Aspects of risk stratification in acute coronary syndrome: Prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography

Abstract


Aim. To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). Materials and methods. The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3±0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). Results. Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, ΔTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, ΔTEF (as compared to the baseline data), and ISCI during the peak stress test. Conclusion. The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.

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About the authors

V A Gukasian

S T Matskeplishvili

V I Ioshina

M A Aripov

L S Shakhnazarian

É U Asymbekova

E V Zhertovskaia

Iu I Buziashvili

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