1
|
Kleb C, Sims OT, Fares M, Ruthmann N, Ansari K, Esfeh JM. Screening Modalities for Coronary Artery Disease in Liver Transplant Candidates: A Review of the Literature. J Cardiothorac Vasc Anesth 2023; 37:2611-2620. [PMID: 37690949 DOI: 10.1053/j.jvca.2023.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/16/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
Patients with cirrhosis undergoing liver transplant (LT) are at high risk of postoperative cardiopulmonary complications. It is known that patients with coronary artery disease (CAD) have greater rates of post-LT morbidity and mortality than patients without CAD. Thus, identifying significant CAD in LT candidates is of the utmost importance to optimize survival posttransplant. Consensus is lacking on the ideal screening test for CAD in LT candidates. Traditional exercise and many pharmacologic stress tests are impractical and inaccurate in patients with cirrhosis due to their unique physiology. The purpose of this review is to describe different screening modalities for CAD among LT candidates. The background, diagnostic accuracy, and limitations of each screening modality are described to achieve this goal.
Collapse
Affiliation(s)
- Cerise Kleb
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD.
| | - Omar T Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Maan Fares
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Nicholas Ruthmann
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Kianoush Ansari
- Department of Diagnostic Radiology, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
2
|
Seraphim A, Knott KD, Augusto JB, Menacho K, Tyebally S, Dowsing B, Bhattacharyya S, Menezes LJ, Jones DA, Uppal R, Moon JC, Manisty C. Non-invasive Ischaemia Testing in Patients With Prior Coronary Artery Bypass Graft Surgery: Technical Challenges, Limitations, and Future Directions. Front Cardiovasc Med 2022; 8:795195. [PMID: 35004905 PMCID: PMC8733203 DOI: 10.3389/fcvm.2021.795195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery effectively relieves symptoms and improves outcomes. However, patients undergoing CABG surgery typically have advanced coronary atherosclerotic disease and remain at high risk for symptom recurrence and adverse events. Functional non-invasive testing for ischaemia is commonly used as a gatekeeper for invasive coronary and graft angiography, and for guiding subsequent revascularisation decisions. However, performing and interpreting non-invasive ischaemia testing in patients post CABG is challenging, irrespective of the imaging modality used. Multiple factors including advanced multi-vessel native vessel disease, variability in coronary hemodynamics post-surgery, differences in graft lengths and vasomotor properties, and complex myocardial scar morphology are only some of the pathophysiological mechanisms that complicate ischaemia evaluation in this patient population. Systematic assessment of the impact of these challenges in relation to each imaging modality may help optimize diagnostic test selection by incorporating clinical information and individual patient characteristics. At the same time, recent technological advances in cardiac imaging including improvements in image quality, wider availability of quantitative techniques for measuring myocardial blood flow and the introduction of artificial intelligence-based approaches for image analysis offer the opportunity to re-evaluate the value of ischaemia testing, providing new insights into the pathophysiological processes that determine outcomes in this patient population.
Collapse
Affiliation(s)
- Andreas Seraphim
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Kristopher D Knott
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Joao B Augusto
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Katia Menacho
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sara Tyebally
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Benjamin Dowsing
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Leon J Menezes
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Rakesh Uppal
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - James C Moon
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| |
Collapse
|
3
|
Hossain N, Hossain N, Al-Sadawi M, Haq S. Bezold–Jarisch reflex-mediated asystole during dobutamine stress testing: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33532694 PMCID: PMC7837248 DOI: 10.1093/ehjcr/ytaa348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Background The Bezold–Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography. Case summary We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal. Discussion This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.
