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Eugenio Picano - One of the best experts on this subject based on the ideXlab platform.
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The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study.
American Heart Journal, 2020Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:Background Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. Aim To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. Methods We studied 329 consecutive patients (193 men, age 61 ± 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. Results During follow-up (28 ± 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (>6 months) coronary revascularizations. Moreover, 9 patients underwent early ( P P P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. Conclusions In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
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End-Systolic Elastance and Ventricular-Arterial Coupling Reserve Predict Cardiac Events in Patients with Negative Stress Echocardiography
BioMed Research International, 2013Co-Authors: Tonino Bombardini, Rosa Sicari, Marco Fabio Costantino, Quirino Ciampi, Lorenza Pratali, Eugenio PicanoAbstract:Background. A maximal Negative Stress echo identifies a low-risk subset for coronary events. However, the potentially prognostically relevant information on cardiovascular hemodynamics for heart-failure-related events is unsettled. Aim of this study was to assess the prognostic value of Stress-induced variation in cardiovascular hemodynamics in patients with Negative Stress echocardiography. Methods. We enrolled 891 patients (593 males mean age 63 ± 12, ejection fraction 48 ± 17%), with Negative (exercise 172, dipyridamole 482, and dobutamine 237) Stress echocardiography result. During Stress we assessed left ventricular end-systolic elastance index (ELVI), ventricular arterial coupling (VAC) indexed by the ratio of the ELVI to arterial elastance index (EaI), systemic vascular resistance (SVR), and pressure-volume area (PVA). Changes from rest to peak Stress (reserve) were tested as predictors of main outcome measures: combined death and heart failure hospitalization. Results. During a median followup of 19 months (interquartile range 8–36), 50 deaths and 84 hospitalization occurred. Receiver-operating-characteristic curves identified as best predictors ELVI reserve for exercise (AUC = 0.871) and dobutamine (AUC = 0.848) and VAC reserve (AUC = 0.696) for dipyridamole. Conclusions. Patients with Negative Stress echocardiography may experience an adverse outcome, which can be identified by assessment of ELVI reserve and VAC reserve during Stress echo.
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Prognostic correlates of combined coronary flow reserve assessment on left anterior descending and right coronary artery in patients with Negative Stress echocardiography by wall motion criteria
Heart, 2009Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Aims: To assess the prognostic correlates of Doppler echocardiographically derived coronary flow reserve (CFR) on two coronaries in patients with Negative Stress echo. Vasodilator Stress echocardiography allows dual imaging of regional wall motion and CFR both on left anterior descending (LAD) and right coronary artery (RCA). Methods: The study group comprised 460 patients with known or suspected coronary artery disease and Negative Stress echo by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) Stress echo with CFR evaluation of either LAD or RCA by Doppler, and were followed up for a median of 32 months. A CFR value of ⩽2.0 was taken as abnormal. Results: CFR was abnormal in 174 patients (38%) (57 in LAD only, 48 in RCA only, and 69 in both LAD and RCA) and normal in 286 patients (62%). During follow-up, there were 77 cardiac events: 5 deaths, 44 acute coronary syndromes (6 STEMI, and 38 NSTEMI) and 28 late (>6 months from Stress echo) revascularisations. CFR of ⩽2.0 on LAD was the strongest multivariable predictor of either definite (death, acute coronary syndrome) and major (death, acute coronary syndrome, late revascularisation) events, followed by diabetes mellitus. Anti-ischaemic therapy at the time of testing and resting wall motion abnormality were also independently associated with major events. Preserved CFR in both LAD and RCA was associated with better (p Conclusion: CFR evaluation of either LAD or RCA allows the identification of distinct prognostic patterns. In particular, preserved CFR in both coronary vessels is highly predictive of a very favourable outcome, while reduced CFR in either coronary vessel, and especially on LAD, is a strong predictor of future cardiac events.
