Wednesday, October 3, 2007
Heart attacks can occur in teenagers
Heart attacks can occur in teenagers
Tue Oct 2, 2007 12:44 PM ET
By Megan Rauscher
NEW YORK (Reuters Health) - Although quite rare, heart attacks can occur in adolescents without heart defects; and a case series reported by two cardiologists from The Heart Center at Akron Children's Hospital, Ohio, serves as a of reminder this.
Reporting in the current issue of Pediatrics, Drs. John R. Lane and Giora Ben-Shachar describe nine healthy adolescents (eight boys and one girl), ages 12 to 20 years, who developed severe chest pains and met the criteria for a diagnosis of heart attack.
Eight of the patients had abnormal EKGs, all of them had abnormal cardiac enzyme levels, and three had abnormalities revealed by echocardiogram. Heart rhythm abnormalities were seen in four patients. Although several other types of irregularities were detected, none of the patients has abnormal anatomy.
Tests for drug abuse, cholesterol levels, and blood coagulation rate were all negative, the authors report.
Heart attacks in teens are "obviously rare but not an impossible diagnosis," Lane told Reuters Health. When an adolescent develops severe chest pain typical of a heart attack, it should not be dismissed lightly.
Lane also noted that this is a "different disease" than heart attacks in adults - the young patients did not have any obvious risk factors, they had normal coronary arteries and they tended to recover without any long-term problems.
None of the patients had blood clots, so drugs to break up a clot would not have been useful, Lane said. On the other hand, drugs to expand the arteries of the heart can be helpful, which suggests that a heart spasm may be the cause of the heart attack.
SOURCE: Pediatrics, September 2007.
Tue Oct 2, 2007 12:44 PM ET
By Megan Rauscher
NEW YORK (Reuters Health) - Although quite rare, heart attacks can occur in adolescents without heart defects; and a case series reported by two cardiologists from The Heart Center at Akron Children's Hospital, Ohio, serves as a of reminder this.
Reporting in the current issue of Pediatrics, Drs. John R. Lane and Giora Ben-Shachar describe nine healthy adolescents (eight boys and one girl), ages 12 to 20 years, who developed severe chest pains and met the criteria for a diagnosis of heart attack.
Eight of the patients had abnormal EKGs, all of them had abnormal cardiac enzyme levels, and three had abnormalities revealed by echocardiogram. Heart rhythm abnormalities were seen in four patients. Although several other types of irregularities were detected, none of the patients has abnormal anatomy.
Tests for drug abuse, cholesterol levels, and blood coagulation rate were all negative, the authors report.
Heart attacks in teens are "obviously rare but not an impossible diagnosis," Lane told Reuters Health. When an adolescent develops severe chest pain typical of a heart attack, it should not be dismissed lightly.
Lane also noted that this is a "different disease" than heart attacks in adults - the young patients did not have any obvious risk factors, they had normal coronary arteries and they tended to recover without any long-term problems.
None of the patients had blood clots, so drugs to break up a clot would not have been useful, Lane said. On the other hand, drugs to expand the arteries of the heart can be helpful, which suggests that a heart spasm may be the cause of the heart attack.
SOURCE: Pediatrics, September 2007.
Sex and Race Disparities Found in ICD Use
Sex and Race Disparities Found in ICD Use
Wide racial and gender disparities exist in the use of implantable cardioverter-defibrillators (ICDs), according to two JAMA reports.
One, a study of some 230,000 Medicare beneficiaries, examined ICD use for primary or secondary prevention of sudden cardiac death. Researchers found that men were 3.2 times more likely than women to receive ICD therapy for primary prevention, and 2.4 times more likely for secondary prevention. There were no significant survival benefits in the primary-prevention cohort in the year following implantation.
The other study, of some 13,000 patients with heart failure, also found that women were less likely than men to receive ICDs and that black patients — both men and women — were less likely to get them.
An editorialist says that the results "highlight disturbing patterns of health care inequality." With regard to survival benefits, she writes that paradoxically the bad news may be for white men "who are undergoing a procedure that, for primary prevention, has not been shown to extend their lives."
