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Yoda S, Hori Y, Hayase M, Mineki T, Hatta T, Suzuki Y, Matsumoto N, Hirayama A. Correlation between early revascularization and major cardiac events demonstrated by ischemic myocardium in Japanese patients with stable coronary artery disease. J Cardiol 2017; 71:44-51. [PMID: 28732592 DOI: 10.1016/j.jjcc.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD. METHODS We retrospectively investigated 3581 stable CAD patients who underwent rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio (n=450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups. RESULTS The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p=0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p=0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p=0.0036). The incidence of MCEs in the patients with 6-10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p=0.3235). CONCLUSIONS Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia.
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Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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203
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Zelt JGE, Liu PP, Erthal F, deKemp RA, Wells G, O'Meara E, Garrard L, Beanlands RSB, Mielniczuk LM. N-Terminal Pro B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T Levels Are Related to the Extent of Hibernating Myocardium in Patients With Ischemic Heart Failure. Can J Cardiol 2017; 33:1478-1488. [PMID: 28966019 DOI: 10.1016/j.cjca.2017.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Increased N-terminal pro b-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) can identify patients with heart failure (HF) who are at increased risk of cardiac events. The relationship of these biomarkers to the extent of hibernating myocardium and scar has not been previously characterized in patients with ischemic left ventricular dysfunction and HF. METHODS Patients with ischemic HF meeting recruitment criteria and undergoing perfusion and fluorodeoxyglucose-positron emission tomography to define myocardial hibernation and scar were included in the study. A total of 39 patients (mean age 67 ± 8 years) with New York Heart Association class II-IV HF and ischemic cardiomyopathy (ejection fraction [EF], 27.9% ± 8.5%) were enrolled in the study. RESULTS Serum NT-proBNP and hs-cTnT levels were elevated in patients with ≥ 10% hibernating myocardium compared with those with < 10% (NT-pro-BNP, 7419.10 ± 7169.5 pg/mL vs 2894.6 ± 2967.4 pg/mL; hs-cTnT, 789.3 ± 1835.3 pg/mL vs 44.8 ± 78.9 pg/mL; P < 0.05). The overall receiver operating characteristic under the curve value for NT-proBNP and hs-cTnT to predict hibernating myocardium was 0.76 and 0.78, respectively (P < 0.05). The NT-proBNP (P = 0.02) and hs-cTnT (P < 0.0001) levels also correlated with hibernation, particularly in patients with ≥ 10% scar, independent of EF, age, and estimated glomerular filtration rate. No differences were noted in biomarker levels for patients with vs those without ≥ 10% scar. CONCLUSIONS NT-proBNP and hs-cTnT levels are elevated in patients with ischemic HF hibernation and are correlated with the degree of hibernation but not with the presence or extent of scar. Taken together, these data support the novel concept that NT-proBNP and hs-cTnT release in patients with ischemic HF reflects the presence and extent of hibernating myocardium.
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Affiliation(s)
- Jason G E Zelt
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter P Liu
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Fernanda Erthal
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Robert A deKemp
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - George Wells
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Eileen O'Meara
- Division of Cardiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - Linda Garrard
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rob S B Beanlands
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa M Mielniczuk
- Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
Noninvasive cardiac imaging has witnessed tremendous advances in the recent past, particularly with regard to coronary computed tomography angiography (CCTA) where substantial improvements in image quality have been achieved while at the same time patients' radiation dose exposure has been reduced to the sub-millisievert range. Similarly, for single-photon emission computed tomography (SPECT) the introduction of novel cadmium-zinc-telluride-based semiconductor detectors has significantly improved system sensitivity and image quality, enabling fast image acquisition within less than 2-3 min or reduction of radiation dose exposure to less than 5 mSv. However, neither imaging modality alone is able to fully cover the two aspects of coronary artery disease (CAD), that is, morphology and function. Both modalities have distinct advantages and shortcomings: While CCTA may prove a superb modality for excluding CAD through its excellent negative predictive value, it does not allow for assessment of hemodynamic relevance if obstructive coronary lesions are detected. Conversely, SPECT myocardial perfusion imaging cannot provide any information on the presence or absence of subclinical coronary atherosclerosis. This article aims to highlight the great potential of cardiac hybrid imaging that allows for a comprehensive evaluation of CAD through combination of both morphological and functional information by fusing SPECT with CCTA.
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Affiliation(s)
- P A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - R R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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205
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Anavekar NS, Chareonthaitawee P, Narula J, Gersh BJ. Revascularization in Patients With Severe Left Ventricular Dysfunction: Is the Assessment of Viability Still Viable? J Am Coll Cardiol 2017; 67:2874-87. [PMID: 27311527 DOI: 10.1016/j.jacc.2016.03.571] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/18/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022]
Abstract
Myocardial viability assessment is typically reserved for patients with coronary artery disease and significant left ventricular dysfunction. In this setting, there is myocardial adaptation to an altered physiological state that is potentially reversible. Imaging can characterize different parameters of cardiac function; however, despite previously published appraisals of different imaging modalities, there is still uncertainty regarding the role of these tests in clinical practice. The purpose of this review is to reflect on the physiological basis of myocardial viability, discuss the imaging tests available that characterize myocardial viability, and summarize the current published reports on the use of these tests in clinical practice.
