Echocardiography and Cardiac Magnetic Resonance in the Assessment of Left-Ventricle Remodeling: Differences Implying Clinical Decision.

Introduction: Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) are the most important modalities used in clinical practice to assess cardiac chambers. However, different imaging techniques may affect their results and conclusions. The aim of our study was to compare left-ventricle (LV) remodeling assessed using TTE and CMR in the context of various cardiovascular diseases. Methods: A total of 202 consecutive patients sent for an elective cardiovascular diagnosis were scheduled for a 2D TTE and CMR, performed within 2 weeks. The study group was divided and analyzed based on the clinical indications for CMR, including coronary artery disease, heart failure, native aortic valve regurgitation or paravalvular leak after aortic valve replacement, or cardiomyopathies. Results: The mean LV mass index (LVMi) values calculated using TTE were significantly larger (127.1 ± 44.5 g/m²) compared to the LVMi assessed using CMR (77.1 ± 26.2 g/m²; p < 0.001). The LV end-diastolic volumes assessed using TTE were underestimated for all the study patients (78.6 ± 43 mL vs. 100.5 ± 39 mL; p < 0.0001) and subgroups, but a statistical trend was observed in patients with cardiomyopathy. Those differences in single parameters led to differences in LV remodeling and the final treatment decision. CMR and TTE provided similar conclusions on LV systolic dysfunction in 68% of the patients. Conclusions: Our results showed that the greater the degree of LV remodeling and dysfunction, the greater the difference between the modalities. Therefore, CMR should be introduced into routine clinical practice, especially for patients undergoing LV remodeling, which may change clinical decisions in a considerable number of cases.

Dyslipidemia treatment and attainment of LDL-cholesterol treatment goals in patients participating in the Managed Care for Acute Myocardial Infarction Survivors program.

BACKGROUND: Patients after acute myocardial infarction (AMI) are at very high cardiovascular (CV) risk. Therefore, appropriate management of dyslipidemia with adequate lipid-lowering therapy is crucial for preventing subsequent CV events in these patients. AIMS: Our analysis aimed to assess the treatment of dyslipidemia and attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in patients after AMI who participated in the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program. METHODS: This study is a retrospective analysis of consecutive patients with AMI who agreed to participate and completed the 12-month MACAMIS program at one of three tertiary referral cardiovascular centers in Poland between October 2017 and January 2021. RESULTS: 1499 patients after AMI were enrolled in the study. High-intensity statin therapy was prescribed for 85.5% of analyzed patients on hospital discharge. Combined therapy with high-intensity statin and ezetimibe increased from 2.1% on hospital discharge to 18.2% after 12 months. In the whole study cohort, 20.4% of patients achieved the LDL-C target of < 55 mg/dl ( < 1.4 mmol/l), and 26.9% of patients achieved at least a 50% reduction in LDL-C level one year after AMI. CONCLUSIONS: Our analysis suggests that participation in the managed care program might be associated with improved quality of dyslipidemia management in AMI patients. Nonetheless, only one-fifth of patients who completed the program achieved the treatment goal for LDL-C. This highlights the constant need for optimizing lipid-lowering therapy to meet treatment targets and reduce CV risk in patients after AMI.

Managed Care after Acute Myocardial Infarction (MC-AMI) - Poland's nationwide program of comprehensive post-MI care improves prognosis in 2-year follow-up. A single high-volume center intention-to-treat analysis.

BACKGROUND: Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve longterm prognosis. AIMS: Our study aimed to compare 24-month mortality and the incidence of major cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. METHODS: We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control group). In the study group, 57% of patients participated in MC-AMI while 43% of patients remained under standard care. The patients were followed up for 24 months. Mortality and MACE were recorded. RESULTS: Treatment in the MC-AMI era was related to a 30% reduction in all-cause mortality and a 14% reduction of MACE although it was not related to the reduction of hospitalization for heart failure (HF) or AMI in 24 months. The 24-month survival rate was the highest in MC-AMI enrolled patients while patients treated in the MC-AMI era but not enrolled had a similar prognosis to those treated before the MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001). CONCLUSIONS: AMI treatment in the MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.

Managed Care after Acute Myocardial Infarction (MC-AMI) improves prognosis in AMI survivors with pre-existing heart failure: A propensity score matching analysis of Polish nationwide program of comprehensive post-MI care.

