Left Ventricle Systolic Dysfunction Research Articles

Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics

Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.

Ethnicity and the risk of ventricular arrhythmias due to stable ischemic heart disease

Objective: determination of the of life-threatening ventricular arrhythmias risk in native nationality patients with stable ischemic heart disease. Methods. The cohort study included 216 patients with stable ischemic heart disease with left ventricular ejection fraction not less than 40%. All participants initially underwent anthropometric measurements, laboratory routine tests, 6-minute walking test, ECG, 24-hours ECG monitoring, echocardiography. After 3, 6 and 12 months, participants were invited to repeat 24-hours ECG monitoring procedure for life-threatening ventricular arrhythmias episodes detection. Results. Participants cohort included 130 native nationality persons (Kazakhs) and 86 Caucasian patients. Characteristics of the sample: 181 men (84%), the average age of 62 [57; 66], the average follow-up period - 12,7 ± 1,2 months. Increased relative risk of ventricular arrhythmias in Kazakh patients was revealed: high grading ventricular premature beats RR 1.98 (95% CI 1,02-3,84), P = 0.010); non-sustained ventricular tachycardia RR 2.80 (95% CI 1,07-8,97), P <0.001). Signifcant independent influence on life-threatening ventricular arrhythmias development in patients Kazakh nationality had anemia, obesity, diabetes and limitation in 6-minute walking test performing. Conclusion. Arrhythmic events in native nationality patients with stable ischemic heart disease without severe left ventricle systolic dysfunction are different from those of Caucasians, that should be considered when predicting the individual risk of arrhythmic events and sudden cardiac death in native nationality patients.

Long-Term Outcome of Interdisciplinary Management of Patients with Duchenne Muscular Dystrophy Receiving Daily Glucocorticoid Treatment

To evaluate clinical outcomes and steroid side effects in a cohort of patients with Duchenne muscular dystrophy (DMD) treated with long-term daily glucocorticoid therapy. Although daily glucocorticoid therapy has been shown to extend ambulatory function in DMD, less frequent dosing is often used because of side effect concerns. Retrospective study of 97 patients with DMD aged 10 to <16 years treated with daily glucocorticoid (89% on deflazacort) for a mean of 8.5 years. Outcome measures were motor, pulmonary, and cardiac function, and scoliosis. Side effects were growth failure and weight gain, facial fullness, blood pressure, bone health, cataracts, gastrointestinal symptoms, behavior, hypertrichosis, and need for medication interventions. For 13- to 16-year-old patients, 40% could rise from the floor and 50% could perform the 30-foot run test. Forced vital capacity for the entire cohort was well preserved. Thirteen percent of younger (10- to <13-year-old) and 21% of older patients had findings of left ventricle systolic dysfunction. Six percent (all aged 16 years) developed scoliosis (Cobb angle >20 degrees). Eighty-six percent had normal weight velocities; 30% had no increased facial fullness; 72% had short stature; and 19% had asymptomatic cataracts. Asymptomatic spine compression deformities were noted in 76% and long bone fractures in 30%. One patient stopped glucocorticoid because of behavioral concerns. With evidence for improved outcomes and manageable side effects, we recommend use of daily glucocorticoid therapy for patients with DMD with anticipatory management of side effects and a coordinated interdisciplinary care approach.

Paradoxical hypoperfusion suggesting early and severe coronary dysfunction in tako-tsubo disease

Tako-tsubo disease (TD) is an unusual and paradigmatic clinical entity of unknown pathophysiology characterized by acute apical dysfunction usually triggered by physical or emotional stress. We describe the case of a woman with TD presenting early myocardial perfusion defects with transient dilatation and systolic dysfunction of left ventricle in gated-SPECT myocardial perfusion imaging, discussing the more likely mechanisms suggested by these functional findings.

Effects of Acute Carbon Monoxide Poisoning on ECG and Echocardiographic Parameters in Children.

