Coronary Artery Disease: Kasprzak J

Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Zamorano JL, Anonymous00198. · Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy. · Eur J Echocardiogr. · Pubmed #18579481 links to  free full text

Abstract: Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion coronary flow reserve assessment. The additional clinical benefit of myocardial perfusion contrast echocardiography and myocardial velocity imaging has been inconsistent to date, whereas the potential of adding - coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in dilated cardiomyopathy. In spite of its dependence upon operator's training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.

Wierzbowska K, Kurpesa M, Peruga J, Drozdz J, Krzemińska-Pakuła M, Kasprzak J. · Klinika Kardiologii Instytutu Medycyny Wewnetrznej Akademii Medycznej w Łodzi. · Przegl Lek. · Pubmed #12632885 No free full text.

Abstract: BACKGROUND: The limitations of exercise electrocardiography in the detection of coronary artery disease includes low sensitivity, especially in isolated right coronary artery (RCA) disease. Recent studies postulated the addition of right precordial leads to the standard exercise ECG (ExT) recording for better detection of right ventricular ischemia. PURPOSE: We tested the hypothesis that the replacement of the standard first precordial lead (V1) with a fourth right chest lead (V4R) can improve the diagnostic accuracy of ExT. MATERIALS AND METHODS: We studied 100 patients (78 men and 22 women, aged 55 +/- 9 years (31-71)) who underwent treadmill ExT (Bruce protocol) and coronary angiography. 52 patients had the V4R lead (Group V4R) instead of V1. The control group (Group V1) included 48 patients with the standard 12-lead ECG. Hemodynamically significant lesions were defined as stenosis > = 50% in left main coronary artery or > = 70% in other arteries. RESULTS: 76 out of 100 patients had significant coronary lesions on the arteriogram, 81% in Group V4R and 71% in Group V1. Overall sensitivity (71% Group V4R vs 79% Group V1), specificity (40% Group V4R vs 21% Group V1) and accuracy (65% Group V4R vs 63% Group V1) of ExT for detection of significant coronary artery disease was similar in both groups. There was also no statistically significant difference in the ability to define an inferior or right ventricle vs. anterolateral ischemia between both groups. Only 5 out of 32 (16%) patients with significant lesions in RCA revealed ST changes in V4R. CONCLUSIONS: In our study, the application of V4R instead of V1 did not significantly change the accuracy of ExT. Typical ECG signs of ischemia in V4R have high specificity, but low sensitivity for RCA disease. Thus, modification of the standard 12-lead scheme cannot be advocated for routine ExT, however although the use of a wider electrocardiographic window (e.g. V3R-V5R) might be more successful for recording right ventricular ischemia.

Lewandowski M, Szwed H, Kowalik I, Sadowski Z, Gasior Z, Gackowski A, Kasprzak J, Spring A, Płońska E, Nartowicz E, Szyszka A, Michalski M, Krzymińska-Stasiuk E, Górski J, Jaworska K, Janion M. · Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie. · Pol Arch Med Wewn. · Pubmed #10740420 No free full text.

Abstract: The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.

Płońska E, Szyszka A, Olszewski R, Gasior Z, Gackowski A, Maciejewski M, Kamiński L, Kossuth I, Gościniak P, Kasprzak J. · Klinika Kardiologii Pomorskiej Akademii Medycznej. · Pol Merkur Lekarski. · Pubmed #15518426 No free full text.

