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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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2
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Raposo L, Gonçalves M, Roque D, Gonçalves PA, Magno P, Brito J, Leal S, Madeira S, Santos M, Teles RC, E Abreu PF, Almeida M, Morais C, Mendes M, Baptista SB. Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period. Rev Port Cardiol 2021; 40:771-781. [PMID: 34857116 DOI: 10.1016/j.repce.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/17/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.
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Affiliation(s)
- Luís Raposo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
| | - Mariana Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - David Roque
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Pedro Araújo Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Pedro Magno
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - João Brito
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sílvio Leal
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Miguel Santos
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Pedro Farto E Abreu
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Manuel Almeida
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Carlos Morais
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Miguel Mendes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Bravo Baptista
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal; University Clinic of Cardiology, Faculty of Medicine at University of Lisbon, Lisboa, Portugal
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Assante R, Zampella E, Acampa W. Advanced technology in the risk stratification-based strategy: The way forward to keep going. J Nucl Cardiol 2021; 28:2937-2940. [PMID: 32533425 DOI: 10.1007/s12350-020-02198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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4
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 310] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:2218-2261. [PMID: 34756652 DOI: 10.1016/j.jacc.2021.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709928 DOI: 10.1161/cir.0000000000001030] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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8
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Neglia D, Maroz-Vadalazhskaya N, Carrabba N, Liga R. Coronary Revascularization in Patients With Stable Coronary Artery Disease: The Role of Imaging. Front Cardiovasc Med 2021; 8:716832. [PMID: 34778391 PMCID: PMC8581143 DOI: 10.3389/fcvm.2021.716832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
In the last decades, the effective management of some cardiovascular risk factors in the general population has led to a progressive decrease in the prevalence of coronary artery disease (CAD). Nevertheless, coronary heart disease remains the major cause of death in developed and developing countries and chronic coronary syndromes (CCS) are still a major target of utilization of non-invasive cardiac imaging and invasive procedures. Current guidelines recommend the use of non-invasive imaging in patients with CCS to identify subjects at higher risk to be referred for invasive coronary angiography and possible revascularization. These recommendations are challenged by two opposite lines of evidence. Recent trials have somewhat questioned the efficacy of coronary revascularization as compared with optimal medical therapy in CCS. As a consequence the role of imaging in these patients and in in patients with ischemic cardiomyopathy is under debate. On the other hand, real-life data indicate that a consistent proportion of patients undergo invasive procedure and are revascularized without any previous non-invasive imaging characterization. On top of this, the impact of COVID-19 pandemic on the sanitary systems caused a change in the current management of patients with CAD. In the present review we will discuss these conflicting data analyzing the evidence which has been recently accumulated as well as the gaps of knowledge which should still be filled.
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Affiliation(s)
- Danilo Neglia
- Cardiovascular Department, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy.,Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Nazario Carrabba
- Cardiothoracovascular Department, Careggi Hospital, Florence, Italy
| | - Riccardo Liga
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.,Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
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9
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Raposo L, Gonçalves M, Roque D, Gonçalves PA, Magno P, Brito J, Leal S, Madeira S, Santos M, Teles RC, E Abreu PF, Almeida M, Morais C, Mendes M, Baptista SB. Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period. Rev Port Cardiol 2021; 40:S0870-2551(21)00322-X. [PMID: 34474954 DOI: 10.1016/j.repc.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.
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Affiliation(s)
- Luís Raposo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
| | - Mariana Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - David Roque
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Pedro Araújo Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Pedro Magno
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - João Brito
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sílvio Leal
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Miguel Santos
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Pedro Farto E Abreu
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Manuel Almeida
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Carlos Morais
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Miguel Mendes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Bravo Baptista
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal; University Clinic of Cardiology, Faculty of Medicine at University of Lisbon, Lisboa, Portugal
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Anagnostopoulos CD, Siogkas PK, Liga R, Benetos G, Maaniitty T, Sakellarios AI, Koutagiar I, Karakitsios I, Papafaklis MI, Berti V, Sciagrà R, Scholte AJHA, Michalis LK, Gaemperli O, Kaufmann PA, Pelosi G, Parodi O, Knuuti J, Fotiadis DI, Neglia D. Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography. Eur Heart J Cardiovasc Imaging 2019; 20:897-905. [PMID: 30629151 DOI: 10.1093/ehjci/jey199] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Abstract
Aims
To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA).
Methods and results
vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783–0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648–0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799–0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632–0.929; P = 0.13).
Conclusion
vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.
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Affiliation(s)
| | - Panagiotis K Siogkas
- University of Ioannina, Materials Science and Engineering, Ioannina, Greece
- Biomedical Research Institute, FORTH, Ioannina, Greece
| | - Riccardo Liga
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | - Georgios Benetos
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece
| | | | | | - Iosif Koutagiar
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece
| | - Ioannis Karakitsios
- Biomedical Research Foundation of Academy of Athens, 4 Soranou Ephesiou, Athens, Greece
| | | | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy
| | - Roberto Sciagrà
- Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy
| | | | | | | | | | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | | | - Dimitrios I Fotiadis
- University of Ioannina, Materials Science and Engineering, Ioannina, Greece
- Biomedical Research Institute, FORTH, Ioannina, Greece
| | - Danilo Neglia
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, IT, Italy
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Dai N, Zhao M, Ge J. Which Functional Imaging Should We Refer to When Encountering an Anatomically Intermediate Coronary Stenosis? JACC Cardiovasc Imaging 2019; 12:939-940. [DOI: 10.1016/j.jcmg.2018.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 10/26/2022]
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12
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