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INTRODUCTION: Coronary artery disease (CAD) is a cause of death in 75% of patients with diabetes. Its often asymptomatic nature delays diagnosis. In aeronautics, it can cause in-flight incapacitation, beyond which it represents a major fear for the medical expert. Screening for CAD is still a topical subject with the advent of new cardiovascular (CV) risk biomarkers and more effective screening tests. We report the experience of the Aeromedical Expertise Center of Rabat in this screening of diabetic pilots, with a recommendations review. METHODS: A prospective study over 1yr included diabetic pilots who benefited from systematic screening for CAD after a CV risk stratification. Coronary angiography is performed if a screening test is positive. Subsequent follow-up is carried out in consultation with the attending physician with regular evaluation in our center. RESULTS: There were 38 pilots included in our study. The average age was 55 ± 4.19yr and about 73% had a high CV risk. CAD was detected in 4 cases (10.52%) who had abnormal resting electrocardiograms and required revascularization with the placement of active stents. Approximately 75% of pilots with CAD returned to fly through a waiver with restrictions. DISCUSSION: Screening for coronary disease in diabetics is controversial, and current recommendations are not unanimous. In our study, the screening did not identify coronary diabetic pilots who could benefit from bypass surgery. Nevertheless, coronary disease was diagnosed, justifying grounding to preserve flight safety, which is an absolute priority in aviation medicine. [ABSTRACT FROM AUTHOR]

Objective To investigate the application value of 24-hour ambulatory electrocardiography (AECG) in the diagnosis of silent myocardial ischemia (SMI). Methods A total of 135 patients with suspected SMI were selected as the research subjects, and they underwent both routine ECG and 24-hour AECG. The detection rate of SMI was compared between the two examination methods. The diagnostic efficiency of SMI was analyzed by using coronary angiography (CAG) as the gold standard. Results Among the 135 patients suspected with SMI, 107 cases were confirmed by CAG. Ninety-two cases were detected by routine ECG with a positive detection rate of 85. 98% (92 / 107) while 24-hour AECG detected 102 cases with a positive rate of 95. 33% ( 102 / 107). The positive rate of 24-hour AECG proves to be significantly higher than that of routine ECG (χ² = 5. 515, P = 0. 019). The diagnostic sensitivity, accuracy rate and negative predictive value of 24-hour AECG were 94. 39%, 94. 81% and 81. 82%, respectively, which were all significantly higher than those of routine ECG ( separately 84. 11%, 85. 93% and 60. 47%; P<0. 05). Conclusion The 24-hour AECG could improve the sensitivity and accuracy in the diagnosis of SMI. [ABSTRACT FROM AUTHOR]

