Archive for the ‘Myocardial Infarction’ Category

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Clinical Implications

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Clinical ImplicationsNoninvasive Risk Stratification in Patients after AMI
Several noninvasive modalities of stress testing are widely used for the functional and prognostic assessment of patients following AMI. The predischarge exercise ECG can reflect the risk of subsequent ischemic events when no preexisting ST-segment abnormalities are present. However, because of its limited diagnostic sensitivity, the requirement for no preexisting ECG changes, and the reduced exercise capacity of patients after AMI, exercise ECG is not as good as either the stress scintigraphy or the stress echocardiography. Treadmill stress echocardiography also provides useful information for assessing the risk of subsequent ischemic events, such as exercise endurance and time to the development of symptoms, and is therefore helpful in providing indicators for proper exercise rehabilitation. canadian healthcare mall
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Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Predictors of Cardiac Events in Diabetic and Nondiabetic Patients

Predictors of Cardiac Events in Diabetic and Nondiabetic Patients
In the diabetic group, the dobutamine time and presence of peripheral arterial disease were both independent predictors of cardiac events. The time to ischemia (the ischemic threshold), has been used as an index of disease severity with both the dipyridamole and dobutamine regimens. Many studies using dipyridamole or dobutamine echocardiography have emphasized the important role of the dipyridamole or dobutamine time. Some investigators have found that a relationship exists between complex lesion morphology and pharmacologic echocardiography test positiv-ity, indicating that the physiologic consequences of a stenosis cannot always be predicted with a simple anatomic approach. With appreciation that coronary stenosis severity is not the only variable of coronary stenosis, it is suggestive that dobutamine time (the ischemic threshold) is not the same for simple and complex coronary lesions. Read the rest of this entry »

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: DSE in Detecting Myocardial Ischemia in Diabetic Patients

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: DSE in Detecting Myocardial Ischemia in Diabetic PatientsDSE in Detecting Myocardial Ischemia in Diabetic Patients
Previously, Calnon et al found that the ischemic pattern induced by dobutamine stress in subjects with more severe coronary disease is characterized as “failure to increase systolic thickening during dobutamine stress”. Lu et al also found that DSE results are associated not only with stenosis severity but also, even more importantly, with lesion morphology. Furthermore, many investigators who evaluated the prediction of multivessel disease by DSE in patients with resting left ventricular asynergy consistently reported a high specificity but a low and markedly varied sensitivity. These findings suggest that the diagnostic value of DSE using the present criteria of detecting myocardial ischemia is not satisfactory, and could explain why the rate of positive DSE results was similar between the two groups, despite a higher frequency of triple vessel disease and a trend of more left ventricular asynergic segment in diabetic than in nondiabetic patients. buy birth control online
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Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Discussion

The results of the present study reveal that a positive DSE result has a powerful prognostic value for both hard events and all cardiac events following AMI in patients without diabetes. However, in diabetic patients, the prognostic value of a positive DSE result was lower for both cardiac death and reinfarction. The only significant role of DSE in diabetic patients is for predicting future unstable angina; however, the predictive value is not as good as in the nondiabetic group. Read the rest of this entry »

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Hard Events

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Hard EventsThe dobutamine time in diabetic patients with hard events was significantly shorter than those without hard events (12.9 ± 2.9 vs 14.7 ± 2.6, respectively; p = 0.025); however, this significant difference was not observed in nondiabetic patients (13.8 ± 2.9 vs 14.4 ± 2.6, respectively; p = 0.245). Multivariate stepwise analysis revealed that peripheral arterial disease and shorter dobutamine time, but not DSE positivity, independently predicted a worse outcome in diabetic patients (Table 4). In nondiabetic patients, the WMSI at peak stress was the strongest independent predictor, followed by a positive DSE result. Read the rest of this entry »

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: DSE

Among the nondiabetic patients with cardiac death, DSE results were positive in 11 patients (6 died of reinfarction, 2 of progressive heart failure, and 3 sudden deaths) and were negative in 3 patients (2 died of progressive heart failure, and 1 of reinfarction). The frequencies of future reinfarction, unstable angina, and hard and all events were significantly greater in patients with positive DSE results than in those with negative DSE results (Table 2). In the 17 cases of reinfarction, the infarct location was predicted correctly by DSE in 13 cases but not in 4 cases (2 with positive test results and 2 with negative test results). The accuracy of DSE in predicting the reinfarct location in the nondiabetic group was slightly, but insignificantly, better than in the diabetic group (76% vs 60%, respectively; p = 0.415). Read the rest of this entry »

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Results

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: ResultsOf a total of 354 patients with AMI, 16 were excluded from the study because of intolerance to dobutamine stress (n = 5), hypertension (n = 5), dobutamine extravasation (n = 3), or atrial fibrillation induced during dobutamine stress (n = 3). The remaining 338 patients were included in the final analysis. Of these, 116 patients (34.3%) were diabetic and 222 patients (65.7%) were nondiabetic.
Baseline Characteristics
As compared to the nondiabetic patients, diabetic patients had a higher percentage of female gender, they more frequently had a history of hypertension and peripheral arterial disease, and they had a lower prevalence of smoking (Table 1). The frequencies of triple vessel disease and NYHA functional class III were significantly greater in the diabetic group. Although there was no significant difference in the left ventricular ejection fraction between the two groups, the resting WMSI in the diabetic group was slightly higher than in the nondiabetic group. The infarct location, Killip class, dobutamine time (the time to ischemia), and the rate of DSE positivity were similar in the two groups. Reading here
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