JAMA article on sex differences (Free)
JAMA article on sex and race differences (Free abstract; full text requires subscription)
JAMA editorial (Subscription required)
Wide racial and gender disparities exist in the use of implantable cardioverter-defibrillators (ICDs), according to two JAMA reports.
One, a study of some 230,000 Medicare beneficiaries, examined ICD use for primary or secondary prevention of sudden cardiac death. Researchers found that men were 3.2 times more likely than women to receive ICD therapy for primary prevention, and 2.4 times more likely for secondary prevention. There were no significant survival benefits in the primary-prevention cohort in the year following implantation.
The other study, of some 13,000 patients with heart failure, also found that women were less likely than men to receive ICDs and that black patients — both men and women — were less likely to get them.
An editorialist says that the results "highlight disturbing patterns of health care inequality." With regard to survival benefits, she writes that paradoxically the bad news may be for white men "who are undergoing a procedure that, for primary prevention, has not been shown to extend their lives."
JAMA article on sex differences (Free)
JAMA article on sex and race differences (Free abstract; full text requires subscription)
JAMA editorial (Subscription required)
Tuesday, October 2, 2007
The Resting Electrocardiogram in the Management of Patients With CHF
The Resting Electrocardiogram in the Management of Patients With CHF
Abstract
The resting electrocardiogram (ECG) furnishes essential information for the diagnosis, management, and prognostic evaluation of patients with congestive heart failure (CHF). Almost any ECG diagnostic entity may turn out to be useful in the care of patients with CHF, revealing the non-specificity of the ECG in CHF. Nevertheless a number of CHF/ECG correlates have been proposed and found to be indispensable in clinical practice; they include, among others, the ECG diagnoses of myocardial ischemia and infarction, atrial fibrillation, left ventricular hypertrophy/dilatation, left bundle branch block and intraventricular conduction delays, left atrial abnormality, and QT-interval prolongation. In addition to the above well-known applications of the ECG for patients with CHF, a recently described association of peripheral edema (PERED), sometimes even imperceptible by physical examination, with attenuated ECG potentials, could extend further the diagnostic range of the clinician. These ECG voltage attenuations are of extracardiac mechanism, and impact the amplitude of QRS complexes, P-waves, and T-waves, occasionally resulting also in shortening of the QRS complex and QT interval duration. PERED alleviation, in response to therapy of CHF, reverses all above alterations. These fresh diagnostic insights have potential application in the follow-up of patients with CHF, and in their selection for implantation of cardioverter/defibrillator and/or cardiac resynchronization systems. If sought, PERED-induced ECG changes are abundantly present in the hospital and clinic environments; if their detection and monitoring are incorporated in the clinician's "routine," considerable improvements in the care of patients with CHF may be realized.
Abstract
The resting electrocardiogram (ECG) furnishes essential information for the diagnosis, management, and prognostic evaluation of patients with congestive heart failure (CHF). Almost any ECG diagnostic entity may turn out to be useful in the care of patients with CHF, revealing the non-specificity of the ECG in CHF. Nevertheless a number of CHF/ECG correlates have been proposed and found to be indispensable in clinical practice; they include, among others, the ECG diagnoses of myocardial ischemia and infarction, atrial fibrillation, left ventricular hypertrophy/dilatation, left bundle branch block and intraventricular conduction delays, left atrial abnormality, and QT-interval prolongation. In addition to the above well-known applications of the ECG for patients with CHF, a recently described association of peripheral edema (PERED), sometimes even imperceptible by physical examination, with attenuated ECG potentials, could extend further the diagnostic range of the clinician. These ECG voltage attenuations are of extracardiac mechanism, and impact the amplitude of QRS complexes, P-waves, and T-waves, occasionally resulting also in shortening of the QRS complex and QT interval duration. PERED alleviation, in response to therapy of CHF, reverses all above alterations. These fresh diagnostic insights have potential application in the follow-up of patients with CHF, and in their selection for implantation of cardioverter/defibrillator and/or cardiac resynchronization systems. If sought, PERED-induced ECG changes are abundantly present in the hospital and clinic environments; if their detection and monitoring are incorporated in the clinician's "routine," considerable improvements in the care of patients with CHF may be realized.
