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Background: Stress-induced myocardial ischemia seems not to be associated with cardiovascular events. However, its effects on myocardial tissue characteristics remain under debate. Thus, we sought to assess whether documented stress-induced ischemia is associated with changes in myocardial microstructure evaluated by magnetic resonance native T1 map and extracellular volume fraction (ECV)., Methods: This is a single-center, analysis of the previously published MASS V Trial. Multivessel patients with a formal indication for myocardial revascularization and with documented stress-induced ischemia were included in this study. Native T1 and ECV values evaluated by cardiac magnetic resonance imaging of ischemic and nonischemic myocardial segments at rest and after stress were compared. Myocardial ischemia was detected by either nuclear scintigraphy or stress magnetic cardiac resonance protocol., Results: Between May 2012 and March 2014, 326 prospective patients were eligible for isolated CABG or PCI and 219 were included in the MASS V trial. All patients underwent resting cardiac magnetic resonance imaging. Of a total of 840 myocardial segments, 654 were nonischemic segments and 186 were ischemic segments. Native T1 and ECV values of ischemic segments were not significantly different from nonischemic segments, both at rest and after stress induction. In addition, native T1 and ECV values of myocardial segments supplied by vessels with obstructive lesions were similar to those supplied by nonobstructive ones., Conclusion and Relevance: In this study, cardiac magnetic resonance identified similar T1 mapping values between ischemic and nonischemic myocardial segments. This finding suggests integrity and stability of myocardial tissue in the presence of stress-induced ischemia., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier Inc.)

Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics., Methods: One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS)., Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006)., Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling., (Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Introduction: Coronary atherosclerotic burden and SYNTAX Score (SS) are predictors of cardiovascular events., Objectives: To investigate the value of SYNTAX scores (SS, SYNTAX Score II (SSII) and residual SYNTAX Score (rSS)) for predicting cardiovascular events in patients with coronary artery disease (CAD)., Design: Retrospective cohort study., Setting: Single tertiary centre., Participants: Medicine, Angioplasty or Surgery Study database patients with stable multivessel CAD and preserved ejection fraction., Interventions: Patients with CAD undergoing coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical treatment (MT) alone from January 2002 to December 2015., Primary and Secondary Outcomes: Primary: 5-year all-cause mortality. Secondary: composite of all-cause death, myocardial infarction, stroke and subsequent coronary revascularisation at 5 years., Results: A total of 1719 patients underwent PCI (n=573), CABG (n=572) or MT (n=574) alone. The SS was not considered an independent predictor of 5-year mortality in the PCI (low, intermediate and high SS at 6.5%, 6.8% and 4.3%, respectively, p=0.745), CABG (low, intermediate and high SS at 5.7%, 8.0% and 12.1%, respectively, p=0.194) and MT (low, intermediate and high SS at 6.8%, 6.9% and 6.5%, respectively, p=0.993) cohorts. The SSII (low, intermediate and high SSII at 3.6% vs 7.9% vs 10.5%, respectively, p<0.001) was associated with a higher mortality risk in the overall population. Within each treatment strategy, SSII was associated with a significant 5-year mortality rate, especially in CABG patients with higher SSII (low, intermediate and high SSII at 1.8%, 9.7% and 10.0%, respectively, p=0.004) and in MT patients with high SSII (low, intermediate and high SSII at 5.0%, 4.7% and 10.8%, respectively, p=0.031). SSII demonstrated a better predictive accuracy for mortality compared with SS and rSS (c-index=0.62)., Conclusions: Coronary atherosclerotic burden alone was not associated with significantly increased risk of all-cause mortality. The SSII better discriminates the risk of death., Trial Registration Number: ISRCTN66068876., Competing Interests: Competing interests: MEF has received research grants from Amgen, Novo Nordisk and Novartis. LCG has received the Frederick Banting and Charles Best Canada Graduate Scholarship (Doctoral Research Award) from the Canadian Institutes of Health Research., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up., Methods: This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE., Results: In the CABG sample, SSI had a median of 23 (IQR 17-29.5), median SSII of 25.4 (IQR 19.2-32.8), and median rSS of 2 (IQR 0-6.5); in PCI SSI had a median of 14 (IQR 10-19.1), median SSII of 28.7 (IQR 23-34.2), and median rSS of 4.7 (IQR 0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13-3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74-10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01-1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function., Conclusion: Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis., (© 2021. The Author(s).)

