Jul 2026· Community Based Medical Journal· Vol 15, pp. 296-303· 0 citations
TL;DR
A 12-week course of guideline-directed medical therapy in CAD patients leads to significant early echocardiographic improvement in systolic and diastolic function, and the utility of short-interval echocardiographic follow-up to objectively monitor therapeutic response is supported.
Abstract
Coronary artery disease (CAD) is a leading cause of global morbidity and mortality, with progressive left ventricular dysfunction being a critical determinant of prognosis. Serial monitoring of cardiac function during guideline-directed medical therapy (GDMT) is essential, yet data on the short-term echocardiographic trajectory in a real-world setting are limited. Objective: This study aimed to prospectively assess changes in echocardiographic parameters of cardiac function in CAD patients over a standardized 12-week GDMT period. This prospective cohort study was conducted at International Medical College, Dhaka, Bangladesh, from January to December 2023. Using purposive sampling, 63 diagnosed CAD patients were enrolled. All participants received optimized GDMT per standard protocols. Transthoracic echocardiography was performed at baseline and after 12 weeks, with key measurements including left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), end-systolic volume (LVESV), and E/e' ratio. Data were analyzed using SPSS version 23.0, employing paired t-tests for normally distributed data (p<0.05 considered significant). Among 63 patients (mean age 58.7±9.2 years, 68.3% male), significant improvements were observed in key echocardiographic parameters after 12 weeks. Left ventricular ejection fraction increased from 45.2±7.8% to 49.5±8.1% (p=0.003). Concurrently, left ventricular end-systolic volume decreased from 68.5±15.2 mL to 62.1±14.7 mL (p=0.010), and the average E/e' ratio declined from 12.4±3.1 to 10.8±2.9 (p=0.020). A 12-week course of guideline-directed medical therapy in CAD patients leads to significant early echocardiographic improvement in systolic and diastolic function. These findings support the utility of short-interval echocardiographic follow-up to objectively monitor therapeutic response.
CBMJ 2026 July: Vol. 15 No. 02 P:296-303
Routinely available ECG-derived P-wave dispersion and echocardiographic LAVI are independent, complementary predictors of MACE in CAD patients, and integrating these two parameters into a simple risk model significantly enhances risk discrimination and reclassification, providing a practical, cost-effective tool for individualized management.
Qin Wu, Gang Chen, Jian Chang· Frontiers in Medicine· 0 citations
Background Cardiovascular disease is the leading cause of mortality among End-Stage Renal Disease (ESRD) patients in Southeast Asia. While left ventricular function is routinely assessed, the prognostic significance of right ventricular (RV) dysfunction remains critically understudied in Myanmar.
Objectives To determine the prevalence of RV dysfunction in maintenance hemodialysis patients and evaluate its independent association with a composite risk of one-year all-cause mortality and cardiovascular hospitalization.
Methods This prospective observational cohort study enrolled 200 adult ESRD patients. To minimize volume loading artifacts, comprehensive post-dialysis transthoracic echocardiography was performed. RV function was assessed using Tricuspid Annular Plane Systolic Excursion (TAPSE), RV Fractional Area Change, and Tissue Doppler Systolic Velocity. The primary composite endpoint evaluated 12-month all-cause mortality and decompensated heart failure hospitalization.
Results The cohort (mean age 53.1±12.4 years; 62% male) exhibited a 41.3% prevalence of RV dysfunction (TAPSE < 17 mm). Over a 12-month median follow-up, the primary endpoint occurred in 26.7% of patients. Non-survivors presented with significantly lower TAPSE (13.8±3.1 vs. 18.9±4.2 mm, p<0.001) and serum albumin. Kaplan-Meier analysis indicated significantly reduced event-free survival for patients with RV dysfunction (p<0.001). Following multivariable Cox regression adjustment for age, LVEF, dialysis vintage, and nutritional status, TAPSE < 17 mm remained a strong independent predictor of the composite outcome (HR: 2.38; 95% CI: 1.55-3.72; p<0.001).
Conclusions Despite overall mortality being lower than historical national averages, RV dysfunction was an independent predictor of adverse cardiovascular outcomes in this optimized hemodialysis cohort.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
Given its high sensitivity in evaluating left ventricular systolic function in patients with HCM, EF1 represents a promising adjunctive parameter for the multimodal assessment of systolic function in this population.
