The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15-45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure.
- Klíčová slova
- Hybrid approach, Ischemic cardiomyopathy, Left ventricular aneurysm, Left ventricular reconstruction,
- MeSH
- dysfunkce levé srdeční komory diagnostické zobrazování chirurgie MeSH
- ischemická choroba srdeční diagnostické zobrazování chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- kardiomyopatie diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- tepový objem MeSH
- test chůzí MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015. Acute coronary syndrome with ongoing myocardial ischaemia was defined by the presence of persistent/recurrent chest pain/dyspnoea and at least one of the following: persistent ST-segment elevation or depression, bundle branch block, haemodynamic or electric instability due to suspected ischaemia. Major adverse cardiac events (death, reinfarction, stroke, unexpected revascularisation, stent thrombosis) and severe bleeding according to Bleeding Academic Research Consortium criteria were evaluated at 30 days. RESULTS: Acute coronary syndrome was ruled out during the hospital stay in 434 (24.7%) patients. Out of 1280 patients with confirmed acute coronary syndrome, 732 (57%) had clinical signs of ongoing myocardial ischaemia at first medical contact. Coronary angiography was performed in 94.7% of patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 89% of patients with confirmed acute coronary syndrome without ongoing myocardial ischaemia (P<0.001). The major adverse cardiac event rate was 9.8% for patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 5.5% for patients without ongoing myocardial ischaemia (P=0.005), the 30-day severe bleeding rate was 1.6% and 1.5% (P=1.0). Patients with ongoing myocardial ischaemia admitted to regional hospitals had higher major adverse cardiac event rates compared with patients admitted directly to cardiocentres with percutaneous coronary intervention capability (13.3% vs. 8.2%, P=0.034). CONCLUSIONS: Ongoing myocardial ischaemia was present in more than half of patients hospitalised with acute coronary syndrome. These very high-risk patients may benefit from direct admission to percutaneous coronary intervention-capable centres.
- Klíčová slova
- Acute coronary syndromes, ongoing myocardial ischaemia, outcome, treatment strategy,
- MeSH
- akutní koronární syndrom komplikace epidemiologie patofyziologie MeSH
- bolesti na hrudi diagnóza etiologie patofyziologie MeSH
- cévní mozková příhoda epidemiologie MeSH
- hospitalizace MeSH
- incidence MeSH
- ischemická choroba srdeční diagnostické zobrazování mortalita patofyziologie terapie MeSH
- koronární angiografie statistika a číselné údaje MeSH
- koronární angioplastika metody MeSH
- krvácení epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty škodlivé účinky MeSH
- trombóza epidemiologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30-7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.
- Klíčová slova
- CZT, Low-dose, Myocardial perfusion, Prognostic value, SPECT, Thallium,
- MeSH
- časové faktory MeSH
- dávka záření * MeSH
- design vybavení MeSH
- gama kamery * MeSH
- ischemická choroba srdeční diagnostické zobrazování mortalita patofyziologie terapie MeSH
- jednofotonová emisní výpočetní tomografie škodlivé účinky přístrojové vybavení metody MeSH
- kadmium * MeSH
- koronární cirkulace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- progrese nemoci MeSH
- puriny aplikace a dávkování MeSH
- pyrazoly aplikace a dávkování MeSH
- radiační expozice škodlivé účinky prevence a kontrola MeSH
- radiofarmaka aplikace a dávkování škodlivé účinky MeSH
- radioizotopy thallia aplikace a dávkování škodlivé účinky MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- telur * MeSH
- vazodilatancia aplikace a dávkování MeSH
- zátěžový test MeSH
- zinek * MeSH
- zobrazování myokardiální perfuze škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- CdZnTe MeSH Prohlížeč
- kadmium * MeSH
- puriny MeSH
- pyrazoly MeSH
- radiofarmaka MeSH
- radioizotopy thallia MeSH
- regadenoson MeSH Prohlížeč
- telur * MeSH
- Thallium-201 MeSH Prohlížeč
- vazodilatancia MeSH
- zinek * MeSH
BACKGROUND: Heart failure (HF) is a major chronic illness and results in high morbidity and mortality. The most frequent cause of HF with reduced ejection fraction (HFREF) is coronary artery disease (CAD). Although revascularisation of ischemic myocardium lead to improvements in myocardial contractility and systolic function, it cannnot restore the viability of the already necrotic myocardium. METHODS/DESIGN: The aim of our prospective randomised study is to assess the efficacy of the retrograde application of non-selected bone marrow autologous cells concentrate (BMAC) in patients with HFREF of ischemic aetiology. The evaluated preparation is concentrated BMAC, obtained using Harvest SmartPReP2 (Harvest Technologies, Plymouth, MA, USA). The study population will be a total of 40 patients with established CAD, systolic dysfunction with LV EF of ≤40% and HF in the NYHA class 3. Patients have been on standard HF therapy for 3 months and in a stabilised state for at least 1 month, before enrolling