Ischemic Versus Non-Ischemic (Neurogenic) Myocardial Contractility Impairment in Acute Coronary Syndromes: Prevalence and Impact on Left Ventricular Systolic Function Recovery

Iwaszczuk, Paweł; Kołodziejczyk, B.; Kruczek, T.; Drabik, Leszek; Płazak, Wojciech; Komar, Monika; Podolec, Piotr; Musiałek, Piotr

doi:10.12659/msm.907466

Cited by 13 publications

(23 citation statements)

References 37 publications

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“…Indeed, a randomized study showed that CR reduced fat weight without a reduction in lean body weight, and also reduced the levels of TC in older patients with CAD [41]. These direct and indirect effects may have led to the reduction in cardiovascular events, and these effects can predict MACE in ACS patients, such as neurogenic mechanism and CRP [50,51].…”

Section: Discussionmentioning

confidence: 99%

Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis

Fang

Yuan

et al. 2019

Med Sci Monit

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Background Acute coronary syndrome (ACS) has become an important cause of death from cardiovascular disease. Cardiac rehabilitation (CR) plays an essential role in ACS patients after treatment. Therefore, in order to detect the impact of CR on mortality and major adverse cardiac events in patients with ACS, we conducted this meta-analysis. Material/Methods We searched PubMed, Web of science, and EMBASE databases to obtain published research results from 2010 to August 2018 to determine the relevant research. Random-effects model or fixed-effects model were used to calculate relative risk (RR) and 95% confidence interval (CI). Results Overall, a total of 25 studies with 55 035 participants were summarized in our meta-analysis. The results indicated that the hazard ratio (HR) of mortality significantly lower in the CR group than in the non-CR group (HR=−0.47; 95% CI=(−0.56 to −0.39; P<0.05). Fourteen studies on mortality rate showed exercise was associated with reduced cardiac death rates (RR=0.40; 95% CI=0.30 to 0.53; P<0.05). We found the risk of major adverse cardiac events (MACE) was lower in the rehabilitation group (RR=0.49; 95% CI=0.44 to 0.55; P<0.05). In 11 articles on CR including 8098 participants, the benefit in the CR group was greater than in the control group concerning revascularization (RR=0.69, 95% CI: 0.53 to 0.88; P=0.003). The recurrence rate of MI was reported in 13 studies, and the risk was lower in the CR group (RR=0.63, 95% CI: 0.57–0.70; P<0.05). Conclusions Our meta-analysis results suggest that CR is clearly associated with reductions in cardiac mortality, recurrence of MI, repeated PCI, CABG, and restenosis.

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Section: Discussionmentioning

confidence: 99%

Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis

Fang

Yuan

et al. 2019

Med Sci Monit

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“…According to the absence/presence of angiographically depicted lesions in a major epicardial vessel, CAGs were classified as showing the following: no CAD (normal coronary arteries, no luminal irregularity [ 26 ]) or CAD presence (‘any’ CAD) that was inclusive of stenosis(es) < 50% of the lumen diameter, stenosis(es) ≥ 50%, stenosis(es) ≥ 70%, occlusion(s) [ 3 – 8 ]. In addition, angiographic prevalence of the left main coronary artery (LM) stenosis ≥ 50% [ 3 ] was evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…In general, coronary artery lesions with below 50% diameter stenosis (considered angiographically ‘insignificant’) require no interventional management but rather modification of risk factors and pharmacotherapy to prevent or minimize lesion progression and the risk of lesion destabilization [ 3 ]. On the other hand, patients with lesion(s) ≥ 50% (considered angiographically ‘significant’ CAD [ 4 – 8 ]) may benefit from procedural intervention (particularly in the case of documented myocardial ischemia [ 3 ]) and lesions ≥ 70% are usually considered to require intervention [ 3 ]. Thus unequivocal determination of CAD severity continues to play a fundamental role in clinical decision-making in contemporary cardiology.…”

Section: Introductionmentioning

confidence: 99%

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Chmiel

Książek

Stryszak

et al. 2018

pwki

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IntroductionInvasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.AimTo assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.Material and methodsAnonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001).ResultsThe median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.ConclusionsDespite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.

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“…NSC and TTS have been appropriately linked as having similar clinical presentation, histopathologic findings and most likely also pathophysiology, the only distinction being the presence or absence of structural or infectious brain insult [25,45]. The apical-sparing types of these conditions (basal, mid-ventricular and focal) remain largely undetected, due to their less vivid clinical presentation [4]. All these new data, delineating the very elusive and yet apparent brain-heart crosstalk, solidify the exciting emerging field of neurocardiology [4,25,[46][47][48][49].…”

Section: Stress Induces Acute Heart Failurementioning

confidence: 99%

“…On the other hand, intense acute emotional stress can cause severe medical conditions such as post-traumatic stress disorder (PTSD), takotsubo syndrome (TTS), deep venous thrombosis and pulmonary embolism (DVT/PE), and trigger myocardial infarction (MI), life-threatening arrhythmias and sudden cardiac death (SCD) [1][2][3]. Recent evidence indicates that the psycho-neurogenic component of the stress response is at least partially responsible for cardiac contractility impairment in one fourth of patients newly diagnosed with acute coronary syndrome (ACS) [4]. The effects of long-term psychological stress have been proven detrimental for human health.…”

Section: Introductionmentioning

confidence: 99%

Patient periprocedural stress in cardiovascular medicine: friend or foe?

Iwaszczuk¹,

Łosiak²,

Szczeklik³

et al. 2021

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Stress, a disruption of homeostasis, is an unavoidable part of everyday life. In medical procedures, stress profoundly affects both operators and patients. Although the stress reaction has evolved to aid survival of physical trauma, it may also be harmful, by aggravating the baseline medical condition and/or creating new stress-related medical problems. Stress responses comprise several protective mechanisms that are particularly relevant in the clinical setting (e.g., a procoagulatory state and blood loss counteraction, preservation of blood perfusion pressure, prevention of hypoglycemia, enhanced immune response). Beneficial psychological effects prevent recurrence of traumatic memories, and promote patient compliance and positive lifestyle changes. In contrast, overt acute stress responses may lead to severe pathological conditions such as cytokine storm, post-traumatic stress disorder, takotsubo syndrome, deep venous thrombosis and pulmonary embolism, myocardial infarction, life-threatening arrhythmias and sudden cardiac death. There is also evidence that stress exposure may promote atherosclerosis and reduce long-term benefits from the intervention (increase in major adverse clinical events, in-stent restenosis, etc.). Insights into the role of stress on the operator's performance have recently led to the introduction of counteractive measures such as simulation training. Conversely, very little is known about the effect of the patient's periprocedural stress on the outcomes of cardiovascular procedures. Recent data show that the patient periprocedural stress affects the well-being of whole families. This review, focused on topics particularly relevant to cardiovascular interventions, provides a mechanistic insight into beneficial and harmful effects of periprocedural patient stress, including the array of available stress-relieving measures.

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Ischemic Versus Non-Ischemic (Neurogenic) Myocardial Contractility Impairment in Acute Coronary Syndromes: Prevalence and Impact on Left Ventricular Systolic Function Recovery

Cited by 13 publications

References 37 publications

Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis

Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Patient periprocedural stress in cardiovascular medicine: friend or foe?

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