Collapse
Affiliation(s)
- Nimrah Hossain
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
| | - Naseem Hossain
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Mohammed Al-Sadawi
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Salman Haq
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
| |
Collapse
|
4
|
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
|
5
|
Nkoulou R, Wolfrum M, Pazhenkottil AP, Fiechter M, Buechel RR, Gaemperli O, Kaufmann PA. Gated SPECT myocardial perfusion imaging with cadmium-zinc-telluride detectors allows real-time assessment of dobutamine-stress-induced wall motion abnormalities. J Nucl Cardiol 2019; 26:1734-1742. [PMID: 29340989 DOI: 10.1007/s12350-018-1187-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (EF) during high dobutamine stress (HD) by real-time gated-SPECT myocardial perfusion imaging (MPI) on a cadmium-zinc-telluride (CZT) gamma camera was validated versus cardiac magnetic resonance imaging (CMR). METHODS AND RESULTS After injecting 99mTc-tetrofosmin (320 MBq) in 50 patients (mean age 64 +/- 11 years), EF at rest and post-stress as well as relevant changes in EF at HD (ΔEF ≥ 5%) were assessed. CZT and CMR rest EF values yielded an excellent correlation and agreement (r = 0.96; P < 0.001; Bland-Altman limits of agreement (BA): + 0 to 14.8%). HD EF acquisition was feasible using CZT and correlated better to HD CMR EF than did post-stress CZT EF (r = 0.85 vs 0.76, respectively, all P < 0.001). Agreement in ΔEF detection between HD CMR and immediate post-stress CZT (reflecting standard acquisition using conventional SPECT camera unable to scan during stress) was 45%, while this increased to 85% with real-time HD CZT scan. CONCLUSION Real-time ultrafast dobutamine gated-SPECT MPI with a CZT device is feasible and provides accurate measurements of HD LV performance.
Collapse
Affiliation(s)
- Rene Nkoulou
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland.
| | - Mathias Wolfrum
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
6
|
Dimitriu-Leen AC, Scholte AJHA, Katsanos S, Hoogslag GE, van Rosendael AR, van Zwet EW, Bax JJ, Delgado V. Influence of Myocardial Ischemia Extent on Left Ventricular Global Longitudinal Strain in Patients After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:1-6. [PMID: 27776800 DOI: 10.1016/j.amjcard.2016.08.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Abstract
Two-dimensional echocardiographic left ventricular (LV) global longitudinal strain (GLS) after ST-segment elevation myocardial infarction (STEMI) is moderately correlated with infarct size and reflects the residual LV systolic function. This correlation may be influenced by the presence of myocardial ischemia. The present study investigated how myocardial ischemia modulates the correlation between LV GLS and infarct size determined with single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with first STEMI treated with primary coronary intervention. A total of 1,128 patients (age 60 ± 11 years) who underwent SPECT MPI for the evaluation of infarct size and residual ischemia were evaluated. LV GLS was measured on transthoracic echocardiography. The time interval between echocardiography and SPECT MPI was 1 ± 1 month. A moderate correlation between echocardiographic LV GLS and infarct size on SPECT MPI was observed (r = 0.58, p <0.001). This correlation was weakened by the presence or extent of ischemia; in the group of patients without ischemia, the correlation between LV GLS and infarct size on SPECT MPI was r = 0.66 (p <0.001), whereas in patients with mild or moderate-to-severe ischemia, the correlations were r = 0.56 and 0.38, respectively (both p <0.001). Moderate-to-severe myocardial ischemia was independently associated with more impaired LV GLS after adjusting for infarct size, age, diabetes mellitus, and hypertension (β 0.60, 95% confidence interval 013 to 1.06). In conclusion, the presence of myocardial ischemia after STEMI impacts on the correlation between echocardiographic LV GLS and infarct size measured on SPECT MPI. Residual ischemia is independently associated with more impaired LV GLS.
Collapse
Affiliation(s)
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Spyridon Katsanos
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Georgette E Hoogslag
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Erik W van Zwet
- Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
7
|
Standbridge K, Reyes E. The role of pharmacological stress testing in women. J Nucl Cardiol 2016; 23:997-1007. [PMID: 27515346 DOI: 10.1007/s12350-016-0602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
Pharmacological stress is an alternative method to dynamic exercise that combined with noninvasive imaging allows the detection of flow-limiting coronary artery disease (CAD). It represents the stress procedure of choice in patients who cannot exercise appropriately. In women, pharmacological stress combined with myocardial perfusion scintigraphy (MPS) has demonstrated to be highly accurate for the detection of obstructive CAD and a valuable tool that helps separate patients at low cardiac risk from those with an adverse prognosis. Pharmacological stress with positron emission tomographic (PET) imaging is increasingly used in the investigation of suspected obstructive CAD; available evidence shows that the diagnostic profile and prognostic value of stress PET imaging is similar to that of stress MPS in women.
