Caroline Veltman | Leiden University (original) (raw)

Papers by Caroline Veltman

Research paper thumbnail of For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest prognostic value in patients with chronic heart failure? Results of a pooled individual patient data meta-analysis

European heart journal cardiovascular Imaging, 2014

The purpose of this study was to determine the most appropriate prognostic endpoint for myocardia... more The purpose of this study was to determine the most appropriate prognostic endpoint for myocardial (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with chronic heart failure (CHF) based on aggregate results from multiple studies published in the past decade. Original individual late (3-5 h) heart/mediastinum (H/M) ratio data of 636 CHF patients were retrieved from six studies from Europe and the USA. All-cause mortality, cardiac mortality, arrhythmic events, and heart transplantation were investigated to determine which provided the strongest prognostic significance for the MIBG imaging data. The majority of patients was male (78%), had a decreased left ventricular ejection fraction (31.1 ± 12.5%), and a mean late H/M of 1.67 ± 0.47. During follow-up (mean 36.9 ± 20.1 months), there were 83 deaths, 67 cardiac deaths, 33 arrhythmic events, and 56 heart transplants. In univariate regression analysis, late H/M was a significant predictor of all event categories, but lowe...

Research paper thumbnail of Influence of coronary vessel dominance on short-and long-term outcome in patients after ST-segment elevation myocardial infarction

European Heart Journal, 2014

Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infar... more Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short-and longterm outcome after STEMI.

Research paper thumbnail of THE PROGNOSTIC VALUE OF CORONARY VESSEL DOMINANCE AS DETERMINED USING COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY

Journal of the American College of Cardiology, 2011

Limited information is available about the difference in prognosis between patients with right do... more Limited information is available about the difference in prognosis between patients with right dominant (RD), left dominant (LD) or balanced coronary artery system. The purpose was to determine the prognostic value of coronary vessel dominance as assessed on computed tomography coronary angiography (CTA).

Research paper thumbnail of HEAD-TO-HEAD COMPARISON OF CALCIFICATION PATTERNS ON MULTIDETECTOR COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY TO VULNERABLE PLAQUE CHARACTERISTICS ON VIRTUAL HISTOLOGY INTRAVASCULAR ULTRASOUND

Journal of the American College of Cardiology, 2011

Category: 36. CT Coronary Angiography Session-Poster Board Number: 1061-204

Research paper thumbnail of REPRODUCIBILITY OF HEART TO MEDIASTINUM RATIO ON 123IODINE-META-IODOBENZYLGUANIDINE (123I-MIBG) MYOCARDIAL SCINTIGRAPHY IN PATIENTS WITH HEART FAILURE

Journal of the American College of Cardiology, 2012

Category: 23. Imaging: Nuclear

Research paper thumbnail of Association of atherosclerosis in the descending thoracic aorta with coronary artery disease on multi detector row computed tomography coronary angiography in patients with suspected coronary artery disease

The International Journal of Cardiovascular Imaging, 2013

The association between atherosclerosis in the descending thoracic aorta (DTA) visualized on comp... more The association between atherosclerosis in the descending thoracic aorta (DTA) visualized on computed tomography coronary angiography (CTA) and coronary artery disease (CAD) has not been extensively explored. Therefore, a comprehensive analysis of DTA atherosclerosis on CTA was performed and the association of DTA atherosclerosis with CAD was evaluated in patients with suspected CAD. A total of 344 patients (54 ± 12 years, 54% men) with suspected CAD underwent CTA. CTA were classified based on CAD severity in no signs of atherosclerosis or minor wall-irregularities <30%, non-significant CAD 30-50%, or significant CAD ≥50% stenosis. The DTA was divided in segments according the posterior intercostal arteries. Per segment the presence of atherosclerotic plaque (defined as ≥2 mm wall thickness) was determined and maximal wall thickness was measured. Plaque composition was scored as non-calcified or mixed and the percentage of DTA segments with atherosclerosis was calculated. Significant CAD was present in 152 (44%) patients and 278 (81%) had DTA atherosclerotic plaque. DTA maximal wall thickness and percentage of DTA segments with atherosclerosis were 2.7 ± 1 mm and 49 ± 36%. The presence, severity and extent of DTA atherosclerosis significantly increased with increasing CAD severity. Multivariate logistic regression analysis corrected for age and other risk factors demonstrated independent associations of DTA plaque (OR 6.56, 95% CI 1.78-24.19, p = 0.005) and maximal DTA wall thickness (OR 2.00, 95% CI 1.28-3.12, p = 0.002) with significant CAD. The presence and severity of DTA atherosclerosis were independently related with significant CAD on CTA in patients with suspected CAD.

