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Prognostic risk stratification based on left ventricular mechanical dyssynchrony in patients at low or intermediate risk of major cardiac events using the J-ACCESS risk model. Heart Vessels 2023; 38:195-206. [PMID: 35960340 DOI: 10.1007/s00380-022-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/27/2022] [Indexed: 01/10/2023]
Abstract
There have been no reports on prognostic prediction and risk stratification based on stress phase bandwidth (SPBW), or a left ventricular (LV) mechanical dyssynchrony index, in patients with known or suspected stable coronary artery disease (CAD) at low or intermediate risk of major cardiac events (MCEs) using the J-ACCESS risk model. We retrospectively investigated 4,996 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and followed up for 3 years to confirm their prognosis. MCE risk over 3 years was estimated using an equation based on that used in the J-ACCESS study. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), and severe heart failure requiring hospitalization. SPBW was calculated by phase analysis with the Heart Risk View-F software and its normal upper limit was set to 38°. Based on the estimated 3-year incidence of MCEs obtained from the J-ACCESS risk model, 4,123 of the 4,996 consecutive patients were classified as low (n = 2,653) or intermediate risk (n = 1,470) and they were analyzed for follow-up. During the follow-up, 153 patients experienced MCEs: cardiac death (n = 38), non-fatal MI (n = 45), and severe heart failure (n = 70). The results of the multivariate analysis showed age, estimated glomerular filtration rate (eGFR), stress LV ejection fraction, and stress SPBW to be independent predictors of MCEs. The actual 3-year MCE rate in patients at intermediate risk was significantly higher than in those at low risk (6.7% vs. 2.1%, P < 0.0001). However, the actual 3-year MCE rate in patients with abnormal SPBW (> 38°) was 4.0% and 9.2% in low- and intermediate-risk patients, respectively, which corresponded to intermediate and high risk. Kaplan-Meier analysis also showed significant risk stratification by normal SPBW values for both low- and intermediate-risk patients. LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for risk stratification of known or suspected stable CAD patients at low or intermediate risk of MCEs and may help identify higher risk patients who could not be identified as being at risk based on J-ACCESS risk assessment.
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Georgiopoulos G, Mavraganis G, Aimo A, Giorgetti A, Cavaleri S, Fabiani I, Giannoni A, Emdin M, Gimelli A. Sex-specific associations of myocardial perfusion imaging with outcomes in patients with suspected chronic coronary syndrome. Hellenic J Cardiol 2022; 71:8-15. [PMID: 36566838 DOI: 10.1016/j.hjc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) is an established diagnostic technique for inducible ischemia in patients with suspected chronic coronary syndrome (CCS). Some MPS findings, most notably an ischemia extent>10% of the left ventricle (LV), hold prognostic significance and support maximization of anti-ischemic treatment. We aimed to assess sex-specific associations of MPS findings with cardiovascular (CV) events in a population at high risk of CCS. METHODS In a prospective cohort study, 1,229 consecutive patients (age 70 ± 9.5 years, 73.5% males) without known CCS were referred to stress-rest MPS. All patients were followed for a median of 4.6 years for CV events. RESULTS Men and women had comparable risk profiles and incidence rates of CV events (6.6% vs. 4.6% respectively, P = 0.186). A summed stress score (SSS) > 7 was associated with the primary endpoint, including CV death and/or nonfatal myocardial infarction (MI) (adjusted hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.79-5.46; P = 0.001), all-cause mortality (HR, 3.01; 95% CI, 1.31-6.93; P = 0.01), and incidence of late revascularization (HR, 1.84; 95% CI, 1.22-2.78; P = 0.004) in men but not women. A summed difference score (SDS) > 6 was related to a higher rate of the primary endpoint only in men (adjusted HR, 1.97; 95% CI, 1.18-3.30; P = 0.009). CONCLUSIONS Among patients undergoing a diagnostic workup for suspected CCS, stress perfusion and reversible ischemia abnormalities may independently predict worse survival and more CV events in men. However, the obtained results indicated the need for sex-specific cutoffs to refine risk stratification and assist in clinical decisions on anti-ischemic therapy beyond coronary artery anatomy.
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Affiliation(s)
- Georgios Georgiopoulos
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, Strand, London WC2R 2LS, London, UK.
