Stress Echocardiography Research Articles

THE FUNCTIONAL STATE OF THE CARDIOVASCULAR SYSTEM IN THE CONDITIONS OF A STRESS TEST IN JUNIOR FEMALE STUDENTS WITH MANIFESTATIONS OF PSYCHO-EMOTIONAL IMBALANCE

Introduction. The purpose of the study is to assess the state of the functional reserves of the cardiovascular system in junior female students with manifestations of maladaptation and excessive anxiety in conditions of stress. Research materials and methods. At the initial stage, 70 female students were examined using standardized questionnaires by Cohen and Spielberger. Based on the results of the survey, the main group of girls (n = 26) with signs of maladjustment and excessive anxiety, and the control group with negative survey results (n = 12) were formed. Female students in both groups were of the same age and had the same body mass index. At the second stage of the study, indicators of the cardiovascular system were studied among girls of both groups at the height of the cardiac stress test (CST) test according to the Cornell protocol. At the same time, the heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), the stroke volume (CV), minute blood volume, and the index of the chronotropic and inotropic reserves of the heart were determined. Research results. It was established that the girls of the main group had a decrease in the tolerance of the CST to (103.85 ± 4.43) W, against the average indicator of (147.92 ± 6.86) W in the control group. The result obtained in the main group was accompanied by an early increase in HR, minute blood volume, SBP, and a decrease in indicators of inotropic and chronotropic reserves, a double product, which indicated the presence of hidden disorders of the regulatory mechanisms of the stress-limiting system. Changes in hemodynamics detected in female students of the main group correlated with low stress resistance, excessive anxiety. At the same time, in the control group of female students, hemodynamic indicators underwent changes at the late stage of the SCT, which indicated a better state of neurohumoral reserves. Conclusion. Timely detection of homeostasis disorders in adolescence and their consequences through the use of diagnostic tests and functional tests will make it possible to detect adaptation disorders and possible psychosomatic conditions in adolescent girls and to develop ways to prevent them or reduce clinical manifestations and improve the quality of life, including the learning process and further professional activity.

Uric Acid Is Associated with Worsening of Diastolic Function and Adverse Outcomes in Patients with Coronary Slow Flow.

The impact of uric acid on worsening of diastolic function and clinical outcomes in patients with coronary slow flow remains unclear. This study aims to investigate possible associations between serum uric acid, worsening of diastolic function, and major adverse cardiovascular events in coronary slow flow patients. Blood samples were obtained prospectively from 537 patients who had been angiographically diagnosed with coronary slow flow. Of those, 425 patients underwent comprehensive cardiac function assessment both before and after maximal treadmill exertion by stress echocardiography. The association between serum uric acid and major adverse cardiovascular events was examined using Cox proportional hazards regression model. Among the 425 patients (mean age: 58 ± 11 years; 52.2% men), worsening of diastolic function occurred in 176 (41.4%) after exercise stress. Patients with worsening of diastolic function had elevated levels of serum uric acid compared to those without (5.7[4.1,6.7] vs 4.3 [3.6, 5.3] mg/dL, respectively; P <.001). Higher serum uric acid levels were also significantly associated with neutrophil counts and high-sensitive C-reactive protein in patients with worsening of diastolic function but not in those without. Multivariate regression analysis found serum uric acid to be an independent predictor of worsening of diastolic function (oddsratio = 1.87 [1.17-3.82], P =.023). Moreover, serum uric acid remained associated with major adverse cardiovascular events even after adjusting for echocardiographic and clinical variables (hazard ratio = 1.56 [1.03-2.89], P =.016). Serum uric acid is associated with worsening of diastolic function and may be mediated by inflammation. These findings indicate that uric acid is a risk factor for major adverse cardiovascular events in patients with coronary slow flow.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and nonviable myocardium. Materials and Methods: In this prospective Cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for Dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine Dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction(EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences(SPSS) version 16.0. Results: Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) &gt;0.03 m/s and baseline mitral annular systolic velocity &gt;0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

Pressure/Volume Ratio as a Simple Parameter for Assessment of left Ventricular Contractile Reserve during Stress Echocardiography

Pressure/Volume Ratio as a Simple Parameter for Assessment of left Ventricular Contractile Reserve during Stress Echocardiography

