1
|
Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
| |
Collapse
|
2
|
Karthikeyan G, Peix A, Devasenapathy N, Jimenez-Heffernan A, Haque SU, Rodella C, Giubbini R, Rosas EA, Ozkan E, Keng YJF, Vitola J, Sobic-Saranovic D, Soni M, López L, Cabrera LO, Camacho-Freire S, Manovel-Sanchez A, Naeem H, Fatima S, Rinaldi R, Carvajal-Juarez I, Esenboga K, Dondi M, Paez D. Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT STEMI trial. J Nucl Cardiol 2023; 30:1091-1102. [PMID: 36284033 PMCID: PMC9595582 DOI: 10.1007/s12350-022-03108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied. METHODS We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation. RESULTS In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI - 1.3%-1.6%, P < .0001; non-inferiority margin 5%). CONCLUSION A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings. (CTRI/2018/08/015384).
Collapse
Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, 24, 7th Floor, New Delhi, 110029, India.
| | - Amalia Peix
- Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, Havana, Cuba
| | | | | | - Saif-Ul Haque
- Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Carlo Rodella
- Health Physics Department, ASST-Spedali Civili, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Erick Alexanderson Rosas
- National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Physiology, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Elgin Ozkan
- Department of Nuclear Medicine, Medical School, Ankara University, Ankara, Turkey
| | - Yung Jih Felix Keng
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - João Vitola
- Quanta Diagnóstico por Imagem, Curitiba, Brazil
| | - Dragana Sobic-Saranovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Nuclear Medicine, University Clinical Centre of Serbia (UCCS), Belgrade, Serbia
| | - Manoj Soni
- The George Institute for Global Health, New Delhi, India
| | - Leonardo López
- Department of Interventional Cardiology, Cardiology and Cardiovascular Surgery Institute, Havana, Cuba
| | - Lázaro O Cabrera
- Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, Havana, Cuba
| | | | | | - Hesham Naeem
- Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Shazia Fatima
- Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Roberto Rinaldi
- Health Physics Department, ASST-Spedali Civili, Brescia, Italy
| | - Isabel Carvajal-Juarez
- National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Hospital de Cardiología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Kerim Esenboga
- Department of Cardiology, Medical School Ankara University, Ankara, Turkey
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|
3
|
Comparing the diagnostic accuracy of PET and CMR for the measurement of left ventricular volumes and ejection fraction: a system review and meta-analysis. Nucl Med Commun 2022; 43:1143-1154. [PMID: 36120812 DOI: 10.1097/mnm.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has been recognized as the gold standard for the evaluation of left ventricular (LV) function. Cardiac gated PET allows the simultaneous assessment of LV function with the evaluation of myocardial perfusion and metabolism. But the correlations between PET and CMR remain controversial. METHODS We conducted a systematic electronic search of PubMed, Embase and the Cochrane Library . Forest plot, spearman correlation analysis and Bland-Altman analysis were used to evaluate the correlations between PET and CMR. RESULTS Pooled analysis of 13 studies showed that PET underestimated left ventricular end-diastolic volumes (LVEDV) [mean difference (MD), -15.30; 95% confidence interval (CI), -23.10 to -7.50; P < 0.001] and left ventricular end-systolic volumes (LVESV) (MD, -6.20; 95% CI, -12.58 to 0.17; P = 0.06) but not left ventricular ejection fraction (LVEF) (MD, -0.35; 95% CI, -1.75 to 1.06; P = 0.63). Overall, there were very good correlations between PET and CMR measurements for LVEDV ( r , 0.897), LVESV ( r , 0.924) and LVEF ( r , 0.898). Subgroup analysis indicated that LVEDV ≥180 ml and LVEF <40% reduced the accuracy of PET, especially the measurement of LVEF ( r , LVEDV ≥180 vs . r , LVEDV < 180 : 0.821 vs. 0.944; r , LVEF < 40% vs . r , LVEF ≥40% : 0.784 vs. 0.901). CONCLUSIONS Correlations between PET and CMR measurements of LVEDV, LVESV and LVEF were excellent, but these two methods could not be used interchangeably for accurate measurements of LV volume and LVEF in patients with significantly increased LV volume and decreased LVEF.
Collapse
|
4
|
Nuclear cardiology for a cardiothoracic surgeon. Indian J Thorac Cardiovasc Surg 2022; 38:268-282. [PMID: 35529010 PMCID: PMC9023643 DOI: 10.1007/s12055-021-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures such as single-photon emission computed tomography and positron emission tomography provide the surgeon with objective information that augments standard clinical and angiographic assessments related to the diagnosis, prognosis, and potential benefit from any intervention. Myocardial perfusion is imaged with the use of radiopharmaceuticals that accumulate rapidly in the myocardium in proportion to the myocardial blood flow. Radionuclide lung imaging most commonly involves the demonstration of pulmonary perfusion using technetium-99 m macro aggregate albumin (Tc-99 m MAA), as well as the assessment of ventilation using inspired inert gas, usually xenon, or Tc-99 m-labelled aerosols. Nuclear cardiology is extensively used as a part of the work-up of ischemic heart disease and cardiac failure in deciding the optimal therapeutic strategy with its ability to predict the severity of the disease. It has also proved extremely useful in the management of congenital heart disease and the diagnosis of pulmonary embolism, among many other applications. Myocardial perfusion imaging is a basic adjunct to the noninvasive assessment of patients with stable angina, baseline electrocardiogram (ECG) abnormalities, post-revascularisation assessment, and heart failure. This review article covers a summary of basic concepts of nuclear cardiology about what a cardiac surgeon should be aware of. To many, it is just a perfusion test, but the versatility, reliability, and future of the technology are without a doubt.
