Probability Of Ischemic Heart Disease Research Articles

Abstract 15136: Toward the Development of an AI Application to Diagnose Ischemic Heart Disease From a Medical Interview

Background: Interviewing technique for patients with chest pain depends on each doctor’s skill. Therefore, an artificial intelligence (AI)-based interview system may be useful to stratify probability of ischemic heart disease based on patient’s complaint. Methods: As a definitive diagnosis corresponding to the interview is needed as a sample, a medical interview is taken from patients presenting with chest pain as a chief complaint, which is combined with the patient's baseline data to develop an AI algorithm. Results: The items used as input attributes in the interview are listed in Table 1. A multilayer perceptron (MLP) was applied to the subjects (N=125) for the prediction of patients diagnosed with angina pectoris (54 cases). These models were validated using the leave-one-out method. Comparisons were made with models in which each of diabetes (45 cases), dyslipidemia (88 cases), hypertension (95 cases) and smoking (never: 60 cases; past: 50 cases; current: 15 cases) were added as attributes in addition to the items in Table 1. (Table 2) The ROC curves of the multilayer perceptron with only the questionnaire items in Table 1 as input attributes and the multilayer perceptron with the dyslipidemia attribute added are shown in Figure 1. Conclusion: It was found that the diagnosis of angina pectoris could be detected interview data while the prediction accuracy was improved by adding the attribute of dyslipidemia. Further investigation is needed to complete a highly accurate AI-based application by increasing the number of samples.

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison.

Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East-Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non-invasive diagnosis of symptomatic patients with a low to moderate pre-test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.

Assessment of the pre-test probability of ischemic heart disease according to the data of dispersion mapping of an electrocardiogram and analysis of heart rate variability

February 2022 est., there were several validated ischemic heart disease (IND) pretest probability scales presented in the clinical guidelines of various cardiology communities (G.A. Diamond and J.S. Forrester, Duke, ESC 2019 scales). Despite their diversity, they lacked clear quantitative criteria and were based on a subjective assessment of the pain syndrome described by a patient, their gender and age. The purpose of this study was to investigate the possibilities of heart rate variability and ECG dispersion mapping for pre-test assessment of the probability of coronary artery disease. We studied 81 patients (mean age 61.48 ± 13.00 years) with suspected CAD. All patients underwent a five-minute ECG recording with the construction of ECG dispersion mapping and assessment of heart rate variability. Each subject underwent coronary angiography (within 12 months before or after the stress test) to verify the damage to the coronary bed. When analyzing the comparison of the results of coronary angiography and dispersion ECG mapping, 3 groups of patients were formed and studied: group A (coronary artery stenosis more than 50%, n = 18), B (coronary artery stenosis less than 50%, n = 16) and C (without coronary artery disease, n = 21). It was noted that the more pronounced the stenosis of the coronary arteries, the higher the index of microalternations “Myocardium” and T-alternation of the myocardium, and the lower the functional reserve of the myocardium. Considering that a short (thirty second) high-resolution ECG recording is required to perform dispersion ECG mapping, this method can be used as a screening for the selection of patients at high risk of coronary heart disease and exercise testing. We suggest that patients should be referred for exercise testing if two of the three criteria are present: BMI ≥ 22%, Functional reserve ≤ 70%, T-alternation ≥ 18% (AUC ROC is 0.718). The sensitivity and specificity of the presented method can be increased by adding indicators from the analysis of heart rate variability (heart rate, HF, LF) and patient’s age (AUC ROC is 0.929) to the formula.

P210 VENTRICULAR FIBRILLATION IN AN ELDERLY WOMAN WITH APPARENTLY UNREMARKABLE PAST CARDIOLOGICAL HISTORY: AN UNEXPECTED CULPRIT

