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Nappi C, Panico M, Falzarano M, Vallone C, Ponsiglione A, Cutillo P, Zampella E, Petretta M, Cuocolo A. Tracers for Cardiac Imaging: Targeting the Future of Viable Myocardium. Pharmaceutics 2023; 15:pharmaceutics15051532. [PMID: 37242772 DOI: 10.3390/pharmaceutics15051532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Ischemic heart disease is the leading cause of mortality worldwide. In this context, myocardial viability is defined as the amount of myocardium that, despite contractile dysfunction, maintains metabolic and electrical function, having the potential for functional enhancement upon revascularization. Recent advances have improved methods to detect myocardial viability. The current paper summarizes the pathophysiological basis of the current methods used to detect myocardial viability in light of the advancements in the development of new radiotracers for cardiac imaging.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, 80131 Naples, Italy
| | - Maria Falzarano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Carlo Vallone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Paolo Cutillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Petretta
- IRCCS SYNLAB SDN, Via Gianturco 113, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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152
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Blach A, Kwiecinski J. The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases. Diagnostics (Basel) 2023; 13:1791. [PMID: 37238275 PMCID: PMC10217133 DOI: 10.3390/diagnostics13101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.
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Affiliation(s)
- Anna Blach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, 04-628 Warsaw, Poland
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153
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Khalid U, Kayani W, Alam M, Denktas AE. Revascularization Options for Left Main Disease: What Clinicians Need to Know. Curr Atheroscler Rep 2023:10.1007/s11883-023-01105-2. [PMID: 37178417 DOI: 10.1007/s11883-023-01105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE OF REVIEW Left main disease represents the highest-risk lesion subset of coronary artery disease and is associated with adverse cardiovascular events. Accordingly, we aim to understand how the significance of left main disease is assessed by different modalities, followed by a review of management options in current era. RECENT FINDINGS Invasive coronary angiogram remains the gold standard for assessment of left main disease, but intracoronary imaging or physiological testing is indicated for angiographically equivocal disease. Revascularization by either coronary artery bypass surgery or percutaneous coronary intervention is strongly recommended, which have been compared by six randomized trials, as well as recent meta-analyses. Surgical revascularization remains the preferred mode of revascularization, especially in patients with high lesion complexity and left ventricular dysfunction. Randomized studies are needed to understand if current-generation stents with the use of intracoronary imaging and improved medical therapy could match outcomes with surgical revascularization.
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Affiliation(s)
- Umair Khalid
- Section of Cardiology, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Waleed Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali E Denktas
- Section of Cardiology, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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154
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Iannaccone M, Franchin L, Burzotta F, Botti G, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Masiero G, Di Biasi M, Pagnotta P, Casu G, Scandroglio AM, Tarantini G, Chieffo A. Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry. J Pers Med 2023; 13:826. [PMID: 37240996 PMCID: PMC10222801 DOI: 10.3390/jpm13050826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7-8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08-0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.
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Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Luca Franchin
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Giulia Botti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, 80100 Naples, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Federico De Marco
- Valvular and Structural Heart Cardiology, Centro Cardiologico Monzino, 20100 Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Luigi Sacco, 20100 Milan, Italy
| | - Paolo Pagnotta
- Cardiovascular Department, Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Gavino Casu
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | - Anna Mara Scandroglio
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, 20100 Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
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155
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Gaudino M, Andreotti F, Kimura T. Current concepts in coronary artery revascularisation. Lancet 2023; 401:1611-1628. [PMID: 37121245 DOI: 10.1016/s0140-6736(23)00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 05/02/2023]
Abstract
Coronary artery revascularisation can be performed surgically or percutaneously. Surgery is associated with higher procedural risk and longer recovery than percutaneous interventions, but with long-term reduction of recurrent cardiac events. For many patients with obstructive coronary artery disease in need of revascularisation, surgical or percutaneous intervention is indicated on the basis of clinical and anatomical reasons or personal preferences. Medical therapy is a crucial accompaniment to coronary revascularisation, and data suggest that, in some subsets of patients, medical therapy alone might achieve similar results to coronary revascularisation. Most revascularisation data are based on prevalently White, non-elderly, male populations in high-income countries; robust data in women, older adults, and racial and other minorities, and from low-income and middle-income countries, are urgently needed.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
| | - Felicita Andreotti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
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156
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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157
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Vicent L, Álvarez-García J, Vazquez-Garcia R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Fernández-Avilés F, Ariza-Sole A, Martínez-Sellés M. Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction. J Clin Med 2023; 12:3028. [PMID: 37109365 PMCID: PMC10143946 DOI: 10.3390/jcm12083028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, 08025 Barcelona, Spain
| | | | - José R. González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago, CIBERCV, 15076 Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, 46026 Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, 28222 Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Department of Medicine, University of Murcia, 30120 Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Worner
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Cardiology Department, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Albert Ariza-Sole
- Cardiology Department, Bellvitge University Hospital General, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
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158
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Pham V, Moroni A, Gall E, Benedetti A, Zivelonghi C, Picard F. Revascularization and Medical Therapy for Chronic Coronary Syndromes: Lessons Learnt from Recent Trials, a Literature Review. J Clin Med 2023; 12:jcm12082833. [PMID: 37109169 PMCID: PMC10141707 DOI: 10.3390/jcm12082833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Stable coronary artery disease (CAD) has recently been replaced by a new entity described as chronic coronary syndrome (CCS). This new entity has been developed based on a better understanding of the pathogenesis, the clinical characteristics, and the morbi-mortality associated to this condition as part of the dynamic spectrum of CAD. This has significant implications in the clinical management of CCS patients, that ranges from lifestyle adaptation, medical therapy targeting all the elements contributing to CAD progression (i.e., platelet aggregation, coagulation, dyslipidaemia, and systemic inflammation), to invasive strategies (i.e., revascularization). CCS is the most frequent presentation of coronary artery disease which is the first cardiovascular disease worldwide. Medical therapy is the first line therapy for these patients; however, revascularization and especially percutaneous coronary intervention remains beneficial for some of them. European and American guidelines on myocardial revascularization were released in 2018 and 2021, respectively. These guidelines provide different scenarios to help physicians choose the optimal therapy for CCS patients. Recently, several trials focusing on CCS patients have been published. We sought to synthetize the place of revascularization in CCS patients according to the latest guidelines, the lessons learnt from recent trials on revascularization and medical therapy, and future perspectives.