Background: Silent myocardial ischemia (SMI) is more prevalent in type 2 diabetes mellitus (T2DM) patients, resulting in worse cardiovascular outcomes in the future. Therefore, it's early and prompt diagnosis is the need of the hour. It can be identified by traditional cardiac stress testing such as exercise tolerance test. Presence of SMI can also be predicted by microalbuminuria as it can significantly forecast any future cardiovascular event. The objective of this study was to find out the frequency of SMI in T2DM patients with microalbuminuria. Materials & Methods: A cross-sectional survey was carried out at the Diabetes Research Centre Outpatients Clinic, Nishtar Hospital, Multan, 01/01/2020 to 30/06/2020. After taking informed consent, patients having T2DM and microalbuminuria were included. Every participant had to undergo exercise tolerance test (ETT). Patients were regarded as having SMI if they fulfilled Bruce protocol and had myocardial ischemia on stress ETT. All gathered data was analyzed using SPSS version 24. Mean and standard deviation was measured for age and duration of DM. Frequency and percentage was measured for gender and presence or absence of SMI as confirmed by ETT. Results: This study comprised of a total 81 patients. Mean age of patients was 49.72±6.75 years, with range of 30. Male patients were 49(60.5%) whereas 32(39.5%) were female. Mean duration of T2DM was 12.52±4.71 years. SMI was present in 34 (41.9%) T2DM patients with microalbuminuria, as confirmed by ETT. Among the positive cases, majority belonged to 51-60 years age group (50.0%) and most of them were males 20 (58.8%). The majority of patients aged more than 60 years had SMI (85.7%), detected by ETT. Conclusion: Frequency of SMI in the current study (41.9%) is startling and direct us for earlier diagnosis and management of T2DM and microalbuminuria to prevent any cardiovascular event. Screening with ETT should be done for SMI in every diabetic patient with microalbuminuria. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease and a key role in pain transmission. Diabetic patients have a higher risk of silent myocardial ischemia (SMI) due to diabetic neuropathy. We evaluated the correlation between SMI and Vitamin D serum levels in type 2 diabetic patients and assessed whether SMI patients had a worse survival rate than their symptomatic counterpart. We enrolled 253 patients admitted in our Cardiology Unit and compared them with 50 healthy volunteers. We created three sub-groups: symptomatic MI group (125, 32.4%); SMI group (78, 25.7%), and no-MI group (50, 41.9%). 25(OH)D levels (nmol/L) were lower in the SMI group (34.9 ± 5.8) compared to those in the symptomatic MI (49.6 ± 6.1; p = 0.01), no MI (53.1 ± 6.2; p = 0.001), and control groups (62.1 ± 6.7; p = 0.0001). 25(OH)D levels predicted SMI in diabetic patients, with an inverted odds ratio of 1.11 (p = 0.01). Symptomatic MI group survival was higher than the SMI one (6-year survival rate: 83 vs. 69%; p = 0.01). Diabetic patients with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial role that vitamin D has in the pathogenesis of SMI. [ABSTRACT FROM AUTHOR]

Summary. The prevalence of myocardial infarction and its leading role in the structure of overall and cardiovascular mortality encourages the search for predictors of complicated course of disease and the search for optimal means to prevent adverse events. The aim of the study – to establish features of cardiac arrhythmias in patients with myocardial infarction without ST-segment elevation depending on the degree of coronary artery lesions. Materials and Methods. The study involved 156 patients with NSTEMI aged 38 to 80 years. All patients were examined according to the current treatment protocol for patients with acute coronary syndrome without ST segment elevation and daily Holter ECG monitoring was performed for 3-5 days after hospitalization. Results. It was found that the degree of coronary artery lesions is positively correlated with the likelihood of severe adverse ventricular arrhythmias and episodes of silent myocardial ischemia in the early period. Conclusions. By determining the total score of coronary artery disease, it is possible to stratify the adverse course of NSTEMI, in particular, the occurrence of fatal ventricular arrhythmias in the early period.

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings. [ABSTRACT FROM AUTHOR]