Abstract An 85–year–old woman experienced cardiac arrest while she was at the supermarket. Cardiopulmonary resuscitation was promptly performed with ROSC after DC shock on ventricular fibrillation and immediate hemodynamic and neurological recovery. The first ECG performed by the rescuers did not show acute ischemic changes and the patient was admitted to the Cardiological Intensive Care Unit. Past medical history revealed only a previous episode of acute pulmonary embolism for which she was on oral anticoagulant therapy for a limited period of time. She had not family history of sudden cardiac death or cardiomyopathies. Before admission she was completely asymptomatic and she never complained of angina pectoris, palpitation or dyspnoea. The echocardiogram at admission showed moderate left atrial enlargement and hypokinesia of left ventricle apex and mid–apical lateral wall with global EF of 50%. Pulmonary and aortic CT angiography showed no pathological findings. In order to rule out an ACS, the patient underwent a coronary angiography which documented the absence of critical coronary stenosis. Finally, a cardiac MRI with gadolinium was performed, revealing the presence of two small areas of transmural LGE affecting inferior basal and lateral mid–apical segments with no edema, consistent with ischaemic myocardial scars. In light of this findings and to rule out paradoxical coronary artery embolism we decided to perform a transcranial echocolordoppler that showed the absence of a patent foramen ovale. Furthermore, continuous ECG monitoring during the hospital stay did not document arrhythmic recurrences. In consideration of the high probability of ischemic heart disease, therapy with antiplatelet agent, beta–blocker, ace–inhibitor and statin was introduced and the patient was discharged after ICD implantation. Three months later, during her first follow–up visit, we documented short episodes of atrial fibrillation at ICD interrogation. This was in line with the hypothesis of a ventricular fibrillation and cardiac arrest in the contest of an ischemic heart disease with myocardial scars probably due to undatale coronary artery embolism. Oral anticoagulant therapy was started in addition to previous therapy.

Unshielded magnetocardiography contributes to non-invasively rule-out ischemic heart disease in patients with chest pain of uncertain origin

Abstract Background Out of millions of patients (pts) screened every year for chest pain in emergency departments (EDs) only 10% to 20% are affected by an acute coronary syndrome (ACS) or angina due to ischemic heart disease (IHD). Unless ECG recording and serum markers are clearly positive, most of them must undergo complete clinical workout to exclude IHD prior to discharge. Moreover, since even effort-ECG and echocardiography don't exhaustively rule-out IHD, second-level exams are frequently needed, enhancing hospitalization time and related costs. Magnetocardiography (MCG) is increasingly reported as a sensitive, non-invasive, radiation-free method with high negative predictive value (PV) to rule out IHD. Purpose Retrospective cohort study to evaluate the reliability likelihood of unshielded MCG (uMCG) as a tool for rapid rule-out of IHD. Method Rest uMCG data of 263 patients (pts), all chest-pain free at the moment of MCG scan, were retrospectively analyzed. uMCG was recorded with a 36-channel SQUID system (intrinsic sensitivity 30 fT/√Hz, above 1Hz), for 90 seconds. With proprietary software, 13 MCG parameters were automatically calculated from T-wave magnetic field (T-MF): 5 parameters quantifying the dynamics of the MF extrema and eight, obtained from inverse solution with the equivalent magnetic dipole (EMD) model, quantifying the spatial dynamics of the T-wave effective magnetic vector (T-EMV). Pts were stratified as follows: – Group A, chest pain pts, with IHD confirmed by subsequent SPECT and coronary angiography (mean age 66±11 years, 36.7% female); – Group B, chest pain pts, with IHD excluded by subsequent SPECT or coronary angiography (mean age 59±10 years, 28.8% female); – Group C, healthy control subjects (mean age 25±7 years, 48.6% female). Only 60 pts in each group were randomly selected for the analysis. Non-parametric Kruskal-Wallis tests were used to compare the 13 MCG predictors among groups. Linear discriminant analysis was employed to assess likelihood ratios (LHR) and PVs, considering a mean IHD prevalence of 13% (range 10–20%) in chest-pain pts. Results Positive LHR was 9, while the negative LHR was 0.3, resulting in a helpful reduction of the pre-test probability of IHD. Whereas positive PV ranges from 51 to 70%, hardly confirming IHD diagnosis, negative PV ranges from 92 to 96%, giving confidence for a safe IHD rule-out. Conclusions Automatic analysis of T-MF and of T-EMV dynamics from rest MCG provided impressive negative LHR and PV values that, if confirmed in prospective multicenter trials, would rank MCG as a useful tool for quick and early triage of pts with acute chest pain and still non-diagnostic ECG and enzyme patterns, to rule-out those whose symptoms are of non-ischemic origin. Interestingly, a similar high negative PV has been recently reported using MCG QRS predictors. Thus, even better results could be expected by combining algorithms for automatic assessment of both T-wave and QRS predictors. Funding Acknowledgement Type of funding sources: None.

Results of Computed Tomographic Coronary Angiography in Comparison with the Table of Pretest Probability of Chronic Coronary Syndrome.

