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Optimization of the treatment of elderly patients with myocardial infarction by revascularization in combination with inotropic stimulation and myocardial unloading  [cached]
D.S. Krivonosov,L.Yu. Chesnokova,N.I. Tarasov
Rational Pharmacotherapy in Cardiology , 2008,
Abstract: Aim. To study effect of coronary revascularization in combination with inotropic stimulation and myocardial unloading on prognosis in elderly patients with myocardial infarction (MI) complicated with heart failure (HF).Material and methods. 149 elderly patients with ECG picture of acute MI with ST segment elevation and HF symptoms were included into the study. All patients received standard therapy. According to the additional therapeutic maneuvers patients were split into four groups: 18 patients treated with percutaneous transluminal coronary angioplasty (PTCA) combined with inotropic levosimendan (LS) therapy; 20 patients with PTCA only; 22 patients treated with levosimendan (LS) only; control group - 89 patients with standard therapy without PTCA or LS.Results. Combination of PTCA and LS in elderly patients with acute MI complicated by HF had advantages in comparison with PTCA or LS applied separately or not applied at all. Combined therapy with PTCA and LS resulted in more prominent improvement of left ventricle systolic function, increase in exercise tolerance and more effective prevention of cardiac remodeling and was safe.Conclusion. Combined therapy with PTCA and LS is more effective than separate usage of these methods in elderly patients with MI complicated with HF.
Follow up of Complete Revascularization versus Culprit Revascularization in ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention  [PDF]
Ahmed Abdel Aziz Emara, Mohamed Seleem, Hend Mohamed Abdo Eldeeb, Mohamed Mahmoud Nawar
World Journal of Cardiovascular Diseases (WJCD) , 2019, DOI: 10.4236/wjcd.2019.912082
Abstract: Objectives: To compare between only Culprit revascularization versus total revascularization in patients with ST-elevation myocardial infarction undergoing primary PCI with 6 months follow up of occurrence of major adverse cardiovascular events (MACCE). Methods: 50 patients were enrolled in this study during the period from 1/11/2018 to 1/11/2019 at Menoufiya University and national heart institute. All patients present with acute ST-elevation myocardial infarction within 24 hours of onset of symptoms, and have multi vessel coronary artery disease on angiography suitable for PCI. Patients were subjected to detailed medical history, physical examination, and electrocardiography. Results: 50 patients with acute ST-elevation myocardial infarction (28 females and 22 males) underwent primary percutaneous coronary intervention. 25 patients had total revascularization to all coronary arteries, the other 25 patients had only culprit revascularization. We found that there was a significant reduction in the incidence of recurrent chest pain and non-fatal Myocardial infarction in the total revascularization group. Conclusion: Our study showed that Multivessel revascularization resulted in an improved clinical course and a significant reduction of MACCE regarding non-fatal MI and a significant reduction of recurrent chest pain.
The effect of beta-blockers metoprolol and atenolol on left ventricular early remodeling in patients with ST segment elevation acute coronary syndrome
Khasan Mamatkulov,Anis Alavi,Muzaffar Usarov
Medical and Health Science Journal , 2011,
Abstract: Effect of metaprolol and atenolol on early remodeling of the left ventricle in patients with acute coronary syndrome with ST segment elevation. The purpose of the work was to study the effect of cardio selective beta-blockers on the overall and regional contractility of the left ventricle in patients with acute coronary syndrome with ST segment eleva tion. Seventy patients aged 38-65 years were observed. The conventional treatment included anticoagu lants, antiagregants, statins, beta-blockers, nitrates, ACE inhibitors. The patients were randomly divided into 2 groups, 35 each, on atenolol and metaprolol therapies, respectively. Echocardiography was per formed on the first day after revascularization with assessment of cardiac volumes and hemodynamic indi ces. After stabilization of the patients a stress-echocardiography with dobutamine was performed. Disorders of local contractility were differentiated by 4 grade scale: hyperkinesis - 0, normokinesis - 1, hypokinesis - 2, akinesis - 3, dyskinesis - 4. Early use of metaprolol or atenolol beta-blockers allowed the decrease of reperfusion impairment of the myocardium and prevented left ventricle remodeling due to preservation of viable myocardial zones. Metaprolol was superior to atenolol in preventing left ventricle remodeling.
Reperfusion therapy in acute coronary syndrome with ST segment elevation  [cached]
A.L. Alyavi,B.A. Alyavi
Rational Pharmacotherapy in Cardiology , 2009,
Abstract: Aim. To compare effect of percutaneous balloon angioplasty (PCA) and a systemic thrombolysis (STL) on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS) with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group). 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF) and maximal output speed of left ventricle (LV). Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI) with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.
