0.03. Multivessel disease was present in 223(65%) patients. Median follow-up period was 29 months (IQR: 24-36 months). Major adverse cardiovascular events occurred in 22(6%) patients, and target vessel revascularisation was required in 11(3%). Diabetes and percentage of stenosis were found to be independent predictors of major adverse cardiovascular events (p<0.05). CONCLUSIONS: Deferral of revascularisation and opting for medical treatment for coronary artery stenosis with higher fractional flow reserve or instantaneous wave-free ratio could be considered a safe and reasonable strategy.
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Angiografía Coronaria , Reserva del Flujo Fraccional Miocárdico , Revascularización Miocárdica , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Masculino , Femenino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Anciano , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/fisiopatología , Estudios Longitudinales , Estenosis Coronaria/fisiopatología , Estenosis Coronaria/cirugía , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/fisiopatología , Angina Estable/cirugía , Angina Estable/fisiopatología , Resultado del Tratamiento , Intervención Coronaria Percutánea/métodosRESUMEN
INTRODUCTION: Several biomarkers are characteristically elevated in patients with acute heart failure (AHF). Our hypothesis was they could predict early changes in left ventricular (LV) characteristics in acute coronary syndrome (ACS) patients. The objective of this study was two-fold: a) compare circulating concentrations of NT-pro BNP, CA-125, ST2, galectin-3 and pro-adrenomedullin among 4 groups of individuals (healthy controls; patients with ACS without AHF; patients with ACS and AHF and patients admitted for AHF); and b) evaluate whether these biomarkers predict adverse LV remodeling and ejection fraction changes in ACS. METHODS: 6 biomarkers (NT-pro BNP, CA-125, ST2, galectin-3, pro-adrenomedullin and C-reactive) were measured within the first 48 h of admission. Echocardiograms were performed during admission and at 3 months. Variables associated with LV end-diastolic volume (EDV) and ejection fraction (LVEF) change were assessed by multivariate linear regression. RESULTS: We analyzed 51 patients with ACS, 16 with AHF and, 20 healthy controls. NT-pro BNP and ST2 concentrations were elevated at similar values in patients admitted for AHF and ACS complicated with HF but CA-125 concentrations were higher in AHF patients. NT-pro BNP concentrations were positively correlated with CA-125 (rho = 0.58; p < 0.001), ST2 (rho = 0.58; p < 0.001) and galectin-3 (rho = 0.37; p < 0.001) Median change (median days was 83 days after) in EDV and LVEF was 5 %. CA-125 concentrations were positively associated to LV EDV change (ß-coefficient 1.56) and negatively with LVEF trend (ß-coefficient = -0.86). No other biomarker predicted changes in EDV or LVEF. CONCLUSIONS: CA-125 correlates with early LV remodeling and LVEF deterioration in ACS patients.
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Síndrome Coronario Agudo , Biomarcadores , Insuficiencia Cardíaca , Remodelación Ventricular , Humanos , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/fisiopatología , Biomarcadores/sangre , Femenino , Masculino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Anciano , Persona de Mediana Edad , Fragmentos de Péptidos/sangre , Volumen Sistólico , Estudios de Casos y Controles , Péptido Natriurético Encefálico/sangre , Galectinas/sangre , Antígeno Ca-125/sangre , Proteína 1 Similar al Receptor de Interleucina-1RESUMEN
The optimal therapeutic approach to facilitate reverse remodeling is desired in patients with systolic heart failure following acute coronary syndrome (ACS). The association between heart rate (HR) and reverse remodeling in this cohort has remained elusive.Patients with left ventricular ejection fraction (LVEF) < 50% who received echocardiography assessments following ACS were retrospectively included. Theoretically ideal HR was calculated using a previously established formula: 93 - 0.13 × (deceleration time [msec]). Impacts of HR on echocardiographic left ventricular (LV) reverse remodeling during the 2-year observational period were compared between 2 groups stratified by the HR difference between theoretically ideal and actual values: optimal HR group (HR difference ≤ 10 bpm) versus sub-optimal HR group (HR difference > 10 bpm).A total of 27 patients (median 72 years old, 23 males) were included. There were no significant differences in the baseline characteristics including maximum serum creatinine kinase level and the dose of beta-blocker between the 2 groups. LV ejection fraction increased significantly only in the optimal HR group at follow-up (from 42% to 54%; P = 0.001). The optimal HR group exhibited a more pronounced decrease in LV end-diastolic diameter (from 57 to 52 mm) compared to the sub-optimal HR group (from 58 to 56 mm).Optimal HR, which was calculated using a previously proposed formula, was associated with more substantial post-infarct LV reverse remodeling. The implications of aggressive HR modulation targeting theoretically ideal HR among those with systolic heart failure following ACS are the focus of our investigation here.