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Affiliation(s)
- Nandan S Anavekar
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Jagat Narula
- Division of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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206
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Stoller M, Seiler C. Reactive myocardial hyperaemia for functional assessment of coronary stenosis severity. EUROINTERVENTION 2017; 13:e201-e209. [DOI: 10.4244/eij-d-16-00579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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207
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Srivastava AV, Ananthasubramaniam K. Guiding coronary revascularization using PET stress myocardial perfusion imaging: The proof is in the pudding. J Nucl Cardiol 2017; 24:975-979. [PMID: 27033351 DOI: 10.1007/s12350-016-0479-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
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208
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Magri CJ, Tian TX, Camilleri L, Xuereb R, Galea J, Fava S. Red blood cell distribution width and myocardial scar burden in coronary artery disease. Postgrad Med J 2017; 93:607-612. [PMID: 28490545 DOI: 10.1136/postgradmedj-2016-134781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/19/2017] [Accepted: 04/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Red blood cell distribution width (RDW) is a novel independent marker of cardiovascular disease including heart failure, coronary artery disease and myocardial ischaemia. The aim of the study was to investigate a possible relationship between RDW and myocardial scar burden, as assessed by a MIBI viability scan. A secondary objective was to assess whether there is an association between RDW and left ventricular ejection fraction (LVEF). METHODS The study comprised 123 subjects with ischaemic heart disease who underwent a myocardial viability scan between June 2008 and July 2014. Haemoglobin, mean corpuscular volume, RDW, platelet count, mean platelet volume (MPV), estimated glomerular filtration rate, fasting blood glucose, liver and lipid profiles were evaluated for all patients. The extent of myocardial scarring and LVEF were noted. Data were analysed using IBM SPSS Statistics 22.0. Univariate followed by multivariate analyses were performed to assess for independent predictors of myocardial scarring and LVEF, respectively. RESULTS The mean age of the study population was 63.5 years; most of the subjects were men. The median LVEF was 31% and median percentage of myocardial scarring was 8.7%. Multivariate analyses revealed that RDW, HDL-cholesterol and alanine transaminase were independent predictors of myocardial scarring while RDW, MPV, LDL-cholesterol and gamma-glutamyl transpeptidase were independent predictors of LVEF. CONCLUSIONS Increased RDW is an independent predictor both of myocardial scar burden and of impaired left ventricular function in subjects with coronary artery disease.
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Affiliation(s)
- Caroline Jane Magri
- Department of Cardiology, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta
| | - Tan Xiao Tian
- Department of Medicine, Mater Dei Hospita, Tal-Qroqq, Msida, Malta
| | - Liberato Camilleri
- Statistics & Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Robert Xuereb
- Department of Cardiology, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta
| | - Joseph Galea
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta.,Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida, Malta
| | - Stephen Fava
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta.,Department of Medicine, Mater Dei Hospita, Tal-Qroqq, Msida, Malta
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209
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Riccio C, Gulizia MM, Colivicchi F, Di Lenarda A, Musumeci G, Faggiano PM, Abrignani MG, Rossini R, Fattirolli F, Valente S, Mureddu GF, Temporelli PL, Olivari Z, Amico AF, Casolo G, Fresco C, Menozzi A, Nardi F. ANMCO/GICR-IACPR/SICI-GISE Consensus Document: the clinical management of chronic ischaemic cardiomyopathy. Eur Heart J Suppl 2017; 19:D163-D189. [PMID: 28533729 PMCID: PMC5421493 DOI: 10.1093/eurheartj/sux021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stable coronary artery disease (CAD) is a clinical entity of great epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions. Stable CAD encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity, and diet. Adherence to therapy as an emerging risk factor is also discussed.
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Affiliation(s)
- Carmine Riccio
- Cardiovascular Science Department, A.O. Sant’Anna e San Sebastiano, Via Palasciano, 1 81100 Caserta, Italy
| | - Michele Massimo Gulizia
- Department of Cardiology, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- CCU Unit, Department of Cardiology, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | | | | | - Roberta Rossini
- Cardiology Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | | | - Serafina Valente
- Intensive Integrated Cardiology Department, AOU Careggi, Florence, Italy
| | - Gian Francesco Mureddu
- Cardiology and Cardiac Rehabilitation Department, A.O. San Giovanni-Addolorata, Rome, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ospedale Ca’ Foncello, Treviso, Italy
| | | | - Giancarlo Casolo
- Cardiology Unit, Nuovo Ospedale Versilia, Lido di Camaiore, Lucca, Italy
| | - Claudio Fresco
- Cardiology Unit, A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Alberto Menozzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
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Kwong RY, Shaw LJ, Nagel E. Can Stress CMR Impact Care in the Era After COURAGE and FAME-2? JACC Cardiovasc Imaging 2017; 10:538-540. [DOI: 10.1016/j.jcmg.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 11/15/2022]
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211
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Vincenti G, Masci PG, Monney P, Rutz T, Hugelshofer S, Gaxherri M, Muller O, Iglesias JF, Eeckhout E, Lorenzoni V, Pellaton C, Sierro C, Schwitter J. Stress Perfusion CMR in Patients With Known and Suspected CAD: Prognostic Value and Optimal Ischemic Threshold for Revascularization. JACC Cardiovasc Imaging 2017; 10:526-537. [PMID: 28412420 DOI: 10.1016/j.jcmg.2017.02.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to determine the ischemia threshold and additional prognostic factors that identify patients for safe deferral from revascularizations in a large cohort of all-comer patients with known or suspected coronary artery disease (CAD). BACKGROUND Stress-perfusion cardiac magnetic resonance (CMR) is increasingly used in daily practice for ischemia detection. However, there is insufficient evidence about the ischemia burden that identifies patients who benefit from revascularization versus those with a good prognosis who receive drugs only. METHODS All patients with known or suspected CAD referred to stress-perfusion CMR for myocardial ischemia assessment were prospectively enrolled. The CMR examination included standard functional adenosine stress first-pass perfusion (gadobutrol 0.1 mmol/kg Gadovist, Bayer AG, Zurich, Switzerland) and late gadolinium enhancement (LGE) acquisitions. Presence of ischemia and ischemia burden (number of ischemic segments on a 16-segment model), and of scar and scar burden (number and transmurality of scar segments in a 17-segment model) were assessed. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction (MI), and late coronary revascularization (>90 days post-CMR); the secondary endpoint was a composite of cardiac death and nonfatal MI. RESULTS During a follow-up of 2.5 ± 1.0 years, 86 and 32 of 1,024 patients (1,103 screened patients) experienced the primary and secondary endpoints, respectively. On Kaplan-Meier curves for the primary and secondary endpoints, patients without ischemia had excellent outcomes that did not differ from patients with <1.5 ischemic segments. In multivariate Cox regression analyses of the entire population and of the subgroups, ischemia burden (threshold: ≥1.5 ischemic segments) was consistently the strongest predictor of the primary and secondary endpoints with hazard ratios (HRs) of 7.42 to 8.72 (p < 0.001), whereas age (≥67 years), left ventricular ejection fraction (≤40%), and scar burden (LGE score ≥0.03) contributed significantly, but to a lesser extent, in all models with HRs of 2.01 to 3.48, 1.75 to 1.96, and 1.66 to 1.76, respectively. CONCLUSIONS In a large all-comer patient cohort with known and suspected CAD, an ischemia burden of ≥1.5 ischemic segments on stress-perfusion CMR was the strongest predictor of the primary and secondary endpoints. Patients with zero or 1 ischemic segment can be safely deferred from revascularizations.