Collapse
|
5
|
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: 60] [Impact Index Per Article: 30.0] [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.
Collapse
|
6
|
Kontos MC, Villines TC. Observations from stress testing in the troponin twilight zone. J Nucl Cardiol 2021; 28:2949-2951. [PMID: 32557147 DOI: 10.1007/s12350-020-02147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael C Kontos
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Room 285 Gateway Building, 2nd floor Gateway, 1200 E Marshall St, PO Box 980051, Richmond, VA, 23298-0051, USA.
| | - Todd C Villines
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA, USA
| |
Collapse
|
7
|
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: 319] [Impact Index Per Article: 106.3] [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.
Collapse
|
8
|
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.
Collapse
|
9
|
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: 161] [Impact Index Per Article: 53.7] [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.
Collapse
|
10
|
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: 90] [Impact Index Per Article: 30.0] [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.
Collapse
|
11
|
Rrapo Kaso E, Bourque JM. Regadenoson SPECT MPI post-troponin elevation in two different patient populations: A reliable risk-stratification tool. J Nucl Cardiol 2020; 27:2332-2336. [PMID: 31041679 DOI: 10.1007/s12350-019-01726-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Elona Rrapo Kaso
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jamieson M Bourque
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Box 800662, 1215 Lee Street, Charlottesville, VA, 22908, USA.
| |
Collapse
|
12
|
Gowdar S, Ahlberg AW, Rai M, Perucki WH, Felpel KD, Savino JA, Alter EL, Henzlova MJ, Duvall WL. Risk stratification with vasodilator stress SPECT myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol 2020; 27:2320-2331. [PMID: 30815834 DOI: 10.1007/s12350-019-01661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the diagnostic accuracy and prognostic utility of vasodilator stress MPI have been well established in the non-acute setting, the efficacy of all of the vasodilator stressors in risk stratifying post-MI patients as well as the evaluation of cardiac troponin elevation of unclear etiology is not established. Accordingly, the aim of the present study was to investigate the prognostic efficacy of vasodilator stress MPI in the setting of elevated cardiac troponin to accurately risk stratify these higher-risk patients. METHODS All patients from two tertiary centers, from 1/1/2010 through 12/31/2012, with elevated cardiac biomarkers within < 7 days and undergoing stress SPECT MPI testing were studied. Results of stress MPI were scored using a 17-segment model based on semiquantitative scoring as normal or abnormal (mild, moderate, or severe) using a total perfusion defect (TPD) of 0%, 1-10%, 10-20%, and > 20%. Mortality data through the year 2014 were obtained from the National Death Index, and survival analyses were performed. The primary endpoint was all-cause mortality with the secondary endpoint being cardiac mortality. RESULTS A total of 503 patients were followed for an average of 33.6 ± 16.2 months, with a mean age of 69.3 years; 53.7% male; and a majority (88.7%) of them undergoing vasodilator stress. A significant increase in all-cause mortality was seen based on the severity of TPD results for all vasodilators (P < .0001) and regadenoson (P < .0001). Similar prognostic ability was seen for all-cause mortality. This association was maintained even after adjustment for cardiac risk factors, previous coronary disease, and troponin quartiles. MPI results (stress TPD and LVEF) added to traditional cardiac risk factors, and troponin values resulted in a significant incremental increase in the ability to predict all-cause and cardiac mortality, and stress TPD remained independently predictive for both all-cause and cardiac mortality in a multivariate model. CONCLUSION Vasodilator stress (including regadenoson) MPI effectively risk stratifies patients with recently elevated cardiac biomarkers, with the increasing risk of mortality with the increasing severity of perfusion defects. It provides incremental prognostic value, in addition to clinical factors and degree of troponin elevation.
Collapse
Affiliation(s)
- Shreyas Gowdar
- Hartford Hospital Division of Cardiology, Hartford Healthcare Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Alan W Ahlberg
- Hartford Hospital Division of Cardiology, Hartford Healthcare Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Mridula Rai
- Hartford Hospital Division of Cardiology, Hartford Healthcare Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA
| | - William H Perucki
- Hartford Hospital Division of Cardiology, Hartford Healthcare Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Kevin D Felpel
- Department of Medicine, University of Connecticut School of Medicine, Farmington, USA
| | - John A Savino
- Mount Sinai Division of Cardiology, Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Eric L Alter
- Mount Sinai Division of Cardiology, Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Milena J Henzlova
- Mount Sinai Division of Cardiology, Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - W Lane Duvall
- Hartford Hospital Division of Cardiology, Hartford Healthcare Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA.
| |
Collapse
|
13
|
Mahmarian J. A tale of two technologies: Can nuclear cardiology survive the emergence of cardiac CT the seventeenth annual Mario S. Verani lectureship. J Nucl Cardiol 2020; 27:865-890. [PMID: 32476106 DOI: 10.1007/s12350-020-02086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
The Mario S. Verani Lectureship has traditionally been an opportunity for presenters to reflect on the state of nuclear cardiology in clinical practice and expound on new innovations in the field. Mario Verani was a visionary who embraced change and, as a cardiologist, sought to define where other cardiac imaging techniques might complement nuclear cardiology for improving patient care. Over the last decade, nuclear cardiology and cardiac computed tomography (CT) have developed in parallel with both expanding beyond the evaluation of coronary artery disease. However, many consider cardiac CT a formidable threat to nuclear cardiology due to pivotal technical innovations and its subsequent exponential growth in recent years. It is only fitting that this year's lectureship explore the relative value of both techniques in evaluating and managing cardiac disease, their relative strengths and weaknesses, and the potential value of combining nuclear cardiology and cardiac CT imaging for enhancing patient management. To Mario, my mentor, colleague for over 20 years and friend, this lectureship is truly in honor and remembrance of you.
