Diagnosis of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons.
The American College of Physicians (ACP) developed this guideline in collaboration with the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons to help clinicians diagnose known or suspected stable ischemic heart disease.
Literature on this topic published before November 2011 was identified by using MEDLINE, Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were limited to human studies published in English. This guideline grades the evidence and recommendations according to a translation of the ACCF/AHA grading system into ACP's clinical practice guidelines grading system.
This guideline includes 28 recommendations that address the following issues: the initial diagnosis of the patient who might have stable ischemic heart disease, cardiac stress testing to assess the risk for death or myocardial infarction in patients diagnosed with stable ischemic heart disease, and coronary angiography for risk assessment.
[Show abstract][Hide abstract] ABSTRACT: Aim:
To examine whether the heteroplasmy level for 15059G>A mutation in the mitochondrial genome might be associated with essential hypertension.
This cross-sectional study involved 196 unrelated participants randomly selected from general population (90 males and 106 females) who underwent a regular medical check-up at the Institute for Atherosclerosis Research (Moscow, Russia). One hundred and twenty of them (61%) had essential hypertension, and 76 (39%) were apparently healthy normotensive persons. The level of heteroplasmy for 15059G>A mutation occurring in the coding region of cytochrome b gene (MT-CYB) of mtDNA isolated from the blood leukocytes, was quantified using DNA pyrosequencing method.
The 15059G>A heteroplasmy level ranged between 4% and 83%, with a median level of 31%. Between the upper and lower quartiles of 15059G>A heteroplasmy distribution, significant differences were observed for patients' age, systolic blood pressure, and triglyceride levels. 15059G>A heteroplasmy correlated both with age (r = 0.331, P < 0.001) and the presence of hypertension (r = 0.228, P = 0.002). Regression analysis revealed that the age explains 12% variability of 15059G>A heteroplasmy, and hypertension independently explains more 5% variability. The 15059G>A heteroplasmy exceeding 31% was found to be significantly associated with a higher risk of essential hypertension (odds ratio 2.76; P (Fisher) 0.019]. The study participants with high 15059G>A heteroplasmy level were found to have significantly higher age (P < 0.001) and the prevalence of essential hypertension (P = 0.033), as compared to those with low 15059G>A heteroplasmy level. These observations suggested a positive correlation between the level of 15059G>A heteroplasmy and essential hypertension.
This study provides the evidence of association of mtDNA 15059G>A mutation heteroplasmy with essential hypertension.
World Journal of Cardiology (WJC) 05/2013; 5(5):132-140. DOI:10.4330/wjc.v5.i5.132 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Current evidence and guidelines support the strategy of ischemia-guided revascularization for treatment of patients with stable coronary symptoms. However, anatomical stenosis is often targeted in revascularization treatment using percutaneous coronary intervention or coronary artery bypass surgery without seriously considering objective evidence of myocardial ischemia. Particularly, for patients with multivessel disease, angiographic complete revascularization was traditionally considered an ideal objective of revascularization treatment. Recently, however, observational studies contradict the concept of angiographic complete revascularization and support the benefit of ischemia-guided selective revascularization based on noninvasive and invasive functional evaluation detecting ischemia-producing coronary lesions. In the absence of a trial specifically designed to assess the relative benefit of either strategy, the present review explores the current concepts about the strength and weakness of anatomical vs. functional revascularization.
[Show abstract][Hide abstract] ABSTRACT: -Two-dimensional strain echocardiography (2DSE) detects early signs of left ventricular (LV) dysfunction; however, it is unknown if myocardial strain analysis at rest in patients with suspected stable angina pectoris (SAP) predicts the presence of coronary artery disease (CAD).
-In total 296 consecutive patients with clinically suspected SAP, no previous cardiac history, and a normal LVEF were included. All were examined by 2DSE, exercise electrocardiogram and coronary angiography (CAG). 2DSE was performed in the three apical projections. Peak regional longitudinal systolic strain (RLS) was measured in 18 myocardial sites and averaged to provide global longitudinal peak systolic strain (GLS). Duke Score (DS), including ST-segment-depression, chest pain and exercise capacity, was used as the outcome of the exercise test. Patients with an area stenosis ≥70% in at least one epicardial coronary artery were categorized as having significant CAD (n=107). GLS was significantly lower in patients with CAD compared to patients without (17.1%±2.5% vs. 18.8%±2.6%, p<0.001), and remained an independent predictor of CAD after multivariable adjustment for baseline data, exercise test and conventional echocardiography (OR 1.25, p=0.016) per 1% decrease). Area under receiver operating characteristics curve for exercise test and GLS in combination was significantly higher than for exercise test alone (0.84 vs. 0.78, p=0.007). Furthermore, impaired RLS identifies which coronary artery is stenotic.
-In patients with suspected SAP, GLS assessed at rest is an independent predictor of significant CAD and significantly improves the diagnostic performance of exercise test. Furthermore, 2DSE seems capable in identifying high risk patients.
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