The aim of the current study is to investigate the effects of CO (carbon monoxide) on the cardiovascular system via electrocardiographic, echocardiographic and biochemical findings in children. This prospective study included 22 children with CO poisoning and 24 healthy children as a control group. The CO-intoxicated children were evaluated via electrocardiography and echocardiography 1h after admission to the emergency department and daily until their discharge from the hospital. Blood gasses, complete blood account, troponin I and creatinine kinase-MB(CK-MB) were assessed daily. Tpeak-end (p:0.001), QTc durations (p:0.02), Tpeak-end dispersion (p:0.001) and Tpeak-end/QT ratio (p:0.001) of CO-intoxicated patients were significantly higher than those in the control group. Mitral E duration (p:0.001), mitral E/A ratio (p:0.001) and left ventricle contractile fraction (p:0.023) at admission were significantly lower, and left ventricle myocardial performance index was higher (p:0.001) in the CO poisoning group. Troponin I and CK-MB levels were higher at admission in 6 (27%) and 4 (18%) patients, respectively. The heart is the most critical organ in pediatric CO poisoning. These children present subclinical systolic and diastolic left ventricle dysfunction even in mild cases. Although, in children with acute CO-intoxication ventricular repolarization is impaired, it seems to be reversible like other findings.

PS 14-18 INFLUENCE OF GENDER IN CLINICAL PROFILES AND MORTALITY IN A COHORT OF PATIENTS WITH PULMONARY HYPERTENSION IN SUB-SAHARAN AFRICA

Objective: Pulmonary hypertension (PH) is a prominent prognostic feature of heart failure (the final common pathway of most cardiovascular diseases (CVD)) and has limited epidemiological data in Africa. We sought to determine the differences in clinical and echocardiographic characteristics as well as outcomes with respect to gender in a cohort of patients with PH in Douala, Cameroon. Design and Method: A prospective study from March 2012 to December 2013 in which PH patients were consecutively recruited following echocardiography (right ventricle systolic pressure (RVSP) ≥35 mmHg) from two cardiovascular centers in Douala. Patients were followed up for 12 months. Group comparisons were done using chi square & t-tests while survival was estimated using Kaplan-Meier plots and log rank tests for comparisons. Results: In a cohort of 130 patients (54.6% women) with PH (78% being PH due to left heart disease) were recruited. Overall mean age was 58.7years (59.2 for men and 58.3 for women). While hypertension, cigarette smoking and alcohol abuse were more common in men than women (all p < 0.001), women had respectively greater exposure to log smoke (p < 0.001), previous pulmonary tuberculosis infection (p < 0.01) and S3 gallop rhythm (p < 0.01) than men. Echocardiographic left ventricle (LV) systolic dysfunction was found more in men (mean LV ejection fraction: 41.6 vs 51.5, p < 0.01 and mean fractional shortening: 21.4 vs 28.6, p < 0.01), while rheumatic valvular heart disease was frequent in women (p < 0.01). Overall mortality rate was 39.2% and survival was better in females. Conclusions: Though women are more affected by PH, conventional cardiovascular risk factors were more common in men with PH as opposed to rheumatic valvulopathies in women. Interventions targeting control of CVDs in the region should be intensified while accounting for women's specificities.

LBPS 02–27 WHAT IS THE ASSOCIATION BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND SIX-MINUTE WALK TEST IN HYPERTENSIVE PATIENTS?

Objective: We aimed to find the association between the degree of LV diastolic dysfunction and the functional capacity assessed by 6-minute walk test (6MWT) in asymptomatic hypertensive patients. Design and Method: The study included 200 asymptomatic hypertensive patients. All patients had undergone full history taking, complete clinical examination, electrocardiography, echocardiography for assessment of left ventricle (LV) dimensions, systolic, and diastolic dysfunction, and 6MWT. Patients were classified into two groups according to the presence or absence of LV diastolic dysfunction. Results: The clinical and echocardiographic data were comparable between the two groups. Regarding 6MWT, at the end of the test patients with diastolic dysfunction had significantly higher systolic (p = 0.0088) and diastolic (p = 0.019) blood pressure and higher Borg score for dyspnea (p < 0.00001). Conclusions: The presence of LV diastolic dysfunction has a bad effect on 6MWT. The degree of LV diastolic dysfunction is correlated with the results of 6MWT. It may be important to investigate LV diastolic function in hypertensive patients.