BACKGROUND: Despite improvement in acute myocardial infarction (AMI) treatment, post-discharge mortality remains high. The outcomes are supposed to be even worse in patients with post-MI heart failure (HF), as only a half of patients with newly diagnosed HF survive four years. AIMS: The study aimed to analyze whether managed care after acute myocardial infarction (MC-AMI) is associated with better survival in AMI survivors with a pre-existing diagnosis of HF. RESULTS: The study included 7228 patients with a pre-existing diagnosis of HF who survived the hospitalization for AMI in Poland between November 2017 and December 2020, of whom 2268 (31.4%) were referred for the MC-AMI program. The median follow-up was 1.5 (0.7-2.3) years. In the unmatched analysis, patients without MC-AMI had more than twice higher 12-month mortality (21.8% vs. 9.9%; P <0.01) than MC-AMI participants. The difference remained significant after propensity score matching (16,8% vs. 10.0%; P <0.01). In multivariable analysis, participation in MC-AMI was an independent factor of 12-month survival. MC-AMI participants had a lower stroke rate (1.5% vs. 3.0%; P <0.01) and fewer hospital admissions due to HF (22.9% vs. 27.6%; P <0.01). CONCLUSIONS: After propensity score matching, participation in MC-AMI was associated with lower rates of stroke, HF hospitalizations, and all-cause mortality in the 12-month follow-up and was an independent factor of 12-month survival in AMI survivors with pre-existing HF.

Prognostic assessment of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography.

BACKGROUND: Coronary heart disease is the leading cause of mortality, especially in industrialised countries. In the case of detection of significant lesions narrowing the vessel lumen, management is guided by recommendations of international cardiac societies, while in the case of non-critical lesions there are some doubts as to the further prognosis and identification of patients in whom accelerated progression of disease can be expected. AIM: The aim of this study was to evaluate the prognostic significance of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography. METHODS: In 100 symptomatic patients with non-critical stenosis in coronary arteries, cardiovascular events after one and three years of follow-up were assessed and analysed compared to a control group. RESULTS: During the follow-up period there were no deaths. In univariate analysis, factors associated with need for revascularisation in 4% of patients after one year and 7% at three years were: age (odds ratio [OR] 1.16, confidence interval [CI] 0.98-1.35; p = 0.04), fibrinogen concentration (OR 1.01, CI 1.00-1.02; p = 0.05), isovolumetric relaxation time [ms] (OR 1.07, CI 0.79-0.98; p = 0.04), and transmitral flow propagation velocity [cm/s] (OR 0.88, CI 1.01-1.12; p = 0.01). Nearly one third of patients with non-critical lesions despite optimal pharmacotherapy reported symptoms deteriorating quality of life. CONCLUSIONS: Factors predisposing to the occurrence of cardiovascular events in the 12 months of follow-up were: older age, higher plasma fibrinogen concentration, and impaired left ventricular filling pattern.

Assessment of risk factors for mortality in patients with cardiovascular disease and a history of treatment for malignancy.