Association between Pentraxin-3 and Cardiac Troponin-I with Left Ventricular Systolic Function in Patients with Anterior ST-Segment Elevation Myocardial Infarction: Evaluation by Speckle Tracking Echocardiography  [PDF]
Mousa Alharbi, Mohamed Yahia, Mustafa Rashed, Omar S. El-Masry
World Journal of Cardiovascular Diseases (WJCD) , 2019, DOI: 10.4236/wjcd.2019.92007
Abstract:
Background: Pentraxin 3 is an inflammatory biomarker whose serum level is increased during acute myocardial infarction (AMI). The aim of this study was to measure the serum pentraxin-3 level in anterior ST-segment elevation myocardial infarction (STEMI), to investigate correlation with the left ventricular (LV) systolic function assessed by speckle tracking echocardiography, and compare with the well-established cardiac biomarkers of myocardial injury such as troponin-I. Methods: Serum pentraxin-3 level was measured by ELISA in 50 patients with anterior STEMI. LV strain was measured by speckle tracking echocardiography. The results were compared to twenty sex- and age-matched persons who had history of stable angina and normal LV ejection fraction (LVEF). Results: Serum level of pentraxin-3 was significantly higher in STEMI patients in comparison to the control group (8.3 ± 3.1 versus 3.4 ± 1.2 ng/ml, p < 0.001). Average LV global longitudinal strain (GLS) was reduced in STEMI patients in comparison to control subjects (11.2 ± 2.4 versus 20.2 ± 2.1, p < 0.001). In addition, there was a significant negative correlation between serum pentraxin-3 level and LVEF (r = -0.557, p < 0.001) and the average LVGLS (r =-0.529, p < 0.001). Serum pentraxin-3 cutoff value >
Acute ST segment elevation MI with Normal Coronaries  [PDF]
M Barakoti,SC Jha,SM Acharya,CM Paudel
Nepalese Heart Journal , 2011, DOI: 10.3126/njh.v8i1.8335
Abstract: A 45 year-old man with no history of cardiac disease presented to the emergency department with typical angina chest pain of >24 hours duration. He was not thormbolyzed due to late presentation. Having elevated troponin and CK-MB levels and an electrocardiogram demonstrating anterolateral ST segment elevation and persistent of angina pain prompted coronary angiography which could be done only after 3 weeks of symptom onset due to financial constraint; which revealed coronary vessels free of significant disease. An echocardiogram showed dilatation of all cardiac chambers with hypokinesia of anterior wall and mid-septum and akinesia of apex. There was moderate mitral regurgitation and moderate tricuspid regurgitation and moderate systolic dysfunction. A number of conditions can lead to ST segment elevation MI with normal epicardial coronary anatomy. We report a case possibly due to autothrombolysis. Treatment to such cases would be symptomatic drug therapy with reassurance and risk factor reduction. DOI: http://dx.doi.org/10.3126/njh.v8i1.8335 Nepalese Heart Journal Vol.8(1) 2011 pp.33-36
Acute ST segment elevation during exercise stress echocardiography due to severe pulmonary hypertension
Tung H Nguyen, Leonardo C Clavijo, Tasneem Z Naqvi
Cardiovascular Ultrasound , 2011, DOI: 10.1186/1476-7120-9-18
Abstract: A 51-year-old female ex-smoker with a history of hypertension, hepatitis C, and HIV on highly active anti retroviral therapy was referred to cardiology clinic for an exercise stress echocardiogram to evaluate atypical chest pain. Resting blood pressure (BP) was 137/97 mmHg. The electrocardiogram (ECG) was notable for a normal sinus rhythm with a rate of 63 beats per minute (bpm), normal axis, and RSR' in V1 with T-wave inversion (Figure 1A). She performed exercise on an exercise bike (Ergometer). Definity contrast was administered at rest and stress for endocardial border definition. Peak heart rate was 141 bpm (83.4% of predicted) and peak BP was 136/100 mmHg. The test was terminated secondary to shortness of breath and leg fatigue. The patient did not experience any chest pain during exercise or recovery. The patient developed up to 2.5 mm acute ST segment elevation in leads V1-V3 during exercise that persisted into the recovery phase (Figure 1B and 1C). RSR pattern became more prominent and extended to leads V1 and V2 (Figure 1B and 1C). Additionally, the height of the P wave in lead II increased during exercise and persisted during recovery. The normal axis at baseline shifted to a rightward axis during the recovery phase, as suggested by more prominent S waves in lead I, V5 and V6 (Figure 1B and 1C).The resting echocardiogram revealed a normal left ventricle (LV) with an estimated ejection fraction of 65% and wall motion was also normal in all segments (Figure 2A; Additional files 1, 2). There was mild to moderate right ventricular (RV) enlargement and hypertrophy. A saline contrast study did not reveal intracardiac shunting. There was normal valve function. Pulmonary artery systolic pressure (PASP) was estimated at 46 mmHg (Figure 3A). At peak exercise and in the immediate recovery phase, there was marked RV enlargement and interventricular septum flattening (Figure 2B; Additional files 3, 4). The peak PASP was estimated to be 81 mmHg during exercise and 101 m
