The latest medical research on Cardiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiology gathered by our medical AI research bot.
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Residual platelet reactivity after pre-treatment with ticagrelor prior to primary percutaneous coronary intervention is associated with suboptimal myocardial reperfusion.European Heart Journal
The evidence of a clinical benefit of P2Y12 inhibitor pre-treatment in primary percutaneous coronary intervention (PCI) and the relation between the level of platelet inhibition and myocardial reperfusion with newer potent P2Y12 inhibitors remain unclear. We aimed to assess the relationship between platelet reactivity at the time of primary PCI after pre-treatment with aspirin and ticagrelor and the post-PCI myocardial blush grade (MBG).
We prospectively included 61 patients. Platelet reaction units for ticagrelor (PRU) and aspirin reaction units (ARU) were measured using the point-of-care test VerifyNow before PCI. The high on-ticagrelor (PRU >208) and on-aspirin (ARU ⩾ 550) platelet reactivity (HPR and HaPR) were assessed. Patients were divided into two groups according to MBG 3 or <3.
MBG 3 was identified in 28 (46%) patients. Mean PRU was lower in such patients as compared with those with MBG <3 (155.82 ± 90.91 vs. 227.42 ± 65.18; p=0.001) while mean ARU was similar between groups. HPR and HaPR were observed in 30 (49.2%) and 11 patients (18%), respectively. HPR but not HaPR was more frequent in the group with impaired MBG (66.7 vs. 28.6%; p=0.003 and 21.2 vs. 14.3%; p=0.48 respectively).
Our study shows that higher PRU and the subsequent HPR at the time of primary PCI, after pretreatment with ticagrelor, are the only correlates of post PCI MBG. These findings support the earliest possible loading with ticagrelor prior to primary PCI.
A wide range gate data acquisition for diagnosing coronary artery disease.Echocardiography
The turbulence of blood flow caused by stenosis has an impact on the surrounding coronary artery tissue and creates an audio-frequency vibration to the adjacent myocardial wall. We investigated the diagnostic feasibility of a novel diagnostic method using wide range gate (WRG) ultrasound data acquisition for diagnosing coronary artery disease (CAD). WRG data acquisition detects high-frequency vibrations from coronary artery stenosis, using pulse-wave Doppler ultrasound.
We used a Verasonics ultrasound data acquisition system to implement the WRG data acquisition. Investigators performed clinical trials for 80 subjects, with suspected CAD. All enrolled patients participated in WRG data acquisition before coronary angiography (CAG).
As compared with the results of CAG, the sensitivity and specificity of the WRG data analysis were 80% and 84%, respectively. The WRG data analysis showed that the sensitivity and specificity were 81% and 79% in the left anterior descending artery, respectively, 75% and 89% in the left circumflex artery, respectively, and 85% and 82% in the right coronary artery, respectively. In a multivariate analysis, a positive vibrometry result was an independent predictive factor for CAD.
We proposed a new diagnostic method for detecting CAD using ultrasound. The new data acquisition method showed good potential as an initial diagnostic tool for CAD.
Cardiac chloroma or cardiac myeloid sarcoma: Case Report.Echocardiography
Chloroma or myeloid sarcoma is rare extramedullary tumor composed of immature myeloid cells that may occur in association with or during or even be...
Left ventricular dyssynchrony in coronary artery disease patients without regional wall-motion abnormality: Correlation with Gensini score.Echocardiography
Our study investigated left ventricular dyssynchrony (LVD) in coronary artery disease (CAD) patients without regional wall-motion abnormality (RWMA) by three-dimensional echocardiography (3-DE) and explored the relationship between LVD and severity of CAD as assessed by the Gensini score (GS).
Sixty-one patients with a confirmed diagnosis of CAD by coronary angiography (CAG) were enrolled. We quantified LVD parameters, including the left ventricular segments (16, 12, and 6) standard deviation of the time to minimum systolic volume (TmsvSD-16, TmsvSD-12, and TmsvSD-6) and the systolic dyssynchrony index in regions 16, 12, and 6 (16R-SDI, 12R-SDI, 6R-SDI) using 3-DE. The severity of coronary atherosclerotic lesions was evaluated by the GS system on the basis of CAG findings. We further divided all patients into three groups according to the tertiles of GS: low-GS ≤20, mid-GS >20 and ≤48, and high-GS >48. The differences of LVD values among the three groups were compared, and the associations between LVD parameters and GS were analyzed.