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Síndrome Coronario Agudo , Insuficiencia Cardíaca Sistólica , Frecuencia Cardíaca , Volumen Sistólico , Remodelación Ventricular , Humanos , Masculino , Remodelación Ventricular/fisiología , Femenino , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/complicaciones , Insuficiencia Cardíaca Sistólica/fisiopatología , Insuficiencia Cardíaca Sistólica/complicaciones , Anciano , Estudios Retrospectivos , Frecuencia Cardíaca/fisiología , Volumen Sistólico/fisiología , Persona de Mediana Edad , Ecocardiografía , Función Ventricular Izquierda/fisiología , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: The study aimed to investigate the correlation and consistency between resting full-cycle ratio (RFR) and fractional flow reserve (FFR) in functional assessment of coronary arteries in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). DESIGN: Retrospective study. SETTING: A single-centre study in China. PARTICIPANTS: A total of 292 diseased vessels of 226 Chinese patients with NSTE-ACS at Cangzhou Central Hospital of Hebei Medical University from September 2021 to June 2023 were included. METHODS: The correlation between RFR and FFR, resting ratio of distal coronary artery pressure (Pd) to aortic pressure (Pa) and FFR were analysed by using Person correlation, and the consistency between RFR and FFR, resting Pd/Pa and FFR were assessed by Bland-Altman test. The diagnostic values of RFR and resting Pd/Pa for predicting FFR≤0.80 were evaluated according to the receiver operating characteristic (ROC) curves. RESULTS: RFR and resting Pd/Pa were significantly correlated with FFR, and correlation coefficients were 0.787 (p<0.001) and 0.765 (p<0.001), respectively. We found no significant differences between RFR and FFR or between resting Pd/Pa and FFR. The areas under the ROC curves for predicting FFR≤0.80 were 0.883 (p<0.001) for RFR and 0.858 (p<0.001) for resting Pd/Pa, and the optimal critical values were 0.91 for RFR and 0.93 for resting Pd/Pa. The accuracy, sensitivity, specificity and positive and negative predictive values of RFR≤0.91 for predicting FFR≤0.80 were 79.1%, 84.0%, 76.6%, 65.1% and 90.2%, respectively. CONCLUSION: The current study suggests that RFR exhibits a good correlation and consistency with FFR in patients with NSTE-ACS. RFR is expected to significantly enhance the application of coronary artery functional assessment in clinical practice, thereby providing patients with more precise revascularisation strategies.
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Síndrome Coronario Agudo , Vasos Coronarios , Reserva del Flujo Fraccional Miocárdico , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/diagnóstico , China , Anciano , Vasos Coronarios/fisiopatología , Angiografía Coronaria , Curva ROC , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Acute coronary syndrome characterizes the spectrum of myocardial ischemia states, which include non-ST elevated myocardial infarction (MI), and angina. OBJECTIVE: The aim of the present study is to determine the effectiveness of foot massage on selected physiological parameters among patients with acute coronary syndrome. METHODS: A quasi- experimental study was conducted in Karbala center for cardiac diseases and surgery from December 25th, 2023, to May 7th, 2024. A nonprobability purposive sampling consisted of 60 patients with acute coronary syndrome in the intervention group were instructed to performed four-step foot massage similarly 5 min for each foot. While patients in the control group just received routine medical treatment. The physiological parameters were checked in the two groups before, after 5 min, and 10 min after the foot massage. The study instrument consisted of two main parts: part one included patient's socio demographics and clinical data, and the second part was used to assess the physiological parameters. Statistical tests were conducted using the software SPSS, version 24, with a level of significance of 5 % (p value <0.05). RESULTS: that are a significant statistical differences between the mean of the selected physiological parameters readings for the study group except reading of pulse pressure, while there is no significant statistical difference between the mean of the readings of the selected physiological parameters for the control group except the reading of heart rate. CONCLUSION: The study found that the foot massage is effective for improving the blood pressure, heart rate, mean arterial pressure.
