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Lowenstern A, Alexander KP, Pagidipati NJ, Hill CL, Pellikka PA, Cooper LS, Alhanti B, Hoffmann U, Mark DB, Douglas PS. Presenting Symptoms in Patients Undergoing Coronary Artery Disease Evaluation: Association With Noninvasive Test Results and Clinical Outcomes in the PROMISE Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e008298. [PMID: 35369715 PMCID: PMC9117448 DOI: 10.1161/circoutcomes.121.008298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients evaluated for coronary artery disease have a range of symptoms and underlying risk. The relationships between patient-described symptoms, clinician conclusions, and subsequent clinical management and outcomes remain incompletely described. METHODS In this secondary analysis, we examined the association between 4 types of presenting symptoms (substernal/left-sided chest pain, other chest/neck/arm pain, dyspnea, and other symptoms) and patient risk, noninvasive test results, clinical management, and outcomes for stable outpatients randomized in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial. Multivariable regression models were used to evaluate differences in noninvasive test result, all-cause death/myocardial infarction/unstable angina hospitalization and cardiovascular death/myocardial infarction by symptom type. RESULTS Among 9996 patients, most presented with chest pain (47.2% substernal, 29.2% other), followed by dyspnea (14.9%), and other symptoms (8.7%). Patients with dyspnea were older (median age 63 versus 60, P≤0.02) with higher baseline risk (78.2% with atherosclerotic cardiovascular disease >7.5% versus 67.6%, P≤0.02). Using patients with substernal chest pain as a reference, there was no difference in noninvasive test positivity across symptom groups (all P>0.05), but test-positive patients with dyspnea (adjusted odds ratio, 0.66 [95% CI, 0.51-0.85]) or other symptoms (adjusted odds ratio, 0.65 [95% CI, 0.47-0.90]) were less likely to be referred for cardiac catheterization. While symptom type alone was not associated with outcomes, symptom presentation with chest pain or dyspnea did modify the association between a positive noninvasive test and clinical outcome (interaction P=0.025 for both all-cause death/myocardial infarction/unstable angina hospitalization and cardiovascular death/MI). CONCLUSIONS Among low-risk outpatients evaluated for coronary artery disease, typicality of symptoms was not closely associated with higher baseline risk but was related to differences in processes of care and the prognostic value of a positive test. Adverse events were not associated with clinician risk estimates or symptoms alone. These unexpected findings highlight the limitation of relying solely on symptom presentation or clinician risk estimation to evaluate patients for suspected coronary artery disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01174550.
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Affiliation(s)
- Angela Lowenstern
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.).,Vanderbilt University Medical Center (A.L.)
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Neha J Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | | | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, MD (L.S.C.)
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston (U.H.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
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Mehta PK, Wei J, Shufelt C, Quesada O, Shaw L, Bairey Merz CN. Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine. Front Cardiovasc Med 2021; 8:744788. [PMID: 34869650 PMCID: PMC8635525 DOI: 10.3389/fcvm.2021.744788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality among both women and men, yet women continue to have delays in diagnosis and treatment. The lack of recognition of sex-specific biological and socio-cultural gender-related differences in chest pain presentation of CAD may, in part, explain these disparities. Sex and gender differences in pain mechanisms including psychological susceptibility, the autonomic nervous system (ANS) reactivity, and visceral innervation likely contribute to chest pain differences. CAD risk scores and typical/atypical angina characterization no longer appear relevant and should not be used in women and men. Women more often have ischemia with no obstructive CAD (INOCA) and myocardial infarction, contributing to diagnostic and therapeutic equipoise. Existing knowledge demonstrates that chest pain often does not relate to obstructive CAD, suggesting a more thoughtful approach to percutaneous coronary intervention (PCI) and medical therapy for chest pain in stable obstructive CAD. Emerging knowledge regarding the central and ANS and visceral pain processing in patients with and without angina offers explanatory mechanisms for chest pain and should be investigated with interdisciplinary teams of cardiologists, neuroscientists, bio-behavioral experts, and pain specialists. Improved understanding of sex and gender differences in chest pain, including biological pathways as well as sociocultural contributions, is needed to improve clinical care in both women and men.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute and Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart Institute, Cincinnati, OH, United States