Weight Loss Can Normalize Blood Pressure
AHA-BP: Weight Loss Can Normalize Blood Pressure
By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 01, 2007
MedPage Today Action Points
Explain to interested patients that weight loss alone may help lower blood pressure to normal levels in some overweight individuals with stage I hypertension.
The results were reported at a medical conference and as a published abstract and should be considered preliminary until published in a peer-reviewed journal.
Review
TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.
After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.
The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.
"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.
"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.
The study involved men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.
Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.
"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.
After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.
There was a significant reduction in plasma leptin (from 17.3±4.4 to 10.9±3.2 ng/mL, P<0.01), active renin (from 12.9±6.8 to 9.1±5.2 pg/mL P<0.05), and aldosterone (from 71.8±28.4 to 59.7±23.5 P<0.01).
Forty-eight percent of the those with bodyweight loss of 5% or more achieved a normal BMI (< 25 Kg/m2) and 53% showed a BP blood pressure normalization (< 140/90 mmHg). Plasma leptin, active renin and aldosterone decreases were not different than those of the 25 patients who did not achieve the blood pressure normalization despite the BMI normalization.
The study will continue until all patients have been followed for a year.
Primary source: American Heart Association's 61st Annual Fall Conference of the Council on High Blood Pressure Research
Source reference:
Fogari R et al. "Effect of body weight loss on blood pressure in stage I hypertensive overweight patients. American Heart Association's 61st Fall Conference of the Council on High Blood Pressure Research, 2007. Abstract P213.
By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 01, 2007
MedPage Today Action Points
Explain to interested patients that weight loss alone may help lower blood pressure to normal levels in some overweight individuals with stage I hypertension.
The results were reported at a medical conference and as a published abstract and should be considered preliminary until published in a peer-reviewed journal.
Review
TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.
After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.
The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.
"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.
"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.
The study involved men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.
Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.
"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.
After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.
There was a significant reduction in plasma leptin (from 17.3±4.4 to 10.9±3.2 ng/mL, P<0.01), active renin (from 12.9±6.8 to 9.1±5.2 pg/mL P<0.05), and aldosterone (from 71.8±28.4 to 59.7±23.5 P<0.01).
Forty-eight percent of the those with bodyweight loss of 5% or more achieved a normal BMI (< 25 Kg/m2) and 53% showed a BP blood pressure normalization (< 140/90 mmHg). Plasma leptin, active renin and aldosterone decreases were not different than those of the 25 patients who did not achieve the blood pressure normalization despite the BMI normalization.
The study will continue until all patients have been followed for a year.
Primary source: American Heart Association's 61st Annual Fall Conference of the Council on High Blood Pressure Research
Source reference:
Fogari R et al. "Effect of body weight loss on blood pressure in stage I hypertensive overweight patients. American Heart Association's 61st Fall Conference of the Council on High Blood Pressure Research, 2007. Abstract P213.
Monday, October 1, 2007
Panic attacks, heart attacks linked in study
Panic attacks, heart attacks linked in study
Mon Oct 1, 2007 6:32pm ET
CHICAGO (Reuters) - People who experience the anxiety, racing heartbeat and rapid breathing of a panic attack have a higher risk of a heart attack or stroke, researchers said on Monday.
"Our study adds panic attacks to the list of emotional states and psychiatric symptoms that have been linked to excess risk of cardiovascular disease and death," wrote study author Dr. Jordan Smoller of Massachusetts General Hospital in Boston.
Previous research found people with persistent feelings of depression, anger and hostility are at higher risk of heart attack, according to the study, published in the Archives of General Psychiatry.
The study identified a more than three-fold increased risk of a heart attack or stroke within five years in 330 women who had originally reported a panic attack in the prior six months. They were among 3,369 women aged 51 to 83 to participate in the study.
Smoller said several factors may be at work, including that the symptoms of panic attacks inflict damage on the heart and the cardiovascular system.
Feelings of panic could induce blood platelet production that increases the risk of a blood clot, which can trigger a heart attack or stroke. Panic attacks also may lead to a spasm of an artery feeding the heart, which can reduce or cut off blood flow, he added.