Collapse
Affiliation(s)
- John Mahmarian
- Houston Methodist DeBakey Cardiology Associates, 6550 Fannin, Houston, TX, 77030, USA.
| |
Collapse
|
14
|
Batlle JC, Kirsch J, Bolen MA, Bandettini WP, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johnson TV, Khosa F, Krishnamurthy R, Rajiah P, Singh SP, Tomaszewski CA, Villines TC, Wann S, Young PM, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome. J Am Coll Radiol 2020; 17:S55-S69. [PMID: 32370978 DOI: 10.1016/j.jacr.2020.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida.
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | | | - W Patricia Bandettini
- National Institutes of Health, Bethesda, Maryland; Society for Cardiovascular Magnetic Resonance
| | | | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Cardiology Expert
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear Cardiology Expert
| | | | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
15
|
Ong P, Safdar B, Seitz A, Hubert A, Beltrame JF, Prescott E. Diagnosis of coronary microvascular dysfunction in the clinic. Cardiovasc Res 2020; 116:841-855. [DOI: 10.1093/cvr/cvz339] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
The coronary microcirculation plays a pivotal role in the regulation of coronary blood flow and cardiac metabolism. It can adapt to acute and chronic pathologic conditions such as coronary thrombosis or long-standing hypertension. Due to the fact that the coronary microcirculation cannot be visualized in human beings in vivo, its assessment remains challenging. Thus, the clinical importance of the coronary microcirculation is still often underestimated or even neglected. Depending on the clinical condition of the respective patient, several non-invasive (e.g. transthoracic Doppler-echocardiography assessing coronary flow velocity reserve, cardiac magnetic resonance imaging, positron emission tomography) and invasive methods (e.g. assessment of coronary flow reserve (CFR) and microvascular resistance (MVR) using adenosine, microvascular coronary spasm with acetylcholine) have been established for the assessment of coronary microvascular function. Individual patient characteristics, but certainly also local availability, methodical expertise and costs will influence which methods are being used for the diagnostic work-up (non-invasive and/or invasive assessment) in a patient with recurrent symptoms and suspected coronary microvascular dysfunction. Recently, the combined invasive assessment of coronary vasoconstrictor as well as vasodilator abnormalities has been titled interventional diagnostic procedure (IDP). It involves intracoronary acetylcholine testing for the detection of coronary spasm as well as CFR and MVR assessment in response to adenosine using a dedicated wire. Currently, the IDP represents the most comprehensive coronary vasomotor assessment. Studies using the IDP to better characterize the endotypes observed will hopefully facilitate development of tailored and effective treatments.
Collapse
Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Astrid Hubert
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - John F Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, Australia
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
16
|
Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| |
Collapse
|
17
|
Schelde AB, Schmidt M, Madsen M, Nielsen SS, Frøkiær J, Christiansen CF. Impact of the Charlson Comorbidity Index score on risk prediction by single-photon emission computed tomography myocardial perfusion imaging following myocardial infarction. Clin Epidemiol 2019; 11:901-910. [PMID: 31576177 PMCID: PMC6768147 DOI: 10.2147/clep.s211555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Comorbidity is common among patients with myocardial infarction (MI). We examined whether comorbidity level modified the single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI)-based prediction of 5-year risk of MI and all-cause death in patients with MI. Methods This cohort study included patients with prior MI having a SPECT MPI at Aarhus University Hospital, Denmark, 1999–2011. Using nationwide registries, we obtained information on comorbidity levels (low, moderate, and severe) and outcomes. We computed risk and hazard ratios (HRs) with 95% confidence intervals (CIs) for MI and all-cause death, comparing normal (no defects) versus abnormal scan (reversible and/or fixed defects) using Cox regression adjusting for sex, age, and comorbidity level. Results We identified 1,192 patients with MI before SPECT MPI. The 5-year risk for patients with normal versus abnormal scans were 11.7% versus 18.3% for MI, and 8.0% versus 13.2% for all-cause death, respectively. The overall 5-year adjusted HR (aHR) of MI was 1.56 (95% CI: 1.09–2.21), 1.33 (95% CI: 0.82–2.15) with low comorbidity, 1.39 (95% CI: 0.68–2.83) with moderate comorbidity, and 2.53 (95% CI: 1.14–5.62) with severe comorbidity. Similarly, the 5-year aHR for all-cause death was 1.39 (95% CI: 0.90–2.14) overall; 2.33 (95% CI: 0.79–6.84) with low comorbidity, 2.05 (95% CI: 0.69–6.06) with moderate comorbidity, and 1.07 (95% CI: 0.64–1.80) with severe comorbidity. Conclusion We conclude that comorbidity level may modify the 5-year risk prediction associated with an abnormal SPECT MPI scan in patients with previous MI.
