Likelihood Of Ischemic Heart Disease Research Articles

Role of nuclear medicine assessing patients with suspected coronary artery disease

Nuclear medicine is a critical component in the field of cardiology as it provides diagnostic and prognostic insights that are essential for the effective management of heart disease. Both single photon emission computed tomography (SPECT) and positron emission tomography (PET) play a significant role in assessing the likelihood of ischemic heart disease based on pre-test probabilities. Both SPECT and PET should be integrated into the clinical pathway according to the patient’s individual risk profile, symptoms, and initial test results. The guidelines recommend using these imaging modalities to refine risk stratification, particularly in intermediate-risk patients, and to guide further invasive diagnostic or therapeutic procedures based on the imaging findings.

Decreasing albumin within normal range is associated with increased likelihood of ischemic heart disease

Abstract Background Albumin (ALB) is a known biomarker of frailty, and cardiovascular disease and frailty are interdependent. Epidemiological evidence demonstrates that low serum albumin levels are linked to events of ischemic heart disease (IHD), venous thromboembolism, heart failure, atrial fibrillation, and stroke. Purpose We aimed to investigate the association of variations in ALB levels that are within normal range with IHD events among apparently healthy adults. Methods A case-control retrospective study of self-referred adults participating in an executive screening program between 2002 and 2017. All subjects were free of IHD and diabetes at baseline and had their ALB documented in each visit. Only subjects with at least two ALB measurements and whose ALB levels were within the normal range at all visits were included. Relationships between ALB trend and occurrence of IHD (acute coronary syndrome or percutaneous coronary intervention) within 2 years from the last visit were investigated. Results The final study cohort included 16,386 subjects. Median age was 53 (IQR 45–60), 11,461 (70%) were men. Analysis included a total of 99,127 visits. Median number of visits per subject was 5 (IQR 3–9, median inter-visit time 1.02 years) and median ALB level was 4.4 (IQR 4.2–4.6). IHD within 2 years was diagnosed in 545 (3%) subjects. Of those, only 36 were female and they tended to have lower variations in ALB throughout the years. Hence, we conducted an analysis of the 509 males only, and created an equal-size age-matched cohort of IHD-free subjects. Our analysis demonstrated a progressive and significant decrease in ALB levels among IHD cases, but not among controls (mean decrease of 0.021 g/DL vs. 0.004 g/DL per year, p<0.01; OR [CI] = 0.82 [0.72–0.93]; Figure 1). Similar results were found among subjects with at least 3 or 4 visits (0.015 g/DL vs. 0.006 g/DL per year, p=0.027, and 0.009 g/DL vs. 0.003 g/DL per year, p=0.045, respectively). Conclusions Kinetics of ALB within the normal range can identify men at risk for IHD in preventive healthcare screening programs. Funding Acknowledgement Type of funding sources: None.

Protocolo de utilización de pruebas intervencionistas en la cardiopatía isquémica crónica

Invasive coronary arteriography (ICA) is the most important test for the diagnosis of ischaemic heart disease. It is essential to know its indications and the different additional tests that can be performed during cardiac catheterisation. The indications for ICA are a very high clinical likelihood of ischaemic heart disease with high-risk characteristics or extensive areas of ischaemia on non-invasive tests. Invasive functional testing is indicated for angiographically borderline lesions, such as fractional flow reserve. If there are no angiographically significant lesions, we must rule out microvascular dysfunction with tests such as coronary flow reserve. We must also rule out vasospastic angina with vasospasm provocation testing.

Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis.

Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.

Segmental variation of myocardial deformation in patients with suspected ischemic heart disease