Влияние миокардиального станнинга на динамику показателей митральной регургитации и ремоделирования после перенесенного инфаркта миокарда

Aim. To study the dynamics of mitral regurgitation depending on the results of low dose dobutaminestress-echocardiography with effectiveness of myocardial reperfusion and in patients after MI with STsegment elevation.Material and methods. The study included 302 patients with STeMI. All patients underwent myocardialreperfusion. Depending on the effectiveness of reperfusion, the patients were divided into 3 groups: group1 – 196 (65%) patients with successful reperfusion; group 2 – 76 (25%) patients with partial reperfusion,group 3 – 30 (10%) patients with no reperfusion. The indicators of systolic function, LV remodeling, mitralregurgitation at rest, under pharmacological load and after a month were studied. To determine the zoneof viable myocardium, stress echocardiography with low doses of dobutamine was used.Results. Indicators characterizing the severity of MR had a negative trend in patients of group 3, who showedan increase in ERO, PISA and vena contracta width. But in patients of the 1st and 2nd groups with the presence of myocardial stunning, an unreliable decrease in these indicators of the degree of MR was noted. Identification of viable zones by low-dose dobutamine stress echocardiography in areas of LV dysfunction preventsthe progression of MR and serious intracardiac hemodynamic disturbances and will also be reversible.Conclusion. The main mechanism in the progression of MR in patients after AMI is LV myocardial dysfunction with further LV remodeling accompanied by dilatation and spherification of its cavity. The presenceof a viable myocardium in the zone of dysfunction can prevent the progression of MR, and even lead toa decrease in its degree with adequate revascularization. Patients with MR, with a lack of viability in thearea of myocardial dysfunction, are candidates for the development of severe MI.

Cirrhotic cardiomyopathy – negative prognosis factor in cirrhosis

Cirrhotic cardiomyopathy is a complication of cirrhosis which is still incompletely elucidated, being underdiagnosed due to the fact that it is generally latent at rest and it only ma­ni­­fests under stress; however, it can have a bad impact on the prognosis of cirrhotic patients. It is characterized by an im­­paired hemodynamic response to stress, a hyperdinamic cir­­cu­­la­­to­ry status, systolic and diastolic dysfunction and elec­­tro­­phy­­sio­­lo­­gi­­cal impairments (most frequently, QT pro­­lon­­ga­­tion). The diagnosis is difficult because cirrhotic car­­dio­­myo­­pathy is usually asymptomatic at rest and the he­­mo­­dy­­na­­mic alterations together with the signs and symp­toms of heart failure appear only in stressful conditions (ef­fort, drugs, infections, hemorrhage, surgery etc.). The diag­no­sis is made by identifying systolic and diastolic dys­func­tion through stress echocardiography (effort, do­bu­ta­mine etc.) or using myocardial strain imaging. In the absence of a pro­per diag­no­sis and treatment, cirrhotic cardiomyopathy can lead to severe complications such as heart failure, ar­rhyth­mias, he­pa­to­re­nal syndrome or sudden death. At the moment, there is no standardized protocol for the treat­ment of cirrhotic car­dio­myo­pathy, but the main the­ra­peu­tic options are loop diu­re­tics, aldosterone receptor an­ta­go­nists, nonselective beta-blockers (in particular car­ve­di­lol) or angiotensin-con­ver­ting enzyme inhibitors. Liver transplant significantly im­proves systolic and dias­to­lic dys­func­tion and can reverse QT prolongation in some pa­tients. However, there are limited stu­dies that show a risk for cardiovascular complications after liver trans­plant. There­fore, a complex cardiovascular eva­lua­tion is re­com­men­ded before and after the transplant.