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Síndrome Coronario Agudo , Pie , Frecuencia Cardíaca , Masaje , Humanos , Masaje/métodos , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Masculino , Femenino , Persona de Mediana Edad , Pie/fisiopatología , Resultado del Tratamiento , Frecuencia Cardíaca/fisiología , Anciano , Presión Sanguínea/fisiologíaRESUMEN
BACKGROUND: Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. METHODS: We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. RESULTS: Among 270 patients admitted for ACS (mean age 67âyears, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P â<â0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). CONCLUSIONS: LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.
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Síndrome Coronario Agudo , Índice Tobillo Braquial , Enfermedad Arterial Periférica , Análisis de la Onda del Pulso , Rigidez Vascular , Humanos , Masculino , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/complicaciones , Femenino , Anciano , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/complicaciones , Pronóstico , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: Cardiac time intervals are sensitive markers of myocardial dysfunction that predispose to heart failure (HF). We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS). METHODS: This study included 386 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination a median of two days after PCI. Cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and systolic ejection time (ET), and myocardial performance index (MPI) were obtained by tissue Doppler echocardiography. The outcome was incident HF. RESULTS: During follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, IVRT was not associated with HF (HR 1.02 (0.95-1.10), p = 0.61, per 10ms increase), and neither was IVCT (HR 0.07 (0.95-1.22), p = 0.26, per 10ms increase). Increasing MPI was associated with a higher risk of HF (HR 1.20 (1.08-1.34), P = 0.001, per 0.1 increase), and so was decreasing ET (HR 1.13 (1.07-1.18), P < 0.001 per 10ms decrease). After multivariable adjustment for cardiovascular risk factors, MPI (HR 1.13 (1.01-1.27), P = 0.034) and ET (HR 1.09 (1.01-1.17), P = 0.025) remained significantly associated with incident HF. LVEF modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF in patients with LVEF ≥ 36% (HR = 1.15 (1.06-1.24), P = 0.001, per 10ms decrease). CONCLUSION: In patients admitted with ACS, shortened ET and higher MPI were independently associated with an increased risk of incident HF. Additionally, ET was associated with incident HF in patients with LVEF above 36%.
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Síndrome Coronario Agudo , Ecocardiografía Doppler , Insuficiencia Cardíaca , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Masculino , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico , Persona de Mediana Edad , Factores de Tiempo , Anciano , Incidencia , Factores de Riesgo , Intervención Coronaria Percutánea/efectos adversos , Medición de Riesgo , Resultado del Tratamiento , Contracción MiocárdicaRESUMEN
BACKGROUND: Combining morphological and physiological evaluations might improve the risk stratification of patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) culprit lesions. AIMS: We aimed to investigate the clinical utility of morphofunctional evaluation after PCI for identifying ACS patients with increased risk of subsequent clinical events. METHODS: We retrospectively studied 298 consecutive ACS patients who had undergone optical coherence tomography (OCT)-guided PCI. We performed OCT-based morphological analysis and quantitative flow ratio (QFR)-based physiological assessment immediately after PCI. The non-culprit segment (NCS) was defined as the most stenotic untreated segment in the culprit vessel. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, and ischaemia-driven target vessel revascularisation. RESULTS: During a median follow-up period of 990 days, 42 patients experienced TVF. Cox regression analysis revealed that the presence of thin-cap fibroatheroma (TCFA) in the NCS and a low post-PCI QFR, or the presence of TCFA in the NCS and a high ΔQFR in the NCS (QFRNCS), were independently associated with TVF. The subgroup with TCFA in the NCS and a low post-PCI QFR had a significantly higher incidence of TVF (75%) than the other subgroups, and those with TCFA in the NCS and a high ΔQFRNCS had a significantly higher incidence of TVF (86%) than the other subgroups. The integration of TCFA in NCS, post-PCI QFR, and ΔQFRNCS with traditional risk factors significantly enhanced the identification of subsequent TVF cases. CONCLUSIONS: Combining post-PCI OCT and QFR evaluation may enhance risk stratification for ACS patients after successful PCI, particularly in predicting subsequent TVF.
