Stenosis In Other Arteries Research Articles

Using parameters of myocardial deformation as markers of pathological postinfarction remodeling

Abstract Funding Acknowledgements Type of funding sources: None. Objective to predict pathological left ventricular (LV) remodeling using global parameters of strain and twisting. Methods the study included 114 people with primary ST-segment elevation myocardial infarction (STEMI): 14 women and 100 males aged 32 to 67 years (52.3 ± 8.4). STEMI has been confirmed by ECG data, cardiospecific biomarkers (troponin T, CPK-MB) and coronary angiography - the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography has been performed using a MyLab ultrasound scanner (Italy) on the 7th-9th day, 3rd, 6th and 12th months after the disease onset with the evaluation of standard parameters. On the 7th-9th days the parameters of global longitudinal (GLS,%), circumferential (GCS,%) strain, and LV twisting (Twist, °) have been analyzed using the X-Strain ™ software. The criterion for pathological LV remodeling has been considered to be an increase in EDVi ≥ 20% compared with the initial value. Prediction of pathological remodeling has been performed using ROC analysis by 3 criteria. To assess the quality of the model, the area under the curve (AUR –Area under ROC) has been determined with the calculation of 95% confidence intervals and the statistical significance of the point estimate of the area. Results Within 48 weeks pathological remodeling was developed in 45 (39.5%) patients. Three months after the index event, LV remodeling was detected in 24 (53.3%) patients of these 45; after 6 months - in another 15 (33.3%); after 12 months - in another 6 (13.4%). GLS - 11.7% with 96% sensitivity and 80% specificity, AUR 0.750 (95% CI 0.659 - 0.841), GCS - 12.4% with test sensitivity and specificity - 90% and 82%, respectively ((AUR 0.641 ( 95% CI 0.534 - 0.749)), Twist - 7.8 ° with a sensitivity of 93% and a specificity of 78%, AUR 0.657 (95% CI 0.558 - 0.757) predict the development of pathological postinfarction LV remodeling on the 7th-9th day. For all models the value of p ≤ 0.001. Conclusion Previously, LV remodeling has developed within 3 months after STEMI in 45 (39.5%) patients. The longitudinal strain, measured in the acute period of STEMI, has the greatest predictive ability in relation to the development of pathological postinfarction LV remodeling.

Diagnostic value of parameters of myocardial work in patients after myocardial infarction with ST segment elevation

Abstract Funding Acknowledgements Type of funding sources: None. Objective to reveal the differences in the global parameters of myocardial work of the left ventricle (LV) in patients with preserved LV ejection fraction (EF) after ST-segment elevation myocardial infarction (STEMI) and healthy individuals. Methods the study included 45 people with primary STEMI (group 1): 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). The control group (group 2) consisted of 70 healthy individuals aged 39.3 ± 8.9 years, including 34 men and 36 women. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography was performed on the 7th-9th day and 6 months after STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). Echocardiographic image analysis was performed using EchoPAC software version 202 (GE Healthcare). The standard echo parameters were determined: end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), LV myocardial mass index (LVMI, g / m2), EF by the Simpson biplane method,%. The preserved EF was considered the value of EF greater than or equal to 50%. The following indicators of myocardial work were assessed: global myocardial work index (GWI, mm Hg%), global constructive work (GCW, mm Hg%), global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing was performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results 6 months after STEMI, 26 subjects had an EF ≥50% (58.8 ± 5.8%). The mean LVEF in group 2 was 60.8 ± 4.6% (p = 0.12). EDV in group 1 was 122.5 [95% CI 104.4; 140.7] ml, in group 2 - 104.7 [95% CI 99.1; 110.3] ml (p = 0.003). ESV in group 1 - 83.8 [95% CI 28.5; 139.0] ml, in group 2 - 40.7 [95% CI 37.6; 43.7] ml (p = 0.02); in group 1, LVMI was 89.3 [95% CI 77.4; 101.1] g / m2, in group 2 - 67.4 [95% CI 63.7; 71.1] g / m2 (p = 0.03). GWI was 1890.1 [95% CI 1730.0; 2050.2] mm Hg% in group 1, in group 2 - 2039.8 [95% CI 1956.3; 2123.3] mmHg% (p = 0.002), GCW - 2132.4 [95% CI 1958.5; 2306.3] mmHg% and 2335.5 [95% CI 2251.7; 2419.4] mm Hg% (p = 0.003), respectively. GWE 95.4 [95% CI 94.1; 96.6] and 97.1 [95% CI 96.8; 97.4]% (p = 0.02), GWW 76.6 [95% CI 55.9; 97.3] and 50.0 [95% CI 44.0; 56.0] m Hg% (p = 0.06) in the corresponding groups. Conclusion Thus, despite the satisfactory values of LVEF, the indicators of myocardial work, except for global wasted work, had lower values in patients with STEMI compared with healthy individuals.