Aim To compare results of computed tomography coronary angiography (CTCA) with a table of pretest probability of chronic coronary syndrome (CCS) taking into account the following key variants: abnormality, microvascular damage, nonobstructive or obstructive atherosclerotic damage.Material and methods 50 patients (39 men, 20 women) aged 30 to 67 years were evaluated with a computed tomography scanner PHILIPS Brilliance iCT SP 128. A high pretest probability of ischemic heart disease was found in 44 % of cases and medium in 40%.Results According to CCS data, coronary artery (CA) pathology was not found in 28 % of patients. CA hypoplasia was observed in 4 % of patients. 22 % of patients had muscular bridges narrowing the CA lumen during systole by 40-50%. In 26 % of cases, CA had minimal and early stenoses. Moderate and pronounced stenoses were observed in 20% of cases. In one case, there was a total occlusion of the circumflex branch. Calcinates were found in 9.1 % of patients with muscular bridges, in 61.5 % of patients with minimal and early stenoses, and in 80% of patients with moderate and pronounced stenoses. In the group with "clean" CA and congenital defects, calcinates were absent. The mean value of pretest probability was the highest in the patient group with moderate and pronounced stenoses, 22.5±13.13. It was significantly higher than in the group with muscular bridges (р=0.045) and congenital pathology of CA (р=0.01). At the same time, this value did not significantly differ from the group with "clean" CA and the group with minimal and early stenoses. Based on the study results, 2 bypass surgeries and 5 CA stentings were performed.Conclusion Thus, the table of pretest probability of ischemic heart disease does not provide a differential diagnosis and evaluation of the nature of CA damage as compared to results of CTCA.

The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy.ResultsThe voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained).ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

OP315 An Artificial Intelligence Approach To Improve Medical Diagnosis Of Ischemic Cardiopathy In Patients With Non-Traumatic Chest Pain

IntroductionCurrent clinical practice is based on guidelines and local protocols that are informed by clinical evidence. This means that clinical variability is reduced, but can lead to inefficient clinical decision-making and can increase medical errors, decreasing patient's safety. The aim of the EXCON project is to investigate the innovative concept of Intelligent Clinical History (ICH), and to develop functional prototypes of high added-value in healthcare services.MethodsThe innovative EXCON project will take advantage of recent advances in technologies for coding, structuring and semantizing medical information. Thanks to this new structuring, the EXCON platform will be developed. The final users will be health professionals and other decision-makers. Doctors, nurses, epidemiologists and information specialists will be involved in the development and subsequent validation of the platform.ResultsThe EXCON platform identifies profiles of patients with a high probability of ischemic heart disease. In the sample analyzed (n = 4,700), 17 percent of patients were admitted to a cardiology unit with suspected coronary heart disease. Of the patients admitted, 53.7 percent did not have ischemic heart disease at discharge. If we apply the algorithm developed by the EXCON project, 24.8 percent of patients would not have been admitted and did not have ischemic heart disease.ConclusionsIn coming decades, patient management will be impacted by the application of new advanced data analytics tools. This will allow for safer and more efficient clinical management, decrease variability in clinical practice, and improve equity. That is why the development and assessment of these technologies is necessary.

Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease

To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG). The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.

The effect of the economic collapse in Iceland on the probability of cardiovascular events

After several years of a booming economy in Iceland, the economic bubble burst in 2008 and affected most Icelanders in one way or another. We explore whether the economic collapse in 2008 and subsequent economic crisis affected the probability of ischemic heart disease (IHD) events, independent of regular cyclical effects that can be attributed to typical economic conditions. Moreover, we conduct a mediation analysis to study the potential mechanisms through which the relationship between the economic collapse and cardiovascular health travels. We estimate linear probability models using administrative data on IHD events, earnings and balance-sheet status, as well as unemployment for all Icelanders aged 16 and older in 2000–2014.We find that the sharp change in economic conditions in 2008 increased the probability of cardiovascular events in both males and females in the long term. In absolute terms, these effects were small in magnitude but often statistically significant, amounting to approximately 13–16 extra cases of IHD events in each of the two years following the collapse for males and 3–5 addition cases for females. Moreover, they contrast with the finding that general business-cycle fluctuations operated in the opposite direction. Several potential mediators were correlated with the probability of IHD events, but their inclusion had little impact on the estimated effects of the economic crisis. A statistically significant business-cycle effect is found for both genders indicating that in general, harder economic times are beneficial for heart health. Thus, the general business cycle and the economic collapse in 2008 and subsequent crisis can be thought of as separate phenomena with differing effects on IHD.