CLINICAL CHARACTERISTICS,ECHOCARDIOGRAPHIC PROFILE AND OUTCOME OF PERIPARTUM CARDIOMYOPATHY AT BPKIHS, A TERTIARY CARE HOSPITAL IN NEPAL

Background: Peripartum Cardiomyopathy (PPCM) is a pregnancy assosciated myocardial disease. It is a rare disease with unknown etiology. Certain characteristics are risk factors for the disease. Recognition of its risk factors is important for prevention and treatment. Objectives: To determine clinical characteristics, echocardiographic profile and in hospital outcome of patients with peripartum cardiomyopathy. Methods: This is a descriptive retrospective study. All patients files with the diagnosis of peripartum cardiomyopathy from 1 st November 2009 to 30 th December 2014 were studied. Demographic data, echocardiogram and in hospital outcome of patients were reviewed. Results: Sixty five patients were diagnosed with PPCM during the study period. Mean age was 28 ± 6.5yrs. Fifty eight patients (89%) were multigravida and only seven (11%) were primigravida. Only two patients had twin pregnancy. Fourty four (68%) presented after delivery and twenty one (32%) presented during pregnancy. Most of the patients 57 (88%) were in NYHA class III and IV. Fifty seven (88%) patients had moderate to severe Left ventricle systolic dysfunction. Five (8%) had preeclampsia, four (6%) had eclampsia and two developed gestational hypertension. Two patients were diabetic. None of the multiparous patients had history of PPCM. No maternal mortality was there. Fetal outcomes were good with all resulting live births and most were appropriate for gestational age.

Association between intracardiac hemodynamics and respiratory function in patients with coronary artery disease and respiratory comorbidity

The aim of this study was to investigate a relationship between the myocardial structure and function and respiratory parameters in patients with coronary artery disease (CAD) and respiratory disease.Methods. We performed spirometry, body plethysmography, lung diffusing capacity test and measured the left ventricle (LV) systolic and diastolic function in patients with CAD with or without respiratory diseases and ventilation disorders.Results. Patients with CAD (n = 662) participated in the study. The LV systolic dysfunction was found only in 60 patients (9.1%), while diastolic dysfunction was found in 387 patients with CAD (58.4%). Most patients with obstructive ventilation disorders had the systolic or diastolic LV dysfunction (40 patients (66.7%) and 197 patients (79.4%), respectively). Flow and volume lung function parameters and the lung diffusing capacity were associated with some echocardiographic and pulsed wave Doppler parameters.Conclusion. Comorbidity of CAD and lung obstructive disease was associated with more frequent systolic and diastolic LV dysfunction. The relationship between respiratory and cardiac parameters could indicate the cross impact that could deteriorate the course of both the diseases.

095 - Pharmacokinetics/Pharmacodynamics, Efficacy and Safety of Sacubitril/Valsartan Versus Enalapril in Pediatric Patients with Heart Failure Due to Systemic Left Ventricle Systolic Dysfunction: Study Design and Rationale

095 - Pharmacokinetics/Pharmacodynamics, Efficacy and Safety of Sacubitril/Valsartan Versus Enalapril in Pediatric Patients with Heart Failure Due to Systemic Left Ventricle Systolic Dysfunction: Study Design and Rationale

The quantitative assessment of left ventricular local myocardial systolic function in patients with coronary heart disease by velocity vector imaging