Mon Oct 1, 2007 6:32pm ET
CHICAGO (Reuters) - People who experience the anxiety, racing heartbeat and rapid breathing of a panic attack have a higher risk of a heart attack or stroke, researchers said on Monday.
"Our study adds panic attacks to the list of emotional states and psychiatric symptoms that have been linked to excess risk of cardiovascular disease and death," wrote study author Dr. Jordan Smoller of Massachusetts General Hospital in Boston.
Previous research found people with persistent feelings of depression, anger and hostility are at higher risk of heart attack, according to the study, published in the Archives of General Psychiatry.
The study identified a more than three-fold increased risk of a heart attack or stroke within five years in 330 women who had originally reported a panic attack in the prior six months. They were among 3,369 women aged 51 to 83 to participate in the study.
Smoller said several factors may be at work, including that the symptoms of panic attacks inflict damage on the heart and the cardiovascular system.
Feelings of panic could induce blood platelet production that increases the risk of a blood clot, which can trigger a heart attack or stroke. Panic attacks also may lead to a spasm of an artery feeding the heart, which can reduce or cut off blood flow, he added.
Physical Activity and Public Health in Older Adults: Recommendation From the American College of Sports Medicine and the American Heart Association
Title: Physical Activity and Public Health in Older Adults: Recommendation From the American College of Sports Medicine and the American Heart Association
Date Posted: 9/26/2007
Author(s): Nelson ME, Rejeski WJ, Blair SN, et al.
Citation: Circulation. 2007;116:1094-1105.
Perspective: The following are 10 points to remember about this recommendation on physical activity and public health in older adults:
1. Benefits of regular physical activity include reductions in the risk of diabetes, hypertension, cardiovascular disease (including stroke), dyslipidemia, obesity, anxiety, and depression. Physical activity is a component of clinical practice guidelines for coronary heart disease, hypertension, peripheral vascular disease, diabetes, obesity, and hyperlipidemia. Currently, older Americans are the least fit of any age group. In a study of Medicare enrollees, an estimated 14% of the men and 23% of the women were not able to walk 2-3 blocks. This age group is the fastest growing demographic segment in the United States, and has significant medical expenditures. Therefore, increasing physical activity among older adults has significant public health implications.
2. Physical activity recommendations for older adults pertain to all adults ages 65 or older, and to those ages 50-64 years with clinically significant chronic conditions and/or functional limitations. Recommendations are similar to those for adults under 65 years of age; however, intensity recommendations have been adapted to accommodate a wide range of aerobic fitness levels.
3. Physical activity recommendations include a minimum of 30 minutes/day of moderate intensity activity 5 days per week or a minimum of 20 minutes/day of vigorous activity 3 days/week. Moderate intensity activity can be completed in 10-minute intervals throughout the day. On a 10-point scale, moderate intensity is a 5-6 of perceived effort, whereas vigorous activity is a 7-8.
4. The intensity level for older adults is relative to the individual’s aerobic fitness and thus varies by person. These amounts of aerobic activity recommended should be in addition to routine daily activities such as cooking or shopping.
5. If conditions or baseline fitness do not permit the patient to achieve minimum levels of recommended physical activity, older adults should maintain regular physical activity consistent with their abilities and avoid sedentary behavior.
6. Benefits of physical activity appear to have a dose-response relationship, such that reductions in the risk of cardiovascular disease have been observed with as little as 45-75 minutes per week of walking.
7. Muscle strengthening activities are recommended at least 2 times per week and should include 8-10 exercises, which involve major muscle groups (with 10-15 repetitions). For those older adults at increased risk for falls, flexibility and balances exercises should be incorporated into these activities.
8. Physical activity has been observed to reduce risk of falls (and fall injuries) by as much a 35%-40%. Several studies have noted balance exercises to be an effective component of fall prevention.
9. An activity plan for an older adult should tailor recommendations to the person’s abilities and conditions and should include a stepwise plan for gradual increases in physical activity to achieve recommended levels of physical activity.
10. The majority of older Americans should be physically active. Both individual and community interventions are needed to support current recommendations for older adults, particularly in light of the growing number of older men and women residing in the United States.
