Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium.

Background: Repeat coronary artery bypass grafting (redo-CABG) in patients with ischaemic cardiomyopathy is associated with high perioperative risk and worse long-term outcome compared with patients undergoing their first CABG.

Objective: To assess whether patients with viable myocardium undergoing redo-CABG have a better outcome.

Methods: 18 patients with ischaemic cardiomyopathy underwent redo-CABG and 34 underwent their first CABG; all had substantial viability (> or =25% of the left ventricle) on dobutamine stress echocardiography (DSE).

Prognostic role of dobutamine stress echocardiography in myocardial viability.

Purpose Of Review: The aim of this review is to provide a perspective on the role of dobutamine stress echocardiography to evaluate myocardial viability and assess prognosis in patients with ischemic left ventricular dysfunction.

Recent Findings: Pooled analysis of currently available data demonstrates that dobutamine stress echocardiography provides useful information on recovery of dysfunctional but viable myocardium and prognosis. In fact, improvement of long-term prognosis may be the ultimate clinical challenge in the management of patients with ischemic left ventricular dysfunction.

Statins for the prevention of perioperative cardiovascular complications in vascular surgery.

Perioperative cardiovascular complications in vascular surgery remain a significant problem despite recent advancements in perioperative care. This clinical update summarizes the results of recent studies on the effectiveness and safety of perioperative statin use for the prevention of these perioperative cardiovascular complications. Five studies in patients undergoing major noncardiac vascular surgery and two studies in patients undergoing carotid endarterectomy are described.

Prognostic stratification of obese patients by stress 99mTc-tetrofosmin myocardial perfusion imaging.

Unlabelled: Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients.

Pre-operative coronary revascularization: an optimal therapy for high-risk vascular surgery patients?

Cardiac complications are the leading cause of peri-operative morbidity and mortality of patients undergoing vascular surgery. This high incidence of cardiac complications is related to the presence of underlying coronary artery disease. The optimal treatment strategy for these high-risk patients, including the use of pre-operative coronary revascularization for the purpose of improving peri-operative and long-term cardiac outcomes, has been controversial for several decades.

Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a meta-analysis.

Purpose: Non-invasive evaluation of coronary artery disease (CAD) in patients with left bundle branch block (LBBB) has limitations inherent to different tests, and the relative merits of these tests are unclear. This meta-analysis assessed the accuracy of the frequently used non-invasive techniques, including exercise electrocardiography (ECG), myocardial perfusion imaging (MPI) and stress echocardiography (SE), for detection of CAD and prediction of cardiac events in patients with LBBB.

Methods: A review was conducted of all reports on detection of CAD and prediction of cardiac events in patients with LBBB (published between January 1970 and December 2004), and revealed 55 diagnostic and nine prognostic reports with sufficient details to calculate test accuracy.

Hemodynamic responses and long-term follow-up results in patients using chronic beta 1-selective and nonselective beta-blockers during dobutamine stress echocardiography.

Objective: This study was undertaken to determine to what extent hemodynamic responses to dobutamine infusion between patients using concomitant beta1-selective or nonselective beta-blockers differ and whether this difference affects the long-term prognostic value of dobutamine stress echocardiography with respect to cardiac events.

Design: Single center, observational study.

Methods: A total of 1234 patients using chronic beta-blockers underwent dobutamine stress echocardiography and were prospectively included in the study.

Rise and fall of B-type natriuretic peptide levels in patients with coronary artery disease and normal left ventricular function after cardiac revascularization.

Background: Recently, it was shown that B-type natriuretic peptide levels are increased in patients with acute coronary syndromes.

Aims: To assess the relation between B-type natriuretic peptide and ischemia in patients with stable and unstable angina pectoris with normal left ventricular function in relation to the extent of ischemia and response to revascularization.

Methods: Fifty-nine consecutive patients were enrolled in the study, patients were divided into two groups: stable angina patients (group I, n=18), and unstable coronary patients (group II, n=41).

Beneficial effects of statins on perioperative cardiovascular outcome.

Purpose Of Review: This review evaluates clinical and experimental articles that have recently been published on the cardioprotective effect of perioperative statin therapy.

Recent Findings: Perioperative statin therapy improves short and long-term cardiac outcome following noncardiac surgery. This cardiovascular protection has been attributed to the so-called pleiotropic effects, which have a positive effect on plaque stability.

High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients.

Background: Adverse perioperative cardiac events occur frequently despite the use of beta (beta)-blockers. We examined whether higher doses of beta-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome.

Methods And Results: In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and beta-blocker dose.

Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass.

Postoperative cardiac events are related to myocardial ischemia and reduced left ventricular function. The utility of N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) for preoperative cardiac risk evaluation has not been evaluated. The objective of this study was to assess whether plasma NT-pro-BNP predicts postoperative cardiac events in patients who undergo major vascular surgery in addition to clinical and dobutamine stress echocardiographic data.

The impact of hypertension on systolic and diastolic left ventricular function. A tissue Doppler echocardiographic study.