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Síndrome Coronario Agudo , Intervención Coronaria Percutánea , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Resultado del Tratamiento , Medición de Riesgo , Factores de Riesgo , Angiografía CoronariaRESUMEN
INTRODUCTION: The role of uric acid (UA) and Hyper Uricemia (HU) in cardiac rehabilitation (CR) patients have been very little studied. AIM: To evaluate the prevalence of HU and if it is associated to the functional improvement obtained or the left ventricular Ejection Fraction (EF) in CR patients after Acute or Chronic Coronary Syndrome (ACS and CCS respectively). METHODS: We enrol 411 patients (62.4 ± 10.2 years; males 79.8%) enrolled in the CR program at Niguarda Hospital (Milan) from January 2012 to May 2023. HU was defined both as the classic cut-off (> 6 for females, > 7 mg/dL for males) and with the newly identified one by the URRAH study (> 5.1 for females, > 5.6 mg/dL for males). All patients performed a 6MWT and an echocardiography at the beginning and at the end of CR program. RESULTS: Mean UA values were within the normal range (5.6 ± 1.4 mg/dL) with 19.5% (classic cut-off) HU patients with an increase to 47.4% with the newer one. Linear regression analysis showed no role for UA in determining functional improvement, while UA and hyperuricemia (classic cut-off) were associated to admission and discharge EF. The same was not with the URRAH cut-off. CONCLUSIONS: HU is as frequent in CR patients as in those with ACS and CCS. UA didn't correlate with functional recovery while it is associated with admission and discharge EF as also is for HU (classic cut-off). Whit the URRAH cut-off HU prevalence increases significantly, however, it doesn't show any significant association with EF.
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Biomarcadores , Rehabilitación Cardiaca , Hiperuricemia , Recuperación de la Función , Volumen Sistólico , Ácido Úrico , Función Ventricular Izquierda , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/epidemiología , Hiperuricemia/sangre , Hiperuricemia/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Prevalencia , Ácido Úrico/sangre , Anciano , Resultado del Tratamiento , Biomarcadores/sangre , Factores de Tiempo , Síndrome Coronario Agudo/rehabilitación , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/diagnóstico , Factores de Riesgo , Italia/epidemiología , Tolerancia al EjercicioRESUMEN
INTRODUCTION: Patients with acute coronary syndrome (ACS) have a high incidence of Left ventricle diastolic dysfunction (DD). Latest algorithms for the assessment of DD lay on 2D parameters and describe a grading to quantify its severity. However, there persists a "gray zone" of values in which DD remains indeterminate. AIM: to analyze the diagnostic value of Left atrium strain (LAS) for categorization of LV DD and assessment of LV filling pressures in ACS patients. METHODS: Cross-sectional study that prospectively evaluated 105 patients presenting ACS with preserved LV ejection fraction (LVEF). Patients were divided in 4 groups according to the DD grade. Mean values of LAS, corresponding to three phases of atrial function: reservoir (LASr), conduit (LAScd) and contraction (LASct), were obtained by speckle-tracking echocardiography. RESULTS: Mean age was 60±10 years, with a gender ratio of 6.14. LASr and LASct were significantly lower according to DD severity (p combined=0.021, p combined=0.034; respectively). E/e' ratio was negatively correlated to LASr (r= - 0.251; p= 0.022) and LASct (r= -0.197; p=0.077). Left atrial volume index (LAVI) was also negatively correlated to LASr (r= -0.294, p= 0.006) and LASct (r= -0.3049, p=0.005). Peak tricuspid regurgitation was negatively correlated to LASr (r=-0.323, p=0.017) and LASct (r=-0.319, p=0.020). Patients presenting elevated LV filling pressures had lower LASr and LASct (p=0.049, p=0.022, respectively) compared to patients witn normal LV filling pressures. ROC curve analysis showed that a LASr < 22% (Se= 75%, Sp= 73%) and a LASct < 13% (Se= 71%, Sp=58%) can increase the likelihood of DD grade II or III by 4.6 (OR= 4.6; 95% CI: 1.31-16.2; p=0.016) and 3.7 (OR= 3.7; 95% CI: 1.06-13.1; p= 0.047), respectively. CONCLUSION: LAS is a valuable tool, which can be used to categorize DD in ACS patients.