Background: The lack of a correlation between myocardial necrosis biomarkers and electrocardiographic abnormalities after revascularization procedures has resulted in a change in the myocardial infarction (MI) definition., Methods: Patients with stable multivessel disease who underwent percutaneous or surgical revascularization were included. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance and late gadolinium enhancement were performed before and after procedures. MI was defined as more than five times the 99th percentile upper reference limit for cTnI and 10 times for CK-MB in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), respectively, and new late gadolinium enhancement for cardiac magnetic resonance., Results: Of the 202 patients studied, 69 (34.1%) underwent on-pump CABG, 67 (33.2%) off-pump CABG, and 66 (32.7%) PCI. The receiver operating characteristic curve showed the accuracy of cTnI for on-pump CABG, off-pump CABG, and PCI patients was 21.7%, 28.3%, and 52.4% and for CK-MB was 72.5%, 81.2%, and 90.5%, respectively. The specificity of cTnI was 3.6%, 9.4%, and 42.1% and of CK-MB was 73.2%, 86.8%, and 96.4%, respectively. Sensitivity of cTnI was 100%, 100%, and 100% and of CK-MB was 69.2%, 64.3%, and 44.4%, respectively. The best cutoff of cTnI for on-pump CABG, off-pump CABG, and PCI was 6.5 ng/mL, 4.5 ng/mL, and 4.5 ng/mL (162.5, 112.5, and 112.5 times the 99th percentile upper reference limit) and of CK-MB was 37.5 ng/mL, 22.5 ng/mL, and 11.5 ng/mL (8.5, 5.1, and 2.6 times the 99th percentile upper reference limit), respectively., Conclusions: Compared with cardiac magnetic resonance, CK-MB was more accurate than cTnI for diagnosing MI. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Diabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD). Methods: Patients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI), off-pump or on-pump bypass surgery (CABG). Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72 h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c) levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI) on CMR. Results: Ninety (44.5%) of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14) and 2.24 (0.69, 5.42) ng/mL (P = 0.81), and median peak CK-MB was 14.1 (6.8, 31.7) and 14.0 (4.2, 29.8) ng/mL (P = 0.43), in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (P = 0.91), and myocardial edema in 15.5 and 22.9% (P = 0.39) in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (P = 0.98), and in the A1c tertiles was 19.1% versus 13.3% versus 22.2% (P = 0.88). Conclusions: In this study, diabetes mellitus did not add risk of myocardial injury after revascularization interventions in patients with multivessel coronary artery disease. [ABSTRACT FROM AUTHOR]

Introduction: Diagnostic criteria of myocardial infarction related to revascularization procedures are controversial. Late gadolinium enhancement (LGE) on cardiac magnetic resonance may contribute to diagnostic of this entity. Besides, correlation between LGE and prognostic impact in a long-term follow-up in this setting is unclear. Hypothesis: To evaluate prognostic utility of new LGE following elective revascularization in a long-term follow-up. Methods: Patients with stable multivessel coronary disease and preserved ventricular function undergoing percutaneous or surgical revascularization were included. Cardiac magnetic resonance imaging was performed before and after procedures. LGE was evaluated by two blinded physicians. Primary end point was all-cause mortality. Results: In a median follow-up of 4 years, 202 patients were followed, of whom 136 (67.3%) underwent coronary artery bypass grafting (CABG) and 66 (32.7%) underwent percutaneous coronary intervention (PCI). Thirty-six patients (17.8%) presented new LGE. During follow-up, primary outcome was documented in 16 patients (7.9%). New LGE was associated toincreased mortality (p log-rank 0.03). The association remained after multivariate analysis, adjusting for age, gender, comorbidities (hypertension, diabetes and renal function), anatomical severity of coronary lesions and revascularization strategy (p = 0.02; HR 5.39 - 95% CI: 1.25-23.15). Conclusion: In this sample, new LGE after myocardial revascularization is an independent predictor of mortality. [ABSTRACT FROM AUTHOR]