Background: The purpose of this study is to assess the impact of hypertension on systolic function and diastolic function using 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and tissue Doppler imaging (TDI) of the mitral annulus.

Methods: From an outpatient clinic population, 414 consecutive patients underwent 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and TDI of the septal, lateral, inferior, and posterior walls near the mitral annulus. Parameters of systolic left ventricular (LV) function and diastolic LV function were assessed.

Prognostic value of stress 99mTc-tetrofosmin myocardial perfusion imaging in predicting all-cause mortality: a 6-year follow-up study.

Purpose: The aim of this study was to ascertain whether stress myocardial perfusion imaging can independently predict long-term mortality.

Methods: We studied 1,386 patients with known or suspected coronary artery disease by means of stress 99mTc-tetrofosmin myocardial perfusion tomography. The end point during follow-up was death from any cause.

Baseline plasma N-terminal pro-B-type natriuretic peptide is associated with the extent of stress-induced myocardial ischemia during dobutamine stress echocardiography.

Objective: To determine the relationship between baseline plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the presence and extent of myocardial ischemia during dobutamine stress echocardiography (DSE).

Methods: NT-proBNP was measured in 170 consecutive patients prior to DSE. Rest wall motion abnormalities (RWMAs) and new wall motion abnormalities (NWMAs) were scored using a 5-point, 17-segment model.

Mobile right heart thrombus and massive pulmonary embolism.

The current report describes a patient with pulmonary embolism, treated unsuccessfully with heparin. Transthoracic echocardiography revealed free-floating right heart thrombus. Migrating deep vein thrombus to the right heart was suspected.

Mitral regurgitation and left ventricular dyssynchrony: implications for treatment.

Cardiac resynchronisation therapy may provide an alternative treatment for mitral regurgitation in patients unsuitable for surgery.

Protecting the heart with cardiac medication in patients with left ventricular dysfunction undergoing major noncardiac vascular surgery.

Patients with left ventricular dysfunction who are undergoing major noncardiac vascular surgery are at increased risk of adverse postoperative events. We sought to evaluate whether perioperative medication use, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, statins, and aspirin, was associated with a reduced incidence of postoperative in-hospital mortality in these high-risk patients. The study enrolled 511 patients with left ventricular dysfunction (left ventricular ejection fraction <30%) who were undergoing major noncardiac vascular surgery.

Influence of cardiac risk factors and medication on length of hospitalization in patients undergoing major vascular surgery.

Major vascular surgery is associated with a long in-hospital length of stay (LOS). Cardiac risk factors identify patients with an increased risk. Recent studies have associated statin, aspirin, and beta-blocker therapies with improved postoperative outcome.

Effects of statins on renal function after aortic cross clamping during major vascular surgery.

Ischemic reperfusion injury is an important cause of renal dysfunction after major vascular surgery and increases postoperative morbidity and mortality. The aim of the present study was to assess the effect of statins on renal function in patients at high risk for renal dysfunction, that is, those who underwent suprarenal aortic cross clamping-declamping. Seventy-seven patients (28 statin users, 57 men; mean age 69 +/- 8 years) with normal preoperative renal function requiring suprarenal aortic cross clamping-declamping during vascular surgery from 1995 to 2005 were studied.

Non-invasive diagnosis of in stent stenosis by stress 99m technetium tetrofosmin myocardial perfusion imaging.

Background: The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS).

Methods: We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9+/-0.

Determination of interobserver variability for identifying inducible left ventricular wall motion abnormalities during dobutamine stress magnetic resonance imaging.

Aims: To determine the interobserver variability for identifying inducible left ventricular (LV) wall motion abnormalities during high-dose dobutamine/atropine stress cardiovascular magnetic resonance (DSMR).

Methods And Results: Four readers from various institutions were supplied with the image data from 150 consecutive DSMR examinations and asked to grade wall motion and image quality throughout graded doses of dobutamine infusion administered to achieve 85% of the maximum age-predicted heart rate. Inducible ischaemia was identified if more than one segment demonstrated a new or worsening LV wall motion abnormality, and significant stenosis was defined as > or =50% luminal diameter reduction by quantitative contrast coronary angiography.

Prognostic value of routine preoperative electrocardiography in patients undergoing noncardiac surgery.

Electrocardiography is commonly performed as part of preoperative cardiovascular risk assessment in patients undergoing noncardiac surgery. However, the prognostic value of such electrocardiography is still not clear. This study retrospectively studied 23,036 patients who underwent 28,457 surgical procedures at Erasmus Medical Center from 1991 to 2000.

Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease.

Objectives: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD).

Background: Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications.

Statins in the prevention of perioperative cardiovascular complications.

Purpose Of Review: This is a review of recent experimental and clinical evidence for the use of perioperative statins to reduce cardiovascular complications.

Recent Findings: Clinical trials have demonstrated an improved survival of statin users in the perioperative period. This beneficial effect of statins is ascribed to the non-lipid lowering effect to stabilize vulnerable plaques, thereby preventing myocardial ischaemia and infarction.