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Affiliation(s)
- Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alice Moroni
- Department of Cardiology, HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, 2020 Antwerp, Belgium
| | - Emmanuel Gall
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alice Benedetti
- Department of Cardiology, HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, 2020 Antwerp, Belgium
| | - Carlo Zivelonghi
- Department of Cardiology, HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, 2020 Antwerp, Belgium
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Faculté de Santé, Université Paris-Cité, 75006 Paris, France
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159
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Ezad SM, Babu G, O’Kane P. Sudden Cardiac Death in Ischaemic Cardiomyopathy and the Primary Prevention ICD: Time for a More a Personalised Approach? Interv Cardiol 2023. [DOI: 10.15420/icr.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Guidelines recommend primary prevention implantable cardioverter defibrillator (PPICD) for left ventricular ejection fraction (LVEF) <35% only after 3 months of optimal medical therapy (OMT) or 6 weeks after acute MI with persistent LVEF dysfunction. A 73-year-old woman presented with decompensated heart failure secondary to ischaemic cardiomyopathy. Severe coronary disease with sufficient dysfunctional myocardial segments on cardiac MRI suggested potential benefit from revascularisation. Following discussion with the heart team, she underwent percutaneous coronary intervention (PCI). PPICD implantation was deferred as per guideline recommendations. However, 20 days post-PCI, the patient died from malignant ventricular arrhythmia captured on a Holter monitor. This case demonstrates that some high-risk patients may not receive a potentially life-saving PPICD if guidelines are stringently adhered to. We highlight evidence that LVEF alone is of limited value in a risk assessment of arrhythmogenic death, and postulate that a more personalised ICD prescription should be considered using scar characteristics on cardiac MRI to prompt upstream ICD implantation in high-risk patients.
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Affiliation(s)
- Saad M Ezad
- Cardiovascular Division, King’s College London, London, UK; Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Girish Babu
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Peter O’Kane
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
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160
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Rodriguez AE, Fernandez-Pereira C, Mieres JR, Rodriguez-Granillo AM. High Non-Cardiac Death Incidence Should Be a Limitation of Drug-Eluting Stents Implantation? Insights from Recent Randomized Data. Diagnostics (Basel) 2023; 13:diagnostics13071321. [PMID: 37046540 PMCID: PMC10093159 DOI: 10.3390/diagnostics13071321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Despite the introduction of drug-eluting stents (DES) significantly improved the efficacy and safety of percutaneous coronary interventions (PCI), particularly in a high-risk group of patients, the gap between PCI with his competitor’s coronary artery bypass surgery (CABG) and/or optimal medical treatment alone was not reduced. In this revision, we highlighted the fact that in recent years landmark randomized studies reported at mid and long-term follow-ups a high incidence of non-cardiac death, cancer incidence, or both in the DES group of patients. The overall incidence of non-cardiac death was significantly higher in the DES vs. the comparator arm: 5.5% and 3.8%, respectively, p = 0.000018, and non-cardiac death appears to be more divergent between DES vs. the comparator at the extended follow-up to expenses of the last one. One of these trials reported five times greater cancer incidence in the DES arm at late follow-up, 5% vs. 0.7% p < 0.0018. We review the potential reason for these unexpected findings, although we can discard that DES biology could be involved in it. Until all these issues are resolved, we propose that DES implantation should be tailored accorded patient age, life expectancy, and lesion complexity.
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Affiliation(s)
- Alfredo E. Rodriguez
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Carlos Fernandez-Pereira
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Juan Ramon Mieres
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Alfredo Matias Rodriguez-Granillo
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
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161
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Nishimiya K, Poduval RK, Tearney GJ. OCT Emerging Technologies: Coronary Micro-optical Coherence Tomography. Interv Cardiol Clin 2023; 12:237-244. [PMID: 36922064 DOI: 10.1016/j.iccl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Optical coherence tomography (OCT) is an imaging modality that is used in a significant number of interventional cardiology procedures. Key structural changes occurring within the vessel wall, including presence of neutrophils, macrophages, monocytes, and vascular smooth muscle cells, are below the resolution of clinical intracoronary OCT. To address this challenge, a new form of OCT with 1 to 2 μm resolution, termed micro-OCT (μOCT), has been developed. This review article summarizes the ability of μOCT technology to visualize coronary microstructures and discusses its clinical implications.
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Affiliation(s)
- Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Radhika K Poduval
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard-MIT Division of Health Sciences and Technology Division, Cambridge, MA, USA.
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162
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Vassiliki’ Cousoumbas G, Casella G, Di Pasquale G. What is the role of coronary revascularization to recover the contractility of the dysfunctional heart? Eur Heart J Suppl 2023; 25:B75-B78. [PMID: 37091666 PMCID: PMC10120954 DOI: 10.1093/eurheartjsupp/suad072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Coronary artery disease is the predominant aetiology of heart failure and left ventricular dysfunction in industrialized countries. The pathophysiological substrate of hibernating myocardium constitutes the conceptual target of coronary revascularization by coronary artery bypass graft (CABG) or coronary angioplasty or percutaneous coronary intervention (PCI). Studies, mainly observational, conducted in the past have demonstrated a prognostic benefit of CABG on survival. These findings were confirmed by the long-term follow-up of the STICH study in which, however, documentation of inducible ischaemia or myocardial viability was not predictive of a prognostic benefit of CABG. Revascularization via PCI in the recent REVIVED-BCIS2 study did not demonstrate a significant benefit in terms of death or heart failure hospitalization compared with optimal medical therapy. Pending the long-term follow-up of the REVIVED-BCIS2 study, optimized medical therapy, cardiac resynchronization therapy, and the implantable cardioverter defibrillator, where indicated, are the mainstay of treatment in patients with dilated ischaemic cardiomyopathy. The decision for coronary revascularization is made in the individual patient, possibly with a higher bias in patients with angina, three-vessel coronary artery disease, severe left ventricular dysfunction, and cardiac remodelling.