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Assuero Giorgetti
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Samuele Cavaleri
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Iacopo Fabiani
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
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Yong J, Tian J, Zhao X, Yang X, Zhang M, Zhou Y, He Y, Song X. Revascularization or medical therapy for stable coronary artery disease patients with different degrees of ischemia: a systematic review and meta-analysis of the role of myocardial perfusion. Ther Adv Chronic Dis 2022; 13:20406223211056713. [PMID: 35070247 PMCID: PMC8777334 DOI: 10.1177/20406223211056713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study explored the best treatment strategies for stable coronary artery disease (SCAD) patients with differing levels of ischemic severity. METHODS We conducted a comprehensive search of the PubMed, EMBASE, and Cochrane databases - searching for relevant articles through 4 February 2021. We selected studies comparing different treatments for patients with SCAD who had received ischemia assessments. The primary outcome was death. The secondary outcomes were major adverse cardiovascular events (MACEs) and myocardial infarction (MI). RESULTS A total of 11 studies, including 35,607 subjects, were selected for this meta-analysis. Results showed that, compared with medical therapy, revascularization could reduce MACE incidence (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.57-0.94, p < 0.05) in SCAD patients with myocardial ischemia, but that it was not effective for patients without ischemia. For mild ischemia, the incidence of death (OR 0.78, 95% CI: 0.59-1.01, p = 0.063), MACE (OR 0.91, 95% CI: 0.48-1.70, p = 0.762), or MI (OR 1.44, 95% CI: 0.94-2.19, p = 0.093) was the same whether they were treated with revascularization or medical therapy. For moderate to severe ischemia, revascularization reduced the incidence of MACE (OR 0.59, 95% CI: 0.42-0.83, p < 0.05) and MI (OR 0.83, 95% CI: 0.71-0.98, p < 0.05), but the incidence of death (OR 0.73, 95% CI: 0.47-1.12, p = .145) was similar. For SCAD patients with severe ischemia, revascularization may confer survival benefits (OR 0.46, 95% CI: 0.21-1.00, p = 0.05). CONCLUSION For SCAD patients with moderate to severe ischemia, revascularization reduces the MACE and MI incidences, but does not change the incidence of death. Evaluation for myocardial ischemia is vital when selecting a therapeutic strategy.
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Affiliation(s)
- JingWen Yong
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - JinFan Tian
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - XueYao Yang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - MingDuo Zhang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship
Hospital, Capital Medical University, Yongan Road 95, Beijing 100050,
China
| | - XianTao Song
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District,
Beijing 100029, China
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4
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Fujito H, Yoda S, Hatta T, Hori Y, Hayase M, Miyagawa M, Suzuki Y, Matsumoto N, Okumura Y. Prognostic Significance of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology for the Prediction of Major Cardiac Events after Revascularization. Intern Med 2021; 60:3679-3692. [PMID: 34121001 PMCID: PMC8710387 DOI: 10.2169/internalmedicine.6995-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This retrospective study was aimed at determining whether or not stress phase bandwidth (SPBW), a left ventricular (LV) mechanical dyssynchrony index, predicts major cardiac events (MCEs) and stratifies the risk of those in patients with coronary artery disease (CAD) who undergo revascularization. Methods Patients were followed up to confirm the prognosis for at least one year. The SPBW was calculated by a phase analysis using the Heart Risk View-F software program. The composite endpoint was the onset of MCEs, consisting of cardiac death, non-fatal myocardial infarction, unstable angina pectoris, and severe heart failure requiring hospitalization. Patients The study subjects were 332 patients with CAD who underwent coronary angiography and revascularization after confirming ≥5% ischemia detected by rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging. Results During the follow-up, 35 patients experienced MCEs of cardiac death (n=5), non-fatal myocardial infarction (n=3), unstable angina pectoris (n=11), and severe heart failure requiring hospitalization (n=16). A receiver operating characteristics analysis indicated that the optimal cut-off value of the SPBW was 52° for predicting MCEs, and the MCE rate was significantly higher in the patients with an SPBW >52° than in those with an SPBW ≤52°. Results of the multivariate analysis showed the SPBW and estimated glomerular filtration rate to be independent predictors for MCEs. In addition, the cut-off value of the SPBW significantly stratified the risk of MCEs according to the results of the Kaplan-Meier analysis. Conclusion Evaluating the SPBW before revascularization may help predict future MCEs in patients with CAD who intended to undergo treatment.