in the clinical study. Patients will be randomised 1:1 to either retrograde BMAC administration via coronary sinus or standard HF therapy. The primary end-points (left ventricular end-systolic and end-diastolic diameters [LVESd/EDd] and volumes [LVESV/EDV] and left ventricular ejection fraction [LV EF]) will be assessed by magnetic resonance imaging. The follow-up period will be 12 month. DISCUSSION: The application of bone marrow stem cells into affected areas of the myocardium seems to be a promising treatment of ischemic cardiomyopathy. The Harvest BMAC contains the entire population of nuclear cells from bone marrow aspirates together with platelets. The presence of both platelets and additional granulocytes can have a positive effect on the neovascularisation potential of the resulting concentrate. Our assumption is that retrograde administration on non-selected BMAC via coronary sinus, due to the content of platelets and growth factors, might improve left ventricular function and parameters compared to standard HF therapy. Furthermore, it will be associated with improved exercise tolerance in the six-minute corridor walk test and an improvement in the life quality of patients without increasing the incidence of severe ventricular arrythmias. TRIAL REGISTRATION: (ClinicalTrials.gov; https://clinicaltrials.gov ; NCT03372954).
- MeSH
- časové faktory MeSH
- dospělí MeSH
- funkce levé komory srdeční MeSH
- ischemická choroba srdeční komplikace diagnostické zobrazování patofyziologie MeSH
- koronární sinus MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- obnova funkce MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční selhání diagnostické zobrazování etiologie patofyziologie chirurgie MeSH
- tepový objem MeSH
- tolerance zátěže MeSH
- transplantace kostní dřeně * škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- protokol klinické studie MeSH
BACKGROUND Determination of prognosis based on ischemia detection, using single‑photon emission computed tomography myocardial perfusion imaging (SPECT‑MPI), can be challenging in patients with multiple affected coronary arteries. AIMS The aim of the study was to examine the outcomes of SPECT‑MPI combined with the coronary artery calcium score (CACS) to identify predictors of adverse cardiac events (ACEs) in patients for whom ischemia detection may be difficult using SPECT‑MPI. METHODS The study group included 195 patients with a history of chronic kidney disease, suspected ischemic cardiomyopathy, or left bundle branch block. All patients underwent SPECT‑MPI and CACS evaluation. During the follow‑up, ACEs were recorded. Perfusion and functional parameters as well as the CACS were analyzed to find the predictors of ACEs. RESULTS The ACEs were recorded in 58 individuals (29.7%) and were significantly associated with ischemia (P <0.001), abnormal functional parameters (P = 0.04), and higher CACSs (P <0.001). The optimal cutoff value of the CACS to predict an ACE was 530. Cox proportional hazards models revealed that age, mild and severe ischemia, functional abnormalities, and a CACS of 530 or higher were significant predictors of ACEs. In the subgroup of individuals without ischemia, a CACS of 530 or higher was significantly associated with poor outcome, while we recorded only 3 ACEs in these patients when the CACS was lower than 530. CONCLUSIONS The addition of the CACS to SPECT‑MPI improves the identification of patients at higher risk for ACEs, even in individuals for whom SPECT‑MPI is challenging.
- MeSH
- chronické selhání ledvin komplikace MeSH
- ischemická choroba srdeční komplikace diagnóza diagnostické zobrazování MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- koronární cévy diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- multidetektorová počítačová tomografie * MeSH
- prognóza MeSH
- proporcionální rizikové modely MeSH
- senioři MeSH
- vaskulární kalcifikace komplikace diagnóza diagnostické zobrazování MeSH
- zobrazování myokardiální perfuze * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cardiac magnetic resonance imaging (CMR) is an indispensable part of the diagnostic algorithm in cardiology. CMR has become a gold standard in various disorders; moreover, it is well established also as a surrogate end-point in experimental and clinical studies. Particularly, the ability to directly display myocardial injury is a unique feature in comparison with other methods. The mapping of magnetic relaxation properties (T1, T2 and T2* relaxation times) are still relatively new techniques, but promising to improve the robustness of CMR and add new appropriate indications. The high potential of T1 mapping in the diagnostic of myocardial ischemic involvement has been highlighted in several experimental and clinical studies, but the use in clinical routine was limited due to the shortcomings in scanning and image evaluation. However, the quantitative technique of T1 mapping is now commercially available and its simple use, good reproducibility and limited subjectivity allow its incorporation into routine CMR protocols. This review article is aimed to summarise existing results and clinical experience with T1 mapping in patients with ischemic cardiac disease.