Collapse
Affiliation(s)
- Katherine Standbridge
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, United Kingdom
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, United Kingdom.
| |
Collapse
|
8
|
Abdel-Salam Z, Ghazy M, Khaled M, Nammas W. Acute Beta Blockade at Peak Stress: Will It Alter the Sensitivity of Dobutamine Stress Echocardiography in Patients with Normal Resting Wall Motion? ACTA CARDIOLOGICA SINICA 2016; 32:89-95. [PMID: 27122936 DOI: 10.6515/acs20150204d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We compared the accuracy of recovery phase images following administration of intravenous propranolol with peak stress images, for detection of coronary artery disease in patients with no resting wall motion abnormalities undergoing dobutamine stress echocardiography. METHODS We enrolled 100 consecutive patients with no resting wall motion abnormalities who underwent dobutamine stress echocardiography. Propranolol was injected after termination of dobutamine infusion. Positive peak stress images were defined as the induction of wall motion abnormalities at any stage before propranolol injection. Positive recovery phase images were defined as maintenance or worsening of wall motion abnormalities induced at peak stress, or the appearance of new wall motion abnormalities during recovery phase. Significant coronary stenosis was defined as ≥ 50% obstruction of ≥ 1 sizable artery by coronary angiography. RESULTS Seventy-two patients (72%) had significant coronary artery disease. Analysis of peak stress images revealed sensitivity, specificity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, and 63.2%; the overall accuracy was 82%. Analysis of the recovery phase images revealed sensitivity, specificity, positive and negative predictive values of 91.7%, 75%, 90.4%, and 77.8%; here, the overall accuracy was 87%. CONCLUSIONS In patients with no resting wall motion abnormalities, acute beta blockade during dobutamine stress echocardiography improved the sensitivity of recovery phase images for detection of significant coronary artery disease versus peak stress images, but with reduced specificity. KEY WORDS Accuracy; Beta blocker; Coronary artery disease; Dobutamine stress echocardiography; Recovery phase images.
Collapse
Affiliation(s)
- Zainab Abdel-Salam
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Ghazy
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Khaled
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wail Nammas
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
9
|
Fordyce CB, Douglas PS. Optimal non-invasive imaging test selection for the diagnosis of ischaemic heart disease. Heart 2016; 102:555-64. [DOI: 10.1136/heartjnl-2015-307764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
10
|
Barletta G, Del Bene MR. Myocardial perfusion echocardiography and coronary microvascular dysfunction. World J Cardiol 2015; 7:861-874. [PMID: 26730291 PMCID: PMC4691812 DOI: 10.4330/wjc.v7.i12.861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/04/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking.