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Síndrome Coronario Agudo , Ecocardiografía , Disfunción Ventricular Izquierda , Humanos , Femenino , Masculino , Persona de Mediana Edad , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/epidemiología , Estudios Transversales , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/epidemiología , Anciano , Ecocardiografía/métodos , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Estudios Prospectivos , Función del Atrio Izquierdo/fisiología , Diástole/fisiología , Volumen Sistólico/fisiologíaRESUMEN
Periodontitis is a common chronic infection and is associated with cardiovascular disease. This study evaluated whether basic oral care for periodontal disease could improve endothelial function in patients with acute coronary syndrome (ACS).This study enrolled 54 patients with acute coronary syndrome admitted to Kagoshima City Hospital and who had undergone percutaneous coronary intervention. Flow-mediated endothelium-dependent dilatation (FMD) was measured before discharge (initial FMD) and at 8 months after percutaneous coronary intervention (follow-up FMD). The following periodontal characteristics were measured: periodontal pocket depth (PPD, mm), plaque control record (%), and bleeding on probing (%). All patients received basic oral care instructions from dentists. The oral health condition was generally poor in the participants and there were 24 patients (44.4%) who had severe PPD. Despite the intervention of basic oral care, the periodontal characteristics did not improve during the study period; initial FMD and follow-up FMD did not significantly differ (4.38 ± 2.74% versus 4.56 ± 2.51%, P = 0.562). However, the follow-up FMD was significantly lower in patients with severe PPD (≥ 6.0 mm, n = 24) than in patients without severe PPD (≤ 5.0 mm, n = 30) (FMD: 3.58 ± 1.91% versus 5.37 ± 2.67%, P = 0.007). FMD tended to be worse in patients with severe PPD than in patients without severe PPD (ΔFMD: -0.55 ± 2.12 versus 0.81 ± 2.77 %, P = 0.055). In conclusion, during the use of basic oral care, endothelial function improved in patients without severe PPD, while it worsened in patients with severe PPD.
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Síndrome Coronario Agudo , Endotelio Vascular , Intervención Coronaria Percutánea , Humanos , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/complicaciones , Masculino , Femenino , Endotelio Vascular/fisiopatología , Anciano , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Periodontitis/terapia , Periodontitis/fisiopatología , Periodontitis/complicaciones , Higiene Bucal , Salud BucalRESUMEN
BACKGROUND: Differentiating Takotsubo cardiomyopathy (TTC) from acute coronary syndrome involving the left anterior descending coronary artery (LAD-ACS) is difficult due to left ventricular apical wall motion abnormality pattern in both and typically requires an invasive coronary angiography (ICA) study for diagnostic confirmation. OBJECTIVES: To identify differences in the regional wall motion abnormality (RWMA) pattern using a comprehensive comparative analysis of the transthoracic echocardiographic (TTE) findings in patients with TTC versus LAD-ACS. METHODS: This was a retrospective, randomized, blinded comparison study including a derivation cohort of 105 patients with TTC (N=52) or LAD-ACS (N=53) with concomitant TTE and ICA identified from our institutional database. A comprehensive echocardiographic wall motion analysis was performed (unblinded) to search for subtle differences in RWMA patterns by marking the exact locations of the end-systolic hinge points (HP) - defined as the intersection between the normal and abnormal regional myocardial thickening - in all apical views. The HP location relative to mitral annulus in each apical view was compared for symmetry and the apical 2-chamber (A2C) view was identified as having the most consistent, quantitative difference between TTC and LAD-ACS. This A2C quantitative model was then prospectively studied in a randomized, blinded, validation cohort of 30 subjects with either TTC or LAD-ACS by eight echocardiographic readers with all levels of clinical experience. RESULTS: In the unblinded derivation cohort, the A2C view showed that the ratio (1.02) and the absolute distance between the anterior HP (3.57 cm) and the inferior HP (3.53 cm) in TTC was significantly different than the ratio (0.761) and the absolute differences between the AHP (4.5 cm) and the IHP (5.93 cm) in LAD-ACS. An AHP: IHP of 0.96 for men and 0.84 for women was able to correctly categorize 84.8% of male and 91.7% of female patients. When applied to the validation cohort, the model showed fairly accurate results with a 74% prediction rate in diagnosing TTC in female patients. CONCLUSION: We propose a relatively simple 2-D TTE diagnostic tool emphasizing subtle differences in the RWMA pattern in the A2C view alone as a semi-quantitative imaging parameter to help differentiate TTC from LAD-ACS.
