Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography.

BACKGROUND: A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). METHODS: Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. RESULTS: The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. CONCLUSIONS: Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.

Vitamin D and functional arterial parameters in postmenopausal women with metabolic syndrome.

PURPOSE: Our cross sectional study aimed to identify the relation between vitamin D level and functional arterial parameters in postmenopausal women with metabolic syndrome. MATERIAL AND METHODS: 100 postmenopausal women at age 50-65 with diagnosed metabolic syndrome were included in this study. Laboratory tests were performed to determine lipid profile, serum glucose, creatinine, C-reactive protein, serum levels of 25(OH) D, ionized calcium and urine albumin/creatinine ratio. Also non-invasive assessment of arterial function (arterial stiffness, flow-mediated dilatation and carotid artery ultrasound examinations) was performed. RESULTS: The mean vitamin D blood concentration was 47.4±16.9nmol/l. The prevalence of modest insufficiency and deficiency of vitamin D was 62%. Vitamin D concentration in samples assembled from January to March was significantly lower than concentration levels from September to November. No significant relationship was observed between vitamin D and endothelial function, arterial stiffness, carotid intima-media thickness. Week negative correlation was stated between mean arterial pressure and 25(OH) D concentration (p=0.04). A positive correlation was found between high density lipoprotein cholesterol and vitamin 25(OH) D (r=0.3, p<0.05). No significant difference between 25(OH) D and other lipoproteins, calcium ions, glucose, albumin/creatinine ratio and C-reactive protein blood concentrations were found. CONCLUSIONS: The prevalence of vitamin D deficiency in postmenopausal women with metabolic syndrome is high. No relation was found between vitamin D levels and parameters that indicate atherosclerotic vascular lesions. Nevertheless our study revealed the relation between concentrations of vitamin D and mean blood pressure and high density lipoprotein cholesterol.