Introduction: Release of creatine kinase (CK-MB) and high-sensitivity cardiac troponin (hs-cTn) is common after revascularization procedures and represents myocardial injury. However, correlation between release of cardiac biomarkers and prognostic impact in a long-term follow-up is controversial. Hypothesis: To evaluate prognostic utility of elevation ofcardiac biomarkers in a long-term follow-up. Methods: Stable multivessel coronary disease patients who underwent percutaneous or surgical revascularization were included. Cardiac biomarkers were collected before and after procedures. Primary outcome was a composite of death, myocardial infarction, additional revascularizationor hospitalization for cardiac cause. Results: In a median follow-up of 4 years, 202 patients were followed, of whom 136 (67.3%) underwent coronary artery bypass grafting (CABG) and 66 (32.7%) underwent percutaneous coronary intervention (PCI). Fifty-nine (29.2%) and 47 (23.2%) patients had a peak of CK-MB (> 26.35 ng/ml) and a peak of hs-cTn (> 5.67 ng/ml). During follow-up, primary outcome was documented in 16 patients (7.9%). In CABG patients, CK-MB elevation above 26.35 ng/ml was associated toincreased risk of primary outcome (p log-rank 0.04; HR 5.49, 95% CI: 1.1-27.44; p = 0.03). In percutaneous group, release of troponin above 5.67 ng / ml was also associated to higher risk of primary outcome (p log-rank 0.04, HR 5.6, 95% CI: 1.07-29.2; p = 0.04). Conclusion: In this sample, release of cardiac biomarkers after myocardial revascularization procedures was a predictor of cardiovascular events. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is considered a significant risk factor in coronary artery disease (CAD). However, prognostic impact of glycemic control in this setting is still controversial. Hypothesis: To evaluated the association between glycated hemoglobin levels (HbA1C) and cardiovascular outcomes in diabetic patients undergoing different therapeutic strategies for CAD in a very long-term follow-up. Methods: Patients with diabetes and multivessel CAD who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or optimized medical treatment (OMT) in MASS registry were included. Data were analyzed according to value of baseline glycated hemoglobin in two strata: lower (<8.0 g / dl) and higher (≥ 8.0 g / dl). The primary outcome was all-cause mortality. Results: In a median follow-up of 9.5 years (IQR: 5.5 - 11.2), a total of 746 patients were analyzed. In patients with lower HbA1C levels (n = 440), 198 underwent CABG, 112 PCI and 130 OMT. In patients with higher HbA1C levels (n =306), 134 underwent CABG, 86 PCI and 86 OMT. Survival rates in patients with lower and higher HbA1C levels were 76.4% and 67.6%, respectively (p log-rank = 0.023) (HR 1.31; 95% CI 1.02-1.77; p=0.03). Values of HbA1C ≥ 8.0 g / dl persisted as an independent predictor of mortality after multivariate analysis in a model including age, hypertension, lipid profile, left ventricular ejection fraction, SYNTAX score and therapeutic strategy-(adjusted HR:1.3; 95% CI 1.18- 2.57); p=0.005). Conclusions: In diabetic patients with multivessel CAD, mortality rates were higher in those with higher glycated hemoglobin values, regardless of therapeutic strategy used. [ABSTRACT FROM AUTHOR]