BACKGROUND: Patients with advanced cancer after radio- and/or chemotherapy are increasingly commonly hospitalised in cardiology units due to coexisting cardiovascular diseases (CVD). A rational assessment of mortality risk is an important part of patient preparation for invasive cardiac procedures. One disadvantage of cardiac risk scores is the fact that malignancies are not taken into account. At present, accurate estimation of life expectancy is possible in up to 20% of patients with an advanced malignancy. AIM: To evaluate the effect of selected clinical parameters on survival of patients with CVD and coexisting lung or breast cancer after radio- and/or chemotherapy. An additional aim was to identify patients with a high probability of surviving a year in a good general clinical condition. METHODS: The study group involved 326 subjects with established CVD and lung cancer (small-cell or non-small-cell) or breast cancer who were selected from the group of 7818 patients receiving palliative care in the Palium hospice in Czestochowa, Poland, in 2008-2012. The obtained data were collected in a database and subjected to a statistical analysis. RESULTS: The strongest factors associated with an increased risk of death among patients with CVD and coexisting advanced lung or breast cancer after chemo- and/or radiotherapy were the type and stage of malignancy, functional status according to the ECOG classification, and the presence of cachexia. Other factors that had a significant effect on survival included higher severity of heart failure symptoms as evaluated by the New York Heart Association class, decreased left ventricular ejection fraction, presence of ischaemic heart disease, chronic obstructive pulmonary disease, fasting hyperglycaemia, and the severity of fatigue, nausea, and pain. When the effects of drug treatment on survival were analysed, significantly increased survival was observed in patients treated with angiotensin-converting enzyme inhibitors while diuretic and glucocorticosteroid use was associated with decreased survival. Among the evaluated groups of patients with CVD and advanced malignancy after radio- and/or chemotherapy, the highest probability of surviving a year in a relatively good general clinical condition was noted in patients with stage 3 breast cancer without cachexia, ischaemic heart disease and persistent somatic symptoms who were treated with tamoxifen, angiotensin-converting enzyme inhibitors and megestrol acetate. CONCLUSIONS: This is the first study that evaluated the combined effect of oncological and cardiovascular risk factors on survival of patients with CVD and coexisting cancer after radio- and/or chemotherapy treatment. When the three groups of cancer patients with different prognosis were compared, the study revealed varying effects of each factor depending on the underlying malignancy. The analysis confirmed the significance of the cumulative risk. The present study showed that malignancy-related prognostic factors are important in the context of cardiac evaluation and treatment of cancer patients. It also showed that further research is needed to clarify these issues.

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion.

INTRODUCTION: Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI). MATERIAL AND METHODS: Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up. RESULTS: At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. -11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR- group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (-15.58 ±8.9% vs. -25.53 ±8.8%, p < 0.001; -15.02 ±5.6 vs. -19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (-8.7 ±5.8% vs. -13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR- group. According to ROC analysis, circumferential apical strain > -15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI. CONCLUSIONS: Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients' follow-up.

The relationship between cardiovascular risk estimated by use of SCORE system and intima media thickness and flow mediated dilatation in a low risk population.

BACKGROUND: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. METHODS: 119 people (59 men) without known cardiovascular disease and estimated by means of SCORE system risk < 5%, were included in the study. The ultrasound method was used to assess brachial artery diameter (BAd), FMD, nitroglycerin mediated dilatation (NMD) of brachial artery and IMT of common carotid. FMD x BAd and FMD/NMD indexes representing hyperemia-induced vasodilatation independent of brachial artery properties were analyzed. RESULTS: IMT measured was 0.52 +/- 0.08 mm; FMD: 17.5 +/- 7.8%; NMD: 27.0 +/- 9.0%; FMD x BAd: 58.2 +/- 22.4, FMD/NMD: 0.64 +/- 0.19. Independent predictor for both FMD and NMD was BAd (R(2) -0.31; p < 0.001; R(2) -0.44; p < 0.001; respectively), for FMD x BAd index and FMD/NMD index was IMT (R(2) -0.04; p = 0.02; R(2) -0.04; p = 0.015) in a multivariate analysis. Risk estimated by use of the SCORE system was between 0 and 4% (median-1, 25-75 Q: 0-2). A relationship between SCORE risk and IMT (ANOVA p < 0.001), FMD (ANOVA p < 0.001), NMD (ANOVA p < 0.001), FMD x BAd index (ANOVA p = 0.017), but not FMD/NMD index (ANOVA p = 0.27), was found. CONCLUSIONS: The association of a simple stratifying scale (SCORE system) with indices of early vascular remodeling in a low risk population supports its clinical significance.

[A contemporary role of coronary artery calcium scoring in the assessment of the risk for coronary artery disease]. / Wspólczesna rola wskaznika uwapnienia tetnic wiencowych w ocenie ryzyka wystapienia choroby wiencowej.

The growing prevalence of coronary artery disease, also in younger population, inspires constant development of coronary atherogenesis risk stratification and early diagnosis methods. The coronary artery calcium score is a simple parameter, requiring only a relatively small radiation dose to obtain in computed tomography. So far completed studies have provided consistent evidence in support of its specificity to exclude coronary artery disease, along with its predictive value for future cardiac events. Our paper is a review of peerviewed journals regarding in coronary artery calcium scoring, including the most recent guidelines on its use in establishing a diagnosis of coronary artery disease.