Abstract: Dobutamine stress echocardiography (DSE) is widely used for diagnosis of coronary artery disease (CAD). However, data regarding the diagnosis of coronary artery disease in patients with moderately elevated maximal gradient across the stenosed aortic valve (AS) are limited. This study was designed to the value of DSE in the diagnosis of CAD in women with moderately elevated maximal gradient across the AS. PATIENTS AND METHODS: DSE was performed in 162 patients within the multicentre study. The group included 58 (mean age 61 +/- 13 years) females and 104 (mean age 58 +/- 13 years) males. DSE was performed with step-wise infusion every three minutes (5, 10, 20, 30 and 40 microg/kg/min). If the target heart rate was not reached, a further dose of 40 mcg/kg/min. together with atropine 0.25-1 mg was administered, in the absence of signs and symptoms of ischemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography. Coronarography was performed according to generally accepted indications. The significant coronary artery disease (>1 = 50% luminal diameter stenosis) of one of the major epicardial vessel was accepted as positive result for making the diagnosis of CAD. RESULTS: There was significant difference at rest between women and men with regard to left ventricular diastolic diameter (47.7 +/- 6.5 vs 55.6 +/- 8.8 mm), systolic diameter (30.1 +/- 7.9 vs 38.1 +/- 11.5 mm), ejection fraction (67 +/- 12 vs 55 +/- 17%), wall motion score index (1.05 +/- 0.17 vs 1.22 +/- 0.36) p<0.001. There were also a significant difference in left ventricular mass index and diastolic septum diameter (131 +/- 48 vs 152 +/- 46) and (12.5 + 2.7 vs 13.5 +/- 2.6 mm). Dobutamine peak dose was 31 +/- 11 microg/kg/min. The mean heart rate, mean systolic pressure and diastolic pressure were 114 +/- 26/min, 143 +/- 26 and 81 +/- 15 mmHg respectively. Sensitivity, specificity, and accuracy of DSE for the diagnosis of CAD in women were 77.8%, 95.8% and 90.9%. Those in men were 72.7%, 78.8% and 75.6%, respectively (NS). CONCLUSION: The diagnostic value of dobutamine stress echocardiography for the diagnosis of coronary artery disease in women with stenosed aortic valve is high. DSE is good method for the diagnosis.

Lewandowski M, Szwed H, Kowalik I, Gasior Z, Gackowski A, Kasprzak J, Spring A, Płońska E, Nartowicz E, Szyszka A, Michalski M, Krzymińska-Stasiuk E, Górski J, Jaworska K, Janion M, Demczuk M, Kleinrok A. · Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie. · Pol Arch Med Wewn. · Pubmed #15052935 No free full text.

Abstract: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men. CONCLUSIONS: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.

Lewandowski M, Szwed H, Kowalik I, Gasior Z, Gackowski A, Kasprzak J, Spring A, Płońska E, Swiatkiewicz I, Szyszka A, Michalski M, Kośmicki M, Krzymińska-Stasiuk E, Górski J, Jaworska K, Janion M. · Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie. · Pol Arch Med Wewn. · Pubmed #11865579 No free full text.

Abstract: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. Clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery. RESULTS: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%. CONCLUSION: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

Płońska E, Szyszka A, Kasprzak J, Maciejewski M, Gasior Z, Sieńko A, Kowalik I, Gackowski A, Krzymińska E, Hegedus I. · Klinika Kardiologii PAM w Szczecinie. · Pol Merkur Lekarski. · Pubmed #11852809 No free full text.

Abstract: The purpose of the study was to assess the safety of the dobutamine stress echocardiography (DASE) in patients with aortic stenosis (AS). 161 patients (mean age 59 +/- 13 years) with AS were prospectively studied with DASE. There were 58 female and 103 male. Dobutamine was given in stepwise increasing doses from 5 to 40 ug/kg/min. Mean maximal dose achieved was 31.4 ug/kg/min. The test was positive in 40 (24.8%) patients. Significant coronary artery disease was present in 60 (37.3%) patients. DASE resulted in significant increase in transvalvular mean gradient from 29.3 +/- 12.5 mmHg at rest to 46.3 +/- 19.3 mmHg at peak dose. There was no significant increase in valve area. There were no death, myocardial infarction or episodes of sustained ventricular tachycardia as a result of DASE. The test was terminated when following conditions were revealed: target heart rate (39.1%), left ventricular asynergy (25.5%), maximal established dose achieved (8.1%), side effects (27.3%). The most common side effects with the need of test cessation were arrhythmias (9.9%) and hypotension (9.9%). The most side effects were usually well tolerated without need of medical treatment. We conclude that DASE may be safely performed in patients with AS. Side effects are more common than in patients with coronary disease, but are usually well tolerated without need of medical treatment.