Left ventricular ejection fraction (LVEF) is the standard marker for systolic function, but it fails to detect subtle changes in myocardial contractility in patients after an ST-elevation myocardial infarction (STEMI). Thus, a new way to evaluate left ventricular (LV) function with high precision is needed to assess disease progression and guide therapeutic interventions. This study evaluates the prognostic significance of left atrial (LA) strain, LV strain, and myocardial work in patients who have undergone primary percutaneous coronary intervention (pPCI) post-STEMI. The study population was 100 patients diagnosed with STEMI, all of whom received pPCI for their first STEMI event. Patients were admitted to one of two centers, the cardiology department of Fayoum University in Egypt or the cardiac center at King Fahd University Hospital in Saudi Arabia, between November 2022 and March 2024. Conventional echocardiography and 2D speckle-tracking echocardiography (2D-STE) were performed on each participant within 24 h after pPCI and then repeated at least 6 months later. Myocardial work parameters, the global work index, global constructive work (GCW), global wasted work, and global work efficiency and LA strain parameters were derived from 2D-STE and analyzed for their association with subsequent LV remodeling. Myocardial work parameters (e.g., global longitudinal strain) were associated with LV remodeling after STEMI treated with pPCI, with GCW showing the most significant association with LV remodeling among the myocardial work indices evaluated. Furthermore, LV remodeling was associated with significantly impaired cardiac structure and function. Patients who developed LV remodeling exhibited higher LV volumes, lower LVEFs, impaired myocardial work parameters, and longer door-to-balloon times than those without remodeling. Additionally, LA function (e.g., LA ejection fraction) was significantly compromised in the remodeling group. Myocardial work and strain parameters were associated with LV remodeling after STEMI treated with pPCI. GCW demonstrated the strongest association with LV remodeling in the present cohort.
Gomaa Abdelrazek, Mahmoud H. Mahmoud, Gousay A. Alkhazmari et al.· Journal of Cardiovascular Im...· 0 citations
Background: Right ventricular (RV) dysfunction is an important determinant of hemodynamic instability and adverse outcomes in acute inferior wall myocardial infarction (IWMI), but its clinical significance may be underrecognized. This study evaluated the relationship of RV dysfunction with morbidity and in-hospital mortality in patients with acute IWMI.
Methods: A retrospective observational study was conducted among 94 adults with first-time acute IWMI admitted within 24 hours of symptom onset at the Department of Cardiology, SRIHER, Chennai. Diagnosis was established by inferior ST-segment elevation and positive cardiac biomarkers. Transthoracic echocardiography was performed within 24-48 hours, and RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler S' velocity, and RV/LV basal diameter ratio. Clinical, electrocardiographic, echocardiographic, and in-hospital outcome data were analyzed using appropriate statistical tests; p < 0.05 was considered significant.
Results: The mean age was 61.33 ± 11.36 years, with male predominance (69.1%). Dyslipidaemia (52.1%), hypertension (48.9%), and diabetes mellitus (45.7%) were common. Raised jugular venous pressure was present in 54.3%, ST-segment elevation in V4R in 53.2%, and atrioventricular block in 21.3%. Mean LVEF was 42.56 ± 8.60%, while mean TAPSE was 14.92 ± 3.44 mm. RV dysfunction was significantly associated with hypotension requiring inotropic support (χ² = 17.857, p < 0.0001), reduced TAPSE (χ² = 94.00, p < 0.0001), AV block (χ² = 7.680, p = 0.0056), V4R elevation (χ² = 32.292, p < 0.0001), raised JVP (χ² = 3.907, p = 0.0481), and increasing mitral regurgitation severity (χ² = 12.594, p = 0.0056). No significant association was observed with mechanical ventilation, hospital stay, or in-hospital mortality.
Conclusion: RV dysfunction is clinically important in acute IWMI and is strongly associated with hemodynamic compromise, ECG markers, conduction abnormalities, and echocardiographic abnormalities. Routine assessment of RV function, particularly TAPSE and right-sided ECG leads, may improve early risk stratification and guide management. Early recognition may facilitate timely hemodynamic support, intensive monitoring, and comprehensive biventricular assessment.
Hargun Singh, J. Balasubramaniyan· Adolescência e Saúde· 0 citations
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