CT angiographic determination of most frequent anatomic variations of coronary arteries in Erbil population

Background and objective: Computed tomography angiography is one of the best methods for knowing the detailed anatomy of coronary arteries and can successfully detect any variation of coronary arteries. Anatomic variations of coronary arteries have not been studied among Erbil population which is mostly inhabited by Kurds. This study was conducted to compare the incidence of the anatomic variations of coronary arteries in Erbil population with international standards. Methods: Variations of coronary arteries were retrospectively studied by using computed tomography angiography of 412 cases (214 males 198 females) with mean age 51.5 ± 13.5 years (mean ± SD) who underwent this procedure on suspicion of coronary artery disease. The main indication was chest pain in patients with low to intermediate probability of ischemic heart disease. The present study was carried out in the Department of Radiology, Surgical Specialty Hospital/Cardiac Center in Erbil city. Results: The right coronary artery was dominant in 86.4% of cases, while the left main coronary artery was dominant in 10.92% of cases. Co-dominance was observed in 2.67% of cases, and Double Ostia of right aortic sinus was observed in 25% of cases. Long left main coronary artery was observed in 10.68 % of cases. Myocardial bridging was observed in 7.04% of cases. Other variations were also observed, and their prevalence was recorded. Conclusion: Variations of coronary arteries among Erbil population were recorded and were near to the international standards.

Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease?

ObjectiveTo assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methodsWe used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). ResultsWe included 295 patients followed up for a median of 28 (19–36) months. A total of 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). ConclusionsCardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability.

Selection of non-invasive load procedure in diagnosis of ischemic heart disease (review)

The diagnosis of stable ischemic heart disease begins with a careful clinical examination of the patient and non-invasive testing to identify the disease. Patients with very low and very high pretest probability should not undergo various non-invasive tests. Various non-invasive tests are available to assess the presence of coronary heart disease in patients with an intermediate probability of ischemic heart disease (15–65%). The combination of anatomical with functional non-invasive tests helps improve diagnostic capabili of the disease.

¿Podría ser útil la resonancia magnética de estrés en pacientes con baja probabilidad de cardiopatía isquémica?

ObjectiveTo assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methodsWe used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). ResultsWe included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). ConclusionsCardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability.

A Comparison of Decision Tree Induction with Binary Logistic Regression for the Prediction of the Risk of Cardiovascular Diseases in Adult Men

The main purpose of this article was to compare traditional binary logistic regression analysis with decision tree analysis for the evaluation of the risk of cardiovascular diseases in adult men living in the city. Patients and methods. In our study, we used data from the Multifactorial Ischemic Heart Disease Prevention Study (MIHDPS). In the MIHDPS study, a random sample of male inhabitants of Kaunas city (Lithuania) aged 40–59 years was examined between 1977 and 1980. We analysed a sample of 5626 men. Taking blood pressure lowering medicine, disability, intermittent claudication, regular smoking, a higher value of the body mass index, systolic blood pressure, age, total serum cholesterol, and walking in winter were associated with a higher probability of ischemic heart disease or cardiovascular diseases. Having more siblings and drinking alcohol were associated with a lower probability of these diseases. The binary logistic regression method showed a very slightly lower level of errors than the decision tree did (the difference between the two methods was 2.04% for ischemic heart disease (IHD) and 2.86% for cardiovascular disease (CVD), but for consumers, the decision tree is easier to understand and interpret the results. Both of these methods are appropriate to analyse cardiovascular disease data.

Impact of Body Mass Index on Vascular Calcification and Pericardial Fat Volume Among Patients with Suspected Coronary Artery Disease.

This study aimed to assess the effect of body mass index (BMI) on the relationship between pericardial fat volume (PFV), aortic root calcification (ARC) and coronary artery calcification (CAC) among patients with suspected coronary artery disease (CAD). This cross-sectional study took place between January and December 2014 at the Kufa University Teaching Hospital, Najaf, Iraq. A total of 130 consecutive patients with an intermediate pretest probability of ischaemic heart disease who underwent 64-slice multidetector computed tomography (CT) angiography during the study period were recruited. Of these, 111 were included in the study and divided into groups according to BMI. Imaging markers were measured on CT angiography. A total of 28 patients were obese, while 42 and 41 were overweight and normal weight, respectively. The median PFV, CAC and ARC was 109 cm(3) (interquartile range [IQR]: 52-176 cm(3)), 0 Agatston score (IQR: 0-52 Agatston score) and 0 Agatston score (IQR: 0-15 Agatston score), respectively, in the normal weight group in comparison to 79 cm(3) (IQR: 43-138 cm(3)), 0 Agatston score (IQR: 0-54 Agatston score) and 0 Agatston score (IQR: 0-0 Agatston score), respectively, in the obese group. Significant correlations were observed between PFV and CAC (r(2) = 0.22; P = 0.002) and ARC and CAC (r(2) = 0.37; P <0.001) in the normal weight group. However, no significant correlations were observed for obese and overweight patients. These findings indicate that BMI may not be an accurate tool for measuring adiposity or assessing subclinical coronary atherosclerosis in patients with suspected CAD.