Elizabeth A. Jackson, M.D., F.A.C.C.
Date Posted: 9/26/2007
Author(s): Nelson ME, Rejeski WJ, Blair SN, et al.
Citation: Circulation. 2007;116:1094-1105.
Perspective: The following are 10 points to remember about this recommendation on physical activity and public health in older adults:
1. Benefits of regular physical activity include reductions in the risk of diabetes, hypertension, cardiovascular disease (including stroke), dyslipidemia, obesity, anxiety, and depression. Physical activity is a component of clinical practice guidelines for coronary heart disease, hypertension, peripheral vascular disease, diabetes, obesity, and hyperlipidemia. Currently, older Americans are the least fit of any age group. In a study of Medicare enrollees, an estimated 14% of the men and 23% of the women were not able to walk 2-3 blocks. This age group is the fastest growing demographic segment in the United States, and has significant medical expenditures. Therefore, increasing physical activity among older adults has significant public health implications.
2. Physical activity recommendations for older adults pertain to all adults ages 65 or older, and to those ages 50-64 years with clinically significant chronic conditions and/or functional limitations. Recommendations are similar to those for adults under 65 years of age; however, intensity recommendations have been adapted to accommodate a wide range of aerobic fitness levels.
3. Physical activity recommendations include a minimum of 30 minutes/day of moderate intensity activity 5 days per week or a minimum of 20 minutes/day of vigorous activity 3 days/week. Moderate intensity activity can be completed in 10-minute intervals throughout the day. On a 10-point scale, moderate intensity is a 5-6 of perceived effort, whereas vigorous activity is a 7-8.
4. The intensity level for older adults is relative to the individual’s aerobic fitness and thus varies by person. These amounts of aerobic activity recommended should be in addition to routine daily activities such as cooking or shopping.
5. If conditions or baseline fitness do not permit the patient to achieve minimum levels of recommended physical activity, older adults should maintain regular physical activity consistent with their abilities and avoid sedentary behavior.
6. Benefits of physical activity appear to have a dose-response relationship, such that reductions in the risk of cardiovascular disease have been observed with as little as 45-75 minutes per week of walking.
7. Muscle strengthening activities are recommended at least 2 times per week and should include 8-10 exercises, which involve major muscle groups (with 10-15 repetitions). For those older adults at increased risk for falls, flexibility and balances exercises should be incorporated into these activities.
8. Physical activity has been observed to reduce risk of falls (and fall injuries) by as much a 35%-40%. Several studies have noted balance exercises to be an effective component of fall prevention.
9. An activity plan for an older adult should tailor recommendations to the person’s abilities and conditions and should include a stepwise plan for gradual increases in physical activity to achieve recommended levels of physical activity.
10. The majority of older Americans should be physically active. Both individual and community interventions are needed to support current recommendations for older adults, particularly in light of the growing number of older men and women residing in the United States.
Elizabeth A. Jackson, M.D., F.A.C.C.
Influence of Nonfatal Hospitalization for Heart Failure on Subsequent Mortality in Patients With Chronic Heart Failure -- Solomon et al. 116 (13): 1482 -- Circulation
Influence of Nonfatal Hospitalization for Heart Failure on Subsequent Mortality in Patients With Chronic Heart Failure -- Solomon et al. 116 (13): 1482 -- Circulation
Conclusions— In patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission.
Conclusions— In patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission.
Dyssynchrony predicts poor prognosis after CABG
Severe Left Ventricular Dyssynchrony Is Associated With Poor Prognosis in Patients With Moderate Systolic Heart Failure Undergoing Coronary Artery Bypass Grafting
J Am Coll Cardiol, 2007; 50:1315-1323, doi:10.1016/j.jacc.2007.03.070 (Published online 14 September 2007
Reprint requests and correspondence: Dr. Martin Penicka, Cardiocenter, Department of Cardiology, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady in Prague, Srobarova 50, 10034 Prague, Czech Republic. (Email: penicka@fnkv.cz
Objectives: The objective of the present study was to assess the relationship between the presence of left ventricular (LV) dyssynchrony and clinical outcome in patients with moderate systolic heart failure undergoing coronary artery bypass graft (CABG) surgery.