Coronary artery disease patients demonstrated increased LVD parameters compared with healthy controls. TmsvSD12, 16R-SDI, and 6R-SDI were prolonged in the high-GS group compared with the low- and mid-GS groups. 16R-SDI was positively correlated with the GS, and multivariate regression analysis showed that 16R-SDI was an independent predictor of the GS. 16R-SDI above 10.7% had a sensitivity of 84.21% and a specificity of 92.86% for identifying high-GS.
Three-dimensional echocardiography is a noninvasive technique to detect LVD in non-RWMA CAD patients, and the parameter 16R-SDI was significantly correlated with CAD severity.
Cardiomyopathy presenting prenatally with functional tricuspid and pulmonary atresia.Echocardiography
Cardiomyopathy is a rare diagnosis in the fetus that usually presents as a dilated, poorly functioning ventricle. We present the case of a fetus th...
Photorealistic imaging of left atrial appendage occlusion/exclusion.Echocardiography
Recent improvements in 3D TEE post processing rendering techniques referred to as TrueVue (Philips Medical Systems, Andover, MA, USA). It allows fo...
Circumferential and radial deformation assessment in premature infants: Ready for primetime?Echocardiography
Speckle tracking echocardiography (STE) is a validated method to measure longitudinal deformation in premature infants, but there is a paucity of data on STE-derived circumferential and radial strain in this population. We assessed the feasibility and reproducibility of circumferential and radial deformation measurements in premature infants.
In a prospective study of 40 premature infants (<29 weeks of gestation at birth), STE-derived circumferential and radial strain, systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) were measured on day 2 and day 8. Intra- and inter-observer reproducibility analysis were performed using Bland-Altman analysis, coefficient of variation (COV), and intra-class correlation coefficient (ICC). The impact of a persistent patent ductus arteriosus (PDA) was analyzed.
Deformation analysis was feasible in 98% of the acquisitions. Circumferential parameters demonstrated excellent intra- and inter-observer reproducibility with an ICC between 0.89 and 0.99 (all P < 0.001) and a COV between 4% and 13%. Radial parameters demonstrated acceptable intra- and inter-observer reproducibility with an ICC between 0.73 and 0.96 (all P < 0.001) and a COV between 14% and 27%. Infants with a PDA on day 8 (n = 21, 53%) demonstrated higher radial strain, SRs and SRe. There were no differences in circumferential parameters with a PDA at either time point.
This study demonstrates clinical feasibility and reproducibility of circumferential and radial strain by STE in premature infants. A PDA elevates radial deformation measures, suggesting that the increased LV preload from a PDA may augment intrinsic contractility in the radial but not circumferential plane.
Mitral annular disjunction: A systematic review of the literature.Echocardiography
Mitral annular disjunction (MAD) is a structural abnormality where there is a separation between the mitral valve annulus and the left atrial wall which is not well understood.
We conducted a systematic review to evaluate the prevalence of MAD, factors associated with MAD and clinical outcomes among patients with MAD.
A total of 19 studies were included in this review, and the number of noncase report studies had between 23 and 1439 patients. The pooled rate of MAD in studies of myxomatous mitral valve patients was 66/130 (50.8%, 3 studies), and among patients with mitral valve prolapse was 95/291 (32.6%, 3 studies). One study suggests that 78% of patients with MAD had mitral valve prolapse, and another suggested it was strongly associated with myxomatous mitral valve disease (HR 5.04 95% CI 1.66-15.31). In terms of clinical significance, it has been reported that MAD with disjunction > 8.5 mm was associated with nonsustained ventricular tachycardia (OR 10 95% CI 1.28-78.1). There is also evidence that gadolinium enhancement in papillary muscle (OR 4.09 95% CI 1.28-13.05) and longitudinal MAD distance in posterolateral wall (OR 1.16 95% CI 1.02-1.33) was predictive of ventricular arrhythmia and late gadolinium enhancement in anterolateral papillary muscle was strongly associated with serious arrhythmic event (OR 7.35 95% CI 1.15-47.02).
