The sympathetic denervation studies and the studies of microvascular involvement are the most important tools for early detection of Chagas heart disease. Especially the 123I-123I-MIBGSPECT or ...11C-meta-hydroxyephedrine-PET studies since everything starts from sympathetic denervation. Also it is advisable to insist on the assessment of other parameters of early involvement of left ventricular systolic function to understand the importance of the additional information provided by the analysis of the parameters of ventricular remodeling, synchrony, and GLS in patients with normal left ventricular ejection fraction and in the absence of ventricular dilatation for early detection of myocardial dysfunction.
To evaluate the Vall d’Hebron-Risk-Score (VH-RS) to stratify the risk of patients with stable ischemic cardiomyopathy (ICM), and assess whether hemoglobin (Hb) and estimated glomerular filtration ...rate (eGFR) provide additional information to the VH-RS.
We analysed 673 consecutive patients with ICM who underwent gated SPECT. According to VH-RS, we stratified patients into 4-risk-levels: very-low-risk (VLR), low-risk (LR), moderate-risk (MR), and high-risk (HRi). We considered as MACEs: non-fatal myocardial infarction (MI), heart failure hospitalization (HF), coronary revascularization (CR), and cardiac death (CD). Also the cardiac-resynchronization-therapy (CRT), and the implantable-cardioverter-defibrillator (ICD) were investigated. During the follow-up (4.8 ± 2.7 years), 379 patients had MACEs (0.18/patient/year). There were no patients in VLR and LR. All patients were reclassified in 3-risk-levels (MRi = 48; HRi = 121; VHRivery high risk = 504). Most patients with MACEs were in VHRi level (test-for-trend: MACEs ≥ 1 without CRT/ICD, P < .001; combined non-fatal MI, CD and CR, P < .001; MACEs ≥ 1 with CRT/ICD, P < .001). The Hb and eGFR values do not properly improve the risk stratification obtained by the VH-RS (global-NRInet-reclassification-improvement was: (MACEs ≥ 1 without CRT/ICD: − 10.6%; non-fatal MI, CD and CR: − 9.08%; and MACEs ≥ 1 with CRT/ICD: − 8.85%).
VH-RS is effective in evaluating risk of patients with stable ICM. In our population, adding Hb and eGFR variables do not improve the performance of the VH-RS.
Diabetes mellitus is an independent risk factor in the development of coronary artery disease (CAD), myocardial infarction (MI), and cardiac death (CD). The major adverse cardiac events (MACEs) ...between men and women in diabetic patients stratified by CAD (previous MI and/or coronary revascularization, CR) were analyzed.
A cohort of 1327 consecutive diabetic patients (age 66.5 ± 9 years) underwent gated SPECT (single-photon emission computed tomography). During a mean follow-up of 4.7 ± 2.2 years post gated SPECT, MACEs (non-fatal MI, CD, and late CR) were evaluated according to gender stratified by CAD. Among diabetic patients without known CAD (N = 731), men had more MACEs (sHR 1.9;95%CI 1.2-3.2) than women. Among diabetic patients with known CAD (N = 596), there was no difference in MACEs in diabetic men and women (sHR 1.15;95%CI 0.73-1.8). Diabetic women with known CAD (n = 143) were the group with the highest risk (sHR 1.7; P = .041) for MACEs (4.5% MACEs/year, 95%CI 3.1%-6.4%), compared to the remaining diabetic patients (N = 1184) (3% MACEs/year, 95%CI 2.6%-3.5%).
The prognosis of diabetic patients for MACEs is different in men and women stratified by CAD. The worst prognosis for MACEs occurs in women with known CAD.
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