Research paper thumbnail of Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: a comparison with tissue Doppler imaging

European Journal of Nuclear Medicine and Molecular Imaging, 2011

Purpose The aim of the current study was to evaluate the feasibility of phase analysis on gated m... more Purpose The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT (GMPS) for the assessment of left ventricular (LV) diastolic dyssynchrony in a head-to-head comparison with tissue Doppler imaging (TDI). Methods The population consisted of patients with endstage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of ≤35%. LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls (diastolic mechanical delay). Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of >55 ms on TDI. Furthermore, phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony; diastolic phase standard deviation (SD) and histogram bandwidth (HBW) were used as markers of LV diastolic dyssynchrony. Results A total of 150 patients (114 men, mean age 66.0± 10.4 years) with end-stage heart failure were enrolled. Both diastolic phase SD (r=0.81, p<0.01) and diastolic HBW (r= 0.75, p<0.01) showed good correlations with LV diastolic dyssynchrony on TDI. Additionally, patients with LV diastolic dyssynchrony on TDI (>55 ms) showed significantly larger diastolic phase SD (68.1±13.4°vs. 40.7±14.0°, p<0.01) and diastolic HBW (230.6±54.3°vs. 129.0±55.6°, p<0.01) as compared to patients without LV diastolic dyssynchrony on TDI (≤55 ms). Finally, phase analysis on GMPS showed a good intra-and interobserver reproducibility for the determination of diastolic phase SD (ICC 0.97 and 0.88) and diastolic HBW (ICC 0.98 and 0.93). Conclusion Phase analysis on GMPS showed good correlations with TDI for the assessment of LV diastolic dyssynchrony.

Research paper thumbnail of Four-year follow-up of treatment with intramyocardial skeletal myoblasts injection in patients with ischaemic cardiomyopathy

European Heart Journal, 2008

Studies reporting improved left ventricular (LV) function of percutaneous skeletal myoblast (SkM)... more Studies reporting improved left ventricular (LV) function of percutaneous skeletal myoblast (SkM) injection in patients with ischaemic cardiomyopathy had follow-up not exceeding 12 months, and did not include a control group. Our group has reported evidence for myoblast efficacy in the first five out of the 14 treated patients. The objective of the present evaluation was to assess if these effects were sustained at long-term follow-up. We compared function of patients treated with SkM 4 years earlier with a matched control group. Secondary endpoints included mortality, NYHA class, N-terminal pro-B-natriuretic peptide levels, incidence of arrhythmias, and quality of life.

Research paper thumbnail of Comparison of Contrast Agent–Enhanced Versus Non-Contrast Agent–Enhanced Real-Time Three-Dimensional Echocardiography for Analysis of Left Ventricular Systolic Function

The American Journal of Cardiology, 2007

Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study... more Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study was to evaluate the value of contrast agent-enhanced versus non-contrast agent-enhanced real-time 3-dimensional echocardiography (RT3DE) for the assessment of left ventricular (LV) volumes and ejection fraction. Thirty-nine unselected patients underwent RT3DE with and without SonoVue contrast agent enhancement and magnetic resonance imaging (MRI) on the same day. An image quality index was calculated by grading all 16 individual LV segments on a scale of 0 to 4: 0, not visible; 1, poor; 2, moderate; 3, good; and 4, excellent. The 3-dimensional data sets were analyzed offline using dedicated TomTec analysis software. By manual tracing, LV end-systolic volume, LV end-diastolic volume, and LV ejection fraction were calculated. After contrast agent enhancement, mean image quality index improved from 2.4 ؎ 1.0 to 3.0 ؎ 0.9 (p <0.001). Contrast agent-enhanced RT3DE measurements showed better correlation with MRI (LV end-diastolic volume, r ‫؍‬ 0.97 vs 0.86; LV end-systolic volume, r ‫؍‬ 0.96 vs 0.94; LV ejection fraction, r ‫؍‬ 0.94 vs 0.81). The limits of agreement (Bland-Altman analysis) showed a similar bias for RT3DE images with and without contrast agent but with smaller limits of agreement for contrast agent-enhanced RT3DE. Also, inter-and intraobserver variabilities decreased. In a subgroup, patients with poor to moderate image quality showed an improvement in agreement after administration of contrast agent (؎24.4% to ؎12.7%) to the same level as patients with moderate to good image quality without contrast agent (؎10.4%). In conclusion, contrast agent-enhanced RT3DE is more accurate in assessment of LV function as evidenced by better correlation and narrower limits of agreement compared with MRI, as well as lower intra-and interobserver variabilities.

