Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome.

OBJECTIVE: To determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS). PATIENTS AND METHODS: The study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.2 Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the MACE. RESULTS: CKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P=<0.001). They had higher syntax scores (P = 0.005), CIN (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P=<0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity. CONCLUSION: Chronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

The predictive value of speckle tracking during dobutamine stress echocardiography in patients with chronic stable angina.

OBJECTIVE: Evaluation of the diagnostic value of speckle tracking echocardiography (STE) at rest and during dobutamine stress in predicting the presence and severity of coronary artery disease (CAD) in patients with chronic stable angina. METHODS: A total of 100 patients with chronic stable angina were evaluated using STE at rest and during dobutamine stress to detect the presence, severity, and number of affected coronary arteries. Then, the correlation with the SYNTAX score (SS) was analyzed. RESULTS: STE at stress showed better agreement with coronary angiography (CA) than dobutamine stress echocardiography (DSE) in detecting the presence of coronary artery stenosis (Kappa = 0.819, p < 0.001). STE at stress suggested involvement of the left anterior descending artery (LAD) with excellent agreement with CA (Kappa = 0.816, p < 0.001). For right coronary artery, STE at rest and stress showed good agreement with the CA results (Kappa = 0.775 and 0.858, respectively, p < 0.001), whereas for left circumflex artery, STE at rest and stress showed a fair agreement with the CA results (Kappa = 0.556 and 0.583, respectively, p < 0.001). Resting global longitudinal peak systolic strain (GLPSS) ≥ -15.2% had the best diagnostic accuracy (sensitivity = 61.8%; specificity = 93.5%) in predicting SS > 22. Stress GLPSS ≥ -12.5% had the best diagnostic accuracy (sensitivity = 82.4%; specificity = 78.3%) in predicting SS > 22. CONCLUSION: Speckle tracking during DSE has high sensitivity and specificity for predicting the presence of CAD. It provides quantitative diagnostic information that decreases the false positive and false negative results of DSE.

Value of Speckle Tracking Echocardiography for Early Detection of Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus.

BACKGROUND: Cardiac dysfunction due to systemic lupus erythematosus (SLE) may be subclinical, but those patients are at high risk for developing clinical heart failure. AIM: The aim of this study is to assess the role of speckle tracking echocardiography (STE) in the early detection of systolic dysfunction in SLE patients. PATIENTS AND METHODS: This was a case-control study. Participants were subdivided into two groups: Group 1 included 50 SLE patients and Group 2 included 50 healthy controls. Clinical evaluation, echocardiography, tissue Doppler, and STE were performed. RESULTS: Global longitudinal strain (GLS) was significantly reduced in SLE group (-18.95 ± 2.02 vs. -21.4 ± 2.1, P < 0.001). However, there was no significant difference in left ventricular ejection fraction between both groups (P = 0.801). There was a significant positive correlation between the disease duration and age (r = 0.480, P < 0.001), pulmonary artery systolic pressure (PASP) (r = 0.628, P < 0.001), and GLS (%) (r = 0.417, P = 0.012). There was also a significant positive correlation between the disease activity index and GLS (%) (r = 0.7, P < 0.001) and PASP (r = 0.522, P < 0.001). CONCLUSION: SLE group had GLS % lower than the control group, and this was statistically significant, denoting early systolic dysfunction. Longer duration and high SLE activity index significantly affect GLS. GLS is an excellent noninvasive tool for early detection of subclinical left ventricular systolic dysfunction in SLE patients.