Objective To explore the preliminarily clinical value of strain rate parameters using velocity vector imaging (VVI) evaluating left ventricular regional endocardial systolic function in patients with coronary artery heart disease (CAD). Methods A total of eight six inner subjects who were suspected as CAD was enrolled in the study. Patients with the vascular stenosis rate ≥50% were defined as the CAD group, patients with the vascular stenosis rate <50% were defined as the coronary atherosclerosis group, and patients with the completely normal angiographic results were included in the control group, according to the results of angiography. The left ventricular endocardial systolic strain rate parameters of VVI were obtained in standard long axis views (apical two, three, and four-chamber view) and short axis views (at the level of the mitral valve, papillary muscles, and apex). The strain rate parameters were global longitudinal endocardial systolic strain rate in the apical two, three, and four-chamber views (A2-GLSRs, A3-GLSRs, and A4-GLSRs), global radial endocardial systolic strain rate in short axis view of the mitral valve level, papillary muscles, and apex (MV-GRSRs, PM-GRSRs, and AP-GRSRs), and global circumferential endocardial systolic strain rate in short axis view of the mitral valve level, papillary muscles, and apex (MV-GCSRs, PM-GCSRs, and AP-GCSRs). The parametric differences were compared among three groups. Results All the subjects included in the present study had normal left ventricular ejection fraction (LVEF) and there was no significant difference in LVEF across three groups. Compared to other groups, the control group had significantly higher E/A ratio. The LV endocardial systolic strain rate parameters were all significantly reduced in the CAD group compared to the control group and the coronary atherosclerosis group (all P<0.05). Compared to the control group[(-1.37 ± 0.25)/s], the coronary atherosclerosis group[(-1.12 ± 0.42)/s] had significantly lower MV-GCSRs (P<0.01). Conclusions VVI is useful for quantitative assessment of the left ventricular systolic function in CAD. MV-GCSRs might have the potential to predict early left ventricle (LV) systolic dysfunction in subjects with coronary artery stenosis<50% . Key words: Echocardiography; Coronary disease/US

Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up.

Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58 % males, age 30 ± 10years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <-2). Patients with LV systolic dysfunction were mainly males (82 %), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least ¼ of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.

Biplane versus short-axis measures of the left atrium and ventricle in patients with systolic dysfunction assessed by magnetic resonance

PurposeThis study aims to investigate if the time saving biplane method can be an alternative to short-axis measurements for left atrium (LA) and left ventricle (LV) in cardiac magnetic resonance of patients with extensive LV remodeling. Materials and methodsIn 45 patients with coronary artery disease and systolic LV dysfunction [ejection fraction (EF)<50%], LA and LV end-diastolic volume, end-systolic volume, stroke volume, and EF were measured by the biplane area length and by the short-axis volume method. ResultsNo statistical differences between the biplane area length and short-axis volume were found for the LA end-systolic or the LV end-diastolic volumes. However, the biplane area length method overestimated LA stroke volume by 7.1±12.3 ml, LA EF by 6.7±8.8% (both P<.001), LV stroke volume by 6.2±12.9 ml (P=.002), and LV EF by 2.6±4.6% (P<.001). The differences in LV measurements were more evident in patients with severely distorted LV. For LA volume parameters, overall consistency between biplane area length and short-axis approach was good [all intraclass correlation coefficient (ICC)≥0.74] and for LV volume parameters, overall consistency between both approaches was excellent (all ICC≥0.93). ConclusionIn patients with LV systolic dysfunction, the short-axis volume is superior to the biplane method and should be the first choice, when accurate determination of LA and LV EF is the main clinical indication for cardiac magnetic resonance.

Significance of different ECG indices for left ventricle enlargement and systolic dysfunction assessment: A cardiac MRI study

a Cardiology Department, European Society of Hypertension Excellence Center, Hopital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France b Cardiology Department, Hopital Nord-Ouest, F-69400 Villefranche-sur-Saone, France c Radiology Department, Hopital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France d Universite de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Universite Claude Bernard Lyon 1; Hospices Civils de Lyon, France

Cardiotoxicity Associated with Trastuzumab Therapy in Taiwan: A Single Medical Center's 5-Year Experience