| | - Leslee Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
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Kumar A, Mitra V, Oliver C, Ullal A, Biddulph M, Mance I. Estimating Respiratory Rate From Breath Audio Obtained Through Wearable Microphones. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7310-7315. [PMID: 34892786 DOI: 10.1109/embc46164.2021.9629661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Respiratory rate (RR) is a clinical metric used to assess overall health and physical fitness. An individual's RR can change from their baseline due to chronic illness symptoms (e.g., asthma, congestive heart failure), acute illness (e.g., breathlessness due to infection), and over the course of the day due to physical exhaustion during heightened exertion. Remote estimation of RR can offer a cost-effective method to track disease progression and cardio-respiratory fitness over time. This work investigates a model-driven approach to estimate RR from short audio segments obtained after physical exertion in healthy adults. Data was collected from 21 individuals using microphone-enabled, near-field headphones before, during, and after strenuous exercise. RR was manually annotated by counting perceived inhalations and exhalations. A multi-task Long-Short Term Memory (LSTM) network with convolutional layers was implemented to process mel-filterbank energies, estimate RR in varying background noise conditions, and predict heavy breathing, indicated by an RR of more than 25 breaths per minute. The multi-task model performs both classification and regression tasks and leverages a mixture of loss functions. It was observed that RR can be estimated with a concordance correlation coefficient (CCC) of 0.76 and a mean squared error (MSE) of 0.2, demonstrating that audio can be a viable signal for approximating RR.Clinical relevance-The subject technology facilitates the use of accessible, aesthetically acceptable wearable headphones to provide a technologically efficient and cost-effective method to estimate respiratory rate and track cardio-respiratory fitness over time.
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4
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van Rosendael AR, Bax AM, van den Hoogen IJ, Smit JM, Al'Aref SJ, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Narula J, Min JK, Bax JJ. Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. Eur Heart J Cardiovasc Imaging 2020; 23:266-274. [PMID: 33538308 DOI: 10.1093/ehjci/jeaa323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. METHODS AND RESULTS From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. CONCLUSION In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - A Maxim Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, Hendersonville, TN, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.,Department of Medicine, University of Zurich, Zurich, Switzerland
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- Department of Cardiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Department of Cardiology, Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, The Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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5
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Zagatina A, Zhuravskaya N, Shmatov D, Ciampi Q, Carpeggiani C, Picano E. Exercise stress echocardiography with ABCDE protocol in unexplained dyspnoea. Int J Cardiovasc Imaging 2020; 36:823-831. [DOI: 10.1007/s10554-020-01789-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
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6
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Mehta PK, Bess C, Elias-Smale S, Vaccarino V, Quyyumi A, Pepine CJ, Bairey Merz CN. Gender in cardiovascular medicine: chest pain and coronary artery disease. Eur Heart J 2019; 40:3819-3826. [PMID: 31713592 PMCID: PMC7963141 DOI: 10.1093/eurheartj/ehz784] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality among women and men yet women are more often underdiagnosed, have a delay in diagnosis, and/or receive suboptimal treatment. An implicit gender-bias with regard to lack of recognition of sex-related differences in presentation of IHD may, in part, explain these differences in women compared with men. Indeed, existing knowledge demonstrates that angina does not commonly relate to obstructive coronary artery disease (CAD). Emerging knowledge supports an inclusive approach to chest pain symptoms in women, as well as a more thoughtful consideration of percutaneous coronary intervention for angina in stable obstructive CAD, to avoid chasing our tails. Emerging knowledge regarding the cardiac autonomic nervous system and visceral pain pathways in patients with and without obstructive CAD offers explanatory mechanisms for angina. Interdisciplinary investigation approaches that involve cardiologists, biobehavioural specialists, and anaesthesia/pain specialists to improve angina treatment should be pursued.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Courtney Bess
- J. Willis Hurst Internal Residency Program, Emory University, 49 Jesse Hill Jr Drive, FOB Building, 4th floor, Box #92, Atlanta, GA, USA
| | - Suzette Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Geert grooteplein Zuid 10, GA Nijmegen, The Netherlands