Collapse
|
11
|
Dilsizian V, Gewirtz H, Paivanas N, Kitsiou AN, Hage FG, Crone NE, Schwartz RG. Serious and potentially life threatening complications of cardiac stress testing: Physiological mechanisms and management strategies. J Nucl Cardiol 2015; 22:1198-213; quiz 1195-7. [PMID: 25975944 DOI: 10.1007/s12350-015-0141-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Henry Gewirtz
- Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas Paivanas
- Department of Medicine (Division of Cardiology), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Departments of Medicine (Division of Cardiology) and Imaging Sciences (Nuclear Medicine), University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
12
|
Cost-effectiveness of coronary CT angiography in patients with chest pain: Comparison with myocardial single photon emission tomography. J Cardiovasc Comput Tomogr 2015; 9:428-37. [PMID: 25977116 DOI: 10.1016/j.jcct.2015.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 12/20/2014] [Accepted: 02/14/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) has been proven accurate and is incorporated in clinical recommendations for coronary artery disease (CAD) diagnosis workup, but cost-effectiveness data, especially in comparison to other methods such as myocardial single photon emission CT (SPECT) are insufficient. OBJECTIVE To compare the cost-effectiveness of CCTA and myocardial SPECT in a real-world setting. METHODS We performed a retrospective cohort study on consecutive patients with suspected CAD and a pretest probability between 10% and 90%. Test accuracy was compared by correcting referral bias to coronary angiography depending on noninvasive test results based on the Bayes' theorem and also by incorporating 1-year follow-up results. Cost-effectiveness was analyzed using test accuracy and quality-adjusted life year (QALY). The model using diagnostic accuracy used the number of patients accurately diagnosed among 1000 persons as the effect and contained only expenses for diagnostic testing as the cost. In the model using QALY, a decision tree was developed, and the time horizon was 1 year. RESULTS CCTA was performed in 635 patients and SPECT in 997 patients. An accurate diagnosis per 1000 patients was achieved in 725 patients by CCTA vs 661 patients by SPECT. In the model using diagnostic accuracy, CCTA was more effective and less expensive than SPECT ($725.38 for CCTA vs $661.46 for SPECT). In the model using QALY, CCTA was generally more effective in terms of life quality (0.00221 QALY) and cost ($513) than SPECT. However, cost utility varied among subgroups, with SPECT outperforming CCTA in patients with a pretest probability of 30% to 60% (0.01890 QALY; $113). CONCLUSION These results suggest that CCTA may be more cost-effective than myocardial SPECT.
Collapse
|
13
|
Tanaka H, Chikamori T, Hida S, Igarashi Y, Shiba C, Usui Y, Hatano T, Yamashina A. Diagnostic Value of Vasodilator-Induced Left Ventricular Dyssynchrony as Assessed by Phase Analysis to Detect Multivessel Coronary Artery Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.17996/anc.15001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hirokazu Tanaka
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
| | | | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University
| | | | - Chie Shiba
- Department of Cardiology, Tokyo Medical University
| | | | | | | |
Collapse
|
14
|
Golzar Y, Doukky R. Regadenoson use in patients with chronic obstructive pulmonary disease: the state of current knowledge. Int J Chron Obstruct Pulmon Dis 2014; 9:129-37. [PMID: 24489466 PMCID: PMC3904829 DOI: 10.2147/copd.s56879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Stress testing is challenging in patients with chronic obstructive pulmonary disease (COPD). Functional capacity is generally decreased in this patient population, limiting patients’ ability to achieve physiologic stress through exercise. Additionally, due to emphysematous changes, COPD patients tend to have poor acoustic windows that impair the quality and therefore diagnostic accuracy of stress echocardiography techniques. Pharmacologic stress myocardial perfusion imaging (MPI) testing is also problematic, particularly due to the concern for adenosine-induced bronchoconstriction with conventional vasodilator stress agents. Regadenoson, a selective A2A adenosine receptor agonist, has gained popularity due to its ease of administration and improved patient experience in the general population. The literature describing the experience with regadenoson in COPD patients, though limited, is rapidly growing and reassuring. This review summarizes the pharmacology and clinical application of this novel stress agent and presents the available data on the safety and tolerability of its use in COPD patients.
