Prognostic significance of ischemic electrocardiographic changes during stress testing in patients with normal nuclear myocardial perfusion imaging

2021 ◽  
pp. 1-11
Author(s):  
Ghufran Adnan ◽  
Fateh ALi Tipoo Sultan ◽  
Umaira Alauddin ◽  
Maria Ali Khan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Myocardial Perfusion ◽  
Cardiac Death ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress ◽  
Nuclear Myocardial Perfusion Imaging ◽  
Electrocardiographic Changes

Abstract Objectives: The main objective of this study was to evaluate cardiovascular outcome in patients with normal nuclear myocardial perfusion imaging but ischemic ECG changes during pharmacological or exercise stress test. Methods: In this retrospective study, we included a cohort of patients who underwent either pharmacological or exercise stress MPS and have a normal scan with ischemic EKG changes at Aga Khan University Hospital, from January 2013 to December 2014. All cardiac events including angina, myocardial infarction, heart failure, coronary revascularization and cardiac death as well as non-cardiac death were determined for the whole follow up period. Results: Among 2770 eligible patients, 296 patients (10.6%) developed ischemic EKG changes during stress test but myocardial perfusion scan was normal. Out of 296 patients 181(61%) were male and mean age was 61.98 + 15 years. We were able to follow 280 patients (94.5%). During a mean follow-up of 4 years + 7 months, 8 patients (2.8 %) died, of which only one patient (0.3%) died due to cardiac cause. Angina occurred in 25patients (8.9%), myocardial infarction in 2 patients (0.7%) and one patient hospitalized with heart failure (0.3%). We performed coronary angiography of 16 patients (5.7%), of which nine underwent percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was done in three patients. Conclusion: The ischemic electrocardiographic changes during stress testing in patients with normal MPI are not associated with poor out come and the risk of cardiovascular events is relatively low for an intermediate follow up period.  Continuous....

scholarly journals A Method for Predicting the Main Indicators of Cardiopulmonary Stress Testing for Patients with Chronic Heart Failure

2020 ◽  
Vol 23 (1) ◽  
pp. 96-104
Author(s):  
A. S. Krasichkov ◽  
E. Mbazumutima ◽  
F. Shikama ◽  
E. M. Nifontov
Keyword(s):  
Heart Failure ◽  
Oxygen Consumption ◽  
Chronic Heart Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Significant Risk ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Prognostic Information

Introduction. Cardiopulmonary stress test provides significant diagnostic and prognostic information of the condition of patients with cardiovascular and pulmonary diseases. There is a serious problem, that final phase of stress testing is a physically difficult exercise for a person. There is a significant risk of occurrence and development of pathological conditions of the patient's cardiovascular system. One of the solutions is the development of methods for assessing the biological parameters of the patients at the end of a load protocol based on data from the initial stages of the test.Aim. Development of a method for finding an estimate of the maximum heart rate (HR) and of the peak oxygen consumption (OC) for the patients with chronic heart failure at the end of a cardiorespiratory exercise stress test, based on the results of the study obtained at the first initial stages of the test.Materials and methods. For the study, 149 anonymized records of rhythmograms and data of changes in the oxygen consumption of the patients with chronic heart failure were used. The patients underwent a cardiopulmonary stress test by a bicycle ergometer using step-by-step load protocol (the load power increase at each stage was 10 W, the duration of the load stage was 1 min)Results. Based on the analysis of the data obtained, a method for assessing the peak values of HR and of PC of the patients with chronic heart failure was developed.Conclusion. The relative error of the proposed estimate of the HR peak in most cases was no more than 10 %, which allows it to be used for practical purposes. It was established that when performing 70 % of the stress protocol, the error of the proposed estimate of the OC peak in most cases did not exceed 20 %. More research is needed to improve the accuracy of the assessment for using in medical applications aimed to the modernization of methods and equipment for stress testing of the patients.

scholarly journals 56. Long-Term Cardiovascular Outcomes After Drug-Related vs Non-Drug-Related Infective Endocarditis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S39-S40
Author(s):  
Brandon Muncan ◽  
Aikaterini Papamanoli ◽  
Hal A Skopicki ◽  
Andreas Kalogeropoulos
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ischemic Stroke ◽  
Drug Use ◽  
Cardiac Death ◽  
First Episode ◽  
Kaplan Meier ◽  
Icd 10