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Affiliation(s)
- Gabriella Vincenti
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pier Giorgio Masci
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pierre Monney
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Tobias Rutz
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sarah Hugelshofer
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Mirdita Gaxherri
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Olivier Muller
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Juan F Iglesias
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Eric Eeckhout
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Cyril Pellaton
- Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Division of Cardiology, Department of Internal Medicine, Neuchâtel, Switzerland
| | - Christophe Sierro
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Division of Cardiology, Centre Hospitalier du Valais Romand (CHVR), Sion, Switzerland
| | - Juerg Schwitter
- Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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Farahani B, Skandari R, Abbasi MA, Aghalou S, Gohari S, Heydari AH, Farahani M. The Association between Myocardial Perfusion Scan and Electrocardiographic Findings among Patients with Myocardial Ischemia. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2017. [DOI: 10.21859/ijcp-020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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213
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Kaw R. Cardiac Risk Stratification Among Ambulatory Patients Undergoing Non-Cardiac Surgery. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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214
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Budoff MJ, Raggi P, Beller GA, Berman DS, Druz RS, Malik S, Rigolin VH, Weigold WG, Soman P. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology. JACC Cardiovasc Imaging 2016; 9:176-92. [PMID: 26846937 DOI: 10.1016/j.jcmg.2015.11.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/06/2015] [Indexed: 12/21/2022]
Abstract
Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - George A Beller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center and the Cedars-Sinai Heart Institute, Los Angeles, California
| | - Regina S Druz
- Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, Uniondale, New York
| | - Shaista Malik
- Department of Medicine, University of California, Irvine, California
| | - Vera H Rigolin
- Department of Medicine/Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wm Guy Weigold
- Cardiology Division, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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215
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A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve. J Am Coll Cardiol 2016; 68:2247-2255. [DOI: 10.1016/j.jacc.2016.08.055] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/08/2016] [Accepted: 08/31/2016] [Indexed: 11/20/2022]
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216
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Mc Ardle B, Shukla T, Nichol G, deKemp RA, Bernick J, Guo A, Lim SP, Davies RA, Haddad H, Duchesne L, Hendry P, Masters R, Ross H, Freeman M, Gulenchyn K, Racine N, Humen D, Benard F, Ruddy TD, Chow BJ, Mielniczuk L, DaSilva JN, Garrard L, Wells GA, Beanlands RS, Higginson L, Mesana T, Ukkonen H, Yoshinaga K, Renaud J, Klein R, Aung M, Kostuk W, Wisenberg G, White M, Iwanochko R, Mickleborough L, Abramson B, Latter D, Lamy A, Fallen E, Coates G. Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004331. [DOI: 10.1161/circimaging.115.004331] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
Background—
Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)–assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed. Long-term outcomes of viability imaging–assisted management have not previously been evaluated in a randomized controlled trial.
Methods and Results—
PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62–1.07];
P
=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54–0.99;
P
=0.042).
Conclusions—
After a 5-year follow-up in patients with left ventricular dysfunction and suspected CAD, overall, PET-assisted management did not significantly reduce cardiac events compared with standard care. However, significant benefits were observed when there was adherence to PET recommendations. PET viability imaging may be best applied when there is likely to be adherence to imaging-based recommendations.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00385242.
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Affiliation(s)
- Brian Mc Ardle
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Tushar Shukla
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Graham Nichol
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Robert A. deKemp
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Jordan Bernick
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Ann Guo
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Siok Ping Lim
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Ross A. Davies
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Haissam Haddad
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Lloyd Duchesne
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Paul Hendry
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Roy Masters
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Heather Ross
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Michael Freeman
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Karen Gulenchyn
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Normand Racine
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Dennis Humen
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Francois Benard
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Terrence D. Ruddy
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Benjamin J. Chow
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Lisa Mielniczuk
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Jean N. DaSilva
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Linda Garrard
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - George A. Wells
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | - Rob S.B. Beanlands
- From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of
| | | | - T. Mesana
- University of Ottawa Heart Institute
| | | | | | - J. Renaud
- University of Ottawa Heart Institute
| | - R. Klein
- University of Ottawa Heart Institute
| | - M. Aung
- University of Ottawa Heart Institute
| | | | | | | | | | | | | | | | - A. Lamy
- Hamilton Health Sciences Centre
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Iwasaki K, Matsumoto T. Relationship between coronary calcium score and high-risk plaque/significant stenosis. World J Cardiol 2016; 8:481-487. [PMID: 27621776 PMCID: PMC4997529 DOI: 10.4330/wjc.v8.i8.481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/22/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the relationship between coronary calcium score (CCS) and vulnerable plaque/significant stenosis using coronary computed tomographic angiography (CCTA).
METHODS CCTA was performed in 651 patients and these patients were divided into the four groups (CCS 0, 1-100, 101-400 and > 400). We studied the incidence of high-risk plaque, including positive remodeling, low attenuation plaque, spotty calcification, and napkin-ring sign, and significant stenosis in each group.
RESULTS High-risk plaque was found in 1.3%, 10.1%, 13.3% and 13.4% of patients with CCS 0, 1-100, 101-400 and > 400, respectively (P < 0.001). The difference was only significant for patients with zero CCS. The incidence of significant stenosis was 0.6%, 7.6%, 13.3% and 26.9% for each patient group, respectively (P < 0.001), which represented a significant stepwise increase as CCS increased. The combined incidence of high-risk plaque and significant stenosis was 1.9%, 17.7%, 26.9% and 40.3% in each patient group, respectively (P < 0.001), again representing a significant stepwise increase with CCS. The rate of major coronary event was 0%, 4.0%, 7.9% and 17.2% in each patient group, respectively (P < 0.001), another significant stepwise increase as CCS increased.
CONCLUSION Stepwise increased risk of coronary events associated with increasing CCS is caused by increasing incidence of significant stenosis, while that of high-risk plaque remains the same.