Research paper thumbnail of Prognostic Significance of QRS Duration in Patients With Suspected Coronary Artery Disease Referred for Noninvasive Evaluation of Myocardial Ischemia

The American Journal of Cardiology, 2009

The purpose of this study was to evaluate the prognostic significance of QRS duration in patients... more The purpose of this study was to evaluate the prognostic significance of QRS duration in patients with suspected coronary artery disease (CAD) referred for noninvasive evaluation of myocardial ischemia by dobutamine stress echocardiography. QRS duration is a prognostic marker in patients with previous myocardial infarction and/or heart failure. The relation between QRS duration and outcome of patients without known heart disease has not been evaluated. A total of 1,227 patients (707 men, mean age 61 ؎ 14 years) with suspected CAD underwent dobutamine stress echocardiography for evaluation of myocardial ischemia. Patients were followed to determine predictors of cardiac events and to assess the incremental significance of QRS duration compared to clinical and dobutamine stress echocardiographic data. During a mean follow-up of 4.2 ؎ 2.4 years, 280 patients (23%) died (129 cardiac deaths), and 60 (5%) had a nonfatal infarction. Annualized cardiac death rates were 2.0% in patients with QRS duration <120 ms and 4.4% in patients with QRS duration >120 ms, respectively (p <0.0001). Annualized event rates for cardiac death/nonfatal infarction were 2.8% in patients with QRS duration <120 ms and 4.8% in patients with QRS duration >120 ms (p ‫؍‬ 0.0001). Multivariate models identified age, male gender, smoking, QRS duration >120 ms, and an abnormal dobutamine stress echocardiogram as independent predictors of cardiac death and the combined end point cardiac death/nonfatal infarction. In conclusion, QRS duration is an independent predictor of cardiac death and cardiac death/nonfatal infarction in patients with suspected CAD. This risk is persistent after adjustment for clinical variables, left ventricular function, and myocardial ischemia.

Research paper thumbnail of Relation Between Coronary Arterial Dominance and Left Ventricular Ejection Fraction After ST-Segment Elevation Acute Myocardial Infarction in Patients Having Percutaneous Coronary Intervention

The American Journal of Cardiology, 2014

The presence of a left dominant coronary artery system is associated with worse outcome after ST-... more The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.

Research paper thumbnail of For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest prognostic value in patients with chronic heart failure? Results of a pooled individual patient data meta-analysis

European heart journal cardiovascular Imaging, 2014

The purpose of this study was to determine the most appropriate prognostic endpoint for myocardia... more The purpose of this study was to determine the most appropriate prognostic endpoint for myocardial (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with chronic heart failure (CHF) based on aggregate results from multiple studies published in the past decade. Original individual late (3-5 h) heart/mediastinum (H/M) ratio data of 636 CHF patients were retrieved from six studies from Europe and the USA. All-cause mortality, cardiac mortality, arrhythmic events, and heart transplantation were investigated to determine which provided the strongest prognostic significance for the MIBG imaging data. The majority of patients was male (78%), had a decreased left ventricular ejection fraction (31.1 ± 12.5%), and a mean late H/M of 1.67 ± 0.47. During follow-up (mean 36.9 ± 20.1 months), there were 83 deaths, 67 cardiac deaths, 33 arrhythmic events, and 56 heart transplants. In univariate regression analysis, late H/M was a significant predictor of all event categories, but lowe...

Research paper thumbnail of Influence of coronary vessel dominance on short-and long-term outcome in patients after ST-segment elevation myocardial infarction

European Heart Journal, 2014

Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infar... more Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short-and longterm outcome after STEMI.

Research paper thumbnail of THE PROGNOSTIC VALUE OF CORONARY VESSEL DOMINANCE AS DETERMINED USING COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY

Journal of the American College of Cardiology, 2011

Limited information is available about the difference in prognosis between patients with right do... more Limited information is available about the difference in prognosis between patients with right dominant (RD), left dominant (LD) or balanced coronary artery system. The purpose was to determine the prognostic value of coronary vessel dominance as assessed on computed tomography coronary angiography (CTA).