Abstract Background Drug use-related infective endocarditis (IE) has nearly doubled in the past two decades in the United States, largely due to the current opioid crisis. Although there are robust data on surgical outcomes for people who use drugs (PWUD) vs. non-PWUD patients after an initial encounter for IE, long-term comparative data on post-IE outcomes are relatively sparse. Methods Using data from the TriNetX electronic health records network, we identified (1) a cohort of patients 16 to 64 years old who had a first encounter for IE (captured with ICD-10 codes I33, I38, or I39) and history of drug use (captured with ICD-10 codes F11, F13-F16, F18, F19, O99.32, or T40) preceding the IE episode and (2) a propensity score-matched cohort of patients age 16-64 who had a first episode of IE and no documented drug use. We compared the post-IE incidence of (1) mortality; (2) ischemic stroke; (3) intracranial hemorrhage; (4) myocardial infarction; (5) heart failure; and (6) sudden cardiac death (cardiac arrest or ventricular fibrillation or tachycardia) between the 2 cohorts over a 5-year follow up period. We matched the cohorts for demographic data and clinically relevant medical history. We used Kaplan-Meier estimates and Cox models to compare incidence. Results We identified 6,578 PWUD patients and 6,578 matched non-PWUD patients 16-64 years old with a first episode of IE. The baseline characteristics are summarized in Table 1. Standardized mean differences of characteristics were generally < 0.1, indicating adequate matching. The 5-year Kaplan-Meier rates of outcomes of interest are summarized in Table 2. Mortality did not differ between cohorts. However, the incidence of ischemic stroke and intracranial hemorrhage was consistently higher among PWUD throughout the 5-year follow-up. Rates of myocardial infarction were also higher among PWUD; however, the difference was more pronounced later during follow-up. Rates of heart failure and sudden cardiac death did not differ. Conclusion Cardiovascular events after IE were common among both PWUD and non-PWUD patients over a 5-year follow-up period. However, rates of ischemic and hemorrhagic stroke were consistently higher among PWUD. Further investigation is needed to elucidate the sources of elevated stroke risk among PWUD and identify targets for intervention. Disclosures All Authors: No reported disclosures

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

Abstract P326: Myocardial Ischemia and Mobilization of Circulating Progenitor Cells

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Muhammad Hammadah ◽  
Ayman Samman Tahhan ◽  
Ibhar Almheid ◽  
Bryan Ross Kindya ◽  
Mazen Ghafeer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Progenitor Cells ◽  
Linear Models ◽  
Stress Test ◽  
Exercise Stress ◽  
Previous Myocardial Infarction ◽  
Pharmacological Stress ◽  
Pharmacological Stress Test

Background: Circulating progenitor cells (CPCs) are involved in vascular repair and regeneration. Low levels of CPCs in patients with CAD have been linked to adverse cardiovascular outcomes. The response of CPCs to transient myocardial ischemia in patients with CAD has not been studied before. We aimed to investigate the CPC response to exercise provoked myocardial ischemia (demand ischemia), and compare it to myocardial ischemia detected during pharmacological stress test (flow mismatch). Methods: 570 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during exercise (69%), or pharmacological stress (31%). myocardial ischemia was defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. CD34+ CPCs were enumerated by flow cytometry at rest and 30 min after stress testing. The change in CPC count was compared between patients with and without myocardial ischemia using mixed linear models. Results: Mean age was 63±9 years, 76% males, 36% with previous myocardial infarction. The incidence of myocardial ischemia was 31% and 41% during exercise and pharmacological stress test, respectively. No difference was observed in resting CPC between patients undergoing exercise vs pharmacological stress test, nor between patients with or without myocardial ischemia. However, patients who developed myocardial ischemia during exercise stress had a significant decrease in CPC with stress in comparison to those without myocardial ischemia (-12% vs 4%, respectively, p=0.006). Furthermore, the change in CPCs was inversely correlated with the magnitude of myocardial ischemia (R=-0.13, p=0.023), suggesting a greater CPC reduction with larger ischemic burden. These findings remained significant even after adjustment for age, gender, race, BMI, previous myocardial infarction, resting levels of CPCs and hematocrit change with stress. No difference was observed in CPC response to pharmacological stress test (change of -1% vs 3%, for patients with and without myocardial ischemia, respectively, p=0.96). Conclusion: Exercise stress-induced myocardial ischemia is associated with a decrease in CPC counts, likely due to increased homing of stem cells to the ischemic myocardium. Whether the extent of CPC uptake has prognostic implication, or whether the CPC response can be altered with intervention needs further investigation.

scholarly journals Prognostic Value Of Normal Myocardial Perfusion Imaging In Asymptomatic Diabetic Patients With Moderate And High Calcium Scores