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Affiliation(s)
| | | | - Giuseppe Di Pasquale
- Coordination of the Cardiological and Cardiovascular Surgical Network, Emilia-Romagna
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163
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Garry GA, Olson EN. Reprogramming of cardiac cell fate as a therapeutic strategy for ischemic heart disease. J Mol Cell Cardiol 2023; 179:2-6. [PMID: 36997058 DOI: 10.1016/j.yjmcc.2023.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
Direct reprogramming of resident cardiac fibroblasts to induced cardiomyocytes is an attractive therapeutic strategy to restore function and remuscularize the injured heart. The cardiac transcription factors Gata4, Mef2c, and Tbx5 have been the mainstay of direct cardiac reprogramming strategies for the past decade. Yet, recent discoveries have identified alternative epigenetic factors capable of reprogramming human cells in the absence of these canonical factors. Further, single-cell genomics evaluating cellular maturation and epigenetics in the setting of injury and heart failure models following reprogramming have continued to inform the mechanistic underpinnings of this process and point toward future areas of discovery for the field. These discoveries and others covered in this review have provided complementary approaches that further enhance the effectiveness of reprogramming as a means of promoting cardiac regeneration following myocardial infarction and heart failure.
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Affiliation(s)
- Glynnis A Garry
- Department of Molecular Biology, the Hamon Center for Regenerative Science and Medicine, and Sen. Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Eric N Olson
- Department of Molecular Biology, the Hamon Center for Regenerative Science and Medicine, and Sen. Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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164
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Escobar C, Palacios B, Gonzalez V, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Burden of Illness beyond Mortality and Heart Failure Hospitalizations in Patients Newly Diagnosed with Heart Failure in Spain According to Ejection Fraction. J Clin Med 2023; 12:2410. [PMID: 36983410 PMCID: PMC10054096 DOI: 10.3390/jcm12062410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe the rates of adverse clinical outcomes, including all-cause mortality, heart failure (HF) hospitalization, myocardial infarction, and stroke, in patients newly diagnosed with HF to provide a comprehensive picture of HF burden. METHODS This was a retrospective and observational study, using the BIG-PAC database in Spain. Adults, newly diagnosed with HF between January 2013 and September 2019 with ≥1 HF-free year of enrolment prior to HF diagnosis, were included. RESULTS A total of 19,961 patients were newly diagnosed with HF (43.5% with reduced ejection fraction (EF), 26.3% with preserved EF, 5.1% with mildly reduced EF, and 25.1% with unknown EF). The mean age was 69.7 ± 19.0 years; 53.8% were men; and 41.0% and 41.5% of patients were in the New York Heart Association functional classes II and III, respectively. The baseline HF treatments included beta-blockers (70.1%), renin-angiotensin system inhibitors (56.3%), mineralocorticoid receptor antagonists (11.8%), and SGLT2 inhibitors (8.9%). The post-index incidence rates of all-cause mortality, HF hospitalization, and both combined were 102.2 (95% CI 99.9-104.5), 123.1 (95% CI 120.5-125.7), and 182 (95% CI 178.9-185.1) per 1000 person-years, respectively. The rates of myocardial infarction and stroke were lower (26.2 [95% CI 25.1-27.4] and 19.8 [95% CI 18.8-20.8] per 1000 person-years, respectively). CONCLUSIONS In Spain, patients newly diagnosed with HF have a high risk of clinical outcomes. Specifically, the rates of all-cause mortality and HF hospitalization are high and substantially greater than the rates of myocardial infarction and stroke. Given the burden of adverse outcomes, these should be considered targets in the comprehensive management of HF. There is much room for improving the proportion of patients receiving disease-modifying therapies.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | | | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
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165
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Liga R, Colli A, Taggart DP, Boden WE, De Caterina R. Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How. J Am Heart Assoc 2023; 12:e026943. [PMID: 36892041 PMCID: PMC10111551 DOI: 10.1161/jaha.122.026943] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 03/10/2023]
Abstract
Background Myocardial revascularization has been advocated to improve myocardial function and prognosis in ischemic cardiomyopathy (ICM). We discuss the evidence for revascularization in patients with ICM and the role of ischemia and viability detection in guiding treatment. Methods and Results We searched for randomized controlled trials evaluating the prognostic impact of revascularization in ICM and the value of viability imaging for patient management. Out of 1397 publications, 4 randomized controlled trials were included, enrolling 2480 patients. Three trials (HEART [Heart Failure Revascularisation Trial], STICH [Surgical Treatment for Ischemic Heart Failure], and REVIVED [REVascularization for Ischemic VEntricular Dysfunction]-BCIS2) randomized patients to revascularization or optimal medical therapy. HEART was stopped prematurely without showing any significant difference between treatment strategies. STICH showed a 16% lower mortality with bypass surgery compared with optimal medical therapy at a median follow-up of 9.8 years. However, neither the presence/extent of left ventricle viability nor ischemia interacted with treatment outcomes. REVIVED-BCIS2 showed no difference in the primary end point between percutaneous revascularization or optimal medical therapy. PARR-2 (Positron Emission Tomography and Recovery Following Revascularization) randomized patients to imaging-guided revascularization versus standard care, with neutral results overall. Information regarding the consistency of patient management with viability testing results was available in ≈65% of patients (n=1623). No difference in survival was revealed according to adherence or no adherence to viability imaging. Conclusions In ICM, the largest randomized controlled trial, STICH, suggests that surgical revascularization improves patients' prognosis at long-term follow-up, whereas evidence supports no benefit of percutaneous coronary intervention. Data from randomized controlled trials do not support myocardial ischemia or viability testing for treatment guidance. We propose an algorithm for the workup of patients with ICM considering clinical presentation, imaging results, and surgical risk.