Background: Earlier diagnosis of asymptomatic coronary artery disease (CAD) in diabetics may prevent catastrophic cardiac events and hence warrants the need for detection of silent myocardial ischemia (SMI). Therefore, the study aimed to assess the role of treadmill test (TMT) in patients who were asymptomatic, to detect and estimate the occurrence of SMI (positive exercise TMT), and to find the association between presence of SMI and duration of diabetes mellitus (DM). Methodology: A cross-sectional study was undertaken among 162 DM cases (type 2) with a mean age of 55.32 ± 11.89 years, who had undergone a TMT without any CAD evidence clinically. All the subjects had normal 12 lead electrocardiography and underwent TMT. Results: Among 162 subjects, TMT was positive in 63 (38.9%) study subjects. TMT positivity for inducible ischemia in type 2 DM patients was associated with increasing age, higher body mass index (BMI), smoking, higher HbA1C, albuminuria, retinopathy, and atherosclerotic cardiovascular disease (ASCVD) risk score. Smoking, diabetic retinopathy, and urine albumin were associated with TMT significantly (P value < 0.005). A significant linear increasing trend in proportion of TMT positive over HbA1c was observed. Mean height of TMT-positive subjects (159.2 ± 7.47 cm) was more than TMT-negative subjects (P < 0.005). The mean BMI (29.69 ± 3.58 kg/m2) and triglycerides (173.87 ± 112.7 mg/dl) of TMT-positive subjects were more than TMT-negative subjects (P < 0.005). Conclusion: CAD prevalence is greater in asymptomatic cases of type 2 DM in this geographic region. A significant linear increasing trend was observed in TMT positive over HbA1c. Hence, TMT can be incorporated in routine screening for SMI in patients suffering from diabetes. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of heart rate deceleration capacity (DC), heart rate deceleration runs (DRs) and heart rate variability (HRV) indexes in the auxiliary diagnosis of silent myocardial ischemia (SMI). Methods A total of 65 SMI patients who had been admitted and treated in our hospital were selected as the observation group while 65 healthy controls during the same period were enrolled as the control group. Both groups were monitored by 24-hour ambulatory electrocardiography. The values of DC, DRs and HRV indexes of the two groups were compared, and the correlation among these indexes were analyzed. Results The values of DC, DR4, DR8, SDANN, rMSSD and pNN50 in the observation group are lower than those in the control group (P < 0. 05) . There is significant positive correlation between DC, DR2, DR4, DR8, and SDNN, SDANN, rMSSD, pNN50 in the observation group (P <0. 05). Conclusion Compared with healthy people, the levels of DC, DRs and HRV among SMI patients are significantly lower; DC and DRs values are significantly positively correlated with HRV values. Testing of DC, DRs and HRV indexes can be applied as an auxiliary method for screening SMI patients. [ABSTRACT FROM AUTHOR]

Objective: Oncostatin M (OSM) is an inflammatory cytokine of the interleukin-6 family which plays a crucial role in the pathogenesis of atherosclerosis. Therefore, we tested our hypothesis that serum OSM levels are increased in patients with coronary artery diseases (CAD). Methods and results: Serum OSM level was measured by sandwich technique immunoassay in 315 consecutive patients and who underwent coronary angiography at the International University of Health and Welfare Hospital from April 2019 to March 2021. A diagnosis of CAD was made in 169 patients. Serum OSM levels were significantly higher in patients with significant coronary stenosis compared to those without it. [123.0 ± 46.7 pg/mL (n = 169) vs. 98.3 ± 47.9 pg/mL (n = 146), p

Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease and a key role in pain transmission. Diabetic patients have a higher risk of silent myocardial ischemia (SMI) due to diabetic neuropathy. We evaluated the correlation between SMI and Vitamin D serum levels in type 2 diabetic patients and assessed whether SMI patients had a worse survival rate than their symptomatic counterpart. We enrolled 253 patients admitted in our Cardiology Unit and compared them with 50 healthy volunteers. We created three sub-groups: symptomatic MI group (125, 32.4%); SMI group (78, 25.7%), and no-MI group (50, 41.9%). 25(OH)D levels (nmol/L) were lower in the SMI group (34.9 ± 5.8) compared to those in the symptomatic MI (49.6 ± 6.1; p = 0.01), no MI (53.1 ± 6.2; p = 0.001), and control groups (62.1 ± 6.7; p = 0.0001). 25(OH)D levels predicted SMI in diabetic patients, with an inverted odds ratio of 1.11 (p = 0.01). Symptomatic MI group survival was higher than the SMI one (6-year survival rate: 83 vs. 69%; p = 0.01). Diabetic patients with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial role that vitamin D has in the pathogenesis of SMI.