2015 ◽  
Vol 16 (2) ◽  
pp. 109-114
Author(s):  
Irena Peovska Mitevska ◽  
Jelka Daceva Pavlovska ◽  
Maja Zdravkovska ◽  
Marina Zdravskovska
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Diabetes Duration ◽  
Diabetic Patients ◽  
Normal Myocardial Perfusion Imaging

Abstract The purpose of this study was to evaluate the intermediate prognostic value of normal myocardial perfusion imaging (MPI) in asymptomatic diabetic patients with intermediate and high coronary artery calcium (CAC) scores. Methods: A total of 115 asymptomatic diabetic patients with no known coronary artery disease (CAD) underwent MPI after multi-slice computed tomography CAC assessment for the detection of suspected CAD. The study included 75 patients with normal MPI results. A 17-segment model for myocardial perfusion and function analysis was used. Patients were divided into three groups: I gr-20 patients with a diabetes duration between 1-5 years; II gr-24 patients with a diabetes duration 5-10 years; and III gr-31 patients with a diabetes duration >10 years. End points (cardiac death, non-fatal myocardial infarction, heart failure, new angina, revascularization) were assessed at 6, 12 and 24 months. All patients had normal resting left ventricular function and normal myocardial perfusion scans. Forty patients had moderate coronary artery calcification with an average CAC of 290+/−95. Thirty-five patients had severe coronary calcification with an average CAC of 568+/−67. A correlation was found between diabetes duration and CAC severity (r-0,62 for diabetes duration over 10 years). Three cardiac events were identified at 24--month follow-up (new angina with percutaneous coronary intervention-PCI). Hard events (cardiac death, nonfatal myocardial infarction) were observed at a rate of 0% in group I, 4.2% in group II and 6.4% in group III. The overall event rate at 24--month follow-up was 4.0%. MPI and CAC are valuable techniques for the preclinical assessment of CAD in asymptomatic diabetic patients. This could guide decision-making to result in optimal treatment and prognosis. Even diabetic patients with normal MPI are at increased intermediate risk for CV events.

Stress testing for myocardial perfusion scintigraphy

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Myocardial Perfusion ◽  
Stress Testing ◽  
Myocardial Perfusion Scintigraphy ◽  
Stress Test ◽  
Arterial System ◽  
Exercise Stress ◽  
Perfusion Scintigraphy ◽  
Advantages And Disadvantages ◽  
Patient Preparation ◽  
Aid Decision

This chapter focuses on stress testing for myocardial perfusion scintigraphy. Beginning with detail on coronary physiology and exercise testing, it explains the coronary arterial system and the effect of stress methods on flow. By providing practical details on stress testing and exercise stress including equipment, personnel, and patient preparation, this chapter provides a good basis for clinical practice. Information on vasodilator drugs is also provided, with detail on pharmacology, practical considerations when performing the stress test, and adverse effects. Similar detail is provided on dobutamine. A further section details the advantages and disadvantages of methods of stress, including cost considerations, side effects, and variable suitability for a range of patients. A handy and practical algorithm is also provided to aid decision-making for appropriate methods of stress.

Stress testing for myocardial perfusion scintigraphy

2011 ◽  
Author(s):  
Nikant Sabharwal ◽  
Chee Yee Loong ◽  
Andrew Kelion
Keyword(s):  
Myocardial Perfusion ◽  
Stress Testing ◽  
Myocardial Perfusion Scintigraphy ◽  
Stress Test ◽  
Exercise Stress ◽  
Perfusion Scintigraphy ◽  
Coronary Physiology ◽  
Vasodilator Drugs ◽  
Patient Preparation

Coronary physiology and stress testing 76Practical requirements for stress testing 78Patient preparation for stress 80Exercise stress: general considerations 82Exercise stress: practical aspects 84Exercise stress: performing the test 86Vasodilator drugs: pharmacology 88Vasodilator drugs: practical considerations 92Vasodilator drugs: performing the stress test ...

scholarly journals Incidence of cardiovascular events in patients with atrial fibrillation anticoagulated with rivaroxaban after 2.5 years of follow-up: not all is stroke or bleeding

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Anguita Sanchez ◽  
M Ruiz Ortiz ◽  
F Marin ◽  
M Sanmartin ◽  
C Rafols ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Total Mortality ◽  
Cardiac Events ◽  
Current Series