Collapse
Affiliation(s)
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Steen Nielsen
- Department of Clinical Physiology and Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine, Aarhus University Hospital, Skejby, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
18
|
Malahfji M, Mahmarian JJ. Imaging to Stratify Coronary Artery Disease Risk in Asymptomatic Patients with Diabetes. Methodist Debakey Cardiovasc J 2019; 14:266-272. [PMID: 30788012 DOI: 10.14797/mdcj-14-4-266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus. Patients with diabetes have a higher prevalence of CAD and a larger magnitude of ischemia, and they are more likely to have silent myocardial ischemia and myocardial infarction. However, recent large cohort studies demonstrate that diabetic patients are not a homogenous group with similar high risk for cardiac events. In fact, more than 30% of asymptomatic diabetic patients do not have evidence of coronary atherosclerosis and have a very low annual cardiac event rate. Accordingly, there has been a recent paradigm shift as to whether the detection of subclinical coronary atherosclerosis through imaging can best guide therapeutic decision making. This review discusses the role of various cardiac imaging techniques for stratifying cardiovascular risk and optimizing therapy in asymptomatic diabetic patients.
Collapse
|
19
|
Smit JM, Hermans MP, Dimitriu-Leen AC, van Rosendael AR, Dibbets-Schneider P, de Geus-Oei LF, Mertens BJ, Schalij MJ, Bax JJ, Scholte AJ. Long-term prognostic value of single-photon emission computed tomography myocardial perfusion imaging after primary PCI for STEMI. Eur Heart J Cardiovasc Imaging 2018; 19:1287-1293. [PMID: 29315366 DOI: 10.1093/ehjci/jex332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of this study was to determine the long-term prognostic value of infarct size and myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods and results In total, 1092 STEMI patients who underwent primary PCI and SPECT MPI within 1-6 months were included (median follow-up time of 6.9 years). In the entire cohort, SPECT infarct size was independently associated with the composite of cardiac death or reinfarction [hazard ratio (HR) per 10% increase in summed rest score 1.33; 95% confidence interval (95% CI) 1.12-1.58; P = 0.001], whereas myocardial ischaemia was not (HR per 5% increase in summed difference score 1.18; 95% CI 0.94-1.48; P = 0.16). Addition of SPECT infarct size to a model including the clinical variables provided significant incremental prognostic value for the prediction of cardiac death or reinfarction (global χ2 13.8 vs. 24.2; P = 0.002), whereas addition of SPECT ischaemia did not add significantly (global χ2 24.2 vs. 25.6; P = 0.24). In the subgroup of patients with left ventricular ejection fraction (LVEF) ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction (HR 1.59; 95% CI 1.15-2.22; P = 0.006), whereas in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction (HR 1.28; 95% CI 1.00-1.63; P = 0.050). Conclusion In patients with first STEMI and primary PCI, SPECT infarct size was independently associated with cardiac death and/or reinfarction, whereas myocardial ischaemia was not. In patients with LVEF ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction, whereas myocardial ischaemia was not. Conversely, in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction.
Collapse
Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Maaike P Hermans
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Aukelien C Dimitriu-Leen
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Petra Dibbets-Schneider
- Department of Nuclear Medicine, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Nuclear Medicine, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, Science and Technology Faculty, University of Twente, 7500 AE, Drienerlolaan 5, NB, Enschede, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| |
Collapse
|
20
|
Berrocal I, Peix A, Mut F, Shaw LJ, Karthikeyan G, Estrada Lobato E, Paez D. Appropriate use of noninvasive ischemia testing to guide revascularization decision making following acute ST elevation myocardial infarction in Latin American countries: Results from an Expert Panel Meeting of the International Atomic Energy Agency. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Berrocal I, Peix A, Mut F, Shaw LJ, Karthikeyan G, Estrada Lobato E, Paez D. Appropriate use of noninvasive ischemia testing to guide revascularization decision making following acute ST elevation myocardial infarction in Latin American countries: Results from an expert panel meeting of the International Atomic Energy Agency. Rev Esp Med Nucl Imagen Mol 2018; 37:237-243. [PMID: 29778317 DOI: 10.1016/j.remn.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 12/26/2017] [Accepted: 01/16/2018] [Indexed: 11/29/2022]
Abstract
Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention. Although randomized clinical trials have established the value of staged fractional flow reserve-guided revascularization, the use of noninvasive functional imaging modalities may play a similar role at a much lower cost. For LAC, available stress imaging techniques could be applied to define residual ischemia in the non-infarct related artery and to target revascularization in a staged procedure after primary percutaneous coronary intervention The use of nuclear cardiac imaging, supported by its relatively wide availability, moderate cost, and robust quantitative capabilities, may serve to guide effective care and to reduce subsequent cardiac events in patients with coronary artery disease. This noninvasive approach may avert potential safety issues with repeat and lengthy invasive procedures, and serve as a baseline for subsequent follow-up stress testing following the index STEMI event. This consensus document was devised from an expert panel meeting of the International Atomic Energy Agency, highlighting available evidence with a focus on the utility of stress myocardial perfusion imaging in post-STEMI patients. The document could serve as guidance to the prudent and appropriate use of nuclear imaging for targeting therapeutic management and avoiding unnecessary invasive procedures within Latin American and Caribbean countries, where resources could be scarce.