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Affiliation(s)
- Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - Andrea Colli
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - David P. Taggart
- Nuffield Department of Surgical SciencesOxford University John Radcliffe HospitalOxfordUnited Kingdom
| | - William E. Boden
- VA Boston Healthcare SystemBoston University School of MedicineBostonMA
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
- Fondazione VillaSerena per la Ricerca, Città Sant'AngeloItaly
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166
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Megaly M, Zakhour S, Karacsonyi J, Basir MB, Kunkel K, Gupta A, Neupane S, Alqarqaz M, Brilakis ES, Alaswad K. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery. Am J Cardiol 2023; 193:75-82. [PMID: 36878056 DOI: 10.1016/j.amjcard.2023.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/17/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center. Outcomes included in-hospital and long-term major adverse cardiovascular events (MACEs) and changes in left ventricular ejection fraction (LVEF). We performed a subgroup analysis of patients with ischemic cardiomyopathy, defined as an LVEF of 40% or less. From December 2014 to February 2021, 237 patients underwent LAD CTO PCI. The technical success rate was 97.4%, and the in-hospital MACE rate was 5.4%, A landmark analysis after hospital discharge showed an overall survival of 92% and 85% MACE-free survival at 2 years. There was no difference in overall survival or MACE-free survival between those who had ischemic cardiomyopathy versus those who did not. In patients with ischemic cardiomyopathy, LAD CTO PCI was associated with significant improvement in LVEF (10.9% at 9 months), which was further pronounced when these patients had a proximal LAD CTO and were on optimal medical therapy (14% at 6 months). In a single high-volume center, LAD CTO PCI was associated with 92% overall survival at 2 years, with no difference in survival between patients with or without ischemic cardiomyopathy. LAD CTO PCI was associated with an absolute 10% increase in LVEF at 9 months in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Samer Zakhour
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Katherine Kunkel
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Ankur Gupta
- Department of Cardiology, HonorHealth Heart Group - Shea, Phoenix, Arizona
| | - Saroj Neupane
- Department of Cardiology, WakeMed Hospital, Raleigh, North Carolina
| | | | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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167
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Ischämische Kardiomyopathie: PCI ohne Prognoseverbesserung. Dtsch Med Wochenschr 2023. [DOI: 10.1055/a-1962-4421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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168
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Park S, Park SJ, Park DW. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Revascularization of Left Main Coronary Artery Disease. Korean Circ J 2023; 53:113-133. [PMID: 36914602 PMCID: PMC10011221 DOI: 10.4070/kcj.2022.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023] Open
Abstract
Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease. For several decades, coronary artery bypass grafting (CABG) has been the "gold standard" treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.
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Affiliation(s)
- Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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169
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Becher PM, Seiffert M. [Interventional treatment of heart failure : Stents and valves]. Herz 2023; 48:101-108. [PMID: 36700948 DOI: 10.1007/s00059-022-05160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
The pharmacotherapy of heart failure has evolved in recent years and with the aid of new classes of drugs symptomatic and prognostic improvements can be achieved in patients with heart failure. Heart failure is particularly frequently associated with coronary artery disease or higher grade, often functional valve defects. In the context of the underlying disease, the operative risk is often increased, so that interventional treatment is preferred over surgical treatment options in interdisciplinary heart teams. Promising approaches with very different challenges are emerging for interventional myocardial revascularization and percutaneous correction of high-grade aortic valve stenosis or functional mitral or tricuspid valve regurgitation. It has consistently been shown that an elaborate diagnostic work-up and differentiated patient selection are decisive to achieve a prognostic or symptomatic benefit in these patients using interventional treatment. While awaiting further study data on this topic, the integration of a multidisciplinary heart team is essential to ensure a complementary and balanced therapeutic approach for patient-centered care in this complex patient population.
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Affiliation(s)
- Peter Moritz Becher
- Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, 20246, Hamburg, Deutschland. .,Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Hamburg, Deutschland.
| | - Moritz Seiffert
- Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf, 20246, Hamburg, Deutschland.,Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Hamburg, Deutschland
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170
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Ródenas-Alesina E, Romero-Farina G, Herrador L, Jordán P, Espinet-Coll C, Pizzi MN, Ribera A, Ferreira-González I, Aguadé-Bruix S. Development of a risk score for patients with ischaemic cardiomyopathy. Arch Cardiovasc Dis 2023; 116:145-150. [PMID: 36759315 DOI: 10.1016/j.acvd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis. AIM To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease. METHODS All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retrospectively (n=747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model. RESULTS After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomerular filtration rate ≤60mL/min/1.73 m2, age>73 years, diabetes, atrial fibrillation, end-diastolic volume index>83mL/m2 and>12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660-0.740) and calibration was adequate (Hosmer-Lemeshow test P=0.28) for MACE. CONCLUSIONS In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.
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Affiliation(s)
- Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Guillermo Romero-Farina
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Lorena Herrador
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pablo Jordán
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carina Espinet-Coll
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - María Nazarena Pizzi
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Aida Ribera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Santiago Aguadé-Bruix
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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171
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Bennett RG, Deyell MW. Catheter Ablation of Ventricular Tachycardia: Making a Difference, but Not Saving Lives? Can J Cardiol 2023; 39:263-265. [PMID: 36634756 DOI: 10.1016/j.cjca.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Affiliation(s)
- Richard G Bennett
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marc W Deyell
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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172
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Jordan-Rios A, Nuzzi V, Bromage DI, McDonagh T, Sinagra G, Cannata A. Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems. Eur J Intern Med 2023; 109:4-11. [PMID: 36462964 PMCID: PMC9709614 DOI: 10.1016/j.ejim.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022]
Abstract
In the last two years, the COVID-19 pandemic has undeniably changed everyday life and significantly reshaped the healthcare systems. Besides the direct effect on daily care leading to significant excess mortality, several collateral damages have been observed during the pandemic. The impact of the pandemic led to staff shortages, disrupted education, worse healthcare professional well-being, and a lack of proper clinical training and research. In this review we highlight the results of these important changes and how can the healthcare systems can adapt to prevent unprecedented events in case of future catastrophes.