Abstract Introduction Atrial fibrillation (AF) is not a benign arrhythmia, but is associated with an increase in mortality, above all related to the risk of suffering thromboembolic events, mainly stroke. The use of oral anticoagulants (OAC) reduces this risk, but increases the risk of serious bleeding. The DOACs have been shown to be superior to the classic vitamin K antagonists (VKAs). It is not as well known whether AF is associated with an increase in other serious cardiac events. Purpose The objective of this analysis was to assess the incidence of stroke, major bleeding, total mortality and major adverse cardiac events [MACE, defined as cardiac mortality (including death for coronary events, progressive heart failure death and sudden cardiac death), coronary revascularization, myocardial infarction] in a contemporary series of patients with AF anticoagulated with rivaroxaban. Methods To do this, we have analyzed a series of 1,433 patients with AF, anticoagulated with rivaroxaban for at least the previous 6 months, consecutively included in the first half of year 2017 in 79 Spanish centers (EMIR study), and followed for 2.5 years. Results Mean age was 74.2±9.7 years, 44.5% being women. Prevalence of diabetes was 27.1%, chronic renal failure 16.1%, coronary heart disease 16.4% and heart failure 22.7%. 2MACE score was 1.8±1.4, CHA2DS2-VASc was 3.5±1.5 and HAS-BLED 1.6±1.0. 77.1% of patients received 20 mg/ day of rivaroxaban and 22.9% 15 mg/day. After a follow-up of 2.5 years, the annual rate (events/100 patients/year) of myocardial infarction was 0.16 (all non-STEMI), coronary revascularization 0.28, cardiac death 0.63 (sudden 0.16, heart failure 0.41, other 0.06), overall MACE 1.07 and overall mortality 2.73, while the incidence of stroke was 0.57 / 100 patients / year (ischemic 0.35, haemorrhagic 0.22) and major bleeding 1.04 (gastrointestinal 0.63, intracranial 0.28). Conclusion In a current series of patients with AF anticoagulated with rivaroxaban, the incidence of embolic and hemorrhagic complications and mortality are low, while the incidence of serious cardiac events is significant, being overall similar to that of stroke and major bleeding. Attention must be paid to the prevention and diagnosis of these problems. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania

scholarly journals Non-fatal cardiovascular events preceding sudden cardiac death in patients with an acute myocardial infarction complicated by heart failure: insights from the High-Risk-Myocardial-Infarction database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Hui ◽  
A Sharma ◽  
K Docherty ◽  
J.J.V McMurray ◽  
B Pitt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Public Institution ◽  
Funding Source

Abstract Background Sudden cardiac death (SCD) is responsible for 20–40% of mortality following acute myocardial infarction (AMI). The risk of SCD is even higher among patients with AMI complicated by heart failure (HF) (either clinically apparent HF or left ventricular dysfunction). The temporal relationship between an AMI complicated by HF and subsequent SCD and the association of non-fatal cardiovascular (CV) events following AMI with SCD has yet to be described. Purpose Among patients with AMI complicated by HF, we evaluated the probability and temporal association of subsequent non-fatal cardiovascular (CV) events (HF hospitalization, recurrent MI, or stroke) and SCD. Methods The High-Risk Myocardial Infarction (HRMI) database contains 28,771 patients with signs of HF or reduced LV ejection fraction (<40%) after AMI. Among patients with an AMI complicated by HF, we used adjudicated cause of death from the HRMI Database to identify: 1) the temporal distribution of SCD among patients following an index AMI; 2) the probability of having SCD following a non-fatal CV event following the index AMI. Results Median follow-up was 1.9 years. Mean age was 65.0±11.5 years and 70% were male. The incidence of CV death was 7.9 per 100 patient-year [py] and for SCD was 3.1 per 100py (40% of CV deaths). SCD rates were highest in the early period (<90 days) after AMI and decreased over time. Recurrent MI preceded 9.6% of SCD after a median time of 145 days; HF hospitalization preceded 17.0% of SCD after a median 144 days; and stroke preceded 2.7% of SCD after a median of 138 days (vs. non-sudden CV death: MI 46.6% at 1 days, HF hospitalization: 30.9% at 67 days, stroke 12.9% at 9 days). The incidence of SCD preceded by HF hospitalization was significantly higher than SCD without preceding HF hospitalization. Conclusion Among patients with AMI complicated by HF, SCD predominantly occurred in the early “high-risk” period after AMI; SCD rates decreased afterwards. Patients with non-fatal HF hospitalizations during follow-up may have a higher subsequent SCD risk. Preventing HF onset after MI may help decreasing SCD. Proportion of sudden cardiac death Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Lucien Award, McGill University

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