Research paper thumbnail of HEAD-TO-HEAD COMPARISON OF CALCIFICATION PATTERNS ON MULTIDETECTOR COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY TO VULNERABLE PLAQUE CHARACTERISTICS ON VIRTUAL HISTOLOGY INTRAVASCULAR ULTRASOUND

Journal of the American College of Cardiology, 2011

Category: 36. CT Coronary Angiography Session-Poster Board Number: 1061-204

Research paper thumbnail of REPRODUCIBILITY OF HEART TO MEDIASTINUM RATIO ON 123IODINE-META-IODOBENZYLGUANIDINE (123I-MIBG) MYOCARDIAL SCINTIGRAPHY IN PATIENTS WITH HEART FAILURE

Journal of the American College of Cardiology, 2012

Category: 23. Imaging: Nuclear

Research paper thumbnail of Association of atherosclerosis in the descending thoracic aorta with coronary artery disease on multi detector row computed tomography coronary angiography in patients with suspected coronary artery disease

The International Journal of Cardiovascular Imaging, 2013

The association between atherosclerosis in the descending thoracic aorta (DTA) visualized on comp... more The association between atherosclerosis in the descending thoracic aorta (DTA) visualized on computed tomography coronary angiography (CTA) and coronary artery disease (CAD) has not been extensively explored. Therefore, a comprehensive analysis of DTA atherosclerosis on CTA was performed and the association of DTA atherosclerosis with CAD was evaluated in patients with suspected CAD. A total of 344 patients (54 ± 12 years, 54% men) with suspected CAD underwent CTA. CTA were classified based on CAD severity in no signs of atherosclerosis or minor wall-irregularities &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%, non-significant CAD 30-50%, or significant CAD ≥50% stenosis. The DTA was divided in segments according the posterior intercostal arteries. Per segment the presence of atherosclerotic plaque (defined as ≥2 mm wall thickness) was determined and maximal wall thickness was measured. Plaque composition was scored as non-calcified or mixed and the percentage of DTA segments with atherosclerosis was calculated. Significant CAD was present in 152 (44%) patients and 278 (81%) had DTA atherosclerotic plaque. DTA maximal wall thickness and percentage of DTA segments with atherosclerosis were 2.7 ± 1 mm and 49 ± 36%. The presence, severity and extent of DTA atherosclerosis significantly increased with increasing CAD severity. Multivariate logistic regression analysis corrected for age and other risk factors demonstrated independent associations of DTA plaque (OR 6.56, 95% CI 1.78-24.19, p = 0.005) and maximal DTA wall thickness (OR 2.00, 95% CI 1.28-3.12, p = 0.002) with significant CAD. The presence and severity of DTA atherosclerosis were independently related with significant CAD on CTA in patients with suspected CAD.

Research paper thumbnail of Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: a comparison with tissue Doppler imaging

European Journal of Nuclear Medicine and Molecular Imaging, 2011

Purpose The aim of the current study was to evaluate the feasibility of phase analysis on gated m... more Purpose The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT (GMPS) for the assessment of left ventricular (LV) diastolic dyssynchrony in a head-to-head comparison with tissue Doppler imaging (TDI). Methods The population consisted of patients with endstage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of ≤35%. LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls (diastolic mechanical delay). Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of >55 ms on TDI. Furthermore, phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony; diastolic phase standard deviation (SD) and histogram bandwidth (HBW) were used as markers of LV diastolic dyssynchrony. Results A total of 150 patients (114 men, mean age 66.0± 10.4 years) with end-stage heart failure were enrolled. Both diastolic phase SD (r=0.81, p<0.01) and diastolic HBW (r= 0.75, p<0.01) showed good correlations with LV diastolic dyssynchrony on TDI. Additionally, patients with LV diastolic dyssynchrony on TDI (>55 ms) showed significantly larger diastolic phase SD (68.1±13.4°vs. 40.7±14.0°, p<0.01) and diastolic HBW (230.6±54.3°vs. 129.0±55.6°, p<0.01) as compared to patients without LV diastolic dyssynchrony on TDI (≤55 ms). Finally, phase analysis on GMPS showed a good intra-and interobserver reproducibility for the determination of diastolic phase SD (ICC 0.97 and 0.88) and diastolic HBW (ICC 0.98 and 0.93). Conclusion Phase analysis on GMPS showed good correlations with TDI for the assessment of LV diastolic dyssynchrony.

Research paper thumbnail of Four-year follow-up of treatment with intramyocardial skeletal myoblasts injection in patients with ischaemic cardiomyopathy

European Heart Journal, 2008

Studies reporting improved left ventricular (LV) function of percutaneous skeletal myoblast (SkM)... more Studies reporting improved left ventricular (LV) function of percutaneous skeletal myoblast (SkM) injection in patients with ischaemic cardiomyopathy had follow-up not exceeding 12 months, and did not include a control group. Our group has reported evidence for myoblast efficacy in the first five out of the 14 treated patients. The objective of the present evaluation was to assess if these effects were sustained at long-term follow-up. We compared function of patients treated with SkM 4 years earlier with a matched control group. Secondary endpoints included mortality, NYHA class, N-terminal pro-B-natriuretic peptide levels, incidence of arrhythmias, and quality of life.

