Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain

作     者：Guido Pastorini Fabio Anastasio Anna Botto Valentina Tardivo Mauro Feola 

作者机构：Cardiology DivisionRegina Montis Regalis HospitalASLCN1Mondovi’Italy Intensive CareRegina Montis Re-galis HospitalASLCN1 Mondovi’Italy School of GeriatryUniversity of MedicineTurinItaly 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2024年第21卷第7期

页      面：760-767页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：patients echocardiographic branch 

摘      要：Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block(LBBB)have to be stratified for the presence of coronary artery disease and the risk of developing heart failure(HF).We investigated the pro-gnostic role of coronary CT-angiography(CTA)and echocardiographic global longitudinal strain(GLS)in those patients in a mid-term *** Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated *** of HF or a cardiovascular death were the events *** Seventy-eight patients(32 female;mean age:66.0±10.4 years were *** a follow-up of 33 months(IQR:17-77),one patient(1.5%)experienced a cardiovascular death,14 patients(17.9%)required urgent outpatient visits due to acute de-compensated HF(12 hospitalizations).Echocardiography showed a slightly reduced left ventricular ejection fraction(LVEF)(50.0%±9.8%)and GLS within the normal range(-16.2%±4.1%).CTA analysis showed coronary stenosis50%in 28 patients(35.9%).A high Agatston score(100)was observed in 29.5%.Notably,25 patients(32.1%)were diagnosed with left main coron-ary artery disease and 15 patients(16.7%)underwent revascularization during the follow *** associations were ob-served between events and LVEF(P=0.001),diastolic dysfunction grade≥2(P=0.02),GLS(P0.001),multiple coronary stenos-is(P=0.04)and Agatston score(P=0.05).Multivariate analysis confirmed the relationships with LVEF(R^(2)=0.89,P0.001),dia-stolic dysfunction(R^(2)=3.30,P=0.04),GLS(R^(2)=1.43,P0.001),and Agatston score(R^(2)=1.01,P=0.05).Conclusions In patients with complete LBBB,CTA and GLS identified those at a high risk of development HF.