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Affiliation(s)
- Antonio Jordan-Rios
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Theresa McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannata
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
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173
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Weintraub WS, Mancini GBJ, Boden WE. Percutaneous coronary intervention from COURAGE to ISCHEMIA and beyond. Int J Cardiol 2023; 373:39-43. [PMID: 36427605 DOI: 10.1016/j.ijcard.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Multiple randomized clinical trials and observational studies in patients with chronic coronary artery disease have evaluated whether revascularization, in particular PCI, can reduce the incidence of future cardiovascular events and relieve angina. Perhaps the two most widely quoted trials are COURAGE and ISCHEMIA. In both trials revascularization did not reduce the incidence of cardiovascular death or non-fatal events. In both, revascularization did relieve angina, particularly in patients with severe pain. From the time of COURAGE to ISCHEMIA there were also multiple developments. In particular improved stent technology with second and third generation drug eluting stents in ISCHEMIA compared to bare metal stents in COURAGE. There was also the development of new methods to evaluate ischemia, in particular the potential surrogate fractional flow reserve. This period also saw improvement and maturation of coronary computed tomography angiography to assess coronary anatomy non-invasively. There was also greater emphasis on more intensive, guideline directed medical therapy to treat dyslipidemia and hypertension. There has also been greater recognition that not all angina is due to epicardial obstructive disease. Microvascular disease and coronary spasm are responsible for much of the symptom burden of ischemia. These data have led to a paradigm shift toward a more nuanced approach to treating stable ischemic heart disease, with less need for revascularization except in cases of particularly severe anatomic disease or unremitting symptoms while on optimal medial therapy. In recognition of the importance of disparities in cardiovascular health, it is crucial to implement preventive strategies with optimal medical therapy in the community.
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Affiliation(s)
- William S Weintraub
- MedStar Health Research Institute and Georgetown University, Washington, DC, USA.
| | - G B John Mancini
- Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William E Boden
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
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174
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Converting Surgical Turndowns Into PCI Successes. JACC Cardiovasc Interv 2023; 16:274-276. [PMID: 36792253 DOI: 10.1016/j.jcin.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 02/17/2023]
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175
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Sulzgruber P, Baumer U, Niessner A. Surgical or Percutaneous Coronary Revascularization for Heart Failure: a Focus on Symptoms and Stenosis. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07439-y. [PMID: 36780069 DOI: 10.1007/s10557-023-07439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/14/2023]
Affiliation(s)
- Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Ulrike Baumer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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176
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Price S, Kaski JC, Al-Lamee R, Boden WE, Huber K, Katz JN, Krychtiuk K. The year in cardiovascular medicine 2022: the top 10 papers in acute cardiac care and ischaemic heart disease. Eur Heart J 2023; 44:445-447. [PMID: 36587938 DOI: 10.1093/eurheartj/ehac811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Susanna Price
- Royal Brompton & Harefield Hospitals, Guys' and St Thomas' NHS Foundation Trust and National Heart & Lung Institute, Imperial College, Sydney St, London SW3 6NP, UK
| | - Juan Carlos Kaski
- Molecular and Clinical Science Research Institute, St George's, University of London, London, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK
| | - William E Boden
- VA Boston Healthcare System, Boston University School of Medicine and Harvard Medical School, Boston, MA, USA
| | - Kurt Huber
- Department of Cardiology and Intensive Care Medicine, Clinic Ottakring and Sigmund Freud University, Medical School, Vienna, Austria
| | - Jason N Katz
- Cardiac Intensive Care Unit, Duke University, Durham, NC, USA
| | - Konstantin Krychtiuk
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Vienna, Austria
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177
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Pathak S, Lai FY, Miksza J, Petrie MC, Roman M, Murray S, Dearling J, Perera D, Murphy GJ. Surgical or percutaneous coronary revascularization for heart failure: an in silico model using routinely collected health data to emulate a clinical trial. Eur Heart J 2023; 44:351-364. [PMID: 36350978 PMCID: PMC9890210 DOI: 10.1093/eurheartj/ehac670] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS The choice of revascularization with coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in people with ischaemic left ventricular dysfunction is not guided by high-quality evidence. METHODS AND RESULTS A trial of CABG vs. PCI in people with heart failure (HF) was modelled in silico using routinely collected healthcare data. The in silico trial cohort was selected by matching the target trial cohort, identified from Hospital Episode Statistics in England, with individual patient data from the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Allocation to CABG vs. complex PCI demonstrated random variation across administrative regions in England and was a valid statistical instrument. The primary outcome was 5-year all-cause mortality or cardiovascular hospitalization. Instrumental variable analysis (IVA) was used for the primary analysis. Results were expressed as average treatment effects (ATEs) with 95 confidence intervals (CIs). The target population included 13 519 HF patients undergoing CABG or complex PCI between April 2009 and March 2015. After matching, the emulated trial cohort included 2046 patients. The unadjusted primary outcome rate was 51.1 in the CABG group and 70.0 in the PCI group. IVA of the emulated cohort showed that CABG was associated with a lower risk of the primary outcome (ATE 16.2, 95 CI 20.6 to 11.8), with comparable estimates in the unmatched target population (ATE 15.5, 95 CI 17.5 to 13.5). CONCLUSION In people with HF, in silico modelling suggests that CABG is associated with fewer deaths or cardiovascular hospitalizations at 5 years vs. complex PCI. A pragmatic clinical trial is needed to test this hypothesis and this trial would be feasible.
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Affiliation(s)
- Suraj Pathak
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Florence Y Lai
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Joanne Miksza
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Mark C Petrie
- School of Cardiovascular & Metabolic Health BHF GCRC, Glasgow, G12 8TA, UK
| | - Marius Roman
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Sarah Murray
- National Cardiac Surgery Patient and Public Involvement (PPI) Group, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Jeremy Dearling
- National Cardiac Surgery Patient and Public Involvement (PPI) Group, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Divaka Perera
- Cardiovascular Division, Rayne Institute, Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Gavin J Murphy
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
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178
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Mukhopadhyay A, Spertus J, Bangalore S, Zhang Y, Tarpey T, Hochman J, Katz S. Physician preferences for revascularization in patients with ischemic cardiomyopathy: Defining equipoise from web-based surveys. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100263. [PMID: 36844107 PMCID: PMC9956983 DOI: 10.1016/j.ahjo.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background The optimal revascularization approach in patients with heart failure with reduced ejection fraction (HFrEF) and ischemic heart disease ("ischemic cardiomyopathy") is unknown. Physician preferences regarding clinical equipoise for mode of revascularization and their willingness to consider offering enrollment in a randomized trial to patients with ischemic cardiomyopathy have not been characterized. Methods We conducted two anonymous online surveys: 1) a clinical case scenario-based survey to assess willingness to offer clinical trial enrollment for a patient with ischemic cardiomyopathy (overall response rate to email invitation 0.45 %), and 2) a Delphi consensus-building survey to identify specific areas of clinical equipoise (overall response rate to email invitation 37 %). Results Among 304 physicians responding to the clinical case scenario-based survey, the majority were willing to offer the opportunity for clinical trial enrollment to a prototypical patient with ischemic cardiomyopathy (92 %), and felt that a finding of non-inferiority for PCI vs. CABG would influence their clinical practice (78 %). Among 53 physicians responding to the Delphi consensus-building survey, the median appropriateness rating for CABG was significantly higher than that of PCI (p < 0.0001). In 17 scenarios (11.8 %), there was no difference in CABG or PCI appropriateness ratings, suggesting clinical equipoise in these settings. Conclusions Our findings demonstrate willingness to consider offering enrollment in a randomized clinical trial and areas of clinical equipoise, two factors that support the feasibility of a randomized trial to compare clinical outcomes after revascularization with CABG vs. PCI in selected patients with ischemic cardiomyopathy, suitable coronary anatomy and co-morbidity profile.