Research paper thumbnail of Comparison of Contrast Agent–Enhanced Versus Non-Contrast Agent–Enhanced Real-Time Three-Dimensional Echocardiography for Analysis of Left Ventricular Systolic Function

The American Journal of Cardiology, 2007

Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study... more Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study was to evaluate the value of contrast agent-enhanced versus non-contrast agent-enhanced real-time 3-dimensional echocardiography (RT3DE) for the assessment of left ventricular (LV) volumes and ejection fraction. Thirty-nine unselected patients underwent RT3DE with and without SonoVue contrast agent enhancement and magnetic resonance imaging (MRI) on the same day. An image quality index was calculated by grading all 16 individual LV segments on a scale of 0 to 4: 0, not visible; 1, poor; 2, moderate; 3, good; and 4, excellent. The 3-dimensional data sets were analyzed offline using dedicated TomTec analysis software. By manual tracing, LV end-systolic volume, LV end-diastolic volume, and LV ejection fraction were calculated. After contrast agent enhancement, mean image quality index improved from 2.4 ؎ 1.0 to 3.0 ؎ 0.9 (p <0.001). Contrast agent-enhanced RT3DE measurements showed better correlation with MRI (LV end-diastolic volume, r ‫؍‬ 0.97 vs 0.86; LV end-systolic volume, r ‫؍‬ 0.96 vs 0.94; LV ejection fraction, r ‫؍‬ 0.94 vs 0.81). The limits of agreement (Bland-Altman analysis) showed a similar bias for RT3DE images with and without contrast agent but with smaller limits of agreement for contrast agent-enhanced RT3DE. Also, inter-and intraobserver variabilities decreased. In a subgroup, patients with poor to moderate image quality showed an improvement in agreement after administration of contrast agent (؎24.4% to ؎12.7%) to the same level as patients with moderate to good image quality without contrast agent (؎10.4%). In conclusion, contrast agent-enhanced RT3DE is more accurate in assessment of LV function as evidenced by better correlation and narrower limits of agreement compared with MRI, as well as lower intra-and interobserver variabilities.

Research paper thumbnail of Prognostic Significance of QRS Duration in Patients With Suspected Coronary Artery Disease Referred for Noninvasive Evaluation of Myocardial Ischemia

The American Journal of Cardiology, 2009

The purpose of this study was to evaluate the prognostic significance of QRS duration in patients... more The purpose of this study was to evaluate the prognostic significance of QRS duration in patients with suspected coronary artery disease (CAD) referred for noninvasive evaluation of myocardial ischemia by dobutamine stress echocardiography. QRS duration is a prognostic marker in patients with previous myocardial infarction and/or heart failure. The relation between QRS duration and outcome of patients without known heart disease has not been evaluated. A total of 1,227 patients (707 men, mean age 61 ؎ 14 years) with suspected CAD underwent dobutamine stress echocardiography for evaluation of myocardial ischemia. Patients were followed to determine predictors of cardiac events and to assess the incremental significance of QRS duration compared to clinical and dobutamine stress echocardiographic data. During a mean follow-up of 4.2 ؎ 2.4 years, 280 patients (23%) died (129 cardiac deaths), and 60 (5%) had a nonfatal infarction. Annualized cardiac death rates were 2.0% in patients with QRS duration <120 ms and 4.4% in patients with QRS duration >120 ms, respectively (p <0.0001). Annualized event rates for cardiac death/nonfatal infarction were 2.8% in patients with QRS duration <120 ms and 4.8% in patients with QRS duration >120 ms (p ‫؍‬ 0.0001). Multivariate models identified age, male gender, smoking, QRS duration >120 ms, and an abnormal dobutamine stress echocardiogram as independent predictors of cardiac death and the combined end point cardiac death/nonfatal infarction. In conclusion, QRS duration is an independent predictor of cardiac death and cardiac death/nonfatal infarction in patients with suspected CAD. This risk is persistent after adjustment for clinical variables, left ventricular function, and myocardial ischemia.

Research paper thumbnail of Relation Between Coronary Arterial Dominance and Left Ventricular Ejection Fraction After ST-Segment Elevation Acute Myocardial Infarction in Patients Having Percutaneous Coronary Intervention

The American Journal of Cardiology, 2014

The presence of a left dominant coronary artery system is associated with worse outcome after ST-... more The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.