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Sevag Packard RR, Karlsberg RP. Integrating FFRCT Into Routine Clinical Practice: A Solid PLATFORM or Slippery Slope? J Am Coll Cardiol 2016; 68:446-449. [PMID: 27470450 PMCID: PMC5378152 DOI: 10.1016/j.jacc.2016.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California; Department of Molecular, Cellular, and Integrative Physiology, University of California, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California; Cardiovascular Research Foundation of Southern California, Los Angeles, California
| | - Ronald P Karlsberg
- David Geffen School of Medicine at UCLA, Los Angeles, California; Cardiovascular Research Foundation of Southern California, Los Angeles, California; Cedars Sinai Heart Institute, Los Angeles, California.
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219
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Ahmadi A, Stone GW, Leipsic J, Shaw LJ, Villines TC, Kern MJ, Hecht H, Erlinge D, Ben-Yehuda O, Maehara A, Arbustini E, Serruys P, Garcia-Garcia HM, Narula J. Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease. Circ Res 2016; 119:317-29. [DOI: 10.1161/circresaha.116.308952] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/10/2016] [Indexed: 01/10/2023]
Abstract
Risk stratification in patients with stable ischemic heart disease is essential to guide treatment decisions. In this regard, whether coronary anatomy, physiology, or plaque morphology is the best determinant of prognosis (and driver an effective therapeutic risk reduction) remains one of the greatest ongoing debates in cardiology. In the present report, we review the evidence for each of these characteristics and explore potential algorithms that may enable a practical diagnostic and therapeutic strategy for the management of patients with stable ischemic heart disease.
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Affiliation(s)
- Amir Ahmadi
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Gregg W. Stone
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Jonathon Leipsic
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Leslee J. Shaw
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Todd C. Villines
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Morton J. Kern
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Harvey Hecht
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - David Erlinge
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Ori Ben-Yehuda
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Akiko Maehara
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Eloisa Arbustini
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Patrick Serruys
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Hector M. Garcia-Garcia
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
| | - Jagat Narula
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of
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Affiliation(s)
- Christian Seiler
- Department of Cardiology, University Hospital, Bern, Switzerland
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Heber D, Hacker M. [Ischemic burden vs. coronary artery morphology : What is crucial for the indication of revascularization?]. Herz 2016; 41:376-83. [PMID: 27333984 DOI: 10.1007/s00059-016-4450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ischemic heart disease still represents the leading cause of death in the western world despite a decrease of mortality in the last decade. For the diagnostics of coronary artery morphology, invasive coronary angiography represents the gold standard. Nevertheless, in recent years the importance of functional diagnostics of the coronary arteries has increased and various imaging procedures for the measurement of fractional flow reserve (FFR) during coronary angiography were established and recommended for ischemia testing in the actual guidelines on myocardial revascularization.Imaging modalities for diagnostics of the functional relevance of coronary artery disease include stress echocardiography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). These procedures enable advanced risk stratification and therapy guiding in patients with suspected or known coronary artery disease. In future algorithms, hybrid imaging may facilitate the determination of anatomical and functional aspects after only one investigation.In the present article, the role of ischemia testing is compared with morphological methods for the diagnosis of coronary artery disease, individual risk stratification, and therapy guiding.
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Affiliation(s)
- D Heber
- Klinische Abteilung für Nuklearmedizin, Universitätsklinik für Radiologie und Nuklearmedizin, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - M Hacker
- Klinische Abteilung für Nuklearmedizin, Universitätsklinik für Radiologie und Nuklearmedizin, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Briceno N, Perera D. To Revascularise or Not To Revascularise, That Is the Question: the Diagnostic and Management Conundrum of Ischaemic Cardiomyopathy. Curr Cardiol Rep 2016; 18:54. [PMID: 27115418 PMCID: PMC4846708 DOI: 10.1007/s11886-016-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ischaemic cardiomyopathy is an important cardiovascular condition that has differing pathophysiological substrates and clinical manifestations. Contemporary management involves the administration of heart failure pharmacotherapy and device therapy where indicated, which has good prognostic data to support it. Whilst the role of revascularisation is clear in those patients presenting with an acute coronary syndrome or angina, the role in those patients presenting either incidentally, with predominant heart failure symptoms, or in those presenting with acute heart failure with an associated elevated troponin is less well defined and lacks randomised outcome data to support its adoption. The aim of this review is therefore to discuss the challenges in the diagnosis of ischaemic cardiomyopathy with a review of the existing imaging modalities that can facilitate, and to revisit the variety of clinical presentations that can occur, with particular emphasis on the contemporary role of revascularisation in these cohorts of patients.
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Affiliation(s)
- Natalia Briceno
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK.
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Pernot M, Lee WN, Bel A, Mateo P, Couade M, Tanter M, Crozatier B, Messas E. Shear Wave Imaging of Passive Diastolic Myocardial Stiffness: Stunned Versus Infarcted Myocardium. JACC Cardiovasc Imaging 2016; 9:1023-1030. [PMID: 27236522 PMCID: PMC5019097 DOI: 10.1016/j.jcmg.2016.01.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/13/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to investigate the potential of shear wave imaging (SWI), a novel ultrasound-based technique, to noninvasively quantify passive diastolic myocardial stiffness in an ovine model of ischemic cardiomyopathy. Background Evaluation of diastolic left ventricular function is critical for evaluation of heart failure and ischemic cardiomyopathy. Myocardial stiffness is known to be an important property for the evaluation of the diastolic myocardial function, but this parameter cannot be measured noninvasively by existing techniques. Methods SWI was performed in vivo in open-chest procedures in 10 sheep. Ligation of a diagonal of the left anterior descending coronary artery was performed for 15 min (stunned group, n = 5) and 2 h (infarcted group, n = 5). Each procedure was followed by a 40-min reperfusion period. Diastolic myocardial stiffness was measured at rest, during ischemia, and after reperfusion by using noninvasive shear wave imaging. Simultaneously, end-diastolic left ventricular pressure and segmental strain were measured with a pressure catheter and sonomicrometers during transient vena caval occlusions to obtain gold standard evaluation of myocardial stiffness using end-diastolic strain-stress relationship (EDSSR). Results In both groups, the end-systolic circumferential strain was drastically reduced during ischemia (from 14.2 ± 1.2% to 1.3 ± 1.6% in the infarcted group and from 13.5 ± 3.0% to 1.9 ± 1.8% in the stunned group; p <0.01). SWI diastolic stiffness increased after 2 h of ischemia from 1.7 ± 0.4 to 6.2 ± 2.2 kPa (p < 0.05) and even more after reperfusion (12.1 ± 4.2 kPa; p < 0.01). Diastolic myocardial stiffening was confirmed by the exponential constant coefficient of the EDSSR, which increased from 8.8 ± 2.3 to 25.7 ± 9.5 (p < 0.01). In contrast, SWI diastolic stiffness was unchanged in the stunned group (2.3 ± 0.4 kPa vs 1.8 ± 0.3 kPa, p = NS) which was confirmed also by the exponential constant of EDSSR (9.7 ± 3.1 vs 10.2 ± 2.3, p = NS). Conclusions Noninvasive SWI evaluation of diastolic myocardial stiffness can differentiate between stiff, noncompliant infarcted wall and softer wall containing stunned myocardium.