Collapse
Affiliation(s)
- Yasmeen Golzar
- Division of Adult Cardiology, John H Stroger Jr, Hospital of Cook County, Chicago, IL, USA ; Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rami Doukky
- Division of Adult Cardiology, John H Stroger Jr, Hospital of Cook County, Chicago, IL, USA ; Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
15
|
Hochberg KJ, Sandach A, Snyder M, Vishne U. Confidence Interval for the Risk-Score Index. Methodol Comput Appl Probab 2013. [DOI: 10.1007/s11009-012-9294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Malhotra S, Sharma R, Kliner DE, Follansbee WP, Soman P. Relationship between silent myocardial ischemia and coronary artery disease risk factors. J Nucl Cardiol 2013; 20:731-8. [PMID: 23719838 DOI: 10.1007/s12350-013-9708-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/18/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The association between silent myocardial ischemia (SMI) and coronary artery disease (CAD) risk factors in asymptomatic patients with no prior history of CAD referred for stress myocardial perfusion imaging (MPI) is unknown. METHODS We retrospectively evaluated patients who underwent MPI over a 3.4-year period to identify those who did not have chest pain, dyspnea, or known CAD. The presence of risk factors was categorized as none, 1-2, 3-4, and ≥5. MPI was performed using a rest thallium-201/stress Tc-99m sestamibi protocol, and read using a standard five-point perfusion score (0 = normal to 4 = absent) and a 17-segment left ventricular model. Summed stress score and summed rest score were derived as the sum of individual segmental scores at stress and rest, respectively. SMI was diagnosed if the summed differences score (SDS) was ≥2. Prognostically significant ischemia was defined by a SDS ≥ 8. RESULTS Among 1,354 asymptomatic patients, SMI was present in 97 (7.2%) and prognostically significant in 60 (4.4%). The prevalence, but not severity, of SMI increased with increasing CAD risk factors--0 for none, 4.1% for 1-2, 8.8% for 3-4, and 12% for those with ≥5 CAD risk factors (P value for trend = .001), in patients <74 years of age. Of the 59 (4.4%) patients who underwent coronary angiography, only 31 (2%) had significant anatomical CAD. CONCLUSIONS The prevalence of SMI and prognostically significant ischemia is low in asymptomatic patients without known CAD, and is related to the number of CAD risk factors in patients younger than 74 years of age.
Collapse
Affiliation(s)
- Saurabh Malhotra
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA,
| | | | | | | | | |
Collapse
|
17
|
Nguyen J, Juneman E, Movahed MR. The Value of β-Blockers Administration during Recovery Phase of Dobutamine Stress Echocardiography: A Review. Echocardiography 2013; 30:723-9. [DOI: 10.1111/echo.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
18
|
|
19
|
Procedure guidelines for radionuclide myocardial perfusion imaging with single-photon emission computed tomography. Nucl Med Commun 2013; 34:813-26. [PMID: 23719150 DOI: 10.1097/mnm.0b013e32836171eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia and an important cause of hospitalization, morbidity, and mortality. A myriad of drugs can induce AF. However, drug-induced AF (DIAF) receives little attention. Thus, this review is an attempt to attract the attention on this adverse effect. AREAS COVERED Published reports of drug-induced AF (DIAF) are reviewed in this paper, from January 1974 to December 2011, using the PubMed/Medline database and lateral references. EXPERT OPINION In most cases, DIAF is paroxysmal and terminates spontaneously, but sometimes AF persists and it is necessary to perform a cardioversion to restore sinus rhythm and avoid progression to persistent AF. Because of the short duration of DIAF, in addition to physicians/patients not being knowledgeable about this side effect, the real incidence and clinical consequences of DIAF are presently unknown. DIAF is an increasing problem, as some widely prescribed drugs can present this adverse effect. The risk is expected to increase in the elderly and in patients with comorbidities. It is important that physicians understand the significance of DIAF, to increase the collaboration between cardiac and non-cardiac professionals, and to educate patients to make them aware of this adverse side effect.
Collapse
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain.