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additional prognostic value of coronary flow reserve in diabetic and nondiabetic patients with Negative dipyridamole Stress echocardiography by wall motion criteria
Journal of the American College of Cardiology, 2007Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Maurizio Galderisi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Objectives The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. Background The prognostic value of CFR in diabetic patients with Negative Stress echocardiography remains unknown. Methods The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and Negative Stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR ≤2.0 was considered abnormal. Results Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non–ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p Conclusions Coronary flow reserve provides independent prognostic information in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
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Negative Stress echo: further prognostic stratification with assessment of pressure-volume relation.
International Journal of Cardiology, 2007Co-Authors: Tonino Bombardini, Maurizio Galderisi, Eustachio Agricola, V. Coppola, G. Mottola, Eugenio PicanoAbstract:Abstract Background A maximal Negative Stress echo identifies a low risk for subsequent hard events subset. However, the potentially prognostically relevant information on global contractile reserve on the left ventricle is missed by standard regional wall motion assessment, and can be obtained by end-systolic pressure–volume relationship (PVR) evaluation. Aim To assess the relative prognostic value of PVR in patients with Negative Stress echo. Methods We enrolled 99 consecutive patients (age=61±14 years; 81 males, LVEF 47±14%, WMSI=1.42±0.50) with Negative exercise Stress echo for standard wall motion criteria. To build the PVR, the force was determined at rest and peak Stress as the ratio of the systolic pressure/end-systolic volume index. All patients were followed-up on medical therapy. Results Median follow-up was 21 months (interquartile range 12–26). Twenty-nine events have been observed: 6 deaths, 10 heart failure related hospitalization and 13 worsening NYHA class of ≥1 grade. Using Cox's proportional hazard model the best independent predictor of total events was SP/ESV index change (rest–Stress) 2 as determined by ROC analysis cut-off (RR=29, p =0.001, sensitivity=80%, specificity=93%). The overall survival and event-free survival was 34% in patients with change (rest–Stress) SP/ESV index 2 and 97% in whose with >1.5 mm Hg/ml/m 2 . Conclusions In patients with Negative Stress echo, a preserved global contractility response can be easily identified through Stress-induced variation in SP/ESV index, with powerful further risk stratification.
Lauro Cortigiani - One of the best experts on this subject based on the ideXlab platform.
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The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study.
American Heart Journal, 2020Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:Background Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. Aim To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. Methods We studied 329 consecutive patients (193 men, age 61 ± 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. Results During follow-up (28 ± 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (>6 months) coronary revascularizations. Moreover, 9 patients underwent early ( P P P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. Conclusions In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
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Prognostic correlates of combined coronary flow reserve assessment on left anterior descending and right coronary artery in patients with Negative Stress echocardiography by wall motion criteria
Heart, 2009Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Aims: To assess the prognostic correlates of Doppler echocardiographically derived coronary flow reserve (CFR) on two coronaries in patients with Negative Stress echo. Vasodilator Stress echocardiography allows dual imaging of regional wall motion and CFR both on left anterior descending (LAD) and right coronary artery (RCA). Methods: The study group comprised 460 patients with known or suspected coronary artery disease and Negative Stress echo by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) Stress echo with CFR evaluation of either LAD or RCA by Doppler, and were followed up for a median of 32 months. A CFR value of ⩽2.0 was taken as abnormal. Results: CFR was abnormal in 174 patients (38%) (57 in LAD only, 48 in RCA only, and 69 in both LAD and RCA) and normal in 286 patients (62%). During follow-up, there were 77 cardiac events: 5 deaths, 44 acute coronary syndromes (6 STEMI, and 38 NSTEMI) and 28 late (>6 months from Stress echo) revascularisations. CFR of ⩽2.0 on LAD was the strongest multivariable predictor of either definite (death, acute coronary syndrome) and major (death, acute coronary syndrome, late revascularisation) events, followed by diabetes mellitus. Anti-ischaemic therapy at the time of testing and resting wall motion abnormality were also independently associated with major events. Preserved CFR in both LAD and RCA was associated with better (p Conclusion: CFR evaluation of either LAD or RCA allows the identification of distinct prognostic patterns. In particular, preserved CFR in both coronary vessels is highly predictive of a very favourable outcome, while reduced CFR in either coronary vessel, and especially on LAD, is a strong predictor of future cardiac events.