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Affiliation(s)
- Mathieu Pernot
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, ParisTech, Paris, France; CNRS, Unité mixte de recherche 7587, Paris, France; Institut National de la Santé et de la Recherche Médicale, U979, Paris, France; Université Paris Diderot-Paris7, Paris, France.
| | - Wei-Ning Lee
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, ParisTech, Paris, France; CNRS, Unité mixte de recherche 7587, Paris, France; Institut National de la Santé et de la Recherche Médicale, U979, Paris, France; Université Paris Diderot-Paris7, Paris, France
| | - Alain Bel
- Hopital Européen Georges Pompidou, Paris, Unité mixte de recherche 970, PARCC, France
| | - Philippe Mateo
- Institut National de la Santé et de la Recherche Médicale, Unité mixte de recherche-S 769, Châtenay-Malabry, France; Université Paris-Sud, Faculté de Pharmacie, Châtenay-Malabry, France
| | | | - Mickaël Tanter
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, ParisTech, Paris, France; CNRS, Unité mixte de recherche 7587, Paris, France; Institut National de la Santé et de la Recherche Médicale, U979, Paris, France; Université Paris Diderot-Paris7, Paris, France
| | - Bertrand Crozatier
- Institut National de la Santé et de la Recherche Médicale, Unité mixte de recherche-S 769, Châtenay-Malabry, France; Université Paris-Sud, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Emmanuel Messas
- Hopital Européen Georges Pompidou, Paris, Unité mixte de recherche 970, PARCC, France; Université Paris Descartes, Faculté de Médecine, Paris, France
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Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J 2016; 37:1268-1283. [PMID: 26543047 DOI: 10.1093/eurheartj/ehv592] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Nudi F, Schillaci O, Neri G, Pinto A, Procaccini E, Vetere M, Frati G, Tomai F, Biondi-Zoccai G. Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease. J Nucl Cardiol 2016; 23:274-84. [PMID: 25827620 DOI: 10.1007/s12350-015-0077-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) has an established diagnostic and prognostic role in patients with or at risk for coronary artery disease, with ischemia severity and extent having already been identified as key predictors. Whether this is affected by the location of myocardial ischemia is uncertain. We aimed at comparing the prognostic outlook of patients undergoing MPS according to the site of ischemia. METHODS Our institutional database was queried for subjects undergoing MPS, without myocardial necrosis or recent revascularization. We focused on the prognostic impact of location of vessel-related ischemia (VRI) at MPS, distinguishing four mutually exclusive groups: single-VRI involving left anterior descending (LAD), single-VRI not involving LAD, multi-VRI involving LAD, and multi-VRI not involving LAD. The primary outcome was the long-term (>1 year) rate of death or myocardial infarction (D/MI). RESULTS A total of 13,254 patients were included. Moderate or severe VRI occurred in 2,627 (20%) patients. Clinical outcomes were significantly different among the groups of patients with moderate or severe VRI, including death, cardiac death, non-fatal myocardial infarction or their composites (overall P < .001). Specifically, and excluding subjects undergoing revascularization as first follow-up event, D/MI occurred in 8.4% of patients with single-VRI involving LAD, 5.5% of subjects with single-VRI not involving LAD, 16.5% of those with multi-VRI involving LAD, and 7.3% of patients with multi-VRI not involving LAD (overall P < .001). Even at incremental multivariable Cox proportional analysis, hierarchical VRI was independently associated with an increased risk of D/MI [hazard ratio = 1.17 (1.04-1.08) for each class increment, P = .010]. CONCLUSIONS Location and extent of myocardial ischemia at MPS according to the VRI concept have a hierarchical predictive impact, with multi-VRI involving LAD being significantly and independently more prognostically ominous than other types of VRI.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Orazio Schillaci
- Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Maurizio Vetere
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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226
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Lee DS, Husain M, Wang X, Austin PC, Iwanochko RM. Cardiovascular outcomes after pharmacologic stress myocardial perfusion imaging. Am Heart J 2016; 174:138-46. [PMID: 26995380 DOI: 10.1016/j.ahj.2016.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/16/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification improvement (NRI) of prognosis is unknown. METHODS We evaluated the prognostic value of pharmacologic stress MPI for prediction of cardiovascular death or non-fatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. RESULTS Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of cardiovascular death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction ≤50%. Compared to a clinical model which included age, sex, cardiovascular disease, risk factors, and medications, model χ(2) (210.5 vs. 281.9, P < .001) and c-statistic (0.74 vs. 0.78, P < .001) were significantly increased by addition of SPECT-MPI predictors (summed stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P < .001), reclassifying 66.5% of patients as lower risk and 32.8% as higher risk of cardiovascular death or non-fatal MI. Addition of MPI predictors to clinical factors using risk categories, defined as <1%, 1% to 3%, and >3% annualized risk of cardiovascular death or non-fatal MI, yielded a 15.0% improvement in NRI (95% CI 7.6%-27.6%, P < .001). CONCLUSIONS Pharmacologic stress MPI substantially improved net reclassification of cardiovascular death or MI risk beyond that afforded by clinical factors.
