Background: Global Longitudinal Strain (GLS) is a direct echocardiographic assessment of myocardial fiber deformation performed by speckle-tracking echocardiography that can better reflect ischemic and infarct areas and left ventricular function. Ischemic burden is a measurement of ischemic myocardium percentage and can be used to determine the management strategy of Multivessel Coronary Artery Disease (MVCAD). We aimed to investigate the value of GLS to predict the ischemic burden as detected by SPECT Myocardial Perfusion Imaging (MPI) Method: A cross-sectional study of patients with Multivessel Coronary Artery Disease who underwent Cardiac SPECT were included. GLS is assessed using the Automated Function Imaging (AFI) technique that is performed on the same day as the SPECT examination. Ischemic burden was measured by SPECT MPI using semi-quantitative scores on 17-segment assessment according to standard nomenclature and interpreted as small and moderate-large ischemic burden. Result: Total of 52 patients (40 males, mean age 56 ± 6.5 years). There was negative correlation with good strength between GLS value and ischemic burden (r = -0.706, P < 0.001). Using ROC analysis, the optimal cut off value of GLS was < (-13%) that yielded the highest sensitivity and specificity to discriminate between small and moderate-large ischemic burden. Sensitivity, specificity, positive and negative predictive value of GLS ≤(-13%) to predict moderate-large ischemic burden as detected by SPECT analysis were 80%, 75%, 67%, and 86%, respectively. Conclusion: A GLS value is a reliable parameter with good diagnostic value to predict small ischemic burden (<10%) as detected by SPECT MPI. This parameter could also be applied to determine the management strategy of Multivessel Coronary Artery Disease (MVCAD) patients in daily practice.
Background: Patients underwent Coronary Artery Bypass Surgery are at risk of developing post-operative complications that affect length of stay, re-hospitalization and increase in mortality rate. Impaired functional capacity is associated with poor outcomes in patients after CABG. The Six Minute Walk Test (6MWT) is generally used to evaluate functional capacity before cardiac rehabilitation and to prescribe the intensity of exercise training. The six minute walk test (6MWT) is a simple test and has been used in heart failure patients to assess exercise tolerance, the effects of therapy and prognosis. This study is to investigate the relationship between the distance of 6MWTwith re- hospitalization and mortality rate in post coronary artery bypass surgery patients.Method: This is a retrospective cohort study conducted at Cardiac Centre of Adam Malik Hospital. Subjects of the study consists of 104 patients underwent coronary bypass surgery between January 2019 until February 2020. 6MWT is performed before the patient discharge. Rates of re-hospitalisation and mortality were observed during 3 months of follow-up. The distance walk during 6MWT was compare to rate of rehospitalization and cardiac mortality. Result: Total of 104 patients (91 males, mean age 57,4±5,7 years). Six patients died (5,8%) of cardiovascular cause and 18 (17,3%) were rehospitalized. Significant relationship was found between the distance of 6MWT and incidence of mortality and re-hospitalization (p <0.001). Patients with 6MWT <250 meters had a higher risk of re-hospital compared to those with 6MWT >250 meters with RR 16.74 (95% CI: 2.53-110.78) and p = 0.008. Conclusion: The six minute walk test (6MWT) is a predictor of re-hospitalization in patients post CABG. Patients who walked in shorter distance group <250 meters would increase risk of re-hospitalization rate 16.74 greater than patients with distances >250 meters. Keywords: 6MWT; CABG; rehospitalization; mortality
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