Coronary artery disease is the primary cause of death in patients with carotid artery disease and silent ischemia is a marker for adverse coronary events. A new noninvasive cardiac diagnostic test, coronary computed tomography-derived fractional flow reserve (FFR CT) can reliably identify ischemia-producing coronary stenosis in patients with coronary artery disease and help to select patients for coronary revascularization. The purpose of this study is to determine the prevalence of silent coronary ischemia in patients undergoing carotid endarterectomy (CEA) and to evaluate the usefulness of FFR CT in selecting patients for coronary revascularization to decrease cardiac events and improve survival. Patients with no cardiac history or symptoms admitted for elective CEA were enrolled in a prospective, open-label, institutional review board-approved study and underwent preoperative coronary computed tomography angiography (CTA) and FFR CT with results available to physicians for patient management. Lesion-specific coronary ischemia was defined as FFR CT of 0.80 or less distal to a focal coronary stenosis with an FFR CT of 0.75 or less, indicating severe ischemia. Primary end point was incidence of major adverse cardiovascular events (MACE; defined as cardiovascular death, myocardial infarction, or stroke) at 30 days and 1 year. Coronary CTA and FFR CT was performed in 90 CEA patients (age 67 ± 8 years; male 66%). Lesion-specific coronary ischemia was found in 51 patients (57%) with a mean FFR CT of 0.71 ± 0.14. Severe coronary ischemia was present in 39 patients (43%), 26 patients had multivessel ischemia, and 5 had left main disease. CEA was performed as scheduled in all patients with no postoperative deaths or myocardial infarctions. There were no MACE events at 30 days. After recovery from surgery, 36 patients with significant lesion-specific ischemia underwent coronary angiography with coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) in 30 patients (33%). Survival at 1 year was 100% and freedom from MACE was 98%. Patients undergoing CEA have a high prevalence of unsuspected (silent) coronary ischemia, which may place them at risk for coronary events. Preoperative diagnosis of silent ischemia using CTA and FFR CT can identify high-risk patients and help to guide patient management. Selective postoperative coronary revascularization of patients with significant ischemia may decrease the risk of cardiac events and improve survival, but longer follow-up is needed and prospective, controlled trials are indicated. [ABSTRACT FROM AUTHOR]

Diabetic patients with silent myocardial ischemia (SMI) have elevated rates of morbidity and mortality and need intensive care and monitoring. An early predictor of SMI may lead to early diagnosis and medical treatment to prevent progression and adverse clinical events. Therefore, this paper was aimed to evaluate the radial pulse spectrum as risk markers to improve the risk stratification of SMI in type-2 diabetic patients; 195 diabetic patients at high-risk of SMI were enrolled. All patients underwent myocardial perfusion imaging and radial pressure wave measurement. The spectrum analysis of the radial pressure wave was calculated and transformed into Fourier series coefficients Cns and Pns. The risk of SMI (odds ratio: 4.46, 95%, C.I. 1.61-12.4, P

Objective: The prevalence of coronary artery disease (CAD) is high in patients with diabetes. Because ischemia and infarction are often silent in diabetic patients, diagnosis of CAD occurs inevitably late. It is essential to identify the presence of CAD in diabetic patients to start early treatment. Therefore, the aim of this study was to determine the prevalence of abnormal myocardial perfusion in asymptomatic type 2 diabetic patients using myocardial perfusion imaging. Methods: Fifty-nine patients with type 2 diabetes, who did not have any history of CAD, but did have risk factors underwent myocardial perfusion single-photon emission computed tomography (SPECT) imaging using 99mTc-tetrofosmin and a 2-day stress–rest protocol. Two nuclear medicine specialists independently interpreted the images. Statistical analysis was performed to determine if there is a correlation between the presence of perfusion abnormalities and the history of diabetes (duration of disease, type of treatment, level of control, and presence and type of complications). The influence of other factors such as age, sex, smoking history, and family history of CAD, with abnormal scans were also studied. Results: Of the 59 patients, abnormal scans were detected in 22 (37%) including 16 with reversible defects due to stress-induced ischemia. Hence the prevalence was 37%. Duration of diabetes, use of insulin, nephropathy, and neuropathy were significantly associated with abnormal scans (p = 0.048, p = 0.045, p = 0.006, and p = 0.03, respectively). Additionally, positive family history of CAD was highly associated with perfusion abnormalities (p