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additional prognostic value of coronary flow reserve in diabetic and nondiabetic patients with Negative dipyridamole Stress echocardiography by wall motion criteria
Journal of the American College of Cardiology, 2007Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Maurizio Galderisi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Objectives The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. Background The prognostic value of CFR in diabetic patients with Negative Stress echocardiography remains unknown. Methods The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and Negative Stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR ≤2.0 was considered abnormal. Results Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non–ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p Conclusions Coronary flow reserve provides independent prognostic information in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
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the additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria a transthoracic vasodilator Stress echocardiography study
American Heart Journal, 2006Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:BACKGROUND: Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. AIM: To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. METHODS: We studied 329 consecutive patients (193 men, age 61 +/- 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. RESULTS: During follow-up (28 +/- 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (> 6 months) coronary revascularizations. Moreover, 9 patients underwent early (< 6 months) revascularization and were censored. Using a receiver operating characteristic analysis, CFR < or = 1.92 was the best predictor of future events (area under the curve = 0.80, sensitivity = 77%, specificity = 85%) and was taken as criterion for reduced CFR accordingly. Sixty-three (19%) patients had reduced and 266 (81%) had normal CFR on LAD. The 36-month event-free survival was higher in patients with normal and lower in patients with reduced CFR (98% vs 64%, P < .0001). At Cox analysis, CFR of LAD (hazard ratio [HR] 16.52, 95% CI 5.76-47.40, P < .0001), left ventricular mass index (HR 1.03 per unit increment, 95% CI 1.00-1.05, P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. CONCLUSIONS: In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
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Sustained favorable long-term prognosis of Negative Stress echocardiography following uncomplicated myocardial infarction.
American Journal of Cardiology, 2002Co-Authors: Riccardo Bigi, Lauro Cortigiani, P.r. MarianiAbstract:vival Study (4S). Circulation 1997;96:4211–4218. 3. Lewis SJ, Moye LA, Sacks FM, Johnstone DE, Timmis G, Mitchell J, Limacher M, Kell S, Glasser SP, Grant J, et al, for the CARE Investigators. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 1998;129:681–689. 4. Hunt D, Young P, Simes J, Hague W, Mann S, Owensby D, Lane G, Tonkin A, for the LIPID Investigators. Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: results from the LIPID trial. Ann Intern Med 2001;134:931–940. 5. Aronow WS, Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol 125 mg/dl treated with statins versus no lipid-lowering drug. Am J Cardiol 2002;89: 67–69. 6. Aronow WS, Ahn C, Gutstein H. Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and serum lowdensity lipoprotein cholesterol 125 mg/dL treated with statins versus no lipidlowering drug. J Gerontol Med Sci 2002:57A:M333–M335. 7. Joint National Committee. The Sixth Report of the Joint National Committee on the Detection Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997;157:2413–2444. 8. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997;20:1183–1197. 9. Aronow WS, Ahn C, Kronzon I. Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease. Am J Cardiol 1990;66:1257–1259. 10. Kjekshus J, Pedersen TR, Olsson AG, Faergeman O, Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997;3:249–254.
Fausto Rigo - One of the best experts on this subject based on the ideXlab platform.
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The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study.