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Síndrome Coronario Agudo , Ecocardiografía , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Femenino , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/diagnóstico , Masculino , Ecocardiografía/métodos , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Diagnóstico Diferencial , Angiografía Coronaria/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Función Ventricular Izquierda/fisiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Coronary plaque rupture is a precipitating event responsible for two thirds of myocardial infarctions. Currently, the risk of plaque rupture is computed based on demographic, clinical, and image-based adverse features. However, using these features the absolute event rate per single higher-risk lesion remains low. This work studies the power of a novel framework based on biomechanical markers accounting for material uncertainty to stratify vulnerable and non-vulnerable coronary plaques. METHODS: Virtual histology intravascular ultrasounds from 55 patients, 29 affected by acute coronary syndrome and 26 affected by stable angina pectoris, were included in this study. Two-dimensional vessel cross-sections for finite element modeling (10 sections per plaque) incorporating plaque structure (medial tissue, loose matrix, lipid core and calcification) were reconstructed. A Montecarlo finite element analysis was performed on each section to account for material variability on three biomechanical markers: peak plaque structural stress at diastolic and systolic pressure, and peak plaque stress difference between systolic and diastolic pressures, together with the luminal pressure. Machine learning decision tree classifiers were trained on 75% of the dataset and tested on the remaining 25% with a combination of feature selection techniques. Performance against classification trees based on geometric markers (i.e., luminal, external elastic membrane and plaque areas) was also performed. RESULTS: Our results indicate that the plaque structural stress outperforms the classification capacity of the combined geometric markers only (0.82 vs 0.51 area under curve) when accounting for uncertainty in material parameters. Furthermore, the results suggest that the combination of the peak plaque structural stress at diastolic and systolic pressures with the maximum plaque structural stress difference between systolic and diastolic pressures together with the systolic pressure and the diastolic to systolic pressure gradient is a robust classifier for coronary plaques when the intrinsic variability in material parameters is considered (area under curve equal to [0.91-0.93]). CONCLUSION: In summary, our results emphasize that peak plaque structural stress in combination with the patient's luminal pressure is a potential classifier of plaque vulnerability as it independently considers stress in all directions and incorporates total geometric and compositional features of atherosclerotic plaques.
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Análisis de Elementos Finitos , Placa Aterosclerótica , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/fisiopatología , Masculino , Femenino , Fenómenos Biomecánicos , Aprendizaje Automático , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Anciano , Estrés Mecánico , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Ultrasonografía IntervencionalRESUMEN
AIMS: Many studies evaluated the functional response in post-Covid-19 patients; however, they systematically excluded patients with concomitant acute coronary syndrome (ACS). We evaluated the long-term functional capacity assessed by cardiopulmonary exercise test (CPET) in patients hospitalized for ACS and concomitant SARS-CoV2 infection. The secondary aim was to investigate the functional response in patients with symptoms related to "long COVID-19 syndrome" (LCS). METHODS: This cross-sectional case-control study compared 20 patients with ACS and concomitant SARS-COV2 infection with 20 patients without COVID-19. At the follow-up visit (between 6 and 12 months after revascularization procedure) all patients underwent a CPET. RESULTS: Patients with previous ACS and concomitant COVID-19 showed a reduced O2 consumption than controls (predicted peak VÌO2 74.00% vs 86.70%; p = 0.01) with a high degree of ventilatory inefficiency (VE/ VÌCO2 slope 38.04 vs 30.31; p = 0.002). 50% of subjects with previous COVID-19 disease showed symptoms related to "LCS"; this subgroup demarcates the characteristic reduced exercise capacity found in the entire COVID + group. CONCLUSIONS: This study is the first in literature having analyzed the long-term functional capacity phenotype in a population of ACS patients and concomitant SARS-CoV2 infection. Severe ventilatory inefficiency emerged as the functional signature of these patients. Moreover, the subset of patients with symptoms related to LCS has the most compromised long term reduced exercise capacity and an altered ventilation control.