General Mental Health Status of Out-Patients with Atypical Chest Pain, a Case Control Study

Objectives: Psychological problems could have some relationship with undetermined chest pain. The aim of this study was to compare the general mental health status of out-patients with atypical chest pain with a reference age and sex matched controls. Materials and methods: Patients less than 40 years old, with atypical chest pain and low probability of ischemic heart disease were included in the study. The control group were age and sex matched. The Iranian translation of 28 item general health questionnaire (GHQ-28) was used to evaluate the mental status. Results: Totally 113 cases in each group completed the study. Mean age of the study group was 26.33 ± 5.77years and 148 cases (65.5%) were female. Mean GHQ-28 score in the atypical chestpain and the control groups were 31.37±14.69 and 21.31±9.97 respectively (P<0.001). Abnormal GHQ-28 scores (≥24) was seen in 71(62.8%) of the atypical chest pain group and 38(33.6%) of the controls (odds ratio: 3.34, 95% confidence interval =1.93-5.76). Multivariate analysis showed that after adjustment for possible confounding factors, atypical chest pain was an independent predictor of abnormal GHQ-28(odds ratio: 3.32, 95% confidence interval: 1.31-8.47). Discussion: The results of the present study showed that our patients with atypical chest pain had worse general mental health state. It is not clear that worse general health state is a cause of atypical chest pain or an incidental concomitant finding.

Assessment of Left Ventricular Mechanics in Patients with Ischemic Heart Disease

The paper presents new ultrasound technology for assessment of left ventricular (LV) strain in the longitudinal, radial, and circumferential directions and the LV area strain at rest and during dobutamine stressechocardiography in patients with intermediate pretest probability of ischemic heart disease (IHD). Analysis was performed for the first time using real-time three-dimensional echocardiography (4D Strain). It was shown that in patients with single-artery left anterior descending artery (LAD) and left circumflex coronary artery (LCX) stenosis of 50% and more, the decreases in the global LV strain in the longitudinal, radial, and circumferential directions as well as in the LV strain area were observed at peak dobutamine stress in 4D Strain mode. Assessment of global LV strain in 4D Strain mode during dobutamine test had low sensitivity, specificity, and diagnostic accuracy in diagnosing single-vessel coronary artery disease.

Gender disparity impact on the vascular calcification and pericardial fat volume in patients with suspected coronary artery disease

BackgroundThere is no consensus in the literature on the influence of gender on the correlations between coronary artery calcification (CAC) with aortic root calcification (ARC) and pericardial fat volume (PFV). ObjectiveTo investigate the impact of gender on the correlations between PFV, CAC and ARC in Iraqi patients with suspected coronary artery disease (CAD) assessed by multi-detector CT (MDCT). MethodsOne hundred and thirty consecutive Iraqi patients with intermediate pretest probability of ischemic heart disease who underwent MDCT examination for assessment of CAD were recruited between January and December 2014. Of these, 111 patients were found to be eligible and were enrolled in the study. Patients were divided into a male group (n=54) and a female group (n=57). ResultsIn male patients, PFV showed no significant correlation with CAC and ARC. CAC showed a significant correlation with ARC (r=0.392, P=0.003). The correlation between CAC and ARC persisted even after adjustment for PFV, age and cardiac risk factors (P=0.01, CI=0.067–0.492). In female patients, PFV showed a significant correlation with CAC (r=0.413, P=0.001) and this correlation persisted even after multivariate regression adjustment for ARC, age and cardiac risk factors (P=0.016, CI=0.067–0.612) while there was no significant correlation between PFV and ARC. ARC showed no significant correlation with CAC and PFV. ARC showed a significant association with male gender (P=0.04) while there was no significant difference in PFV and CAC between the two groups of study. ConclusionPFV was significantly associated with CAC in female patients while ARC showed a significant association with CAC in male patients.

EXERCISE TESTS IN CARDIOLOGY: PAST, PRESENT AND FUTURE. PART II

The second part of the review focuses on the main principles of exercise tests, protocols of exercise tests, prognostic significance of the values obtained in ischemic heart disease. The problems are accounted on how to use the results of exercise tests for pretest probability of ischemic heart disease, to stratify the risk of cardiovascular complications, to evaluate the efficacy and prognosis.