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Affiliation(s)
- Douglas S Lee
- Robert J. Burns Nuclear Cardiology Laboratory, University of Toronto, Toronto, Canada; Joint Department of Medical Imaging and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada.
| | - Mansoor Husain
- Robert J. Burns Nuclear Cardiology Laboratory, University of Toronto, Toronto, Canada; Joint Department of Medical Imaging and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada; Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada
| | - Robert M Iwanochko
- Robert J. Burns Nuclear Cardiology Laboratory, University of Toronto, Toronto, Canada; Joint Department of Medical Imaging and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
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Hachamovitch R, Nutter B, Menon V, Cerqueira MD. Predicting Risk Versus Predicting Potential Survival Benefit Using 123I-mIBG Imaging in Patients With Systolic Dysfunction Eligible for Implantable Cardiac Defibrillator Implantation: Analysis of Data From the Prospective ADMIRE-HF Study. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.114.003110. [PMID: 26666380 DOI: 10.1161/circimaging.114.003110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac (123)I-metaiodobenzylguanidine ((123)I-mIBG) imaging improves prognostication in patients with left ventricular (LV) dysfunction. Whether (123)I-mIBG can identify optimal candidates for implantable cardiac defibrillator (ICD) placement is unclear. We examined whether (123)I-mIBG enhances risk assessment and identifies patients with enhanced survival with ICD in a patient cohort with reduced LV function who were candidates for ICD implantation. METHODS AND RESULTS We identified 777 patients (66 sites, 12 countries) without ICD at the time of enrollment in Adreview Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) and index (123)I-mIBG study. Patients completed prescribed study protocol and follow-up. Heart-to-mediastinum (H/M) ratio was determined from (123)I-mIBG results. Survival modeling used a Cox proportional hazards mixed-effects model, including a propensity score, to adjust for nonrandomized ICD implantation after (123)I-mIBG. All-cause death occurred in 75 patients (9.6%), and 196 (25%) patients had ICD implantation on follow-up. After adjusting for multiple factors, although the H/M ratio added incremental prognostic value and enhanced reclassification, neither H/M results, BNP levels, nor left ventricular ejection fraction interacted with ICD use in the survival model, indicating that these variables did not identify patients with enhanced survival with ICD implantation. Nonetheless, H/M results did identify the number of lives saved by ICD use per 100 treated. CONCLUSIONS We found that although (123)I-mIBG imaging enhances the risk stratification of patients with left ventricular dysfunction who are ICD candidates, it does not identify which patients may have improved survival with ICD placement. However, (123)I-mIBG identifies the absolute benefit gained with ICD use, thus may play a role in optimizing the cost-effectiveness of this intervention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00126425 and NCT00126438.
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Affiliation(s)
- Rory Hachamovitch
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH.
| | - Benjamin Nutter
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
| | - Venu Menon
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
| | - Manuel D Cerqueira
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
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Acampa W, Buechel RR, Gimelli A. Low dose in nuclear cardiology: state of the art in the era of new cadmium–zinc–telluride cameras. Eur Heart J Cardiovasc Imaging 2016; 17:591-5. [DOI: 10.1093/ehjci/jew036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/13/2016] [Indexed: 01/22/2023] Open
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Vrints CJ, Senior R, Crea F, Sechtem U. Assessing suspected angina: requiem for coronary computed tomography angiography or exercise electrocardiogram? Eur Heart J 2016; 38:1792-1800. [DOI: 10.1093/eurheartj/ehw065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/29/2016] [Indexed: 01/19/2023] Open
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Polte CL, Burck I, Gjertsson P, Lomsky M, Nekolla SG, Nagel E. Cardiac Positron Emission Tomography: a Clinical Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med 2016; 30:188-99. [PMID: 26897008 PMCID: PMC4819542 DOI: 10.1007/s12149-016-1065-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/31/2016] [Indexed: 11/16/2022]
Abstract
As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of 123I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.
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Adjedj J, De Bruyne B, Floré V, Di Gioia G, Ferrara A, Pellicano M, Toth GG, Bartunek J, Vanderheyden M, Heyndrickx GR, Wijns W, Barbato E. Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease. Circulation 2016; 133:502-8. [DOI: 10.1161/circulationaha.115.018747] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Julien Adjedj
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Bernard De Bruyne
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Vincent Floré
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Giuseppe Di Gioia
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Angela Ferrara
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Mariano Pellicano
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Gabor G. Toth
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Jozef Bartunek
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Marc Vanderheyden
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Guy R. Heyndrickx
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - William Wijns
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
| | - Emanuele Barbato
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.)
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Simonsen JA, Johansen A, Gerke O, Mickley H, Thomassen A, Hess S, Rask CK, Tamadoni M, Jensen LO, Hallas J, Vach W, Høilund-Carlsen PF. Outcome with invasive versus medical treatment of stable coronary artery disease: influence of perfusion defect size, ischaemia, and ejection fraction. EUROINTERVENTION 2016; 11:1118-24. [DOI: 10.4244/eijv11i10a226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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234
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Petretta M, Salvatore M, Cuocolo A. Immortality time and serial myocardial perfusion imaging: Only those who do not die may repeat the exam. J Nucl Cardiol 2016; 23:113-6. [PMID: 25971990 DOI: 10.1007/s12350-015-0171-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy.
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Stone GW, Hochman JS, Williams DO, Boden WE, Ferguson TB, Harrington RA, Maron DJ. Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia: The Case for Community Equipoise. J Am Coll Cardiol 2016; 67:81-99. [PMID: 26616030 PMCID: PMC5545795 DOI: 10.1016/j.jacc.2015.09.056] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Gregg W Stone
- Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
| | - Judith S Hochman
- Department of Medicine, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York
| | - David O Williams
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - William E Boden
- Department of Medicine, Samuel S. Stratton VA Medical Center, Albany Medical Center and Albany Medical College, Albany, New York
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, North Carolina
| | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Lindner O, Pascual TNB, Mercuri M, Acampa W, Burchert W, Flotats A, Kaufmann PA, Kitsiou A, Knuuti J, Underwood SR, Vitola JV, Mahmarian JJ, Karthikeyan G, Better N, Rehani MM, Kashyap R, Dondi M, Paez D, Einstein AJ. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries. Eur J Nucl Med Mol Imaging 2015; 43:718-28. [PMID: 26686336 PMCID: PMC4764636 DOI: 10.1007/s00259-015-3270-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/27/2015] [Indexed: 02/04/2023]
Abstract
Purpose Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 – 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.
