Left ventricular hypertrophy contributes to Myocardial Ischemia in Non-obstructive Coronary Artery Disease (the MicroCAD study)

Eskerud, Ingeborg; Gerdts, Eva; Larsen, Terje H.; Lønnebakken, Mai Tone

doi:10.1016/j.ijcard.2019.03.059

Cited by 38 publications

(31 citation statements)

References 38 publications

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“…30 On the other hand, in patients with non-obstructive CAD, left ventricular hypertrophy was proved to be associated with the presence and extent of myocardial ischemia determined by myocardial contrast echocardiography. 31 As a result, the presence of microvascular coronary dysfunction, which is not necessarily induce wall motion abnormality, may contribute to adverse cardiac events in patients with normal stress echocardiography.…”

Section: Discussionmentioning

confidence: 99%

The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

Samiei

Parsaee

Pourafkari

et al. 2019

J Cardiovasc Thorac Res

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Introduction: Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established. Methods: A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis. Results: During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE (P = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE. Conclusion: Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.

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Section: Discussionmentioning

confidence: 99%

The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

Samiei

Parsaee

Pourafkari

et al. 2019

J Cardiovasc Thorac Res

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“…Instead, the dichotomous variable of presence or absence of ischemic heart disease was found to be a significant predictor in our model. Although the association of ischemic heart disease with left ventricular hypertrophy has been shown in previous studies (Eskerud et al), 17 the incorporation of this variable in the predictive model of LVMI is a novel concept. Eventually, the best fit model which was developed with all the significant regressors was able to explain 50.4% of the variability in LVMI irrespective of gender, age, weight, body mass index, presence of diabetes, presence of dyslipidaemia and duration of hypertension.…”

Section: Discussionmentioning

confidence: 99%

<p>Prediction of Left Ventricular Mass Index Using Electrocardiography in Essential Hypertension – A Multiple Linear Regression Model</p>

Ahmed

Jhaj

Sadasivam

et al. 2020

MDER

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Background: Current electrocardiography (ECG) criteria indicate only the presence or absence of left ventricular hypertrophy (LVH). LVH is a continuum and a direct relationship exists between left ventricular mass (LVM) and cardiovascular event rate. We developed a mathematical model predictive of LVM index (LVMI) using ECG and non-ECG variables by correlating them with echocardiography determined LVMI. Patients and Methods: The model was developed in a cohort of patients on treatment for essential hypertension (BP>140/90 mm of Hg) who underwent concurrent ECG and echocardiography. One hundred and forty-seven subjects were included in the study (56.38±11.84 years, 66% males). LVMI was determined by echocardiography (113.76±33.06 gm/m 2). A set of ECG and non-ECG variables were correlated with LVMI for inclusion in the multiple linear regression model. The model was checked for multicollinearity, normality and homogeneity of variances. Results: The final regression equation formulated with the help of unstandardized coefficients and constant was LVMI=18.494+ 1.704 (aLL) + 0.969 (RaVL+SV3) + 0.295 (MBP) + 15.406 (IHD) (aLLsum of deflections in augmented limb leads; RaVL+SV3sum of deflection of (R wave in aVL + S wave in V3); MBPmean blood pressure; IHD=1 for the presence of the disease, IHD=0 for the absence of the disease). Conclusion: In the model, 50.4% of the variability in LV mass is explained by the variables used. The findings warrant further studies for the development of better and validated models that can be incorporated in microprocessor-based ECG devices. The determination of LVMI with ECG only will be a cost-effective and readily accessible tool in patient care.

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“…Isolated papillary muscle infarction may be explained by various potential mechanisms (Table 1). Left ventricular hypertrophy has been reported as a risk factor for PM infarction, and subsequent rupture may occur due to several mechanisms including increased LV filling pressure, increased myocardial oxygen demand, coronary vasospasm, and microvascular dysfunction 3 . Although difficult to be proven angiographically, the selective PM infarction may also be the consequence of distal embolization of the supplying arteries.…”

Section: Discussionmentioning

confidence: 99%

Isolated papillary muscle rupture with nonobstructive coronary artery disease, minimal myocardial infarction, and normal wall motion

et al. 2020

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Papillary muscle (PM) rupture can usually complicate inferior or posterior myocardial infarctions, but selective PM infarction is extremely rare, and the exact underlying pathophysiological mechanism is not entirely clear. We present a case of PM rupture due to isolated PM infarction in a patient with unobstructed coronary arteries, which could be misdiagnosed as a vegetation or other mass given the absence of regional wall motion abnormalities (RWMAs) on transthoracic echocardiogram. Our case highlights that in patients with severe mitral regurgitation and associated mitral valve mass, the absence of RWMAs should not exclude ischemic PM rupture from differential diagnosis.

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Left ventricular hypertrophy contributes to Myocardial Ischemia in Non-obstructive Coronary Artery Disease (the MicroCAD study)

Cited by 38 publications

References 38 publications

The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

<p>Prediction of Left Ventricular Mass Index Using Electrocardiography in Essential Hypertension – A Multiple Linear Regression Model</p>

Isolated papillary muscle rupture with nonobstructive coronary artery disease, minimal myocardial infarction, and normal wall motion

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