American Heart Journal, 2020Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:Background Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. Aim To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. Methods We studied 329 consecutive patients (193 men, age 61 ± 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. Results During follow-up (28 ± 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (>6 months) coronary revascularizations. Moreover, 9 patients underwent early ( P P P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. Conclusions In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
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Prognostic correlates of combined coronary flow reserve assessment on left anterior descending and right coronary artery in patients with Negative Stress echocardiography by wall motion criteria
Heart, 2009Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Aims: To assess the prognostic correlates of Doppler echocardiographically derived coronary flow reserve (CFR) on two coronaries in patients with Negative Stress echo. Vasodilator Stress echocardiography allows dual imaging of regional wall motion and CFR both on left anterior descending (LAD) and right coronary artery (RCA). Methods: The study group comprised 460 patients with known or suspected coronary artery disease and Negative Stress echo by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) Stress echo with CFR evaluation of either LAD or RCA by Doppler, and were followed up for a median of 32 months. A CFR value of ⩽2.0 was taken as abnormal. Results: CFR was abnormal in 174 patients (38%) (57 in LAD only, 48 in RCA only, and 69 in both LAD and RCA) and normal in 286 patients (62%). During follow-up, there were 77 cardiac events: 5 deaths, 44 acute coronary syndromes (6 STEMI, and 38 NSTEMI) and 28 late (>6 months from Stress echo) revascularisations. CFR of ⩽2.0 on LAD was the strongest multivariable predictor of either definite (death, acute coronary syndrome) and major (death, acute coronary syndrome, late revascularisation) events, followed by diabetes mellitus. Anti-ischaemic therapy at the time of testing and resting wall motion abnormality were also independently associated with major events. Preserved CFR in both LAD and RCA was associated with better (p Conclusion: CFR evaluation of either LAD or RCA allows the identification of distinct prognostic patterns. In particular, preserved CFR in both coronary vessels is highly predictive of a very favourable outcome, while reduced CFR in either coronary vessel, and especially on LAD, is a strong predictor of future cardiac events.
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additional prognostic value of coronary flow reserve in diabetic and nondiabetic patients with Negative dipyridamole Stress echocardiography by wall motion criteria
Journal of the American College of Cardiology, 2007Co-Authors: Lauro Cortigiani, Fausto Rigo, Sonia Gherardi, Maurizio Galderisi, Rosa Sicari, Francesco Bovenzi, Eugenio PicanoAbstract:Objectives The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. Background The prognostic value of CFR in diabetic patients with Negative Stress echocardiography remains unknown. Methods The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and Negative Stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR ≤2.0 was considered abnormal. Results Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non–ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p Conclusions Coronary flow reserve provides independent prognostic information in diabetic and nondiabetic patients with known or suspected coronary artery disease and Negative dipyridamole Stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
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the additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria a transthoracic vasodilator Stress echocardiography study
American Heart Journal, 2006Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:BACKGROUND: Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. AIM: To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. METHODS: We studied 329 consecutive patients (193 men, age 61 +/- 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. RESULTS: During follow-up (28 +/- 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (> 6 months) coronary revascularizations. Moreover, 9 patients underwent early (< 6 months) revascularization and were censored. Using a receiver operating characteristic analysis, CFR < or = 1.92 was the best predictor of future events (area under the curve = 0.80, sensitivity = 77%, specificity = 85%) and was taken as criterion for reduced CFR accordingly. Sixty-three (19%) patients had reduced and 266 (81%) had normal CFR on LAD. The 36-month event-free survival was higher in patients with normal and lower in patients with reduced CFR (98% vs 64%, P < .0001). At Cox analysis, CFR of LAD (hazard ratio [HR] 16.52, 95% CI 5.76-47.40, P < .0001), left ventricular mass index (HR 1.03 per unit increment, 95% CI 1.00-1.05, P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. CONCLUSIONS: In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
Jia Zhen Zhang - One of the best experts on this subject based on the ideXlab platform.
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The effect of compression loading on fatigue crack propagation after a single tensile overload at Negative Stress ratios
International Journal of Fatigue, 2018Co-Authors: Jia Zhen ZhangAbstract:Abstract Experiments on fatigue crack propagation under a loading history with a single tensile overload at an overload ratio of ROL = 1.8 were performed at different baseline Stress ratios of R = 0, −0.25, and −1 for aluminium alloy 2A12-O. The widely accepted fatigue crack propagation retardation due to a single tensile overload (OL) in the case of a positive Stress ratio (R) was observed at R = 0. However, the retardation effect gradually decreased from R = 0 to R = −0.25 and disappeared at R = −1. These results indicate that the applied compressive load has a significant effect on the fatigue crack propagation after a single tensile overload for aluminium alloy 2A12-O. To reveal the mechanism of this effect of compression loading, a detailed elastic-plastic finite element (FE) analysis was performed. Based on the results of finite element analysis, a mechanism of additional reverse plastic damage caused by compression loading was proposed to explain the interaction of tensile overload and compressive load. The parameter of reverse plastic zone size was applied to characterize the additional reverse plastic damage. A parameter describing the effect of compression loading on fatigue crack propagation retardation due to a single tensile overload was developed. Using this parameter it was verified that the mechanism of additional reverse plastic damage is effective to explain the compression loading effect on the fatigue crack propagation retardation due to a single tensile overload.