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Affiliation(s)
- Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Mathew Mercuri
- Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Wanda Acampa
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Wolfgang Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | | | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | | | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Madan M Rehani
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria.,Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ravi Kashyap
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA.,Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
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Petretta M, Acampa W, Daniele S, Zampella E, Assante R, Nappi C, Salvatore M, Cuocolo A. Long-Term Survival Benefit of Coronary Revascularization in Patients Undergoing Stress Myocardial Perfusion Imaging. Circ J 2015; 80:485-93. [PMID: 26686993 DOI: 10.1253/circj.cj-15-1093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We assessed the relationship between clinical outcome and coronary revascularization according to stress-gated myocardial perfusion single-photon emission computed tomography (MPS) in an observational series of patients with suspected or known coronary artery disease (CAD), on long-term follow-up. METHODS AND RESULTS The study group consisted of 2,059 patients. During a median follow-up of 61 months, 184 events occurred (126 cardiac deaths and 58 non-fatal MI). The impact of revascularization during follow-up on event-free survival was evaluated using an extended Cox regression model, adjusting for potential clinical and MPS confounders. Revascularization was treated as a binary non-reversible time-dependent covariate. Predefined interactions tested were: (1) revascularization and summed difference score (SDS); (2) revascularization and post-stress left ventricular (LV) ejection fraction (EF); and (3) SDS and post-stress LVEF. Revascularization had a significant effect on event-free survival (adjusted HR, 0.19; P<0.001). Significant interactions were found between revascularization and SDS (P=0.045), and between LVEF and SDS (P=0.015). The protective effect of revascularization increased as SDS increased. For SDS <6 the reduction in HR was detectable only for reduced LVEF. CONCLUSIONS Both the degree of stress-induced ischemia and LVEF predict the effect of revascularization on outcome in patients with suspected or known CAD. The protective effect of revascularization appears to be greater in patients with severe ischemia and preserved LVEF.
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Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University of Naples Federico II
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238
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van Nunen LX, Zimmermann FM, Tonino PAL, Barbato E, Baumbach A, Engstrøm T, Klauss V, MacCarthy PA, Manoharan G, Oldroyd KG, Ver Lee PN, Van't Veer M, Fearon WF, De Bruyne B, Pijls NHJ. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015; 386:1853-60. [PMID: 26333474 DOI: 10.1016/s0140-6736(15)00057-4] [Citation(s) in RCA: 406] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. METHODS The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had FFR measurements of all stenotic arteries and PCI was done only if FFR was 0·80 or less. No one was masked to treatment assignment. The primary endpoint was major adverse cardiac events at 1 year, and the data for the 5-year follow-up are reported here. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00267774. FINDINGS After 5 years, major adverse cardiac events occurred in 31% of patients (154 of 496) in the angiography-guided group versus 28% (143 of 509 patients) in the FFR-guided group (relative risk 0·91, 95% CI 0·75-1·10; p=0·31). The number of stents placed per patient was significantly higher in the angiography-guided group than in the FFR-guided group (mean 2·7 [SD 1·2] vs 1·9 [1·3], p<0·0001). INTERPRETATION The results confirm the long-term safety of FFR-guided PCI in patients with multivessel disease. A strategy of FFR-guided PCI resulted in a significant decrease of major adverse cardiac events for up to 2 years after the index procedure. From 2 years to 5 years, the risks for both groups developed similarly. This clinical outcome in the FFR-guided group was achieved with a lower number of stented arteries and less resource use. These results indicate that FFR guidance of multivessel PCI should be the standard of care in most patients. FUNDING St Jude Medical, Friends of the Heart Foundation, and Medtronic.
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Affiliation(s)
- Lokien X van Nunen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frederik M Zimmermann
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Andreas Baumbach
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Thomas Engstrøm
- Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Volker Klauss
- Medizinische Poliklinik, Campus-Innenstadt, University Hospital, Munich, Germany
| | | | | | | | - Peter N Ver Lee
- Northeast Cardiology Associates and Eastern Maine Medical Center, Bangor, ME, USA
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - William F Fearon
- Stanford University Medical Center and Palo Alto VA Health Care Systems, Stanford, CA, USA
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
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239
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Angina in Revascularization of Ischemic Cardiomyopathy. J Am Coll Cardiol 2015; 66:2101-2103. [DOI: 10.1016/j.jacc.2015.08.880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 11/21/2022]
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Ammirati E, Guida V, Latib A, Moroni F, Arioli F, Scotti I, Rimoldi OE, Colombo A, Camici PG. Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous coronary interventions. BMC Cardiovasc Disord 2015; 15:137. [PMID: 26503520 PMCID: PMC4624381 DOI: 10.1186/s12872-015-0126-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022] Open
Abstract
Background Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear. Methods We retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF). Results The median follow-up was 28 months (inter-quartile range 14–46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF < 35 %, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2 % at baseline to 16.3 % at the last follow up (p < 0.0001). Conclusions IDDM, symptoms of HF, multivessel disease and LVEF < 35 % appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.
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Affiliation(s)
- Enrico Ammirati
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy. .,Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy. .,Cardiothoracic Department, San Raffaele Scientific Institute and University, Via Olgettina 60, 20132, Milan,, Italy.
| | - Valentina Guida
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Azeem Latib
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Moroni
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Arioli
- A.O. Ospedale di Circolo di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Isabella Scotti
- Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | | | - Antonio Colombo
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Paolo G Camici
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Juneau D, Erthal F, Ohira H, Mc Ardle B, Hessian R, deKemp RA, Beanlands RSB. Clinical PET Myocardial Perfusion Imaging and Flow Quantification. Cardiol Clin 2015; 34:69-85. [PMID: 26590781 DOI: 10.1016/j.ccl.2015.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac PET imaging is a powerful tool for the assessment of coronary artery disease. Many tracers with different advantages and disadvantages are available. It has several advantages over single photon emission computed tomography, including superior accuracy and lower radiation exposure. It provides powerful prognostic information, which can help to stratify patients and guide clinicians. The addition of flow quantification enables better detection of multivessel disease while providing incremental prognostic information. Flow quantification provides important physiologic information, which may be useful to individualize patient therapy. This approach is being applied in some centers, but requires standardization before it is more widely applied.