Collapse
Affiliation(s)
| | - A Peix
- Departamento de Medicina Nuclear, Instituto de Cardiología, La Habana, Cuba.
| | - F Mut
- Hospital Asociación Española, Montevideo, Uruguay
| | - L J Shaw
- Emory Clinical Cardiovascular Research Institute, Atlanta, Estados Unidos de América
| | - G Karthikeyan
- All India Institute of Medical Sciences, Nueva Delhi, India
| | | | - D Paez
- International Atomic Energy Agency, Viena, Austria
| |
Collapse
|
22
|
Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, Green LA, Heidenreich PA, Ho PM, Jurgens CY, King ML, Kumbhani DJ, Pancholy S. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2017; 70:2048-2090. [PMID: 28943066 DOI: 10.1016/j.jacc.2017.06.032] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
23
|
Zeltser R, Tortez LM, Druz RS, Kozikowski A, Makaryus AN, Lesser M, Pekmezaris R. Downstream resource utilization following SPECT: Impact of age and gender. J Nucl Cardiol 2017; 24:1657-1661. [PMID: 27324347 DOI: 10.1007/s12350-016-0464-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have identified a downstream referral age and gender bias for invasive coronary anatomy evaluation after single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The present study evaluates if such bias still persists despite advancements in SPECT MPI and angiography. We hypothesized that women and patients ≥80 years old are less likely to undergo invasive coronary angiography after adjusting for clinical and scan variables. METHODS Patients (n = 3824) who referred to a nuclear cardiology laboratory at a tertiary medical center were retrospectively identified. Regression analysis tested age (<55; 55-69; 70-79; ≥80 years) and gender as predictors of diagnostic angiogram at 90 days post-SPECT after adjustment for known CAD, CAD risk equivalent, SSS, SDS, and LVEF. RESULTS Younger patients were more likely to undergo an angiogram as compared to octogenarians (77% more likely if <55 years old, 69% if 55-69 years old, and 52% if 70-79 years old). No effect was found for gender. CONCLUSIONS Older patients were less likely to be referred for angiogram as compared to their younger counterparts. Further study is needed to determine which factors guide this decision-making process in older adults and the influence of these factors on the referral bias.
Collapse
Affiliation(s)
- Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Leanne M Tortez
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA.
| | - Regina S Druz
- Integrative Cardiology Center of Long Island, Mineola, NY, USA
| | - Andrzej Kozikowski
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Martin Lesser
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Renee Pekmezaris
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| |
Collapse
|
24
|
Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, Green LA, Heidenreich PA, Ho PM, Jurgens CY, King ML, Kumbhani DJ, Pancholy S. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:HCQ.0000000000000032. [DOI: 10.1161/hcq.0000000000000032] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
25
|
Rai M, Ahlberg AW, Marwell J, Chaudhary W, Savino JA, Alter EL, Henzlova MJ, Duvall WL. Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol 2017; 24:724-734. [PMID: 26902485 DOI: 10.1007/s12350-016-0448-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND While adenosine and dipyridamole as myocardial perfusion imaging (MPI) stress agents have literature supporting their safety in the setting of myocardial infarction (MI), regadenoson does not. Studying a high risk cohort of patients with elevated cardiac biomarkers may shed light on potential safety issues of these agents which might also affect lower risk cohorts. METHODS All patients who had undergone a clinically indicated stress MPI study at two academic centers from 1/1/2010 through 12/31/2012 with elevated troponin ≤7 days prior to testing were included. The primary endpoint was a composite of death, non-fatal MI, congestive heart failure (CHF), stroke, ventricular arrhythmias, atrial fibrillation/flutter, or atrioventricular block requiring intervention within 24 h of testing. RESULTS Of the 703 stress MPI studies that met inclusion criteria, 360 (51.2%), 199 (28.3%), 74 (10.5%), 9 (1.3%), and 61 (8.7%) underwent regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively. The primary endpoint occurred in 11 (1.6%) patients with an incidence of 1.4% (n = 5), 1.0% (n = 2), 1.4% (n = 1), 11.1% (n = 1), and 3.3% (n = 2) following regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively (P = 0.137). The adverse events included non-fatal MI in 7 (1.0%) patients, death in 1 (0.1%) patient, CHF in 1 (0.1%) patient, ventricular arrhythmia in 1 (0.1%) patient, and atrial arrhythmia in 1 (0.1%) patient. CONCLUSION In the setting of elevated troponin, serious complications associated with either exercise or vasodilator stress testing appear to be relatively rare with no increased risk attributable to a particular vasodilator agent.
Collapse
Affiliation(s)
- Mridula Rai
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - Alan W Ahlberg
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - Julianna Marwell
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Waseem Chaudhary
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - John A Savino
- Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - Eric L Alter
- Department of Medicine, Mount Sinai Medical Center, New York, NY, USA
| | - Milena J Henzlova
- Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - W Lane Duvall
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA.