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Introduction: Several studies have shown that high sensitivity cardiac troponin (hs-cTnT) levels are elevated in patients suffering from end-stage renal disease (ESRD), even in the absence of clinical signs and instrumental features of symptomatic acute coronary syndrome (ACS). In patients undergoing haemodialysis because of ESRD, nephrologists bear witness to this increase, whose origin and clinical impact are not yet well defined.Methods: By a retrospective study, we evaluated data from records of 70 patients with ESRD on haemodialysis, all of them with a history of NAFLD, not suffering for at least 3 months from symptomatic angina and without a history of ischemic heart disease in the same period.Results: Hs-cTnT and C-reactive protein (CRP) levels both increased and were correlated, rho = 0.34, P = 0.004. The correlation coefficient between troponin and age was significant, rho = 0.47, P = 0.0001. Serum concentrations of hs-cTnT for the whole population were positively predicted by CRP levels, P = 0.004. On separation of the population by gender, significant correlation between hs-cTnT and CRP was not found in women and was only present in men, P = 0.66 and P = 0.000, respectively.Discussion: The assessment of hs-cTnT levels could represent a biological marker in particular subgroups of haemodialysis patients, especially for male patients with higher CRP, those at greater risk of silent myocardial ischemia and future major adverse cardiac events.Conclusions: The evaluation of hs-cTnT in haemodialysed patients with NAFLD could indicate that men with higher CRP should undergo close monitoring in order to adopt specific therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of microalbuminuria (MAU) or Moderate Albumin Excretion (MAE) in treatment naïve type II diabetic patients and to compare the frequency of silent myocardial ischemia in treatment naive Type-II diabetic patients with and without microalbuminuria. Methods It was a cross sectional survey conducted in the outpatient Department, Jinnah Hospital Lahore, from 30th May 2015 to 29th November 2015. There were 227 patients, (consecutive treatment naïve type II diabetic patients), presenting to outpatient department were enrolled in the study. MAU/MAE, silent myocardial ischemia and effect modifiers like HbA1C > 7%, smoking pack years and dyslipidemia was determined. MAU/MAE was determined by urinary albumin excretion rate of 30-300 mg/24 hours and included patients underwent exercise tolerance test to diagnose silent myocardial ischemia. Results: Out of total 165 patients (72.7%) were male and remaining 62 patients (27.3%) were female. The 54 patients (23.8%) had MAU/MAE. The 44 patients (19.4%) had silent myocardial infarction. When we cross tabulated microalbuminuria with silent myocardial infarction, result were significant. Out of 54 patients with MAU/MAE, 16 cases had silent myocardial infarction. Conclusion: The frequency of microalbuminuria/Moderate Albumin Excretion in treatment naïve type II diabetic patients was high and associated with the frequency of silent myocardial ischemia in treatment naïve type II diabetic patients with and without MAU MAU/MAE. [ABSTRACT FROM AUTHOR]

Introduction: Complications from diabetes mellitus (DM) include cardiovascular system, peripheral neuropathy (PN), and autonomic dysfunction (AD). Goal: Assess the association of silent myocardial ischemia, AD, and PN in cardiovascular asymptomatic type 2 diabetics. Methods: As part of a multicenter project, 40 patients with type 2 DM were studied, with > 5 years of known disease and a baseline electrocardiogram non suggestive of coronary artery disease. Myocardial SPECT was performed with exercise stress test measuring corrected QT interval (QTc) and heart rate recovery (HRR) post-exercise (abnormal QTc ≥ 450 ms at rest and HRR < 14 beats at the first minute in maximum exercise). After 3 years, it was possible to re-study 32 cases. PN was evaluated with Michigan Neuropathy Screening Instrument (MNSI). Logistic regression analysis was performed to determine associated factors for AD, PN, SI, and survival analysis. Results: Thirty-four percent of the group had ischemia in SPECT; QTc was prolonged in 23.3%; 31% fulfilled criteria of PN; and 25% of AD due to HRR alteration. With bivariate and multivariate analyses, associations were observed between lipid, glycemic parameters, ischemia, PN, and AD. The follow-up (mean 119 months) consigned 4 cardiac-related deaths; ischemia, glycemic control parameters, and microalbuminuria had significant value in bivariate analysis. Conclusion: In our small sample of asymptomatic cardiovascular type 2 DM patients, myocardial ischemia, glycemic control, and microalbuminuria have influence on survival, requiring a more intensive global therapeutic approach. [ABSTRACT FROM AUTHOR]