Comparison of enalapril and perindopril in patients with arterial hypertension and left ventricle systolic dysfunction  [cached]
Yu.I. Grinshtein,O.L. Barbarash,D.A. Yakhontov,A.E. Popelysheva
Rational Pharmacotherapy in Cardiology , 2010,
Abstract: Aim. To compare efficacy of enalapril and perindopril in patients with arterial hypertension (HT) and left ventricle systolic dysfunction.Material and methods. Patients (n=51) with HT and left ventricle systolic dysfunction (ejection fraction<45%) were included in the prospective open randomized comparative study. Patients were randomized into 2 groups of therapy with enalapril 10-20 mg BID (n=25) or with perindopril 4-8 mg OD (n=26). Hydrochlorothiazide (12,5-25 mg OD) was added in case of ineffective therapy. Routine clinical examination, ambulatory blood pressure (BP) monitoring, an electrocardiogram, an echocardiography were performed in all patients.Results. The 24-hour and night antihypertensive effect of enalapril was more prominent than this of perindopril. Target BP level was reached in 21 patients (84%) of enalapril group and in 20 patients (76,9%) of perindopril group. 8 (30,8%) patients of perindopril group did not reach night target BP level vs 3 (12%) patients of enalapril group. Similar improvement of the left ventricle systolic function was observed in both groups.Conclusion. Enalapril and perindopril demonstrated comparable antihypertensive and cardioprotective effect.
End-systolic pressure-diameter relation of the left ventricle during transient and sustained elevations of blood pressure
Bregagnollo, Edson Antonio;Okoshi, Katashi;Matsubara, Beatriz Bojikian;Tucci, Paulo José Ferreira;
Arquivos Brasileiros de Cardiologia , 2000, DOI: 10.1590/S0066-782X2000000700003
Abstract: objective: to assess the effect of transient and sustained variations in cardiac load on the values of the end-systolic pressure-diameter relation (espdr) of the left ventricle. methods: we studied 13 dogs under general anesthesia and autonomic blockade. variations of cardiac loads were done by elevation of blood pressure by mechanical constriction of the aorta. two protocols were used in each animal: gradual peaking and decreasing pressure variation, the "transient arterial hypertension protocol" (tah), and a quick and 10 min sustained elevation, the "sustained arterial hypertension protocol"(sah). then, we compared the esdr in these two situations. results: acute elevation of arterial pressure, being it "transitory" or "sustained", did not alter the heart frequency and increased similarly the preload and after load. however, they acted differently in end systolic pressure-diameter relation. it was greater in the sah than tah protocol, 21.0±7.3mmhg/mm vs. 9.2±1.2mmhg/mm (p<0.05). conclusion: the left ventricular espdr values determined during sustained pressure elevations were higher than those found during transient pressure elevations. the time-dependent activation of myocardial contractility associated with the frank-starling mechanism is the major factor in inotropic stimulation during sustained elevations of blood pressure, determining an increase in the espdr values.
End-systolic pressure-diameter relation of the left ventricle during transient and sustained elevations of blood pressure  [cached]
Bregagnollo Edson Antonio,Okoshi Katashi,Matsubara Beatriz Bojikian,Tucci Paulo José Ferreira
Arquivos Brasileiros de Cardiologia , 2000,
Abstract: OBJECTIVE: To assess the effect of transient and sustained variations in cardiac load on the values of the end-systolic pressure-diameter relation (ESPDR) of the left ventricle. METHODS: We studied 13 dogs under general anesthesia and autonomic blockade. Variations of cardiac loads were done by elevation of blood pressure by mechanical constriction of the aorta. Two protocols were used in each animal: gradual peaking and decreasing pressure variation, the "transient arterial hypertension protocol" (TAH), and a quick and 10 min sustained elevation, the "sustained arterial hypertension protocol"(SAH). Then, we compared the ESDR in these two situations. RESULTS: Acute elevation of arterial pressure, being it "transitory" or "sustained", did not alter the heart frequency and increased similarly the preload and after load. However, they acted differently in end systolic pressure-diameter relation. It was greater in the SAH than TAH protocol, 21.0±7.3mmHg/mm vs. 9.2±1.2mmHg/mm (p<0.05). CONCLUSION: The left ventricular ESPDR values determined during sustained pressure elevations were higher than those found during transient pressure elevations. The time-dependent activation of myocardial contractility associated with the Frank-Starling mechanism is the major factor in inotropic stimulation during sustained elevations of blood pressure, determining an increase in the ESPDR values.
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