Assessment of Left Ventricular Diastolic Reserve in Diabetic Patients by Stress Echocardiography

Background: Patients with type 2 diabetes mellitus (DM) may develop cardiomyopathy independent of traditional risk factors such as hypertension and epicardial coronary artery disease (CAD). The spectrum of myocardial dysfunction may range from subclinical left ventricular (LV) diastolic and systolic dysfunction through to overt systolic dysfunction. Aim and objectives: to determine whether diastolic reserve differs in type 2 DM compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM. Subjects and methods: This study included one hundred consecutive patients (50 patient with DM type II and 50 patient without DM), who underwent rest and exercise echocardiography. Clinical data collected included anthropometric, cardiac risk factors, duration of DM, medications and presence of macrovascular and microvascular complications. Mitral septal é and septal E/é were measured at rest, immediately post, and 10 min into recovery. Results: LDL, cholesterol, triglyceride, creatinine and BMI was significantly higher in in diabetic group than non-diabetic group (P value < 0.05). Regarding rest echocardiography parameters, Septal E/é, Septal é and EF were insignificant between both studied groups. Regarding stress echocardiography parameters, septal E/é was significantly higher and septal é was significantly decreased among diabetic patients among diabetic patients compared to the other group(p

PS-C25-6: HYPERTENSIVE RESPONSE TO EXERCISE AS PREDICTOR FOR DEVELOPMENT OF ESSENTIAL HYPERTENSION AND HOSPITALIZATION DUE TO MAJOR ADVERSE CARDIAC EVENT

Objective: The aim of this study was to determine the structural and metabolic factors associated with hypertensive response to exercise (HRE) in non hypertensive patients and role of HRE in predict development of essential hypertension during follow-up and predict hospitalization due to major adverse cardiac event (MACE). Design and method: This study was a cross-sectional retrospective study using cardiac treadmill stress test (TST) data at Sanglah General Hospital, Bali from 2016–2020. Data analysis used SPSS version 21. Subjects were divided into positive HRE and negative HRE. Pearson-chi square test and Mann-Whitney test were used to compare categorical variables based on age, gender, smoking status, nutritional status, alcohol status, dyslipidemia, type 2 diabetes mellitus (T2DM), HbA1C, total cholesterol, LDL, HDL, triglycerides, history of kidney disease, and mean echocardiographic parameters based on the presence of HRE. Development of essential hypertension during follow up and history of hospitalization after cardiac TST due to MACE until April 2022 based on the presence of HRE was evaluated using receiver operating characteristics. Results: We evaluated 202 non hypertensive patients (47,1% with HRE) who underwent cardiac TST. During follow up, 19.8% experienced hospitalization and 26.1% developed hypertension. Obesity (PR1.727; 95%CI = 1.235–2.413), smoking status (PR1.773; 95%CI = 1.170–2.687), T2DM (PR2.29; 95%CI = 1.16–3.37), HbA1C (PR3.13; 95%CI = 2.31–4.22), high LDL level (PR1.853, 95%CI = 1.229–2.794) and history of kidney disease (PR1.985; 95%CI = 1.478–2.665), were significantly associated with positive HRE (all p-value &lt; 0.05). Regarding the clinical outcomes, patients with HRE were associated with an increased risk of developing essential hypertension (PR1.72; 95%CI = 1.235–2.413 p = 0.05) and hospitalization due to MACE (OR2.27, 95% CI = 1.62–3.16, p = 0.0001) during follow up, with sensitivity of 76.7% and specificity of 93.6%. Subjects with HRE had higher LV mass index (82.34 ± 15.05 vs 70.62 ± 9.76), higher E/E ratio (16.31 ± 2.95 vs 16.01 ± 13.23), higher LAVI (39.75 ± 15.21 vs 34.27 ± 11.15) with all p-value were &lt; 0.05. Conclusions: Patients with impaired cardiometabolic and the presence of cardiac remodeling commonly have HRE that could be detected by cardiac TST examination, which may predict the development of essential hypertension and major adverse cardiac events in the future.

Gender-related differences in left atrial strain mechanics and exercise capacity in hypertrophic cardiomyopathy: a propensity-score matched study from the Cleveland Clinic.