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, CNR Building, Room 3041, Atlanta, GA, USA
| | - Arshed Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Suite 505, Atlanta, GA, USA
| | - Carl J Pepine
- Divsion of Cardiology, University of Florida, 1329 SW 6th Street, PO Box 100288, Gainesville, FL, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, USA
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Lee JH, Han D, Hartaigh BÓ, Gransar H, Lu Y, Rizvi A, Park MW, Roudsari HM, Stuijfzand WJ, Berman DS, Callister TQ, DeLago A, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff G, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Pontone G, Andreini D, Marques H, Rubinshtein R, Achenbach S, Shaw LJ, Chang HJ, Bax J, Chow B, Cury RC, Gomez M, Jones EC, Lin FY, Min JK, Peña JM. Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry). Clin Cardiol 2018. [PMID: 29521447 DOI: 10.1002/clc.22940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6-5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06-2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34-1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.
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Affiliation(s)
- Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.,Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang-si, South Korea
| | - Donghee Han
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.,Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Heidi Gransar
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang-si, South Korea
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Mahn Won Park
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Hadi Mirhedayati Roudsari
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Wijnand J Stuijfzand
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital, Zurich, University of Zurich, Switzerland
| | | | | | - Filippo Cademartiri
- Cardiovascular Imaging Center, Department of Radiology, SDN IRCCS Naples, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, D.C
| | - Yong-Jin Kim
- Cardiovascular Center and Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Hugo Marques
- UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, HARTS, Leiden, The Netherlands
| | - Benjamin Chow
- Department of Medicine and Radiology, University of Ottawa, Ontario, Canada
| | | | - Millie Gomez
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
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8
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Vogel-Claussen J, Elshafee AS, Kirsch J, Brown RK, Hurwitz LM, Javidan-Nejad C, Julsrud PR, Kramer CM, Krishnamurthy R, Laroia AT, Leipsic JA, Panchal KK, Shah AB, White RD, Woodard PK, Abbara S. ACR Appropriateness Criteria ® Dyspnea—Suspected Cardiac Origin. J Am Coll Radiol 2017; 14:S127-S137. [DOI: 10.1016/j.jacr.2017.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/17/2022]
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Izumo M, Takeuchi M, Seo Y, Yamashita E, Suzuki K, Ishizu T, Sato K, Oshima S, Aonuma K, Otsuji Y, Akashi YJ. Prognostic implications in patients with symptomatic aortic stenosis and preserved ejection fraction: Japanese multicenter aortic stenosis, retrospective (JUST-R) registry. J Cardiol 2017; 69:110-118. [DOI: 10.1016/j.jjcc.2016.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/11/2016] [Accepted: 01/23/2016] [Indexed: 11/26/2022]
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Ayoub C, Yam Y, Chen L, Arasaratnam P, Chow CK, Hillis GS, Kritharides L, Chow BJ. The Prognostic Value of Percentage Total Plaque Score Adjusted to Age. Angiology 2016; 67:916-926. [DOI: 10.1177/0003319716633354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Total plaque score (TPS) on coronary computed tomography angiography (CCTA) has been validated as a surrogate measure of coronary artery disease (CAD) burden and is prognostic. We propose a novel measure, percentage TPS adjusted to age (%TPS/age), that may reflect vascular age and potentially more rapidly progressive atherosclerosis and evaluate its potential prognostic value. Methods: %TPS/age was calculated for consecutive patients prospectively enrolled into our institutional CCTA registry and evaluated for primary composite outcome of cardiac death, nonfatal myocardial infarction, and late revascularization. Results: Of 1896 patients identified (mean age 57.7 ± 11.4 years, 50.1% male, median follow-up 18.6 months [interquartile range: 15.3, 32.4]), 552 (29%) had %TPS/age = 0 (no atherosclerosis), with 1 (0.2%) primary outcome observed (annual event rate [AER] = 0.1%). Two events (0.4%, AER = 0.3%) were observed in %TPS/age < 0.314 category, 22 (5.0%, AER = 2.2%) in %TPS/age 0.314 to 0.699 category, and 54 (12.0%, AER = 5.7%) in %TPS/age ≥ 0.700 category. After adjusting for clinical predictors and obstructive CAD, higher %TPS/age category was associated with hazard ratio 1.95 (1.31-2.88, P < .001) for primary outcome on multivariable analysis, Harrell-C-Statistic 0.87 (confidence interval 95%: 0.84-0.90), and net reclassification improvement of 0.71 ( P < .001). Conclusion: %TPS/Age has incremental prognostic value to traditional risk factors and CCTA measures of CAD and improves evaluation of burden of coronary atherosclerosis and clinical risk.
