This new technique can be easily implemented on conventional angiographic equipment at no additional cost. It provides complete, operator-independent exploitation of the angiographic information, resulting in enhanced diagnostic accuracy.
Even if no single variable, derived from exercise testing, is a highly sensitive and specific predictor, specificity increases to a clinically relevant level by combining ST segment depression and a decrease in left ventricular ejection fraction with exercise, and in this way patients with recent infarction may be selected for coronary arteriography.
n-3 Poliunsaturated Fatty Acids (PUFA) are essential; foods rich in n-3 are fat fish and some vegetal oil. PUFA are precursors of Eicosanoids, involved in the processes of inflammation, thrombosis and immunity. Firstly, observational studies measured reduction of cardiovascular disease (CVD) incidence with greater PUFA dietary intake. Experimental studies discovered antiahrrhytmic, antiatherogenic, antiaggregating and antiinflammatory properties. Retrospective analysis found lower incidence of sudden death (SD) in fish consumers. Randomized, prospective trials after myocardial infarction showed, in people either eating fish or receiving an n-3 PUFA supplement, a reduction of SD, explained by specific effect on membrane ion channels. The lack of results on atherothrombosis do not match with most experimental results, and should better be evaluated in absence of aspirin therapy. Low evidence supports use of n-3 PUFA in angina or revascularization procedures. Recent observations denote positive effect on endothelial function of large and resistance arteries. Actually evidence-based medicine suggest: improve of fish consumption for primary prevention of CVD; n-3 PUFA supplementation for hypertrigliceridemia and secondary prevention of SD after myocardial infarction, which is also cost-effectiveness.
In 183 consecutive patients with recent, uncomplicated myocardial infarction, the following variables were associated with 4-year cardiac death: haemodynamic decompensation with exercise (P = 0.01), left ventricular ejection fraction at rest (P = 0.004) and at peak exercise (P = 0.003), persistent ST segment elevation at rest in the area of infarction = (P = 0.004), exercise-induced ST segment elevation (P = 0.02), and late aneurysmal evolution (P = 0.01). Exercise left ventricular ejection fraction was the sole variable selected by Cox regression analysis as an independent predictor of cardiac death. In 40 patients with ST segment elevation at rest, left ventricular ejection fraction was 42 +/- 17% at rest and 40 +/- 18% at peak exercise, versus 52 +/- 12% and 52 +/- 14% in the remaining patients (both P less than 0.01). Among these 40, 16 (all with anterior infarction) also had exercise-induced ST segment elevation; their ejection fraction was 32 +/- 13% at rest, 30 +/- 13% during exercise, versus 53 +/- 15% and 53 +/- 15% in 129 patients with no ST segment elevation either at rest, or during exercise (both P less than 0.01). The 4-year risk of death was 20% in the former 40 patients, 36% in the latter 16, while in the complete absence of ST segment elevation, such risk was 3%. All 14 patients with ST segment elevation only during exercise were alive after 4 years: their left ventricular ejection fraction was 47 +/- 12% at rest, 45 +/- 13% with exercise. ST segment elevation was associated with late aneurysmal evolution but not with exercise-induced ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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