- Klíčová slova
- Cardiac magnetic resonance, Ischemic heart disease, T1 mapping,
- MeSH
- ischemická choroba srdeční diagnostické zobrazování patologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- myokard patologie MeSH
- reprodukovatelnost výsledků MeSH
- srdce diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: The European procedural guidelines for cardiac gated SPECT imaging demonstrate considerable variability in recommended administered radiopharmaceutical activity and imaging protocols. This study compared stress-only and stress-rest protocols to evaluate the safety of stress-only imaging, and to identify characteristics of patients who need full stress-rest imaging. METHODS: Patients referred for a chest pain were scheduled for stress-rest gated SPECT imaging. If the stress images were interpreted as normal according to the perfusion and left ventricular function, the examination of patients was finished and patients did not undergo the rest imaging. A total number of 1063 patients was included (mean age 61 ± 11 years). These patients have been followed for hard cardiac events, i.e. cardiac deaths or nonfatal myocardial infarction. RESULTS: During a follow-up of 3.2 ± 2.5 years, hard events occurred in 12 patients with normal SPECT and 59 with abnormal SPECT had hard events (0.7 vs. 3.6% /year, P < 0.001). Among the 536 patients with normal study, there was no significantly lower incidence of hard events in the subgroup of patients with stress-only imaging (0.6 vs. 0.8% /year, P = 0.641). Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT (1.3 vs. 0.5%/year, P < 0.001). We found a higher incidence of hard events in diabetic patients with normal study with the necessity of full stress-rest imaging in comparison with those with stress-only imaging (1.7 vs. 0.7% /year, P < 0.001). CONCLUSIONS: Our results support the good prognosis of normal stress-only study. Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT. Diabetic patients with normal results who required additional rest imaging had significant adverse outcome.
- Klíčová slova
- coronary artery disease, diabetes mellitus, myocardial perfusion imaging, prognosis, stress-only imaging,
- MeSH
- časové faktory MeSH
- diabetes mellitus patofyziologie MeSH
- incidence MeSH
- ischemická choroba srdeční diagnostické zobrazování epidemiologie etiologie MeSH
- jednofotonová emisní výpočetní tomografie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prognóza MeSH
- rizikové faktory MeSH
- zátěžový test metody MeSH
- zobrazování myokardiální perfuze metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL(Smax)) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q(REST)), and to define the optimal cut-offs for SL(Smax) to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). METHODS AND RESULTS: In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL(Smax) (r=-0.59, P<0.0001) and DE on ceCMR. The SL(Smax) optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL(Smax) for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL(Smax) resp. Q(REST), p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL(Smax) than Q(REST) in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SLSmax resp. Q(REST), P=0.001). CONCLUSIONS: STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.
- MeSH
- dysfunkce levé srdeční komory diagnóza MeSH
- echokardiografie * MeSH
- ischemická choroba srdeční diagnóza diagnostické zobrazování patofyziologie MeSH
- jednofotonová emisní výpočetní tomografie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- odpočinek MeSH
- prediktivní hodnota testů MeSH
- přežití tkáně MeSH
- radiofarmaka * MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- zátěžový test MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- radiofarmaka * MeSH
BACKGROUND: The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery. METHODS AND RESULTS: The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001). CONCLUSIONS: Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.
- MeSH
- elektivní chirurgické výkony * trendy MeSH
- ischemická choroba srdeční diagnostické zobrazování chirurgie MeSH
- jednofotonová emisní výpočetní tomografie trendy MeSH
- koronární bypass * trendy MeSH
- lidé středního věku MeSH
- lidé MeSH
- mitrální insuficience diagnostické zobrazování chirurgie MeSH
- následné studie MeSH
- neúspěšná terapie MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
The assessment of the patients with coronary artery disease is one of the most important clinical applications of echocardiography. The importance of this application lies in the fact that coronary artery disease is the most common form of heart disease and the leading cause of death in all industrial countries. Echocardiography plays a diagnostic role at all stages of the disease from the early detection of transient, stress-induced, ischemic dysfunction, through the phase of acute myocardial infarction and its attendant complications, to the development of chronic ischemic heart disease and heart failure. Finally, echocardiography often provides important prognostic data in patients with coronary artery disease.