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Affiliation(s)
- Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Japan
| | | | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine, Japan
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Ortiz Zegarra CA, Custodio Sánchez P, Rojas de la Cuba P, Mori Pinedo GE, Coloma Araniya R, Gonzales Álvarez BA, Nolte Rickards C. [Should i treat a high risk chronic coronary syndrome invasively from the beginning? Yes, in most cases]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:222-228. [PMID: 38268509 PMCID: PMC10804820 DOI: 10.47487/apcyccv.v1i4.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/19/2020] [Indexed: 01/26/2024]
Abstract
Chronic coronary syndrome (SCC) previously known as stable coronary disease, is the main cause of mortality in the world, and it is one of the most important in Peru. This pathology has a dynamic nature that results in different clinical scenarios that can be modified through various therapeutic options, one of which is coronary interventional treatment, mainly in patients with high ischemic risk defined as ischemia greater than 10% of the entire left ventricular mass. For this reason, we have analyzed the most relevant and current information available, concluding that the treatment of high ischemic risk´s chronic coronary syndrome, after an individual evaluation, would correspond to an invasive management from the beginning, although it would not impact on mortality or cardiovascular events, it would contribute to improve quality of life; also we should consider the incomplete availability of all the therapeutic options for the symptomatic management of this disease, the limited access to the management of acute cardiovascular events in our country, as well as the risk of adverse effects and drug interactions.
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Affiliation(s)
- César Antonio Ortiz Zegarra
- Médico asistente del Servicio de Cardiología Intervencionista. Instituto Nacional Cardiovascular - INCOR. Lima. Perú. Servicio de Cardiología Intervencionista Instituto Nacional Cardiovascular - INCOR Lima Perú
- Secretario de ética de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Piero Custodio Sánchez
- Médico asistente del Servicio de Cardiología Intervencionista. Hospital Nacional Almanzor Aguinaga Asenjo. Chiclayo, Perú. Servicio de Cardiología Intervencionista Hospital Nacional Almanzor Aguinaga Asenjo Chiclayo Perú
- Secretario de filiales de Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Paol Rojas de la Cuba
- Médico asistente del Servicio de Cardiología Intervencionista. Hospital Nacional Guillermo Almenara. Lima, Perú. Servicio de Cardiología Intervencionista Hospital Nacional Guillermo Almenara Lima Perú
- Secretario de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Gorki E Mori Pinedo
- Coordinador CDTE Clínica San Felipe. Lima, Perú. CDTE Clínica San Felipe Lima Perú
- Vicepresidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Ricardo Coloma Araniya
- Jefe de la Unidad de Hemodinámica del Hospital Central FAP. Lima, Perú. Unidad de Hemodinámica del Hospital Central FAP Lima Perú
- Expresidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Bertha Aidee Gonzales Álvarez
- Cardióloga de la Clínica Tezza. Lima, Perú. Clínica Tezza Lima Perú
- Secretaria de Economía de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Christian Nolte Rickards
- Médico asistente del servicio de cardiología intervencionista. Instituto Nacional Cardiovascular - INCOR. Lima, Perú. servicio de cardiología intervencionista Instituto Nacional Cardiovascular - INCOR Lima Perú
- Presidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
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7
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Hatta T, Yoda S, Hayase M, Monno K, Hori Y, Fujito H, Suzuki Y, Matsumoto N, Okumura Y. Prognostic Value of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology in Patients with Known or Suspected Stable Coronary Artery Disease with Preserved Left Ventricular Ejection Fraction. Int Heart J 2020; 61:685-694. [PMID: 32684598 DOI: 10.1536/ihj.20-008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).We retrospectively investigated 3,374 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI and had preserved LVEF (≥ 45%), and followed them up to confirm their prognosis for three years. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris, and severe heart failure requiring hospitalization. LV mechanical dyssynchrony was evaluated with phase analysis with the Heart Risk View-F software to obtain the phase bandwidth and standard deviation.During the follow-up, 179 patients experienced MCEs: cardiac death (n = 42); non-fatal MI (n = 34); unstable angina pectoris (n = 54); and severe heart failure (n = 49). Results of the multivariate analysis showed age, a history of MI, diabetes mellitus, summed stress score, and stress phase bandwidth to be independent predictors for MCEs. In Kaplan-Meier analysis, prognoses were significantly stratified with the tertiles of stress phase bandwidth.LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for predicting a prognosis and stratifying the risk of MCEs in Japanese patients with known or suspected stable CAD with preserved LVEF.