Summary The aim of this study is to investigate if the use of individual, per segment reference values for cardiac strain allows for improved discrimination of pathological deformation. In a cohort of patients with a high likelihood of ischemic heart disease, preliminary results within the subgroup of patients without pathological findings on cardiac MRI suggest a spatial dependency of strain. Background In addition to perfusion and viability, systolic myocardial function constitutes one of the cornerstones in the evaluation of ischemic patients. Technical achievements have improved the accuracy of the quantitative assessment of myocardial function, allowing for better discrimination between healthy and diseased myocardium. These advances cannot be fully exploited without knowledge of the spatial dependency and individual variance of deformation in health and disease. Methods In an ongoing study, a large cohort of patients with moderate chest pain and a high likelihood of coronary artery disease undergo cardiac MRI including cine loops for wall motion, perfusion at rest and during adenosine stress, acquisition of myocardial deformation with displacement encoding with stimulated echo (DENSE), and late gadolinium enhancement to demonstrate scar tissue. In this preliminary study, patient demonstrating maintained perfusion, normal wall motion, and no signs of scar at late gadolinium enhancement were selected for further evaluation. Regional deformation acquired with DENSE was evaluated in terms of radial and circumferential strains. All measurements were reported according to the seventeen segment model of the AHA. The apical cap was excluded from the quantification of regional deformation. Results Preliminary results for radia la nd circumferential strain for the 11 patients without pathological findings are presented in the Figure 1. The figure demonstrates the mean and standard deviation of the strain for the individual myocardial segments. Strain in the basal segments appears to be more spatially dependent than strain in the mid-cavity segments. The strain in the apical segments showed a larger variation between the subjects. Conclusions

How Well do the Framingham Risk Factors Correlate With Diagnoses of Ischemic Heart Disease and Cerebrovascular Disease in a Military Beneficiary Cohort?

We sought to determine how well the Framingham prediction rules correlate with ischemic heart disease and cerebrovascular disease in a military beneficiary cohort by examining demographic and International Classification of Diseases, Ninth Revision codes from electronic medical records between 2001 and 2008. This sample (n = 163,627) included people averaged at 52 years of age (range 18-108); slightly more than half were male (55%), 21% were African-American, and 59% were Caucasian. Fifteen percent of beneficiaries had ischemic heart disease and 3.4% had cerebrovascular disease. The Framingham model fits our data well; all Framingham risk factors were associated with increased likelihood of ischemic heart disease and all Framingham risk factors except gender increased cerebrovascular disease prevalence. Age was the strongest correlate for both ischemic heart disease and cerebrovascular disease (> 60 years old; ischemic heart disease relative risk, 3.9; 95% confidence interval, 3.7-4.0; cardiovascular disease relative risk, 3.9; 95% confidence interval, 3.6-4.2) followed by hyperlipidemia and hypertension. We conclude that military clinicians can risk stratify military beneficiaries using the Framingham risk model.

Diastolic heart failure in the elderly: Underlying mechanisms and clinical relevance

Diastolic heart failure (DHF) is now firmly established as a significant contributor to the heart failure syndrome. However, compared to the better studied systolic dysfunction heart failure relatively little is known about this form of the syndrome. Epidemiological data have demonstrated that it is particularly important in the elderly likely reflecting the combination of several changes occurring in the myocardium occurring with advancing years, including progressive fibrosis and stiffening of the myocardium, the impact of hypertension over the years and the increased likelihood of ischaemic heart disease. This review will focus on the relevant aetiological factors in DHF, possible pathophysiological mechanisms and outline new and evolving therapeutic strategies for this problem.

Mechanisms of exercise‐induced ST‐segment depression in patients without typical angina pectoris

To evaluate if exercise-induced ST-segment depression without typical angina pectoris is related to increases in sympatho-adrenal activity or beta-adrenoceptor sensitivity. Thirteen patients (four men) aged 35-62 years with ST-segment depression during exercise but atypical symptoms and normal myocardial scintigraphy, and 13 matched controls. Patients and controls were compared regarding responses with: (i) exercise testing without treatment, (ii) exercise testing following beta-adrenoceptor blockade by propranolol (0.15 mg kg(-1) i.v.), (iii) incremental adrenaline infusions (0.1, 0.2, 0.4 and 0.8 nmol kg(-1) min(-1)) and (iv) adrenaline infusions during alpha-adrenoceptor blockade by phentolamine (0.5 mg min(-1)). ST-segment depression and tissue Doppler parameters reflecting contractility. Exercise lowered the ST-segment by 2.44 mm without and 0.87 mm with beta-adrenoceptor blockade (P < 0.001 for difference) amongst patients, but not amongst controls. Maximal heart rate was slightly higher amongst patients (P < 0.05), despite similar loads and plasma catecholamine responses to exercise in the two groups; this difference disappeared after beta-adrenoceptor blockade with propranolol. ST-segment depression during adrenaline infusion was greater in patients compared with controls (P < 0.01) despite similar increases in heart rate. alpha-Blockade enhanced the ST-segment depression (P < 0.001) and heart rate (P < 0.001) responses to adrenaline infusion more markedly amongst patients. Tissue Doppler imaging showed similar contractility and diastolic relaxation responses of patients and controls to adrenaline, but early diastolic movements did not increase amongst patients after phentolamine (P < 0.01). Exercise-induced ST-segment depression in patients with a low likelihood of ischaemic heart disease is related to increased beta-adrenergic sensitivity regarding chronotropic and electrophysiological, but not inotropic responses.