Male and female patients with hypertrophic cardiomyopathy (HCM) differ in physiologic characteristics and hemodynamics. Little is known about gender-related differences in left atrial (LA) strain and exercise capacity. The aim of this study was to assess the gender-related differences in the relationship between exercise capacity and cardiac function including LA function in patients with HCM. Five hundred and thirty-two patients with HCM undergoing exercise stress echocardiography and cardiopulmonary exercise testing (CPET) were prospectively recruited between October 2015 and April 2019 as part of a cohort study in a quaternary referral center. To reduce potential confounding factors, propensity score (PS) matching was performed in 420 patients. LA strain mechanics were evaluated using speckle-tracking echocardiography. The majority of patients were male, comprising 58% of the total. Female HCM patients were older (54±14 vs. 50±15 years, P=0.002). After PS matching, percent-predicted peak VO2 was similar between the genders (67.5%±20.7% vs. 65.8%±21.8%, P=0.41), even though female HCM patients had lower peak VO2 (17.7±5.9 vs. 24.1±8.3 mL/kg/min, P<0.001). Left ventricular (LV) diastolic function was worse for female HCM patients. This is shown by worse E/e' ratio (15.0±5.9 vs. 12.9±6.4, P<0.001) and larger LA volume in respect to LV (0.88±0.35 vs. 0.74±0.31, P<0.001), compared with male HCM patients. The gender-related differences in LA reservoir strain were more evident for patients aged 60 years and older (27.5%±8.8% vs. 30.9%±9.1%, P=0.03). LA reservoir strain was found to have a significant association with exercise capacity in both male and female HCM patients (for females, β=0.27, P=0.001; for males, β=0.27, P<0.001), independent of LV diastolic dysfunction and stroke volume. Gender-related differences in LA reservoir strain were increasingly evident for older HCM patients aged 60 years and older. LA reservoir strain was an independent determinant of percent-predicted peak VO2 in male and female patients, underpinning the importance of LA function in determining exercise capacity in HCM.

Silent myocardial ischemia revisited, another silent killer, emphasis on the diagnostic value of stress echocardiography with focused update and review

Silent myocardial ischemia revisited, another silent killer, emphasis on the diagnostic value of stress echocardiography with focused update and review

Early diagnosis of coronary microvascular dysfunction by myocardial contrast stress echocardiography.

Coronary microvascular dysfunction (CMD) is one of the basic mechanisms of myocardial ischemia. Myocardial contrast echocardiography (MCE) is a bedside technique that utilises microbubbles which remain entirely within the intravascular space and denotes the status of microvascular perfusion within that region. Some pilot studies suggested that MCE may be used to diagnose CMD, but without further validation. This study is aimed to investigate the diagnostic performance of MCE for the evaluation of CMD. MCE was performed at rest and during adenosine triphosphate stress. ECG triggered real-time frames were acquired in the apical 4-chamber, 3-chamber, 2-chamber, and long-axis imaging planes. These images were imported into Narnar for further processing. Eighty-two participants with suspicion of coronary disease and absence of significant epicardial lesions were prospectively investigated. Thermodilution was used as the gold standard to diagnose CMD. CMD was present in 23 (28%) patients. Myocardial blood flow reserve (MBF) was assessed using MCE. CMD was defined as MBF reserve < 2. The MCE method had a high sensitivity (88.1%) and specificity (95.7%) in the diagnosis of CMD. There was strong agreement with thermodilution (Kappa coefficient was 0.727; 95% CI: 0.57-0.88, p < 0.001). However, the correlation coefficient (r = 0.376; p < 0.001) was not high.

Left ventricular diastolic reserve by exercise stress echocardiography in prediabetes.

The objective of this study was to evaluate if the diastolic reserve is different in prediabetes versus control during exercise. During the resting stage and graded supine bicycling exertion (25 W, 3 min increment), the mitral inflow and septal mitral annular velocities were determined in 50 patients with prediabetes (21 females, mean age 48 ± 16 years) and 50 gender- and age-matched controls. None demonstrated rest or inducible cardiac ischemia on echocardiography. Between the two study groups, the velocities of the mitral inflow (E) and septal mitral annulus (E') at rest are not significantly different. E' during exercise, on the other hand, was significantly lower in individuals with prediabetes than in controls (8.57 ± 2.46 vs. 9.82 ± 2.42 cm/s at 25 W, P = 0.012; 9.42 ± 1.93 vs. 11.15±2.97 cm/s at 50 W, P = 0.001). E/E' behaves oppositely during exercise with a value that is significantly higher in patients with prediabetes. The diastolic reserve of the left ventricle, as determined by the change in E' and E/E' throughout exercise, is abnormal in individuals with prediabetes who do not have overt cardiac disease. Using exercise stress echocardiography may be helpful for the early recognition of subclinical diastolic dysfunction in prediabetics which may have clinical repercussions in the future.