| |
Collapse
|
26
|
Doukky R, Golzar Y. Safety of stress testing in patients with elevated cardiac biomarkers: Are all modalities created equal? J Nucl Cardiol 2017; 24:735-737. [PMID: 26888370 DOI: 10.1007/s12350-016-0440-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Rami Doukky
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| | - Yasmeen Golzar
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA
| |
Collapse
|
27
|
|
28
|
Shavadia J, Armstrong PW. Risk stratification in non-ST elevation acute coronary syndromes: searching for the right formula. Eur Heart J 2016; 37:3111-3113. [PMID: 26685972 DOI: 10.1093/eurheartj/ehv586] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jay Shavadia
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Armstrong
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
29
|
Nabi F, Kassi M, Muhyieddeen K, Chang SM, Xu J, Peterson LE, Wray NP, Shirkey BA, Ashton CM, Mahmarian JJ. Optimizing Evaluation of Patients with Low-to-Intermediate-Risk Acute Chest Pain: A Randomized Study Comparing Stress Myocardial Perfusion Tomography Incorporating Stress-Only Imaging Versus Cardiac CT. J Nucl Med 2015; 57:378-84. [DOI: 10.2967/jnumed.115.166595] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
30
|
Acampa W, Gaemperli O, Gimelli A, Knaapen P, Schindler TH, Verberne HJ, Zellweger MJ. Role of risk stratification by SPECT, PET, and hybrid imaging in guiding management of stable patients with ischaemic heart disease: expert panel of the EANM cardiovascular committee and EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:1289-98. [PMID: 25902767 DOI: 10.1093/ehjci/jev093] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/21/2015] [Indexed: 01/19/2023] Open
Abstract
Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field.
Collapse
|
31
|
Mahmarian JJ, Peterson LE, Xu J, Cerqueira MD, Iskandrian AE, Bateman TM, Thomas GS, Nabi F. Regadenoson provides perfusion results comparable to adenosine in heterogeneous patient populations: a quantitative analysis from the ADVANCE MPI trials. J Nucl Cardiol 2015; 22:248-61. [PMID: 25287737 DOI: 10.1007/s12350-014-9981-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Total and reversible left ventricular (LV) perfusion defect size (PDS) predict patient outcome. Limited data exist as to whether regadenoson induces similar perfusion abnormalities as observed with adenosine. We sought to determine whether regadenoson induces a similar LV PDS as seen with adenosine across varying patient populations. METHODS AND RESULTS ADVANCE MPI were prospective, double-blind randomized trials comparing regadenoson to standard adenosine myocardial perfusion tomography (SPECT). Following an initial adenosine SPECT, patients were randomized to either regadenoson (N = 1284) or a second adenosine study (N = 660). SPECT quantification was performed blinded to randomization and image sequence. Propensity analysis was used to define comparability of regadenoson and adenosine perfusion results. Baseline clinical and SPECT results were similar in the two randomized groups. There was a close correlation between adenosine and regadenoson-induced total (r (2) = 0.98, P < .001) and reversible (r (2) = 0.92, P < .001) PDS. Serial differences in total (0.00 ± 3.51 vs -0.11 ± 3.46, P = .51) and reversible (0.15 ± 3.79 vs 0.07 ± 3.33, P = .65) PDS were also comparable in patients randomized to regadenoson vs adenosine, respectively, and irrespective of age, gender, diabetic status, body mass index, or prior cardiovascular history. By propensity analysis, regadenoson-induced total PDS was significantly larger than observed with adenosine. CONCLUSION This is the first study to show that regadenoson induces similar, if not larger, perfusion defects than those observed with adenosine across different patient populations and demonstrates the value of quantitative analysis for defining serial changes in SPECT perfusion results. Regadenoson should provide comparable diagnostic and prognostic SPECT information to that obtained with adenosine.
Collapse
Affiliation(s)
- John J Mahmarian
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, 6550 Fannin Street, Suite 677, Houston, TX, 77030, USA,
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.09.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
Esteves FP, Travin MI. The Role of Nuclear Cardiology in the Diagnosis and Risk Stratification of Women With Ischemic Heart Disease. Semin Nucl Med 2014; 44:423-38. [DOI: 10.1053/j.semnuclmed.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
34
|
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139-e228. [PMID: 25260718 DOI: 10.1016/j.jacc.2014.09.017] [Citation(s) in RCA: 2089] [Impact Index Per Article: 208.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
35
|
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2354-94. [PMID: 25249586 DOI: 10.1161/cir.0000000000000133] [Citation(s) in RCA: 747] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
36
|
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e344-426. [PMID: 25249585 DOI: 10.1161/cir.0000000000000134] [Citation(s) in RCA: 636] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
37
|
Mahmarian JJ, Chang S, Nabi F. Nuclear Cardiology: 2014 Innovations and Developments. Methodist Debakey Cardiovasc J 2014; 10:163-71. [DOI: 10.14797/mdcj-10-3-163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
38
|
Duvall WL, Savino JA, Levine EJ, Baber U, Lin JT, Einstein AJ, Hermann LK, Henzlova MJ. A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department. J Nucl Cardiol 2014; 21:305-18. [PMID: 24310280 DOI: 10.1007/s12350-013-9823-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population. METHODS In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups. RESULTS A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P = .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P = .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P = .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar results to the entire cohort. CONCLUSIONS Stress testing with ETT, high-efficiency SPECT MPI, and stress-only protocols had a significantly lower patient radiation dose and less follow-up diagnostic testing than CTA with similar cardiac return visits. CTA had a shorter time to disposition, but there was a trend toward more revascularization than with stress testing.
