Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Geriatric Cardiology Pub Date : 2024-07-28 DOI:10.26599/1671-5411.2024.07.004

Guido Pastorini, Fabio Anastasio, Anna Botto, Valentina Tardivo, Mauro Feola

{"title":"Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain.","authors":"Guido Pastorini, Fabio Anastasio, Anna Botto, Valentina Tardivo, Mauro Feola","doi":"10.26599/1671-5411.2024.07.004","DOIUrl":null,"url":null,"abstract":"Background: Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block (LBBB) have to be stratified for the presence of coronary artery disease and the risk of developing heart failure (HF). We investigated the prognostic role of coronary CT-angiography (CTA) and echocardiographic global longitudinal strain (GLS) in those patients in a mid-term follow-up.Methods: Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated retrospectively. Development of HF or a cardiovascular death were the events scheduled.Results: Seventy-eight patients (32 female; mean age: 66.0 ± 10.4 years were enrolled. During a follow-up of 33 months (IQR: 17-77), one patient (1.5%) experienced a cardiovascular death, 14 patients (17.9%) required urgent outpatient visits due to acute decompensated HF (12 hospitalizations). Echocardiography showed a slightly reduced left ventricular ejection fraction (LVEF) (50.0% ± 9.8%) and GLS within the normal range (-16.2% ± 4.1%). CTA analysis showed coronary stenosis > 50% in 28 patients (35.9%). A high Agatston score (> 100) was observed in 29.5%. Notably, 25 patients (32.1%) were diagnosed with left main coronary artery disease and 15 patients (16.7%) underwent revascularization during the follow up. Significant associations were observed between events and LVEF (P = 0.001), diastolic dysfunction grade ≥ 2 (P = 0.02), GLS (P < 0.001), multiple coronary stenosis (P = 0.04) and Agatston score (P = 0.05). Multivariate analysis confirmed the relationships with LVEF (R2 = 0.89, P < 0.001), diastolic dysfunction (R2 = 3.30, P = 0.04), GLS (R2 = 1.43, P < 0.001), and Agatston score (R2 = 1.01, P = 0.05).Conclusions: In patients with complete LBBB, CTA and GLS identified those at a high risk of development HF.","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341527/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Geriatric Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.26599/1671-5411.2024.07.004","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block (LBBB) have to be stratified for the presence of coronary artery disease and the risk of developing heart failure (HF). We investigated the prognostic role of coronary CT-angiography (CTA) and echocardiographic global longitudinal strain (GLS) in those patients in a mid-term follow-up.

Methods: Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated retrospectively. Development of HF or a cardiovascular death were the events scheduled.

Results: Seventy-eight patients (32 female; mean age: 66.0 ± 10.4 years were enrolled. During a follow-up of 33 months (IQR: 17-77), one patient (1.5%) experienced a cardiovascular death, 14 patients (17.9%) required urgent outpatient visits due to acute decompensated HF (12 hospitalizations). Echocardiography showed a slightly reduced left ventricular ejection fraction (LVEF) (50.0% ± 9.8%) and GLS within the normal range (-16.2% ± 4.1%). CTA analysis showed coronary stenosis > 50% in 28 patients (35.9%). A high Agatston score (> 100) was observed in 29.5%. Notably, 25 patients (32.1%) were diagnosed with left main coronary artery disease and 15 patients (16.7%) underwent revascularization during the follow up. Significant associations were observed between events and LVEF (P = 0.001), diastolic dysfunction grade ≥ 2 (P = 0.02), GLS (P < 0.001), multiple coronary stenosis (P = 0.04) and Agatston score (P = 0.05). Multivariate analysis confirmed the relationships with LVEF (R² = 0.89, P < 0.001), diastolic dysfunction (R² = 3.30, P = 0.04), GLS (R² = 1.43, P < 0.001), and Agatston score (R² = 1.01, P = 0.05).

Conclusions: In patients with complete LBBB, CTA and GLS identified those at a high risk of development HF.

查看原文本刊更多论文

预测出现非典型胸痛和完全性左束支传导阻滞的院外患者的心血管事件：CTA 和超声心动图整体纵向应变的作用。

背景：出现不典型胸痛和完全性左束支传导阻滞（LBBB）的院外患者必须根据是否存在冠状动脉疾病和发生心力衰竭（HF）的风险进行分层。我们研究了冠状动脉 CT 血管造影（CTA）和超声心动图整体纵向应变（GLS）在这些患者的中期随访中的预后作用：方法：对院外接受超声心动图和64排CT血管造影的LBBB患者进行回顾性评估。结果：78 名患者（32 人）接受了超声心动图检查和 64 片 CT 血管造影检查：共纳入 78 名患者（32 名女性；平均年龄：66.0 ± 10.4 岁）。在33个月的随访期间（IQR：17-77），1名患者（1.5%）因心血管疾病死亡，14名患者（17.9%）因急性失代偿性心房颤动需要紧急门诊就医（12次住院）。超声心动图显示左室射血分数（LVEF）略有降低（50.0% ± 9.8%），GLS在正常范围内（-16.2% ± 4.1%）。CTA分析显示，28名患者（35.9%）的冠状动脉狭窄程度大于50%。29.5%的患者阿加特斯通评分较高（> 100）。值得注意的是，25 名患者（32.1%）被诊断出患有左主干冠状动脉疾病，15 名患者（16.7%）在随访期间接受了血管重建手术。观察到事件与 LVEF（P = 0.001）、舒张功能障碍等级≥2（P = 0.02）、GLS（P < 0.001）、多冠状动脉狭窄（P = 0.04）和 Agatston 评分（P = 0.05）之间存在显著关联。多变量分析证实了与LVEF（R2 = 0.89，P < 0.001）、舒张功能障碍（R2 = 3.30，P = 0.04）、GLS（R2 = 1.43，P < 0.001）和Agatston评分（R2 = 1.01，P = 0.05）的关系：结论：在完全性LBBB患者中，CTA和GLS能识别出那些有高风险发展为HF的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Geriatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-GERIATRICS & GERONTOLOGY

CiteScore

3.30

自引率

4.00%

发文量

1161

期刊介绍： JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.