Comparison between Visual Assessment and Longitudinal Strain during Dobutamine Stress Echocardiography.

The relationship between visual assessment and longitudinal strain during dobutamine stress echocardiography (DSE) remains poorly investigated. This study assessed wall motion segments visually graded as normokinetic, hypokinetic, and akinetic at baseline and the peak of DSE and compared with longitudinal strain between segments with and without induced impaired contractility and improved contractility during DSE. This study included 112 patients examined by DSE, consisting of 58 patients referred for diagnostic study and 54 patients referred for viability study. Regional left ventricular (LV) contractility was assessed visually and longitudinal strain was measured using echocardiography transthoracic. At baseline, the strain of LV segments was -16.33 ± 6.26 in visually normokinetic, 13.05 ± 6.44 in visually hypokinetic, and -8.46 ± 5.69 in visually akinetic segments. During peak dose, the strain of LV segments was -15.37 ± 6.89 in visually normokinetic, -11.37 ± 5.11 in visually hypokinetic, and -7.37 ± 3.92 in visually akinetic segments. In segments with visually observed impaired contractility, the median longitudinal strain was significantly lower than in segments without impaired contractility. For segments with visually observed improved contractility, the median longitudinal strain was significantly higher than for segments without improved contractility. In diagnostic study, sensitivity of visual assessment for absolute decrease of >2% longitudinal strain was 77%, respectively. In the viability study, the sensitivity was 82% for an absolute decrease of ≥2% longitudinal strain. There is good association between strain analysis value and visually assessed wall motion contractility.

The Year in Hungarian Cardiology 2022: Cardiac Imaging

In 2022, the Hungarian Cardiovascular Imaging community contributed to several scientifi c papers that were published in international journals. Clinical research activities employed novel echocardiographic methods including two- and three-dimensional, strain and tissue Doppler imaging of all cardiac chambers. These echocardiographic modalities were applied in diff erent patient populations such as patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or post-SARS-CoV-2 aff ected individuals, athletes, patients with systemic autoimmune diseases, cardiomyopathies, hematologic diseases, metabolic diseases, congenital heart disease or valvular interventions. Beyond resting echocardiography, original research results revealed important information in the fi eld of exercise stress echocardiography as well. Hungarian studies using cardiac magnetic resonance imaging evaluated patients with diff erent pathologies such as cardiac amyloidosis, cardiomyopathies, myocarditis due to SARS-CoV-2 vaccinations, and athletes in post-SARS-CoV-2 states. Hungarian research activities in the fi eld of cardiac computed tomographic imaging covered the evaluation of moderate coronary lesions, correlates of myocardial ischemia, coronary plaques, coronary calcium, recurrence of atrial fi brillation after radiofrequency ablation and morphological changes after valvular interventions. Novel technologies have been applied in cardiac computed tomographic imaging by Hungarian researchers, with higher spatial resolution and enhanced spectral capabilities in coronary artery assessment.

Could a non-radiological chest shape assessment reduce false positive exercise stress echocardiography results?

Could a non-radiological chest shape assessment reduce false positive exercise stress echocardiography results?

Usefulness and feasibility of exercise stress echocardiography in patients with congenital heart diseases

Usefulness and feasibility of exercise stress echocardiography in patients with congenital heart diseases

Role of Exercise Stress Echocardiography in the Detection of Subclinical Diastolic Dysfunction in Asymptomatic Diabetics

Role of Exercise Stress Echocardiography in the Detection of Subclinical Diastolic Dysfunction in Asymptomatic Diabetics

Стресс-эхокардиография в диагностике кардиальной дисфункции в раннем постинфарктном периоде