| | | | | |
Collapse
|
21
|
Safety and efficacy of exercise testing with atropine in patients with recent uncomplicated ST elevation acute myocardial infarction. Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Collapse
|
22
|
Hida S, Chikamori T, Tanaka H, Igarashi Y, Shiba C, Usui Y, Hatano T, Yamashina A. Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography. Circ J 2012; 76:1942-52. [DOI: 10.1253/circj.cj-11-1392] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Hida
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Taishiro Chikamori
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Hirokazu Tanaka
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Yuko Igarashi
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Chie Shiba
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Yasuhiro Usui
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Tsuguhisa Hatano
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| |
Collapse
|
23
|
Husain Z, Palani G, Cabrera R, Karthikeyan AS, Dhanalakota S, Pathmanathan S, Jacobsen G, Ananthasubramaniam K. Hemodynamic response, arrhythmic risk, and overall safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic obstructive pulmonary disease and bronchial asthma patients. Int J Cardiovasc Imaging 2011; 28:1841-9. [PMID: 22200931 DOI: 10.1007/s10554-011-0003-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Abstract
Regadenoson (REG) is a A2a receptor selective pharmacologic SPECT imaging agent. Its safety in unselected chronic obstructive pulmonary disease (COPD) or asthma (AM) undergoing SPECT imaging has not been well evaluated. We retrospectively identified 228 patients (COPD n = 126 and AM n = 102, Grp 1) undergoing REG SPECT from Jan to Nov 2009 and compared to 1,142 patients without COPD and AM (control, Grp 2). A standard 400 μg REG bolus was used and gated Tc-99 m tetrofosmin SPECT done. Patient demographics, REG SPECT data, side effects, arrhythmia occurrences, and any exacerbation of COPD or AM leading to treatment, hospitalization or death were evaluated. The side effect profile of Grp 1 was also compared to a historical cohort who underwent intravenous dipyridamole thallium-201 imaging and adenosine SPECT. Both groups were comparable with regards to baseline characteristics. There was 0% incidence of clinical exacerbation of COPD or AM after REG. COPD patients had more non-significant arrhythmias (58.3% vs. Grp 2, 43%, P = 0.004). There was 0% incidence of any atrio-ventricular block and only 2 instances of brief supraventricular tachycardia. When compared to the historical cohort of COPD who underwent IV dipyridamole thallium imaging, COPD in Grp 1, had more dyspnea and flushing and when compared to COPD/AM patients who underwent adenosine SPECT, Grp 1 pts had more of flushing and headache (24.9% vs. 2.8%, P = <0.001) but less of bronchospasm (1.3% vs. 6.9%, P = 0.022) and AV block (0% vs. 4.2%, P = 0.014). REG SPECT can be safely performed in COPD and AM population.
Collapse
Affiliation(s)
- Zehra Husain
- St Joseph Mercy Oakland Hospital, Pontiac, MI, USA.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Comparison between accelerated and conventional dobutamine stress protocols for myocardial perfusion scintigraphy. Int J Cardiovasc Imaging 2011; 28:1823-8. [PMID: 22187197 DOI: 10.1007/s10554-011-0002-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
The conventional dobutamine (Dob) stress protocol for myocardial perfusion scintigraphy (MPS) is long, with frequent adverse effects, and generally requires atropine injection to reach target heart rate. Atropine is usually administered at the end of the protocol, when adverse effects are more frequent. Earlier atropine injection may be useful to shorten the stress protocol and reduce adverse effects. We sought to compare a Dob stress protocol with early atropine injection to a conventional Dob stress protocol in the same patients undergoing MPS. 30 patients underwent Dob-MPS with a conventional protocol (steps of 10, 20, 30 and 40 mcg/kg/min at 3 min intervals, adding atropine to the maximal Dob dose if necessary to achieve 85% of the age-corrected maximal predicted heart rate) and with an accelerated protocol with early atropine injection (at the end of the first stage). We compared stress duration, maximal heart rate (HR), percentage of maximal predicted HR, rate-pressure product, ST changes, MPS scores and the incidence of adverse effects between the 2 protocols. The accelerated protocol was shorter than the conventional protocol (7.1 ± 3.4 min vs. 11.8 ± 1.3 min; P < 0.0001), had the same efficacy to achieve hemodynamic parameters, without increasing adverse effects. The summed stress scores obtained by automatic analysis were similar in both protocols (6.3 ± 6.3 vs. 6.8 ± 6.3; P = NS) as well as the summed difference scores (2.5 ± 3.6 vs. 2.7 ± 3.4; P = NS). Early atropine injection during dobutamine stress protocol shortens stress duration. Our results suggest that patient safety and accuracy of MPS are unaltered, when compared to the conventional protocol, but further, larger studies are still necessary.
Collapse
|
25
|
Abstract
Pharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department.