Clinical predictors for later adverse cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) for silent myocardial ischemia remain undetermined. We investigated clinical features leading to later adverse cardiovascular events in patients who underwent PCI for silent myocardial ischemia. Of a total of 294 consecutive patients with a diagnosis of silent myocardial ischemia who successfully underwent contemporary PCI in our institute between January 2013 and December 2014, an initial event of any of all-cause death, hospitalized heart failure, acute coronary syndromes, and target vessel revascularization were identified as later adverse cardiovascular events and evaluated an association of them with baseline clinical characteristics. Silent myocardial ischemia was defined by an assessment of either electrocardiogram, myocardial perfusion imaging, coronary angiogram, or coronary fractional flow reserve. During a median follow-up of 565 days (interquartile range 361–816), later adverse cardiovascular events were identified in 38 patients (13%) consisting of 6 deaths, 5 hospitalized heart failures, 2 acute coronary syndromes, and 25 target vessel revascularizations. A presence of chronic kidney disease and/or insulin-treated diabetes mellitus, but not other clinical features, was strongly associated with later adverse cardiovascular events (hazard ratio 8.22; 95% confidential interval 2.95–29.25, P < 0.0001). Those events were increased in accordance with advanced stages of chronic kidney disease (P = 0.0003). A presence of chronic kidney disease and/or insulin-treated diabetes mellitus may lead the potential after-effects of PCI in the treatment of silent myocardial ischemia. [ABSTRACT FROM AUTHOR]

Objectives: In light of increased risk of cardiovascular events and the poor prognosis of coronary artery disease (CAD) in diabetic versus nondiabetic patients and also with respect to the importance of early diagnosis of CAD in this status, the study was aimed to assess the importance of microalbuminuria in predicting silent myocardial ischemia (SMI) in patients with type 2 diabetes using myocardial perfusion imaging (MPI). Methods: This study included 120 patients with diabetes type 2, but without previously known CAD or any cardiac symptoms that were stratified into two groups based on presence/absence of microalbuminuria. All participants underwent CAD evaluation using gated myocardial perfusion single-photon emission computed tomography (MPS) imaging. Other clinical and laboratory indices were also recorded. Results: Studied population consisted of 84 males (70%) and 36 females (30%), totally 120 patients with mean age of 58.61±9.90). In total, asymptomatic ischemia was detected in 78 (65%) of the included diabetic patients. Stress induced ischemia was found in 56 patients (87.5%) of albumin+ (Alb) group and in 22 patients (39.3%) of Alb-group. The frequency of stress induced ischemia was 10.81 times higher in the patients with microalbuminuria compared to Alb-ones [p<0.001, Odds ratio: 10.81, 95% confidence interval: 4.33-26.99]. On the other hand, no relationship was found between the presence of stress induced ischemia and therapy type, diabetes duration, history of evident retinopathy, history of hypertension and also serum levels of hemoglobin A1c (p>0.05). Conclusion: The current study showed that abnormal MPI findings are significantly more common in diabetic patients with microalbuminuria. With respect to low cost and availability of urine Alb detection tests, it might be as a biomarker for prediction of SMI in daibetic population. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical value of 24-hour ambulatory electrocardiography(AECG) combined with treadmill exercise test(TET) in diagnosing latent coronary heart disease(LCHD). MethodsWe selected 100 patients definitely diagnosed with LCHD by coronary angiography(CAG) in our hospital from January 2015 to February 2018. The clinical diagnosis results of 24-hour AECG, TET and CAG were analyzed, respectively. ResultsBetween 24-hour AECG and TET, the sensitivity(82.81% vs. 82.54%), specificity(61.11% vs. 67.56%), accuracy(75.00% vs. 77.00%), and negative and positive predictive values(66.67% vs. 69.44%, 79.10% vs. 81.25%) did not vary significantly(P>0.05). The specificity(91.89%) and positive predictive value(94.23%) of the tandem method(AECG combined with TET) were higher than either of the two methods(P<0.05) while the sensitivity(95.23%) and negative predictive value(88.00%) of the parallel method were also significantly higher(P<0.05). ConclusionThe tandem and parallel methods of AECG combined with TET are obviously more valuable than single examination in the diagnosis of LCHD. They can effectively improve the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Abstract Background There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. Methods A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. Results Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498–0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175–0.942, p = 0.036). Conclusions In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia. Highlights • In patients with silent ischemia, the role of revascularization is uncertain and previous studies show conflicting results. • This study showed a significantly lower risk of mortality in the revascularization group than in the medical treatment group. • Patients with resolution of ischemia showed significantly lower risk of cardiac death than those with residual ischemia after PCI. [ABSTRACT FROM AUTHOR]

Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p

A 73-year-old Japanese man was admitted with extreme intradialytic hypertension of four months' duration that was refractory to antihypertensive agents. He had started hemodialysis five years previously because of diabetic nephropathy. Coronary angiography revealed coronary artery disease with significant stenosis of the left main trunk and the right coronary artery, and he underwent a coronary artery bypass graft. Thereafter, the intradialytic hypertension disappeared. Ischemic heart disease appears to be one cause of intradialytic hypertension. < Learning objective: Intradialytic hypertension occurs in some patients with hemodialysis. Such patients are at increased risk for mortality and adverse cardiovascular events. Although the pathophysiological mechanisms remain unknown, ischemic heart disease appears to be one cause of intradialytic hypertension.> [ABSTRACT FROM AUTHOR]

The given review considers the pathogenesis, diagnosis, and clinical significance of silent myocardial ischemia (SMI) in individual patient groups. It discusses the problem of SMI in acute coronary syndrome (ACS), the possible causes of SMI and the specific features of its diagnosis. It also indicates that there is a need for 12-lead ECG telemonitoring in intensive care unit patients with ACS to intraoperatively correct patient management and treatment policy.

One of the most important causes of death is still myocardial ischemia which is caused by myocardial oxygen demand not supplied by coronary blood flow due to coronary artery disease in increased workload conditions. Stable coronary artery disease due to supply-demand imbalance in the myocardium caused by progressive coronary atherosclerosis detected at coronary angiography presents itself as recurrent episodes of chest pain, called angina pectoris. Unstable coronary artery disease due to plaque rupture which is associated with plaque complications accompanied by thrombosis and thrombolysis processes causes acute coronary syndromes. Besides, there is also a group in which ischemia and infarction develop without significant obstructive atherosclerotic coronary artery disease at coronary angiography. This term, called cardiac syndrome X, is used to describe the microvascular angina caused by coronary microvascular dysfunction due to structural and functional causes. Coronary microvascular disease caused by an increased vascular contraction in microvascular structures in response to exercise or pharmacologic agents, or failure of endothelium-dependent/independent vasodilatation, or a combination of such conditions, is responsible for the clinical findings in the symptomatic cases with normal coronary angiogram. In this review, the different aspects of coronary microvascular disease are aimed to be discussed in light of the current literature. [ABSTRACT FROM AUTHOR]