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Affiliation(s)
- Amrita Mukhopadhyay
- NYU Langone Health, NYU Grossman School of Medicine Department of Medicine, United States of America
| | - John Spertus
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Sripal Bangalore
- NYU Langone Health, NYU Grossman School of Medicine Department of Medicine, United States of America
| | - Yan Zhang
- NYU Langone Health, NYU Grossman School of Medicine Department of Population Health, United States of America
| | - Thaddeus Tarpey
- NYU Langone Health, NYU Grossman School of Medicine Department of Population Health, United States of America
| | - Judith Hochman
- NYU Langone Health, NYU Grossman School of Medicine Department of Medicine, United States of America
| | - Stuart Katz
- NYU Langone Health, NYU Grossman School of Medicine Department of Medicine, United States of America
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179
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Nakamaru R, Shiraishi Y, Niimi N, Ueda I, Ikemura N, Suzuki M, Noma S, Inohara T, Numasawa Y, Fukuda K, Kohsaka S. Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry). Am J Cardiol 2023; 188:44-51. [PMID: 36470011 DOI: 10.1016/j.amjcard.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Healthcare Quality Assessment, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Shigetaka Noma
- Department of Cardiology Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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180
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Gersh BJ, De Mets D. Revascularization in ischaemic cardiomyopathy: how to interpret current evidence. Eur Heart J 2023; 44:365-367. [PMID: 36670170 DOI: 10.1093/eurheartj/ehac794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - David De Mets
- Department of Biostatistics Medical Informatics, School of Medicine Public Health, University of WisconsinMadison, Madison, WI, USA
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181
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Sengodan P, Davies RE, Matsuno S, Chan AK, Kearney K, Salisbury A, Grantham JA, Hirai T. Chronic Total Occlusion Interventions in Patients with Reduced Ejection Fraction. Curr Cardiol Rep 2023; 25:43-50. [PMID: 36576680 DOI: 10.1007/s11886-022-01832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this paper is to review the current evidence surrounding CTO PCI in patients with low EF, the most high-risk population to treat. We also present pertinent case examples and offer practical tips to increase success and lower complications when performing CTO PCI in patients with low EF. RECENT FINDINGS In a prospective randomized control study, greater improvement in angina frequency and quality of life, assessed by the Seattle Angina Questionnaire, was achieved by CTO PCI compared to optimal medical therapy. Furthermore, after successful CTO PCI, improvements in health status were similar in patients with both low and normal EF. CTO PCI can not only ameliorate symptoms of angina in patients with low EF but may also potentially improve EF in carefully selected populations. However, information regarding treatment of this high-risk population is lacking and large-scale studies targeting patients with severely reduced EF remain necessary.
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Affiliation(s)
| | | | | | - Albert K Chan
- University of Missouri Columbia, One Hospital Drive, Columbia, MO, 65212, USA
| | | | - Adam Salisbury
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | - Taishi Hirai
- University of Missouri Columbia, One Hospital Drive, Columbia, MO, 65212, USA.
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182
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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, Argacha JF, Cosyns B, De Maeseneer M, De Mey J. Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR CT ) in no apparent coronary artery disease. Echocardiography 2023; 40:103-112. [PMID: 36607158 DOI: 10.1111/echo.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFRCT ) even without coronary artery disease (CAD). The relationship between ramus-induced turbulence and FFRCT is unclear. METHOD AND RESULTS A total of 120 patients with <20% coronary stenosis assessed by both FFRCT and invasive coronary angiography were evaluated. The patients were divided into three groups: absent-ramus (n = 72), small-ramus that could not be analyzed by FFRCT (n = 18), and large-ramus that could be analyzed by FFRCT (n = 30). FFRCT measurements were performed at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery. With absent-ramus and small-absent ramus groups, FFRCT was measured at the distal end of the left main trunk at the same level for the proximal segments of the LAD and LCX. In absent-ramus group, proximal FFRCT showed no significant differences between three vessels (LAD = .96 ± .02; MID = .97 ± .02; LCX = .97 ± .02). However, in small and large-ramus groups, proximal FFRCT was significantly higher in the ramus artery than LAD and LCX (small-ramus, LAD = .95 ± .03, Ramus = .97 ± .02, LCX = .95 ± .03; large-ramus: LAD = .95 ± .03, Ramus = .98 ± .01; LCX = .96 ± .03; p < .05). A large ramus was associated with a higher prevalence of a distal FFRCT ≤.80 (odds ratio 7.0, 95% CI 1.2-40.1, p = .03). A proximal ramus diameter predicted distal FFRCT ≤.80 (cut-off 2.1 mm, AUC .76, sensitivity 100%, specificity 52%, 95% CI .61-.90). CONCLUSIONS The presence of a large-ramus artery may cause an FFRCT decline in no apparent CAD.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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183
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Zhou W, Sin J, Yan AT, Wang H, Lu J, Li Y, Kim P, Patel AR, Ng MY. Qualitative and Quantitative Stress Perfusion Cardiac Magnetic Resonance in Clinical Practice: A Comprehensive Review. Diagnostics (Basel) 2023; 13:524. [PMID: 36766629 PMCID: PMC9914769 DOI: 10.3390/diagnostics13030524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) imaging is a well-validated non-invasive stress test to diagnose significant coronary artery disease (CAD), with higher diagnostic accuracy than other common functional imaging modalities. One-stop assessment of myocardial ischemia, cardiac function, and myocardial viability qualitatively and quantitatively has been proven to be a cost-effective method in clinical practice for CAD evaluation. Beyond diagnosis, stress CMR also provides prognostic information and guides coronary revascularisation. In addition to CAD, there is a large body of literature demonstrating CMR's diagnostic performance and prognostic value in other common cardiovascular diseases (CVDs), especially coronary microvascular dysfunction (CMD). This review focuses on the clinical applications of stress CMR, including stress CMR scanning methods, practical interpretation of stress CMR images, and clinical utility of stress CMR in a setting of CVDs with possible myocardial ischemia.