Collapse
|
26
|
Prediction of future cardiac events using myocardial perfusion SPECT: a middle-term follow-up study. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2011; 30:360-4. [PMID: 21549453 DOI: 10.1016/j.remn.2011.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/04/2011] [Accepted: 03/18/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) provides highly valuable information for risk stratification and determination of optimal clinical management. The goal of the present study was to assess the prognostic value of myocardial perfusion SPECT for the prediction of future cardiac events in Asian population. METHODS Five hundred and ten consecutive patients, who had undergone myocardial perfusion SPECT between 2005 and 2006, were prospectively followed-up. Patients' data were collected from recorded files. Follow-ups were performed by scripted telephone interviews by a physician blinded to the patients' MPI results and also from the hospital records. The total completed follow-ups consisted of 482 patients (follow-up rate, 94.5%). RESULTS Over the mean follow-up period of 434 ± 62 days, 14 out of 482 patients (2.9%) died from cardiac events. Also in 61 patients (12.7%), the clinical condition led to a cardiac intervention (Percutaneous coronary intervention or coronary artery bypass grafting). Those patients without cardiac events on follow-up (including cardiac death or myocardial infarction) were younger and with less severity of MPI abnormalities. Severe MPI abnormalities (Summed Stress Score > 13) were found in 42.9% of those with cardiac death, while in 17.2% of those with myocardial infarction. The rate of cardiac death had a direct relationship with the severity of scan abnormalities, however, the same association was not found between the severity of MPI abnormality and the rate of myocardial infarction. CONCLUSION MPI is a valuable tool for risk stratification and prediction of future fatal cardiac events in Asian population. The risk of cardiac death as a mid-term outcome of coronary artery disease increases significantly with severity of MPI abnormalities.
Collapse
|
27
|
Wuthiwaropas P, Wiste JA, McCully RB, Kane GC, Scott CG, Pellikka PA. Neuropsychiatric Symptoms During 24 Hours after Dobutamine-Atropine Stress Testing: A Prospective Study in 1,006 Patients. J Am Soc Echocardiogr 2011; 24:367-73. [DOI: 10.1016/j.echo.2010.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Indexed: 10/18/2022]
|
28
|
Tejani FH, Thompson RC, Iskandrian AE, McNutt BE, Franks B. Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: rationale and design of a prospective, randomized, multicenter study. J Nucl Cardiol 2011; 18:73-81. [PMID: 21082298 DOI: 10.1007/s12350-010-9311-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Caffeine attenuates the coronary hyperemic response to adenosine by competitive A₂(A) receptor blockade. This study aims to determine whether oral caffeine administration compromises diagnostic accuracy in patients undergoing vasodilator stress myocardial perfusion imaging (MPI) with regadenoson, a selective adenosine A(2A) agonist. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group study includes patients with suspected coronary artery disease who regularly consume caffeine. Each participant undergoes three SPECT MPI studies: a rest study on day 1 (MPI-1); a regadenoson stress study on day 3 (MPI-2), and a regadenoson stress study on day 5 with double-blind administration of oral caffeine 200 or 400 mg or placebo capsules (MPI-3; n = 90 per arm). Only participants with ≥ 1 reversible defect on the second MPI study undergo the subsequent stress MPI test. The primary endpoint is the difference in the number of reversible defects on the two stress tests using a 17-segment model. Pharmacokinetic/pharmacodynamic analyses will evaluate the effect of caffeine on the regadenoson exposure-response relationship. Safety will also be assessed. CONCLUSION The results of this study will show whether the consumption of caffeine equivalent to 2-4 cups of coffee prior to an MPI study with regadenoson affects the diagnostic validity of stress testing (ClinicalTrials.gov number, NCT00826280).