Mitral annular disjunction appears to be common in myxomatous mitral valve disease and mitral valve prolapse which can be detected on cardiac imaging and may be important because of its association with ventricular arrhythmias and sudden cardiac death.
Top 100 most-cited articles on echocardiography: A bibliometric analysis.Echocardiography
Echocardiography has been widely applied since 1970s, and has developed into a reliable approach to assess the heart in both cardiology and interdi...
A standardized imaging protocol improves quality and reduces practice variability in echocardiographic assessment of ventricular function by first-year pediatric cardiology fellows.Echocardiography
Echocardiography education for pediatric cardiology fellows has been a recent focus leading to the implementation of "boot camps." Less is described about continuing education through fellowship and improving image quality. We noticed practice variation in echocardiograms assessing ventricular function performed on nights and weekends. Thus, we implemented a standardized protocol and assessed its impact on imaging and reporting completeness.
We created an imaging protocol for the assessment of ventricular function in the acute setting. The protocol included demographic information, a list of images to be obtained, and the methods to quantify ventricular function. The protocol was explained to first-year fellows and distributed on an electronic quick reference card. Echocardiograms independently performed by first-year fellows during their first 4 months of on-call time were assessed pre- and postintervention using a standard rubric.
Compliance with demographic reporting was high pre- and postintervention, but significantly improved after the standardized protocol (P < 0.001). Use of the protocol increased the median number of unique images obtained per echocardiogram from 13 to 17 (out of 23 required views, P < 0.001). Particularly improved was the performance of quantitative evaluations of function, including Simpson's method for left ventricular ejection fraction (four chamber: 40% vs 67%, P < 0.001; two chamber: 33% vs 67%, P < 0.001) and tricuspid annular plane systolic excursion (45% vs 80%, P < 0.001).
The introduction of a standardized imaging protocol and its distribution to first-year fellows resulted in improvements in echocardiographic reporting completeness and increased the quality of information obtained by providing more quantitative assessments of ventricular function.
Cardiac sarcoidosis in monozygotic twins: An opportunity for early surveillance and treatment.Echocardiography
Genetic factors play an important role in the development of cardiac sarcoidosis and may determine disease pattern, severity, and prognosis. A 55-y...
Tricuspid annular plane systolic excursion is dependent on right ventricular volume in addition to function.Echocardiography
Tricuspid annular plane systolic excursion (TAPSE) is an effective parameter for assessing right ventricular (RV) function in echocardiographic studies. The preload dependency of TASPE has not been explored.
We retrospectively reviewed 380 cardiac magnetic resonance (CMR) exams. RV ejection fraction (EF) and end-diastolic volume (EDV) were measured from short-axis cine images. TAPSE was measured as the difference of the perpendicular distance of the tricuspid annulus to the RV apex during diastole and systole. RV dysfunction was defined as RVEF <47%. The relationship of TAPSE, RVEF, and indexed RVEDV (RVEDVi) were evaluated. The TAPSE cut-off values derived from CMR were tested in a validation group (n = 46) with an echocardiographic exam performed within 1 month of the CMR.
TAPSE had a good linear correlation with RVEF (r = .69, P < .001). In normal RVEF patients, TAPSE had a positive correlation with RVEDVi (r = .208, P = .014). Receiver operating characteristic analysis revealed a higher TAPSE cut-off value of 2.4 cm in the top normal to mildly dilated RV volume group for identifying RV dysfunction with lower predictive accuracy (sensitivity 80%, specificity 67%, area under the curve = 0.78, P < .001) as compared with 2.0 cm for the normal RV size or moderate to severely dilated RV groups. The higher TAPSE cutoff showed improved sensitivity (73% vs 43%) and Youden index (0.55 vs 0.43) in our validation cohort.
Tricuspid annular plane systolic excursion not only correlates with RVEF, but also is dependent on RV volume. The cut-off value and predictive accuracy of TAPSE for detecting RV dysfunction vary with different RV volumes.