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Affiliation(s)
- Wenli Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Jason Sin
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Andrew T. Yan
- St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Jing Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Paul Kim
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ming-Yen Ng
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen 518009, China
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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184
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Barbato E, McEntegart M, Gori T. The year in cardiovascular medicine 2022: the top 10 papers in interventional cardiology. Eur Heart J 2023; 44:259-261. [PMID: 36587942 DOI: 10.1093/eurheartj/ehac778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1035/103900189 Roma, Italy
| | - Margaret McEntegart
- Department of Cardiology, Columbia University Medical Center, 622 West 168th Street, Presbyterian Hospital Building PH-3, New York, NY 10032, USA
| | - Tommaso Gori
- Kardiologie I, Center for Cardiology, University Medical Centre Mainz and DZHK Standort Rhein-Main, Langenbeckstr 1, 55131 Mainz, Germany
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185
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De Silva K, Campbell T, Kumar S. PCI for Ischemic Left Ventricular Dysfunction. N Engl J Med 2023; 388:187. [PMID: 36630632 DOI: 10.1056/nejmc2214569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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186
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Jabbour RJ, Curzen N. National Institute for Health and Care Excellence guidelines on myocardial revascularisation. Heart 2023:heartjnl-2022-321397. [PMID: 36631143 DOI: 10.1136/heartjnl-2022-321397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023] Open
Abstract
Cardiologists in the UK predominantly use the National Institute for Health and Care Excellence (NICE) and European Society of Cardiology guidelines to help guide decision-making. This article will appraise the current recommendations from NICE regarding myocardial revascularisation and compare them with other major international guidelines. While there are many similarities, subtle differences exist. These differences arise in part due to the evidence base at time of publication, as well as from the different healthcare systems that they are designed for, and from the cost-effectiveness models that dominate the methodology used by NICE. The clinical implications of the differences between the international guidelines will be analysed.
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Affiliation(s)
- Richard J Jabbour
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Curzen
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,Faculty of Medicine, University of Southampton, Southampton, UK
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187
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Hybrid Coronary Revascularization: Best of 2 Worlds in the Environment Where Revascularization Is in Reverse. JACC Cardiovasc Interv 2023; 16:61-63. [PMID: 36599588 DOI: 10.1016/j.jcin.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 01/03/2023]
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188
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de Boer RA, Bauersachs J. The year in cardiovascular medicine 2022: the top 10 papers in heart failure and cardiomyopathies. Eur Heart J 2023; 44:342-344. [PMID: 36587945 PMCID: PMC9890248 DOI: 10.1093/eurheartj/ehac781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/20/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Rudolf A de Boer
- Corresponding author. Tel: +31 10 703 3938, Fax: +31 (0) 10 7035498,
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189
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King SB. Do Clinical Trials Change Practice? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:124-125. [PMID: 36372723 DOI: 10.1016/j.carrev.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Spencer B King
- Emory St. Joseph's Hospital, 5665 Peachtree Dunwoody Road NE, Atlanta, GA 30342, United States of America.
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190
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UpToDate®. Nurse Pract 2023; 48:9. [PMID: 36573853 DOI: 10.1097/01.npr.0000903004.19250.d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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191
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Wadowski PP, Piechota-Polańczyk A, Andreas M, Kopp CW. Cardiovascular Disease Management in the Context of Global Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:689. [PMID: 36613012 PMCID: PMC9819164 DOI: 10.3390/ijerph20010689] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/28/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) initiated a pandemic that has deteriorated health care access and thus disadvantaged vulnerable populations [...].
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Affiliation(s)
- Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Aleksandra Piechota-Polańczyk
- Department of Medical Biotechnology, Faculty of Biophysics, Biochemistry and Biotechnology, Jagiellonian University, 30-387 Cracow, Poland
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph W. Kopp
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
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192
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Weberling LD, Lossnitzer D, Frey N, André F. Coronary Computed Tomography vs. Cardiac Magnetic Resonance Imaging in the Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2022; 13:diagnostics13010125. [PMID: 36611417 PMCID: PMC9818886 DOI: 10.3390/diagnostics13010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Coronary artery disease (CAD) represents a widespread burden to both individual and public health, steadily rising across the globe. The current guidelines recommend non-invasive anatomical or functional testing prior to invasive procedures. Both coronary computed tomography angiography (cCTA) and stress cardiac magnetic resonance imaging (CMR) are appropriate imaging modalities, which are increasingly used in these patients. Both exhibit excellent safety profiles and high diagnostic accuracy. In the last decade, cCTA image quality has improved, radiation exposure has decreased and functional information such as CT-derived fractional flow reserve or perfusion can complement anatomic evaluation. CMR has become more robust and faster, and advances have been made in functional assessment and tissue characterization allowing for earlier and better risk stratification. This review compares both imaging modalities regarding their strengths and weaknesses in the assessment of CAD and aims to give physicians rationales to select the most appropriate modality for individual patients.
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Affiliation(s)
- Lukas D. Weberling
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-8676
| | - Dirk Lossnitzer
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
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193
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Kucheriava MV, Mankovsky GB. Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/km057-2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale.
Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated.
Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05).
Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.