IntroductionTrastuzumab, a recombinant humanized monoclonal antibody, targets the external domain of HER2 to improve the efficacy of HER2-positive breast cancer treatment and inhibit carcinoma cellular proliferation. The purpose of this study was to identify early changes in cardiac function and dimensional changes in heart size in patients treated with trastuzumab. Materials and MethodsSeventy three female patients with Her2/neu overexpression (IHC 3+/Fish +) in breast cancer underwent echocardiography before and after trastuzumab therapy. ResultsCardiac complications developed in 14 patients (19.2%), including asymptomatic left ventricle systolic dysfunction (n = 12), symptomatic heart failure (n = 2), new asymptomatic left bundle branch block (n = 1), new negative T waves on electrocardiogram (n = 2), pericardial effusion (n = 1), and death (n = 1). No significant deterioration in diastolic function was noted, and right heart diameters and function did not change significantly. Most patients remained in an asymptomatic stage of cardiac disease. A significant decrease in left ventricular ejection fraction (LVEF) was observed in 14 patients (19.2%), and new mitral regurgitation (≥ grade 1) was noted after 3 months of trastuzumab therapy in 7 patients (9.6%). ConclusionsTrastuzumab led to measurable decreases in LVEF (but only 2.7% was symptomatic heart failure) and new mitral regurgitation. Therefore, regular follow-up with echocardiography is essential for early detection and prevention of trastuzumab-induced cardiomyopathy.

Changes in laboratory parameters and functional state of the left ventricle in men with overweight and obesity depending on the severity of chronic heart failure

The main links of CHF pathogenesis are: structural-geometric heart reconstruction, myocardium functional state disorder (formation of systolic and diastolic heart functions disorder), local and system inflammatory changes, specific metabolic disorders and so on. The aim of research was the study of changes of laboratory parameters and functional state of the left ventricle (LV) in men with overweight and obesity depending on CHF severity. Methods: There were examined 123 persons with CHF of I-III functional class (FC) who had normal and surplus body weight and abdominal obesity of I-III degree. All patients underwent laboratory and echocardiographic examination. The processing of received data was carried out with methods of parametric and non-parametric statistics. Results : Laboratory changes in men at CHF deepening are demonstrated in inclination to formation and spreading of anemia, kidney dysfunction and cardiogenic liver injury. With an increase of FC of disease there takes place the gradual decrease of CHF frequency with preserved emission fraction (EF) of LV at the expense of systolic dysfunction spreading. The decrease of myocardium systolic function at CHF deepening is attended with development of pulmonary hypertension parallel with spreading and deepening of diastolic dysfunction (DD) of I type. The more severe clinical course of CHF is attended with the decrease of isolated DD frequency of myocardium of I type at the expense of increase of spreading of combined systolic and diastolic dysfunction of the LV. Conclusions : With an increase of CHF FC there takes place an inclination to anemisation, formation of kidney dysfunction and cardiogenic liver injury, the spreading of systolic and diastolic LV dysfunction and pulmonary hypertension

The echocardiographic aspects of diagnostic of phenomenon of trabecularization of myocardium of left ventricle and non-compact myocardium

The left ventricular non-compaction is a disease characterizing by hyper-trabecularization of myocardium causing development of chronic heart failure. In the development of structural damages under this pathology the main role belongs to genetic disorders and dysfunction of organogenesis in early periods of gestation. The clinical manifestations are associated with development of systolic dysfunction of left ventricle, intricate abnormalities of rhythm and thromboembolic occurrences. In patients with systolic dysfunction of left ventricle phenomenon of hyper-trabecularization of myocardium is quite often found during transthoracic echocardiography. The modern diagnostic criteria permit approaching differentially issues of verification of non-compact myocardium and redundant trabecularization in patients with chronic heart failure with reduced fraction of output of left ventricle.

Confounders of uric acid level for assessing cardiovascular outcomes.

We read the article entitled Serum uric acid as a prognostic marker in the setting of advanced vascular disease: a prospective study in the elderly by Stolfo, et al.[1] with great interest. The authors evaluated the association of serum uric acid (SUA) levels with adverse cardiovascular events and deaths in an elderly population affected by advanced atherosclerosis. They founded meaningful association between SUA levels and of cardiovascular events and cancer related death. We believe that these findings will lead for further studies on uric acid. Recent studies have shown that hyperuricemia may damage endothelial function and increases the cardiovascular event risk.[2] Thus, investigation of the association between uric acid and cardiovascular events may contribute to understand the underlying mechanism. However SUA level may be affected by several factors and its exclusion is very difficult. In this well designed study, the authors had compared groups for traditional cardiovascular risk parameters such as hypertension, dyslipidemia, and diabetes mellitus, etc. Beyond these, alcohol consumption or hypothyroidism are well known confounders for uric acid level so it would have been better if the authors had compared these parameters too.[3],[4] Most diuretics elevate the SUA level and in this study the authors have shown that high SUA group has increased diuretic use.[1] In our daily practice, we use diuretics frequently in hypertension and congestive heart failure patients. Thus, it is possible that high SUA group may have lower ejection fraction rates. Poor outcomes are directly associated with left ventricle systolic dysfunction.[5] If the authors had mentioned about ejection fraction rates, a more comprehensive assessment would be possible. In conclusion this article enlightens the relationship between uric acid and poor cardiovascular outcomes. However new studies with more detailed risk factors assessment and using all echocardiographic parameters may contribute to our knowledge in this area.