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Study on Fatigue Crack Propagation at Negative Stress Ratio in 2A12 Aluminum Alloy
Advanced Materials Research, 2011Co-Authors: Jia Zhen ZhangAbstract:This paper intends to get compressive loading effect on fatigue crack growth of 2A12 aluminum alloy. The fatigue crack propagation tests at Negative Stress ratio R=-0.5, -1and -2 were made in different applied compressive loading. The result showed that the effect of the compressive loading part of the applied Stress cycle on fatigue crack growth rate in 2A12 aluminum alloy at Negative Stress ratio can not be omitted.
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Fatigue Crack Propagation at Negative Stress Ratio in 2A12 Aluminum Alloy
Advanced Materials Research, 2010Co-Authors: Jia Zhen ZhangAbstract:Fatigue crack propagation tests in the Paris region were performed in order to get compressive loading effect on fatigue crack growth at Negative Stress ratio (R) in 2A12 aluminum alloy. The results of the tests showed that the effect of the compressive loading part of the applied Stress cycle on fatigue crack growth rate da/dN in 2A12 aluminum alloy at Negative Stress ratio can not be omitted. The fatigue crack growth rate at R0 under the same range of Stress intensity factor Kmax. The da/dN is the function of Kmax and Stress ratio R. The promoting effect has an increase trend with the increase of the absolute value of the Negative Stress ratio R. Then a model involved compressive loading effect on fatigue crack propagation at Negative Stress was obtained. The model has been obtained good agreements with the experimental data.
Emilio Pasanisi - One of the best experts on this subject based on the ideXlab platform.
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The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study.
American Heart Journal, 2020Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:Background Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. Aim To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. Methods We studied 329 consecutive patients (193 men, age 61 ± 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. Results During follow-up (28 ± 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (>6 months) coronary revascularizations. Moreover, 9 patients underwent early ( P P P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. Conclusions In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
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the additional prognostic value of coronary flow reserve on left anterior descending artery in patients with Negative Stress echo by wall motion criteria a transthoracic vasodilator Stress echocardiography study
American Heart Journal, 2006Co-Authors: Fausto Rigo, Lauro Cortigiani, Emilio Pasanisi, M. Richieri, V. Cutaia, Massimo Celestre, Antonio Raviele, Eugenio PicanoAbstract:BACKGROUND: Vasodilator Stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. AIM: To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and Negative Stress echo. METHODS: We studied 329 consecutive patients (193 men, age 61 +/- 13 years) with known (n = 101) or suspected (n = 228) CAD and Negative Stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) Stress echo with CFR evaluation of LAD by Doppler. RESULTS: During follow-up (28 +/- 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (> 6 months) coronary revascularizations. Moreover, 9 patients underwent early (< 6 months) revascularization and were censored. Using a receiver operating characteristic analysis, CFR < or = 1.92 was the best predictor of future events (area under the curve = 0.80, sensitivity = 77%, specificity = 85%) and was taken as criterion for reduced CFR accordingly. Sixty-three (19%) patients had reduced and 266 (81%) had normal CFR on LAD. The 36-month event-free survival was higher in patients with normal and lower in patients with reduced CFR (98% vs 64%, P < .0001). At Cox analysis, CFR of LAD (hazard ratio [HR] 16.52, 95% CI 5.76-47.40, P < .0001), left ventricular mass index (HR 1.03 per unit increment, 95% CI 1.00-1.05, P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. CONCLUSIONS: In patients with known or suspected CAD and Negative Stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.