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194
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Ezad SM, Ryan M, Perera D. Can Percutaneous Coronary Intervention Revive a Failing Heart? Heart Int 2022; 16:72-74. [PMID: 36741102 PMCID: PMC9872779 DOI: 10.17925/hi.2022.16.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022] Open
Abstract
Coronary artery disease (CAD) remains the most common cause of heart failure with reduced ejection fraction; despite its prevalence, there is limited evidence to guide physicians in managing patients with CAD with percutaneous revascularization. The REVIVED-BCIS2 trial (ClinicalTrials.gov identifier: NCT01920048) represents the first randomized trial to assess the value of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular systolic dysfunction and stable CAD. In this article, we review the results of the REVIVED-BCIS2 trial and compare them to the ClinicalTrials.gov Identifier: NCT00023595 trial (ClinicalTrials.gov Identifier: NCT00023595), which investigated the benefit of surgical revascularization on such patients. Finally, we suggest a pathway for physicians managing patients with ischaemic left ventricular systolic dysfunction based on the current evidence and highlight potential avenues for future research.
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Affiliation(s)
- Saad M Ezad
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Hamzaraj K, Kammerlander A, Gyöngyösi M, Frey B, Distelmaier K, Graf S. Patient Selection and Clinical Indication for Chronic Total Occlusion Revascularization-A Workflow Focusing on Non-Invasive Cardiac Imaging. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010004. [PMID: 36675954 PMCID: PMC9864679 DOI: 10.3390/life13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Percutaneous coronary intervention of chronic total occlusion (CTO PCI) is a challenging procedure with high complication rates and, as not yet fully understood long-term clinical benefits. Ischemic symptom relief in patients with high ischemic burden is to date the only established clinical indication to undergo CTO PCI, supported by randomized controlled trials. In this context, current guidelines suggest attempting CTO PCI only in non-invasively assessed viable CTO correspondent myocardial territories, with large ischemic areas. Hence, besides a comprehensive coronary angiography lesion evaluation, the information derived from non-invasive cardiac imaging techniques is crucial to selecting candidates who may benefit from the revascularization of the occluded vessel. Currently, there are no clear recommendations for a non-invasive myocardial evaluation or choice of imaging modality pre-CTO PCI. Therefore, selecting among available options is left to the physician's discretion. As CTO PCI is strongly recommended to be carried out explicitly in experienced centers, full access to non-invasive imaging for risk-benefit assessment as well as a systematic institutional evaluation process has to be encouraged. In this framework, we opted to review the current myocardial imaging tools and their use for indicating a CTO PCI. Furthermore, based on our experience, we propose a cost-effective systematic approach for myocardial assessment to help guide clinical decision-making for patients presenting with chronic total occlusions.
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Koifman E, Giladi E. All Models Are Right But Some Are More Useful. J Am Heart Assoc 2022; 11:e028357. [PMID: 36533619 PMCID: PMC9798801 DOI: 10.1161/jaha.122.028357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Edward Koifman
- Department of CardiologyMeir Medical CenterKfar‐SabaIsrael,Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ela Giladi
- Department of CardiologyMeir Medical CenterKfar‐SabaIsrael
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Vergallo R, Liuzzo G. The REVIVED-BCIS2 trial: percutaneous coronary intervention vs. optimal medical therapy for stable patients with severe ischaemic cardiomyopathy. Eur Heart J 2022; 43:4775-4776. [PMID: 36213942 DOI: 10.1093/eurheartj/ehac568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Rocco Vergallo
- Department of Cardiovascular Medicine, Interventional Cardiology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli, 8-00168, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Medicine, Interventional Cardiology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli, 8-00168, Rome, Italy.,Catholic University of the Sacred Heart, Largo F. Vito, 8, 00168, Rome, Italy
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198
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Costa G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Barbosa Ribeiro H, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, De Marco F, Tesorio T, Rheude T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Joner M, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Kargoli F, Tamburino C, Barbanti M. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e012417. [PMID: 36538579 DOI: 10.1161/circinterventions.122.012417] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Ignacio J Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.C.)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Francesco Saia
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Matjaz Bunc
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Philippe Garot
- Institute cardiovasculaire Paris Sud, Massy, France (P.G., A.G.)
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | | | - Francesco Burzotta
- IRCSS Policlinico Universitario "Agostino Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy (F.B.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Federico De Marco
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Roberto Valvo
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Italo Porto
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, Siena, Italy (A.I.)
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | - Markus Mach
- Wien University Hospital, Austria (M.M., M.A.)
| | - Azeem Latib
- Montefiore Medical Center, New York (A.L., F.K.)
| | - Luigi Biasco
- Azienda sanitaria locale di Ciriè, Chivasso e Ivrea, ASLTO4, Italy (L.B.)
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland (M.T.)
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Brazil (H.B.R., S.F.C.)
| | - Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Mateusz Orzalkiewicz
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | | | | | | | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.).,Galway University Hospital, Ireland (D.M., M.L.)
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Vincenzo Cesario
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Vincenzo De Marzo
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Elisa Piredda
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | | | | | - Elena Dipietro
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | | | - Silvia Motta
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Marco Barbanti
- University Medical Centre Ljubljana, Slovenia (M.B., K.S.)
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Ryan M, De Silva K, Morgan H, O’Gallagher K, Demir OM, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah AM, Chiribiri A, Perera D. Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circ Cardiovasc Interv 2022; 15:e012394. [PMID: 36538582 PMCID: PMC9760472 DOI: 10.1161/circinterventions.122.012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. METHODS Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. RESULTS Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2 s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2 s-1 had 86% sensitivity and 76% specificity. CONCLUSIONS Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
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Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kalpa De Silva
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Holly Morgan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kevin O’Gallagher
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ozan M. Demir
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Haseeb Rahman
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Howard Ellis
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Luke Dancy
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | - Daniel Sado
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | | | | | - Michael Marber
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ajay M. Shah
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
- Imaging Sciences Division, King’s College London, UK (A.C.)
| | - Divaka Perera
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
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200
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Ishii H. Importance of the Assessment of Infarction Size in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction. Circ J 2022; 86:1980-1981. [PMID: 36310050 DOI: 10.1253/circj.cj-22-0638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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