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Affiliation(s)
- Daniel Juneau
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Fernanda Erthal
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Hiroshi Ohira
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; First Department of Medicine, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Brian Mc Ardle
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Renée Hessian
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
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Arsanjani R, Dey D, Khachatryan T, Shalev A, Hayes SW, Fish M, Nakanishi R, Germano G, Berman DS, Slomka P. Prediction of revascularization after myocardial perfusion SPECT by machine learning in a large population. J Nucl Cardiol 2015; 22:877-84. [PMID: 25480110 PMCID: PMC4859156 DOI: 10.1007/s12350-014-0027-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to investigate if early revascularization in patients with suspected coronary artery disease can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. METHODS 713 rest (201)Thallium/stress (99m)Technetium MPS studies with correlating invasive angiography with 372 revascularization events (275 PCI/97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation, stress combined supine/prone total perfusion deficit (TPD), supine rest and stress TPD, exercise ejection fraction, and end-systolic volume, along with clinical parameters including patient gender, history of hypertension and diabetes mellitus, ST-depression on baseline ECG, ECG and clinical response during stress, and post-ECG probability by boosted ensemble ML algorithm (LogitBoost) to predict revascularization events. These features were selected using an automated feature selection algorithm from all available clinical and quantitative data (33 parameters). Tenfold cross-validation was utilized to train and test the prediction model. The prediction of revascularization by ML algorithm was compared to standalone measures of perfusion and visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. RESULTS The sensitivity of machine learning (ML) (73.6% ± 4.3%) for prediction of revascularization was similar to one reader (73.9% ± 4.6%) and standalone measures of perfusion (75.5% ± 4.5%). The specificity of ML (74.7% ± 4.2%) was also better than both expert readers (67.2% ± 4.9% and 66.0% ± 5.0%, P < .05), but was similar to ischemic TPD (68.3% ± 4.9%, P < .05). The receiver operator characteristics areas under curve for ML (0.81 ± 0.02) was similar to reader 1 (0.81 ± 0.02) but superior to reader 2 (0.72 ± 0.02, P < .01) and standalone measure of perfusion (0.77 ± 0.02, P < .01). CONCLUSION ML approach is comparable or better than experienced readers in prediction of the early revascularization after MPS, and is significantly better than standalone measures of perfusion derived from MPS.
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Affiliation(s)
- Reza Arsanjani
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Damini Dey
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Tigran Khachatryan
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
| | - Aryeh Shalev
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
| | - Mathews Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Rine Nakanishi
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
| | - Guido Germano
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Artificial Intelligence in Medicine Program, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA.
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Zimmermann FM, De Bruyne B, Pijls NHJ, Desai M, Oldroyd KG, Park SJ, Reardon MJ, Wendler O, Woo J, Yeung AC, Fearon WF. Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 Trial: a comparison of fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass graft surgery in patients with multivessel coronary artery disease. Am Heart J 2015; 170:619-626.e2. [PMID: 26386784 DOI: 10.1016/j.ahj.2015.06.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/14/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Guidelines recommend coronary artery bypass graft (CABG) surgery over percutaneous coronary intervention (PCI) for the treatment of 3-vessel coronary artery disease (3-VD). The inferior results of PCI demonstrated by previous large randomized trials comparing PCI and CABG might be explained by the use of suboptimal stent technology and by the lack of fractional flow reserve (FFR) guidance of PCI. TRIAL DESIGN The objective of this investigator-initiated, multicenter, randomized clinical trial is to investigate whether FFR-guided PCI with new-generation stents is noninferior to CABG in patients with 3-VD, not including the left main coronary artery. Eligible patients must have ≥50% coronary stenoses in all 3 major epicardial vessels or major side branches. Patients with a nondominant right coronary artery may be included only if the left anterior descending artery and left circumflex have ≥50% stenoses. Consecutive patients who meet all of the inclusion criteria and none of the exclusion criteria will be randomized in a 1:1 fashion to either CABG or FFR-guided PCI. Coronary artery bypass graft will be performed based on the angiogram as per clinical routine. Patients assigned to FFR-guided PCI will have FFR measured in each diseased vessel and only undergo stenting if the FFR is ≤0.80. The primary end point of the study is a composite of major adverse cardiac and cerebrovascular events, including death, myocardial infarction, repeat coronary revascularization, and stroke at 1 year. Key secondary end point will be a composite of death, myocardial infarction, and stroke at 3-year follow-up. Other secondary end points include the individual adverse events, cost-effectiveness, and quality of life at 2-year, 3-year, with up to 5-year follow-up. CONCLUSION The FAME 3 study will compare in a multicenter, randomized fashion FFR-guided PCI with contemporary drug-eluting stents to CABG in patients with 3-VD.
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Affiliation(s)
| | | | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Manisha Desai
- Stanford University School of Medicine and Cancer Institute, Stanford, CA
| | | | - Seung-Jung Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK
| | - Joseph Woo
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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Shaw LJ. The next generation of prognostic series: Where we can improve on risk stratification? J Nucl Cardiol 2015; 22:1145-7. [PMID: 25814220 DOI: 10.1007/s12350-015-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Room 529, 1462 Clifton Road NE, Atlanta, GA, 30324, USA.
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245
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Trägårdh E, Carlsson M, Edenbrandt L. Computerized decision making in myocardial perfusion SPECT: The new era in nuclear cardiology? J Nucl Cardiol 2015; 22:885-7. [PMID: 25500801 DOI: 10.1007/s12350-014-0041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Marcus Carlsson
- Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lars Edenbrandt
- Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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Guaricci AI, Brunetti ND, Marra MP, Tarantini G, di Biase M, Pontone G. Diagnosis and prognosis of ischemic heart disease. J Cardiovasc Med (Hagerstown) 2015; 16:653-62. [DOI: 10.2459/jcm.0000000000000267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Prognostic value of stress-only and stress-rest normal gated SPECT imaging: higher incidence of cardiac hard events in diabetic patients who underwent full stress-rest imaging. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:455-9. [DOI: 10.5507/bp.2014.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/07/2014] [Indexed: 11/23/2022] Open
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248
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Prognostic evaluation in obese patients using a dedicated multipinhole cadmium-zinc telluride SPECT camera. Int J Cardiovasc Imaging 2015; 32:355-361. [DOI: 10.1007/s10554-015-0770-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
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249
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Kasama S, Toyama T, Sato M, Sano H, Ueda T, Sasaki T, Nakahara T, Higuchi T, Tsushima Y, Kurabayashi M. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study. Eur J Nucl Med Mol Imaging 2015; 43:302-311. [DOI: 10.1007/s00259-015-3197-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
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