Cardiac Memory versus Likelihood of Ischemic Heart Disease in Hypertensive Patients with Ventricular Repolarization Abnormalities after Repetitive Uniform Ventricular Extrasystoles

Objectives: To investigate the value of T-wave inversion after premature ventricular complexes (PVCs) for the prediction of hypertensive patients with a likelihood of ischemic heart disease (IHD). Patients and Methods: Ambulatory 24-hour ECG, ambulatory 24-hour blood pressure (BP) recording, echocardiography, treadmill exercise ECG test and thallium-201 scintigraphy were performed for 210 hypertensive patients. Results: Predictive indices showed that persistent symmetrical T-wave inversion after repetitive uniform PVCs equaling 30 min can be considered an indicator for the prediction of IHD in hypertensive patients as sensitivity was 80%, specificity: 73%, accuracy: 78%, positive predictive value: 83%, and negative predictive value: 69%. kappa coefficient value (ĸ) indicated that there was good agreement between changes in ventricular repolarization after PVCs and stress thallium scintigraphy (ĸ = 0.897). Receiver-operating characteristic curve data showed that the ideal cutoff value of T-wave inversion voltage to predict IHD in hypertensive patients was 2.2 mV (sensitivity: 66% and false positive: 35%, and area under curve: 0.716), but the ideal cutoff value of time for resolution of T-wave inversion was 34 min (sensitivity: 83% and false positive: 18%, and area under curve: 0.873). Multivariate analysis revealed that T-wave inversion after repetitive uniform PVCs was significantly associated with non-sustained ventricular tachycardia, decreased parasympathetic activity, increased sympathetic activity, morning BP surge, systolic BP load >50% and left ventricular diastolic dysfunction status. Conclusion: The data show that persistent symmetrical T-wave changes following resumption of sinus rhythm after repetitive uniform PVCs are an independent variable for the prediction of IHD in hypertensive patients.

Direct access exercise electrocardiography: a new service that improves the management of suspected ischaemic heart disease in the community.

To assess the safety and value of an exercise electrocardiography service for the diagnosis of suspected ischaemic heart disease to which general practitioners have direct access. Direct access to a hospital exercise electrocardiography service was offered on a trial basis to 122 general practitioners in a defined urban area. Maximal exercise tests were performed according to the modified Bruce protocol and the results were dispatched promptly to the referring doctors who were responsible for the subsequent management of their patients. All general practices in north and west Belfast (combined list size about 180,000) and the regional medical cardiology centre. 212 request forms were received in a two year period and 192 eligible patients attended for exercise testing. All patients were suspected to have pain due to myocardial ischaemia, were aged < or = 65, and had no contraindications to exercise testing. Proportion of general practitioners who used the service. Proportion of exercise tests that were positive. Referring doctors' assessment of the service. 43% of general practitioners referred patients and 34 tests (18%) were positive. No complications occurred. The pretest likelihood of ischaemic heart disease, assessed by the referring doctor, was high in 48 (25%), moderate in 82 (43%), and low in 62 (32%). A high pretest likelihood of ischaemic heart disease predicted a positive test result with a sensitivity of 50% and specificity of 80%. General practitioners decided to refer 19 (10%) patients to a hospital cardiology department for further assessment, including 16 of the 34 who had a positive exercise test. In most cases the service was found to be helpful and 97% of patients would have been referred directly to a hospital cardiology clinic if it had not been available. Direct access exercise electrocardiography for patients with suspected ischaemic heart disease is safe, feasible, and helpful to general practitioners. This service seems to reduce the number of patients referred to cardiology outpatient clinics and to facilitate the management of these patients in the community.