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Affiliation(s)
- Chadi Ayoub
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, ON, Canada
- University of Sydney, New South Wales, Australia
| | - Yeung Yam
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, ON, Canada
| | - Li Chen
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, ON, Canada
| | - Punitha Arasaratnam
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, ON, Canada
| | | | - Graham S. Hillis
- University of Sydney, New South Wales, Australia
- Department of Cardiology, Royal Perth Hospital, University of Western Australia
| | - Leonard Kritharides
- University of Sydney, New South Wales, Australia
- Department of Cardiology, Concord Hospital, Sydney Local Health District, New South Wales, Australia
| | - Benjamin J.W. Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, ON, Canada
- Department of Radiology, University of Ottawa, ON, Canada
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Paudel R, Beridze N, Aronow WS, Ahn C, Sanaani A, Agarwal P, Farell K, Jain D, Timmermans R, Cooper HA, Panza JA. Association of chest pain versus dyspnea as presenting symptom for coronary angiography with demographics, coronary anatomy, and 2-year mortality. Arch Med Sci 2016; 12:742-6. [PMID: 27478454 PMCID: PMC4947621 DOI: 10.5114/aoms.2016.60959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 02/04/2015] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The association of chest pain versus dyspnea with demographics, coronary angiographic findings, and outcomes of patients undergoing coronary angiography is unknown. MATERIAL AND METHODS We studied 1,053 patients who had coronary angiography to investigate the association of chest pain versus dyspnea with demographics, coronary angiographic findings, and outcomes. RESULTS Of 1,053 patients, 654 (62%) had chest pain, 229 (22%) had dyspnea, and 117 (11%) had chest pain and dyspnea. Patients with dyspnea were older (p < 0.0001) and had higher serum creatinine (p = 0.0011), lower left ventricular ejection fraction (LVEF) (p < 0.0001), more cardiogenic shock (p = 0.0004), less obstructive coronary artery disease (CAD) (p < 0.0001), less percutaneous coronary intervention (p < 0.0001), and similar 2-year mortality. Stepwise Cox regression analysis showed no significant difference in mortality between chest pain and dyspnea. Significant risk factors for time to death were age (hazard ratio (HR) = 1.07, p < 0.0001), serum creatinine (HR = 1.5, p < 0.0001), body mass index (HR = 0.93, p = 0.005), and obstructive CAD graft (HR = 3.2, p = 0.011). CONCLUSIONS Patients undergoing coronary angiography presenting with dyspnea were older and had higher serum creatinine, lower LVEF, more frequent cardiogenic shock, less obstructive CAD, and less percutaneous coronary intervention compared to patients presenting with chest pain but similar 2-year mortality.
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Affiliation(s)
- Rajiv Paudel
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Natalia Beridze
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abdallah Sanaani
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Pallak Agarwal
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Kim Farell
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Diwakar Jain
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Robert Timmermans
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Howard A. Cooper
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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