The purpose — to assess the importance of stress echocardiography in identifying the nature and severity of cardiac dysfunction in patients with myocardial infarction. Material and methods.86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with primary coronary angioplasty with stenting. Results.Echocardiography revealed left ventricular hypertrophy (LVH) in 34 patients with myocardial infarction with concomitant arterial hypertension. Patients with LVH are characterized by more pronounced structural and functional LV remodeling, which is expressed in a lower LVEF and increased LVEDD, LVESVand LVEDV(p&lt;0.05). There were no differences in stroke volume between patients with and without LVH. The performed diastolic stress test in patients with LVH is characterized by significantly lower average early diastolic mitral annular velocity e` (7.6 vs. 9.3 cm/s, p&lt;0.01) without differences in the peak early transmitral Doppler flow velocity E (69.8 vs 78.0, p&gt;0.05) compared with patients without LVH. The revealed differences between patients with and without LVH are due to a higher post-exercise velocity e` in patients with normal LV geometry and a decrease in eccentric LVH subgroup. Conclusions.1) Patients with LVH in the early postinfarction period (6 weeks) have more pronounced LV systolic dysfunction, expressed in a decrease in LVEF and an increase in LVEDD, LVESV, LVEDV compared to patients without LVH.2) Left ventricular hypertrophy, in conditions of myocardial infarction, is associated with latent diastolic dysfunction, which is manifested by a lower average early diastolic mitral annular velocity e` after the stress-test.

Risk Stratification in Patients with Coronary Artery Disease: Timeliness of Invasive Interventions

Coronary artery disease (CAD) remains a top cause of morbidity and mortality nowadays. Current guidelines are used to deϐine timely diagnostic and management strategies for a patient with new angina symptom. According to the guidelines, the main purpose is assessment of the pretest probability of obstructive CAD. Exercise electrocardiography is the most accessible methodwith 85-90% speciϐicity and 45-50% sensitivity. Cardiopulmonary exercise testing (CPET) with concomitant monitoring of electrocardiogram, heart rate and blood pressure, expired gas analysis has become widespread among different exercise tests. CPET is an important clinical tool to estimate exercise capacity. In most cases it allowsto determine the causes of limited physical activity, evaluate both the blood supply (pulmonary, cardiovascular, haematopoietic systems) and tissue oxygen metabolism (skeletal muscle system) in response to physical exercise.The indications for invasive coronary angiography include: high clinical risk of CAD, symptoms which are refractory to medical therapy, low tolerance to exercise or if revascularization is considered for improvement of prognosis.&#x0D; The aim. To highlight the need for a combination of non-invasive stresstesting (CPET, stress echocardiography) and invasive testing (such as coronary angiography) to develop proper tactics of treating patients with established CAD.&#x0D; Conclusion. Described clinical case demonstrates preferences of combined different functional non-invasive tests (CPET, stress echocardiography) in a patient with confirmed CAD, who received prognosis modifying therapy and had high exercise tolerance due to regular cardio training. This gave the reason for postponing the repeated ICA to determine the dynamics of the progression of coronary atherosclerosis. However, when an anginal attack occurred and repeated urgent ICA was performed, it became necessary to perform coronary artery bypass grafting and, later, due to the continuation of anginal attacks and the presence of areas of ischemia, stenting of the trunk of the left coronary artery.

Neutrophil-to-Lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Myocardial Infarction and Chronic Coronary Syndrome

Background: Inflammation has an essential role in atherosclerosis that is the leading reason for acute coronary syndrome (ACS) which includes acute myocardial infarction (AMI) and unstable angina (UA). The objective of this work was to study the existence of difference in Neutrophil to Lymphocyte ratio and its relation to inflammatory markers between cases with AMI and cases with chronic coronary syndrome.&#x0D; Methods: This work included sixty consecutive cases with AMI and ACS who presented to cardiovascular medicine department at Tanta university hospital. The cases were classified into two equal groups; group I: cases with AMI and group II: cases with chronic coronary syndrome. All participants were subjected to ECG, Echocardiography, color Doppler, coronary angiography and laboratory investigations as differential CBC, cardiac enzymes, troponine, CK, CK-MB, CRP, urea, creatinine and random blood sugar. Patients who didn’t meet the criteria for invasive treatment, continued on medication and further noninvasive investigations done, starting from stress ECG, stress echocardiography, or CCTA.&#x0D; Results: There were insignificantly different between the two groups regarding age, gender and residency (p= 1.00). There was insignificant difference between the two groups regarding hypertension (p= 0.592), DM (p= 0.795) and dyslipidemia (p= 0.504). 7 (23.3%) cases were smokers in group I and 8(26.7%) patients were smokers in group II with insignificantly different between the two groups (p= 1.00).&#x0D; Conclusions: NLR is a powerful marker of myocardial damage in acute myocardial cases.