Collapse
Affiliation(s)
- W Lane Duvall
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA,
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Katikireddy CK, Mann N, Brown D, Van Tosh A, Stergiopoulos K. Evaluation of myocardial ischemia and viability by noninvasive cardiac imaging. Expert Rev Cardiovasc Ther 2014; 10:55-73. [DOI: 10.1586/erc.11.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
Li Y, Wang L, Zhao SH, He ZX, Wang DY, Guo F, Fang W, Yang MF. Gated F-18 FDG PET for assessment of left ventricular volumes and ejection fraction using QGS and 4D-MSPECT in patients with heart failure: a comparison with cardiac MRI. PLoS One 2014; 9:e80227. [PMID: 24404123 PMCID: PMC3880258 DOI: 10.1371/journal.pone.0080227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 10/01/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose Ventricular function is a powerful predictor of survival in patients with heart failure (HF). However, studies characterizing gated F-18 FDG PET for the assessment of the cardiac function are rare. The aim of this study was to prospectively compare gated F-18 FDG PET and cardiac MRI for the assessment of ventricular volume and ejection fraction (EF) in patients with HF. Methods Eighty-nine patients with diagnosed HF who underwent both gated F-18 FDG PET/CT and cardiac MRI within 3 days were included in the analysis. Left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), and EF were obtained from gated F-18 FDG PET/CT using the Quantitative Gated SPECT (QGS) and 4D-MSPECT software. Results LV EDV and LV ESV measured by QGS were significantly lower than those measured by cardiac MRI (both P<0.0001). In contrast, the corresponding values for LV EDV for 4D-MSPECT were comparable, and LV ESV was underestimated with borderline significance compared with cardiac MRI (P = 0.047). LV EF measured by QGS and cardiac MRI showed no significant differences, whereas the corresponding values for 4D-MSPECT were lower than for cardiac MRI (P<0.0001). The correlations of LV EDV, LV ESV, and LV EF between gated F-18 FDG PET/CT and cardiac MRI were excellent for both QGS (r = 0.92, 0.92, and 0.76, respectively) and 4D-MSPECT (r = 0.93, 0.94, and 0.75, respectively). However, Bland-Altman analysis revealed a significant systemic error, where LV EDV (−27.9±37.0 mL) and ESV (−18.6±33.8 mL) were underestimated by QGS. Conclusion Despite the observation that gated F-18 FDG PET/CT were well correlated with cardiac MRI for assessing LV function, variation was observed between the two imaging modalities, and so these imaging techniques should not be used interchangeably.
Collapse
Affiliation(s)
- Yan Li
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Wang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shi-Hua Zhao
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo-Xiang He
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dao-Yu Wang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Guo
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (WF); (M-FY)
| | - Min-Fu Yang
- Department of Nuclear Medicine, Chaoyang Hospital, Capital Medical University, Beijing, China
- * E-mail: (WF); (M-FY)
| |
Collapse
|
41
|
Thomas GS, Kinser CR, Kristy R, Xu J, Mahmarian JJ. Is regadenoson an appropriate stressor for MPI in patients with left bundle branch block or pacemakers? J Nucl Cardiol 2013; 20:1076-85. [PMID: 24132816 DOI: 10.1007/s12350-013-9802-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/02/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with LBBB or ventricular pacemaker undergoing MPI are at risk for false positive MPI results in the setting of an elevated heart rate (HR) with exercise or dobutamine stress. The areas of increased apparent ischemia are typically the LAD and septal territories. METHODS In a subanalysis of the ADVANCE MPI 1 and 2 studies, perfusion on an initial adenosine and a second MPI study with regadenoson or adenosine was compared by visual and quantitative analysis. Among 2,015 patients, 64 had LBBB and 93 had pacemakers. The hemodynamic response during the second scan was compared in those with and without LBBB and PM. RESULTS Following regadenoson, peak HR in the LBBB group increased by a mean of 25.4 compared to 15.3 bpm following adenosine (P = .0083). In the pacemaker group HR was blunted, 11.8 and 8.1 following regadenoson and adenosine, respectively (P = .1262). However, the visually assessed summed difference score and the quantitatively assessed extent of ischemia for the LAD and septal territories and the entire LV did not differ between the initial adenosine and subsequent regadenoson scans. CONCLUSIONS The significant increase in HR observed with regadenoson compared to adenosine did not translate into greater perfusion defects in the LAD or septal territories in patients undergoing regadenoson stress.
Collapse
Affiliation(s)
- Gregory S Thomas
- MemorialCare Heart & Vascular Institute, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA, 90806, USA,
| | | | | | | | | |
Collapse
|
42
|
Pharmacologic manipulation of coronary vascular physiology for the evaluation of coronary artery disease. Pharmacol Ther 2013; 140:121-32. [DOI: 10.1016/j.pharmthera.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/24/2022]
|
43
|
Beller GA. Is there a role for myocardial perfusion imaging in patients with an elevated high-sensitivity troponin? J Nucl Cardiol 2013; 20:705-6. [PMID: 23959827 DOI: 10.1007/s12350-013-9774-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Hung GU. Diagnosing CAD: additional markers from myocardial perfusion SPECT. J Biomed Res 2013; 27:467-77. [PMID: 24285945 PMCID: PMC3841472 DOI: 10.7555/jbr.27.20130135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/15/2013] [Indexed: 11/04/2022] Open
Abstract
Over the past decades, stress/rest myocardial perfusion SPECT (MPS) has been utilized as a standard modality for the diagnosis, risk stratification and prognostic assessment of coronary artery disease (CAD). In addition to the perfusion information, MPS can also provide functional information of the left ventricle, including volume, ejection fraction, wall motion and dyssynchrony. This article introduces the incremental value of these non-perfusion parameters as markers and prognosticators of CAD.