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Síndrome Coronario Agudo , COVID-19 , Prueba de Esfuerzo , Tolerancia al Ejercicio , Humanos , COVID-19/fisiopatología , COVID-19/complicaciones , COVID-19/epidemiología , Masculino , Síndrome Coronario Agudo/fisiopatología , Femenino , Persona de Mediana Edad , Estudios Transversales , Anciano , Prueba de Esfuerzo/métodos , Estudios de Casos y Controles , Tolerancia al Ejercicio/fisiología , Consumo de Oxígeno/fisiología , Síndrome Post Agudo de COVID-19 , Estudios de SeguimientoRESUMEN
BACKGROUND: In 5%-25% of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients, coronary angiography reveals no obstructive coronary arteries (MINOCA). Coronary microvascular disease (CMD) is a potential causal pathophysiological mechanism in these patients and can be diagnosed by continuous thermodilution assessment. Recently, the microvascular resistance reserve (MRR) has been introduced as a novel index to assess the vasodilatory capacity of the microcirculation. However, continuous thermodilution and MRR have never been investigated in the acute setting in MINOCA patients and invasive assessment of the microcirculation in these patients are currently lacking. AIMS: The objectives of the study were to investigate the incidence of CMD (MRR ≤ 2.7) in patients with MINOCA and to evaluate the feasibility and safety of continuous thermodilution-based assessment during index coronary angiography in the acute setting. METHODS: This study was a prospective, observational, pilot study investigating coronary physiology in the acute setting in MINOCA patients. Patients admitted with a diagnosis of NSTE-ACS were eligible for inclusion. RESULTS: In total, 19 MINOCA patients were included in this analysis; the mean age was 70 ± 9 years, and 79% were females. CMD was present in 6 patients (32%). Qrest was significantly higher in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (0.076 [0.057-0.100] vs. 0.049 [0.044-0.071] L/min, p = 0.03). Rµ,rest was significantly lower in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (1083 [710-1510] vs. 1563 [1298-1970] WU, p = 0.04). No periprocedural complications or hemodynamic instability have occurred during continuous thermodilution assessment during the index coronary angiography. CONCLUSION: In patients admitted for MINOCA undergoing immediate coronary angiography, continuous thermodilution assessment and MRR are feasible and safe in the acute setting, and evidence of functional CMD could be observed in one-third of the MINOCA patients.
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Síndrome Coronario Agudo , Angiografía Coronaria , Circulación Coronaria , Estudios de Factibilidad , Microcirculación , Valor Predictivo de las Pruebas , Termodilución , Resistencia Vascular , Humanos , Proyectos Piloto , Femenino , Masculino , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/terapia , Vasos Coronarios/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Cateterismo Cardíaco , Infarto del Miocardio sin Elevación del ST/fisiopatología , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Infarto del Miocardio sin Elevación del ST/terapia , Vasodilatación , Anciano de 80 o más AñosRESUMEN
The traditional approach to management of cardiovascular disease relies on grouping clinical presentations with common signs and symptoms into pre-specified disease pathways, all uniformly treated according to evidence-based guidelines ("one-size-fits-all"). The goal of precision medicine is to provide the right treatment to the right patients at the right time, combining data from time honoured sources (e.g., history, physical examination, imaging, laboratory) and those provided by multi-omics technologies. In patients with ischemic heart disease, biomarkers and intravascular assessment can be used to identify endotypes with different pathophysiology who may benefit from distinct treatments. This review discusses strategies for the application of stratified management to patients with acute and chronic coronary syndromes.