Vlad Chubuchny | PubMed Health

PubMed2003

Aortic valve sclerosis is associated with systemic endothelial dysfunction.

OBJECTIVES: We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process. BACKGROUND: Clinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery. METHODS: A total of 102 in-hospital patients (76 men; mean age 63.5 +/- 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD). RESULTS: Aortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 +/- 28.6 vs. 35.2 +/- 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 +/- 3.5% vs. 5.3 +/- 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01). CONCLUSIONS: Aortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events.

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PubMed2002

Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease: a multicenter study.

OBJECTIVE: We evaluated the feasibility, safety, and diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) test as a potential alternative to exercise or pharmacologic stress in patients with suspected or known coronary artery disease (CAD). BACKGROUND: Transesophageal atrial pacing echocardiography is an accurate test for detection of CAD, but its practical impact has been blunted by semi-invasiveness. In the expanding population of patients with permanent pacemakers (PMs), a pacing stress test can be administered noninvasively by external programming of the PM. METHODS: In a prospective, multicenter, international study design, transthoracic stress-pacing echocardiography was performed in 46 consecutive patients with a permanent PM (33 men, 13 women; age 66.6 +/- 11.1 years) with suspected or known CAD. All patients underwent noninvasive PM-stress test by external programming (10 beats/min increments up to ischemia or target heart rate). Coronary angiography was performed in all patients independently of test results. Significant CAD was defined as >/=50% visually assessed diameter reduction in at least one major epicardial coronary artery. All coronary angiograms were scored by Duke prognostic weight values. RESULTS: Fifteen patients were stimulated in atrial, and the remaining 31 in ventricular mode during stress. No significant side effects were observed. Echocardiographic images were interpretable in all patients. The average duration of stress was 8.9 +/- 3.5 min. Significant CAD was found in 27 patients. Sensitivity of PASE for identifying patients with significant CAD was 70%, specificity was 90%, and accuracy was 78%. When any abnormal wall motion at rest that remained unchanged at peak stress was regarded as a positive result of PASE, then the sensitivity, specificity, and accuracy levels for identifying patients with significant CAD were 85%, 84%, and 85%, respectively. Four of the eight patients with a false negative did not reach the target heart rate. The Duke values had significant correlation with values of wall motion score index at peak stress (r = 0.67) and with peak heart rate (r = -0.3). CONCLUSIONS: Noninvasive PASE is a simple, rapid, safe, and diagnostically efficient option for patients with permanent PM and suspected or known CAD.

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