Background: The presence of LV dyssynchrony is associated with poor prognosis in patients with LV dysfunction.
Methods: The study consisted of 215 consecutive patients with ischemic cardiomyopathy and dyspnea (age 65 ± 9 years, 81% male) undergoing CABG. Dyssynchrony was calculated by tissue Doppler imaging from regional time intervals in basal LV segments before and 1 month after CABG. Myocardial viability was assessed using single-photon emission computed tomography (SPECT) before CABG.
Results: Twenty-five patients (11.6%) died within 30 days (in-hospital mortality) of CABG. The presence of pre-CABG dyssynchrony 119 ms had the highest predictive accuracy for in-hospital mortality, with a sensitivity of 84% and a specificity of 71%. During the median follow-up period of 359 days (interquartile range 219 to 561), an additional 19 patients (10.3%) died and 34 patients (18.5%) were hospitalized for worsening heart failure. At Cox regression analysis, post-CABG dyssynchrony 72 ms and 5 viable segments were identified as independent predictors of clinical events, with a hazard ratio (HR) of 5.02, 95% confidence interval (CI) 2.57 to 10.02 (p < 0.001), and an HR of 0.63, 95% CI 0.55 to 0.75 (p < 0.001), respectively. Patients without post-CABG dyssynchrony and with viable myocardium had excellent prognosis compared with patients with severe post-CABG dyssynchrony and nonviable myocardium (event rate 3% vs. 64%; p < 0.001).
Conclusions: The presence of severe LV dyssynchrony is associated with poor clinical outcomes despite revascularization. These results advocate a routine assessment of both LV dyssynchrony and viability to predict outcome in systolic heart failure patients undergoing CABG surgery.
J Am Coll Cardiol, 2007; 50:1315-1323, doi:10.1016/j.jacc.2007.03.070 (Published online 14 September 2007
Reprint requests and correspondence: Dr. Martin Penicka, Cardiocenter, Department of Cardiology, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady in Prague, Srobarova 50, 10034 Prague, Czech Republic. (Email: penicka@fnkv.cz
Objectives: The objective of the present study was to assess the relationship between the presence of left ventricular (LV) dyssynchrony and clinical outcome in patients with moderate systolic heart failure undergoing coronary artery bypass graft (CABG) surgery.
Background: The presence of LV dyssynchrony is associated with poor prognosis in patients with LV dysfunction.
Methods: The study consisted of 215 consecutive patients with ischemic cardiomyopathy and dyspnea (age 65 ± 9 years, 81% male) undergoing CABG. Dyssynchrony was calculated by tissue Doppler imaging from regional time intervals in basal LV segments before and 1 month after CABG. Myocardial viability was assessed using single-photon emission computed tomography (SPECT) before CABG.
Results: Twenty-five patients (11.6%) died within 30 days (in-hospital mortality) of CABG. The presence of pre-CABG dyssynchrony 119 ms had the highest predictive accuracy for in-hospital mortality, with a sensitivity of 84% and a specificity of 71%. During the median follow-up period of 359 days (interquartile range 219 to 561), an additional 19 patients (10.3%) died and 34 patients (18.5%) were hospitalized for worsening heart failure. At Cox regression analysis, post-CABG dyssynchrony 72 ms and 5 viable segments were identified as independent predictors of clinical events, with a hazard ratio (HR) of 5.02, 95% confidence interval (CI) 2.57 to 10.02 (p < 0.001), and an HR of 0.63, 95% CI 0.55 to 0.75 (p < 0.001), respectively. Patients without post-CABG dyssynchrony and with viable myocardium had excellent prognosis compared with patients with severe post-CABG dyssynchrony and nonviable myocardium (event rate 3% vs. 64%; p < 0.001).
Conclusions: The presence of severe LV dyssynchrony is associated with poor clinical outcomes despite revascularization. These results advocate a routine assessment of both LV dyssynchrony and viability to predict outcome in systolic heart failure patients undergoing CABG surgery.
Subscribe to:
Posts (Atom)