Exploration of Cardiology

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Original Article

Normal physiologic coronary flow velocity gradient across the left anterior descending artery in healthy asymptomatic subjects
Aim: Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across th [...] Read more.

Aim:

Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD.

Methods:

In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments.

Results:

The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid).

Conclusions:

A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data.

Fausto Rigo ... Maurizio Agnoletto

Published: August 31, 2023 Explor Cardiol. 2023;1:42–48
DOI: https://doi.org/10.37349/ec.2023.00006

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Aim:

Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD.

Methods:

In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments.

Results:

The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid).

Conclusions:

A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data.

Open Access

Perspective

Alcohol zero: the end, the beginning of the end, or just the end of the beginning?
Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommend [...] Read more.

Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population.

Miodrag Ostojic ... Dusko Vulic

Published: August 31, 2023 Explor Cardiol. 2023;1:35–41
DOI: https://doi.org/10.37349/ec.2023.00005

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Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population.

Open Access

Original Article

Left ventricular systolic function and initial exercise capacity—their importance for results of cardiac rehabilitation after acute coronary syndrome
Aim: The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilit [...] Read more.

Aim:

The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation.

Methods:

A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed.

Results:

The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (> 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [> 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF > 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found.

Conclusions:

The combination of LVEF > 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation.

Barbara Uznańska-Loch ... Tomasz Rechciński

Published: August 30, 2023 Explor Cardiol. 2023;1:26–34
DOI: https://doi.org/10.37349/ec.2023.00004
This article belongs to the special issue Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin

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Aim:

The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation.

Methods:

A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed.

Results:

The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (> 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [> 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF > 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found.

Conclusions:

The combination of LVEF > 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation.

Open Access

Review

Alcohol—dose question and the weakest link in a chemical interplay
The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive [...] Read more.

The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive system abnormalities, and circulatory dysfunctions, in addition to socio-psychological aspects. Within the domain of cardiology, a substantial portion of the ongoing scientific discourse centers on elucidating the toxic dose of alcohol. Presented herewith are the findings from a comprehensive review of the latest publications pertinent to this crucial issue.

Piotr Hamala, Karina Wierzbowska-Drabik

Published: August 18, 2023 Explor Cardiol. 2023;1:15–25
DOI: https://doi.org/10.37349/ec.2023.00003
This article belongs to the special issue Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin

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The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive system abnormalities, and circulatory dysfunctions, in addition to socio-psychological aspects. Within the domain of cardiology, a substantial portion of the ongoing scientific discourse centers on elucidating the toxic dose of alcohol. Presented herewith are the findings from a comprehensive review of the latest publications pertinent to this crucial issue.

Open Access

Original Article

In search of heart barometer—advantage of left atrial dimension over electrocardiographic indices of left ventricular hypertrophy in arterial hypertension
Aim: Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. [...] Read more.

Aim:

Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH.

Methods:

The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared.

Results:

Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women—rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R²= 0.52, P < 0.0001.

Conclusions:

LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.

Bogusława Nowak ... Karina Wierzbowska-Drabik

Published: July 14, 2023 Explor Cardiol. 2023;1:4–14
DOI: https://doi.org/10.37349/ec.2023.00002
This article belongs to the special issue Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin

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Aim:

Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH.

Methods:

The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared.

Results:

Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women—rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R²= 0.52, P < 0.0001.

Conclusions:

LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.

Open Access

Editorial

Exploration of Cardiology: a new journal is born

Eugenio Picano

Published: July 01, 2023 Explor Cardiol. 2023;1:1–3
DOI: https://doi.org/10.37349/ec.2023.00001

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