Assessment of the global work of the myocardium in myocardial infarction with ST segment elevation of various localization

Abstract Funding Acknowledgements Type of funding sources: None. Purpose To assess the degree of impairment of the global myocardial function of the left ventricle in different localization of myocardial infarction with ST segment elevation (STEMI) using speckle tracking echocardiography. Methods The study included 45 patients with primary STEMI aged 38 to 66 years (52.3 ± 7.4). Myocardial infarction was confirmed by ECG data, biomarkers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography has been performed 7-9 days after STEMI on a Vivid GE 95 Healthcare ultrasound scanner (USA) using EchoPAC software version 202 (GE Healthcare). In the automatic mode, the indicators of myocardial work have been calculated: the index of global myocardial work (GWI, mm Hg%.), Global constructive work (GCW, mm Hg.%.), Global wasted work (GWW, mm Hg.%.) %.), global work efficiency (GWE,%). Statistical data processing has been performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results Taking into account the localization of STEMI on the 7th-9th day, patients were divided into two groups: group 1, which included 29 patients (64.4%) with lesions of the anterior LV wall (LAD), group 2 - 16 patients (35, 6%) with LV posterior wall infarction (RCA and CA). The comparison of the indices of global myocardial work in the two groups, has found that the GWI in group 1 was 1219 [95% CI 1053.1; 1384.9] mm Hg%, in group 2 - 1550.8 [95% CI 1371.6; 1730] mm Hg%, (p = 0.02). The GWE parameter in group 1 was 88.2 [95% CI 85.5; 90.9]%, in group 2 - 94.3 [95% CI 92; 96.6]%, (p = 0.01). The GСW index had the following values: in group 1 - 1383 [95% CI 1205.1; 1560.9] mm Hg%, in group 2 - 1805.5 [95% CI 1576.2; 2034.8] mm Hg%, (p = 0.01). GWW in group 1 was 152.8 [95% CI 94.3; 211.3] mm Hg%, in group 1b - 73.3 [95% CI 47.6; 99.0] mm Hg%, (p = 0.02). Conclusion Thus, the localization of STEMI is reflected in the indicators of myocardial function. LV anterior wall infarction has lower GWI, GWE, and GCW values and higher GWW values than posterior wall infarction.

Clinical analysis of risk factors of the patency of the descending branch of the lateral circumflex femoral artery

Many studies have provided anatomical statistics of the descending branch of lateral circumflex femoral artery (LCFA) through its use as the pedicle of anterolateral thigh (ALT) flaps. However, most of the results from these studies were acquired during surgeries or from cadavers. Therefore, this study has studied the descending branch of LCFA in patients with underlying diseases or risk factors using lower extremity angiography, and how such risk factors and the degree of stenosis in other arteries affect the patency and stability of the descending branch. The subjects of retrospective study were 89 legs from 49 patients who had received lower extremity angiography. Risk factors included age, BMI, diabetes, hypertension, tobacco use, hyperlipidemia, cardiac status, carotid status, renal disease, pulmonary status, and history of lower limb amputation. Analysis of the degree of stenosis in the descending branch of LCFA in regard to each risk factor have shown that hypertension, pulmonary function, history of lower limb amputation, and the total score of 11 risk factors were statistically significant. Also, in the correlation study of lower limb arteries, there was a significant correlation with the degree of stenosis in the posterior tibial artery, but not so in others. Therefore, when planning a flap surgery using the descending branch of LCFA, one needs to run imaging tests such as angiography to check arterial patency in patients with hypertension, impaired pulmonary function, and history of lower limb amputation.