Collapse
Affiliation(s)
- Guang-Uei Hung
- Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan 505, China
| |
Collapse
|
45
|
Abstract
Acute chest pain suggestive of ischemic cardiac origin, with a normal or nondiagnostic electrocardiogram and negative initial cardiac markers for myocardial necrosis represent a significant diagnostic dilemma for clinicians. Multiple imaging modalities play a pivotal role in early diagnosis and safe discharge of these patients. In this review, we compare the current imaging modalities available for these patients including their diagnostic accuracy, feasibility, and cost effectiveness. Acute rest myocardial perfusion imaging significantly improves the clinical outcome in these patients and reduces the overall cost when incorporated into the decision making pathway. The choice of imaging modality recommended should be based on local institutional expertise and the overall clinical presentation. The imaging modality with high diagnostic accuracy and negative predictive value will provide for precise risk stratification which is important to clinical decision making, including patients who require admission to the hospital and those who can be safely discharged.
Collapse
Affiliation(s)
- Abhijit Ghatak
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | |
Collapse
|
46
|
Won KS, Song BI. Recent trends in nuclear cardiology practice. Chonnam Med J 2013; 49:55-64. [PMID: 24010067 PMCID: PMC3759683 DOI: 10.4068/cmj.2013.49.2.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 01/28/2023] Open
Abstract
Over the past three decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for ischemic heart disease. It is currently appropriate for all aspects of detecting and managing ischemic heart disease, including diagnosis, risk assessment and stratification, assessment of myocardial viability, and evaluation of left ventricular function. The purpose of this article was to review recent trends in nuclear cardiology practice, excluding positron emission tomography. The past few years have brought several rapid developments that have increased photon sensitivity in nuclear cardiology scanner hardware. Additionally, software applying new methods of single photon emission tomography (SPECT) reconstruction on conventional and dedicated systems has preserved or even improved SPECT image quality with lower count statistics. On the other hand, much interest has been shown in lowering the radiation dose by the stakeholders of MPS.
Collapse
Affiliation(s)
- Kyoung Sook Won
- Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | | |
Collapse
|
47
|
Ascione L, Carlomagno G, Sordelli C, Iengo R, Monda V, Severino S, Merenda R, D'Andrea A, Caso P. Dipyridamole coronary flow reserve stratifies prognosis in acute coronary syndrome patients without left anterior descending disease. Eur Heart J Cardiovasc Imaging 2013; 14:858-64. [DOI: 10.1093/ehjci/jes305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Farzaneh-Far A, Phillips HR, Shaw LK, Starr AZ, Fiuzat M, O'Connor CM, Sastry A, Shaw LJ, Borges-Neto S. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging 2012; 5:715-24. [PMID: 22789940 DOI: 10.1016/j.jcmg.2012.01.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/09/2012] [Accepted: 01/26/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the independent prognostic significance of ischemia change in stable coronary artery disease (CAD). BACKGROUND Recent randomized trials in stable CAD have suggested that revascularization does not improve outcomes compared with optimal medical therapy (MT). In contrast, the nuclear substudy of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial found that revascularization led to greater ischemia reduction and suggested that this may be associated with improved unadjusted outcomes. Thus, the effects of MT versus revascularization on ischemia change and its independent prognostic significance requires further investigation. METHODS From the Duke Cardiovascular Disease and Nuclear Cardiology Databanks, 1,425 consecutive patients with angiographically documented CAD who underwent 2 serial myocardial perfusion single-photon emission computed tomography scans were identified. Ischemia change was calculated for patients undergoing MT alone, percutaneous coronary intervention, or coronary artery bypass grafting. Patients were followed for a median of 5.8 years after the second myocardial perfusion scan. Cox proportional hazards regression modeling was used to identify factors independently associated with the primary outcome of death or myocardial infarction (MI). Formal risk reclassification analyses were conducted to assess whether the addition of ischemia change to traditional predictors resulted in improved risk classification for death or MI. RESULTS More MT patients (15.6%) developed ≥5% ischemia worsening compared with those undergoing percutaneous coronary intervention (6.2%) or coronary artery bypass grafting (6.7%) (p < 0.001). After adjustment for established predictors, ≥5% ischemia worsening remained a significant independent predictor of death or MI (hazard ratio: 1.634; p = 0.0019) irrespective of treatment arm. Inclusion of ≥5% ischemia worsening in this model resulted in significant improvement in risk classification (net reclassification improvement: 4.6%, p = 0.0056) and model discrimination (integrated discrimination improvement: 0.0062, p = 0.0057). CONCLUSIONS In stable CAD, ischemia worsening is an independent predictor of death or MI, resulting in significantly improved risk reclassification when added to previously known predictors.
Collapse
Affiliation(s)
- Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Shaw LJ, Hage FG, Berman DS, Hachamovitch R, Iskandrian A. Prognosis in the era of comparative effectiveness research: where is nuclear cardiology now and where should it be? J Nucl Cardiol 2012; 19:1026-43. [PMID: 22760523 DOI: 10.1007/s12350-012-9593-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, GA 30324, USA.
| | | | | | | | | |
Collapse
|
50
|
Depuey EG, Mahmarian JJ, Miller TD, Einstein AJ, Hansen CL, Holly TA, Miller EJ, Polk DM, Samuel Wann L. Patient-centered imaging. J Nucl Cardiol 2012; 19:185-215. [PMID: 22328324 DOI: 10.1007/s12350-012-9523-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|