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Objectives: Patients surviving an acute myocardial infarction (AMI) are different today than when oral β-blockers first were shown to have an incremental effect on mortality. They are now, as opposed to then, offered revascularization procedures and effective secondary prevention. In this pilot-study, we aimed to explore the prescription of β-blockers to these patients stratified by their left ventricular ejection fraction (LVEF)., Methods: Consecutive stable patients treated with a percutaneous coronary intervention (PCI) procedure following an AMI were included for measurement of LVEF after 1-5 days. β-Blocker treatment was recorded at inclusion and after 3 months., Results: We included 159 patients, 89% with LVEF ≥40% (56% had a LVEF ≥50% [preserved], 33% LVEF 40-49% [mid-range] and 11% LVEF <40% [reduced]). At discharge the prescription rates of β-blockers according to LVEF stratification were 79% for preserved, 79% for mid-range and 94% for reduced LVEF. After 3 months 72% of all patients continued such treatment., Conclusions: In this prospective study, a large proportion of contemporary managed patients with AMI but without clinical heart failure does not have reduced LVEF shortly after PCI, but the majority is still treated with a β-blocker., (© 2018 S. Karger AG, Basel.)

Background: Patients evaluated for acute and chronic chest pain comprise a large, heterogeneous group that often provides diagnostic challenges. Although speckle tracking echocardiography (STE) has proved to have diagnostic value in acute coronary syndrome it is not commonly incorporated in everyday practice. The purpose of the present systematic review was to assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE to predict significant coronary artery stenosis (CAD+) or not (CAD-) verified by coronary angiography in patients with chest pain suspected to be of cardiac ischemic origin., Methods: 4 electronic databases; Embase, Medline, Cochrane and PubMed ahead-of print were searched for per 19.05.14. Only full-sized articles including >40 patients were selected., Results: A total of 166 citations were identified, 16 full-size articles were assessed of which 6 were found eligible for this review. Of 781 patients included 397 (60%) had CAD+. The overall weighted mean global longitudinal strain (GLS) was -17.2% (SD=2.6) among CAD+ vs. -19.2% (SD=2.8) in CAD- patients. Mean area under curve in 4 studies for predicting CAD+ ranged from 0.68 to 0.80. The study cut-off levels for prediction of CAD+ in the ROC analysis varied between -17.4% and -19.7% with sensitivity from 51% to 81% and specificity between 58% and 81%. In 1 study GLS obtained during dobutamine stress echocardiography (DSE) had the best accuracy. Regional strain measurements were not uniform, but may have potential in detecting CAD., Conclusions: GLS measurements at rest only have modest diagnostic accuracy in predicting CAD+ among patients presenting with acute or chronic chest pain. The results from regional strain, layer specific strain and DSE need to be verified in larger studies.

Recent guidelines regard three-dimensional echocardiography (DE) derived measurements of left ventricular (LV) volumes and ejection fraction (EF) as the method of choice. The feasibility of 3DE and agreement between 2DE and 3DE was examined. Our hypothesis was that a number of patients can only be examined with 2DE in a patient population admitted to a general hospital. Hospitalised patients referred for echocardiography by residents on call who found grounds to perform a pocket-sized ultrasound examination (PCU) were included. A subsequent 2DE and 3DE was planned. 3DE was considered unfeasible in the presence of irregular heart rhythm and poor quality imaging (included inability to hold breath). Agreement was evaluated with correlation and Bland-Altman analyses. Of 273 consecutive patients examined with 2DE, 202 (74 %) had satisfactory 3DE images for LV volume and EF measurements. Reasons for exclusion of 71 patients from the 3DE study included irregular heart rhythm in 58 patients and poor quality images in 13 patients. Median LV end-diastolic volume was 146 mL with 3DE and 161 mL with 2DE (p < 0.001). The respective values for LV end-systolic volume were 76 mL and 83 mL (p < 0.001), and for LVEF 48 % and 49 % (p = 0.061). Optimal 3DE assessment of LV volumes and EF could only be performed in 3/4 of patients. A significant overestimation of LV volumes was observed in terms of 2DE versus 3DE, whereas no such difference was found for LVEF.

Background: Recent developments in 3-dimensional echocardiography (3DE) have resulted in smaller probes, faster data acquisition and wider applicability. In spite of this, there is still an ongoing debate as to its ability to provide additional information to 2DE in general hospital clinical practice., Methods: A systematic literature search in EMBASE and MEDLINE was performed in order to identify original articles comparing the two techniques. Studies with a blinded comparison between 2DE and 3DE against a "gold standard" were included; these studies comprised patients with well defined inclusion and exclusion criteria. The number of patients, selection criteria, echo manufacturer, cardiac disorder, and types of comparisons, along with "gold standard" and principal results were compared., Results: A total of 836 original articles were identified, of which 35 were screened for eligibility. 20 studies from 18 publications were included for analysis. The results for LV assessment and reproducibility were clearly in favour of 3DE. In valvular heart disease the superiority of 3DE was also apparent, but was less convincing due to patient selection, methodological problems and the application of questionable "gold standards"., Conclusions: In patients with a regular heart rhythm and for whom it was possible to obtain good quality images the introduction of 3DE has improved the accuracy and reproducibility of LV volume and EF measurements. The results for valvular heart disease are still controversial. It does not seem justifiable to introduce 3DE into common cardiac practice. Further studies are needed in order to support such an implementation., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)