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Affiliation(s)
- Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine
| | - Koyuru Monno
- Department of Cardiology, Nihon University School of Medicine
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine
| | - Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine
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8
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Hayase M, Yoda S, Hatta T, Hori Y, Monno K, Fujito H, Suzuki Y, Matsumoto N, Okumura Y. Prognostic Significance of the Residual SYNTAX Score and Ischemic Reduction Detected with Nuclear Cardiology for Prediction of Major Cardiac Events after Revascularization. Intern Med 2020; 59:1361-1371. [PMID: 32161215 PMCID: PMC7332621 DOI: 10.2169/internalmedicine.3397-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective There is no report on the risk stratification of major cardiac events (MCEs) with a combination of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score and ischemic reduction detected with rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon-emission computed tomography (SPECT) after revascularization in Japanese patients with coronary artery disease (CAD). Methods This was a retrospective study. The patients were followed up to confirm their prognosis for at least one year. Ischemia was evaluated based on the summed difference scores converted to the percentage of the total myocardium Safety Data Sheet (SDS%). The SYNTAX score and SDS% were calculated before and after revascularization. The endpoint was the occurrence of MCEs. Patients Study subjects were 293 patients who had a ≥75% stenotic lesion detected with coronary angiography following confirmation of ≥5% ischemia with SPECT, underwent revascularization, and thereafter received a re-evaluation with SPECT and coronary angiography. Results During the follow-up, 25 patients experienced MCEs of cardiac death (n=2), non-fatal myocardial infarction (n=3), and unstable angina pectoris (n=20). A receiver operating characteristic analysis indicated that the best cut-off values of the residual SYNTAX score and ΔSDS% were 12 and 5%, respectively, for the prediction of MCEs. The patients with a low residual SYNTAX score (<12) and high ΔSDS% (≥5%) had the best prognosis, while those with a high residual SYNTAX score (≥12) and low ΔSDS% (<5%) had the worst prognosis. Conclusion The combination of the residual SYNTAX score and ischemic reduction detected with nuclear cardiology is useful for predicting MCEs after revascularization.
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Affiliation(s)
- Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Koyuru Monno
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine, Japan
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Mineki T, Yoda S, Hatta T, Hayase M, Monno K, Hori Y, Suzuki Y, Matsumoto N, Okumura Y. Risk Stratification of Cardiovascular Events in Very Elderly Patients with Known or Suspected Coronary Artery Disease Who Had Normal Single-photon Emission Computed Tomographic Myocardial Perfusion Imaging Findings. Intern Med 2019; 58:3351-3359. [PMID: 31366795 PMCID: PMC6928491 DOI: 10.2169/internalmedicine.2843-19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective We aimed to stratify the risk of major cardiovascular (MCV) events in Japanese patients with known or suspected coronary artery disease (CAD) who had normal single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) findings and to compare the risk by generation. Methods This was a retrospective study. The composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Patients The study subjects were 2,035 patients with normal SPECT MPI findings at baseline who had been followed up to confirm their prognosis for 3 years. The patients were categorized into 3 age groups: very elderly (≥80 years old, n=311), elderly (65-79 years old, n=1,097), and younger (<65 years old, n=542). Results During the follow-up, 68 patients experienced MCV events: cardiovascular death (n=29), non-fatal myocardial infarction (n=15), and non-fatal stroke (n=24). The MCV event rate was significantly higher in very elderly patients than in other patients. Multivariate predictors were age categories, the estimated glomerular filtration rate, atrial fibrillation, and stress left ventricular ejection fraction. The MCV event rate was 6.1% in very elderly patients. However, the MCV event rate in those with normal cardiac and renal functions without atrial fibrillation was 3.3%, which was similar to that in elderly and younger patients. Conclusion The MCV event rate was high in very elderly patients despite their normal SPECT MPI findings at baseline. Therefore, very elderly patients with multivariate risks should be carefully followed to avoid a poor prognosis.
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Affiliation(s)
- Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Koyuru Monno
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Japan
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine, Japan
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