Peri-Infarction Zone as a Risk Marker for Patients With Postmyocardial Infarction

IntroductionThe role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients with depressed left ventricle (LV) function is widely studied. In this study, we investigated the myocardial infarct size and characteristics by ce-magnetic resonance imaging (MRI) and its relationship with spontaneous ventricular arrhythmia occurrence during follow-up of in patients with mild LV systolic dysfunction and nonsustained ventricular tachycardia (VT). Materials and MethodsThis study enrolled 32 patients with postmyocardial infarction with an LV ejection fraction between 40% and 50% and nonsustained VT. Cardiac MRI performed to identify cardiac scar size and characteristics. Dense scar, peri-infarction zone and total infarct masses were calculated, these values to LV mass ratios were obtained. All patients were followed up 48 ± 6 months. Cardiac magnetic resonance data compared among patients with (n = 6) and without spontaneous sustained VT (n = 26). ResultsDuring follow-up, 6 patients experienced sustained VT (VT+ group), whereas 26 patients had no sustained ventricular arrhythmia (VT− group). The groups had similar baseline clinical characteristics. The LV masses, volumes and ejection fractions did not differ significantly between 2 groups. For the VT+ group versus VT− group dense scar to LV mass were similar (3.1 ± 0.3% versus 3.3 ± 0.9%, P = not significant). Ratio of peri-infarction zone to LV mass (30.9 ± 6.1% versus 21.3 ± 7.5%, P = 0.007) and total infarct to LV mass (34.1 ± 6.1% versus 24.6 ± 7.9%, P = 0.011) were larger in patients with sustained VT. ConclusionsThis small study supports the potential utility of ce-MRI to identify patients with postmyocardial infarction prone to develop serious ventricular arrhythmias.

High on-treatment platelet reactivity: risk factors and 5-year outcomes in patients with acute myocardial infarction.

Objective:The aim of the present study was to assess long-term prognostic value of high on-treatment platelet reactivity (HTPR) in patients after acute myocardial infarction (MI) and its association with possible risk factors.Methods:This prospective, case-control study was an observation of 198 patients who had acute MI. Response to aspirin and clopidogrel was assessed using impedance aggregometry. Patients were divided into groups of adequate response, dual poor responsiveness (DPR), poor responsiveness to aspirin (PRA), and poor responsiveness to clopidogrel (PRC). Simultaneously, potential risk factors of HTPR development were recorded. After 5 years, MI recurrence and overall mortality were assessed.Results:HTPR was more frequent in New York Heart Association Class III and IV patients, and in patients with left ventricle systolic dysfunction. Five-year mortality rate was higher in all groups of patients with HTPR compared to patients with sufficient response to antiplatelet treatment: in PRA patients, 38.1% vs. 19.2%, p<0.01; in PRC patients, 45.2% vs. 17.3%, p<0.001; and in DPR patients, 50.0% vs. 19.9%, p<0.05. Risk of repeat MI also increased (hazard ratio [HR] 4.0, p<0.05 for DPR group; HR 4.37, p<0.01 for PRA group; and HR 3.25, p<0.05 for PRC group).Conclusion:PRA, PRC, and DPR are independent predictors of increased 5-year mortality and risk of repeat non-fatal MI. The study has demonstrated that HTPR is frequently observed in patients with severe heart failure and left ventricle systolic dysfunction.