Collapse
|
29
|
Sheldon SH, Askew JW, Klarich KW, Scott CG, Pellikka PA, McCully RB. Occurrence of Atrial Fibrillation during Dobutamine Stress Echocardiography: Incidence, Risk Factors, and Outcomes. J Am Soc Echocardiogr 2011; 24:86-90. [DOI: 10.1016/j.echo.2010.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Indexed: 11/30/2022]
|
30
|
Reyes E, Stirrup J, Roughton M, D'Souza S, Underwood SR, Anagnostopoulos C. Attenuation of Adenosine-Induced Myocardial Perfusion Heterogeneity by Atenolol and Other Cardioselective β-Adrenoceptor Blockers: A Crossover Myocardial Perfusion Imaging Study. J Nucl Med 2010; 51:1036-43. [PMID: 20554740 DOI: 10.2967/jnumed.109.073411] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Eliana Reyes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
31
|
Jevon P, Hodgkins L. Nurse-led pharmacological stress testing: an overview. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2010; 19:569-574. [PMID: 20505580 DOI: 10.12968/bjon.2010.19.9.48056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Myocardial perfusion imaging (MPI) is a noninvasive diagnostic tool that can provide valuable information on coronary blood flow at rest and during stress. Dynamic exercise is the stress technique of choice with patients who can achieve an acceptable workload; for those unable to do so, pharmacological stress testing with adenosine or dobutamine can be used. Nurses trained in ECG interpretation and advanced resuscitation skills are increasingly involved in supervising pharmacological stress tests. This article provides an overview of nurse-led pharmacological stress testing.
Collapse
|
32
|
Bart BA, Cen YY, Hendel RC, Lee R, Marwick TH, Missov ED, Bachour FA, Herzog CA. Comparison of dobutamine stress echocardiography, dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging in patients with end-stage renal disease. J Nucl Cardiol 2009; 16:507-15. [PMID: 19308650 DOI: 10.1007/s12350-009-9076-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 02/09/2009] [Accepted: 03/03/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to assess and compare the diagnostic accuracy and prognostic value of dobutamine stress echocardiography (DSE), dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging (MPI) in patients with end-stage renal disease (ESRD). BACKGROUND The optimal stress imaging modality for patients with ESRD has not yet been determined. METHODS Forty-nine patients with ESRD underwent DSE, dobutamine SPECT MPI, and adenosine SPECT MPI. The primary endpoint of the trial was concordance between stress tests with respect to the presence or absence of ischemia. RESULTS Agreement on the presence or absence of ischemia between adenosine SPECT MPI and DSE was 69% (kappa = .25, P = NS). Agreement on the presence or absence of ischemia between adenosine and dobutamine SPECT MPI was 77% (kappa = .37, P = <.009). Summed stress scores for adenosine and dobutamine SPECT MPI studies were highly correlated (r = .9, P = <.0001). DSE and SPECT MPI results provided incremental prognostic information when added to clinical variables. CONCLUSIONS There is moderate concordance between DSE and adenosine SPECT MPI in ESRD patients referred for stress testing. Interobserver agreement was higher for SPECT MPI compared to DSE. Based on these observations, the optimal approach for diagnosing severe coronary artery disease and assessing risk in patients with ESRD has yet to be determined, but appears to warrant further investigation.
Collapse
Affiliation(s)
- Bradley A Bart
- Hennepin County Medical Center and University of Minnesota, O5 HCMC, 701 Park Avenue South, Minneapolis, MN 55415, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Levsky JM, Travin MI, Spevack DM, Menegus MA, Huang PW, Goldberg Y, Clark ET, Banoth P, Freeman KD, Tobin JN, Haramati LB. Rationale and design of a randomized controlled trial comparing stress myocardial perfusion imaging with coronary CT angiography as the initial imaging study for intermediate-risk patients admitted with chest pain. J Cardiovasc Comput Tomogr 2009; 3:264-71. [DOI: 10.1016/j.jcct.2009.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/17/2009] [Accepted: 05/05/2009] [Indexed: 11/29/2022]
|
34
|
Parsai C, Baltabaeva A, Anderson L, Chaparro M, Bijnens B, Sutherland GR. Low-dose dobutamine stress echo to quantify the degree of remodelling after cardiac resynchronization therapy. Eur Heart J 2008; 30:950-8. [DOI: 10.1093/eurheartj/ehp050] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
Stress Test: A Primer for Primary Care Physicians. South Med J 2008; 101:806-14. [DOI: 10.1097/smj.0b013e31817b07c0] [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]
|
36
|
Krenning BJ, Nemes A, Soliman OI, Vletter WB, Voormolen MM, Bosch JG, ten Cate FJ, Roelandt JR, Geleijnse ML. Contrast-enhanced three-dimensional dobutamine stress echocardiography: between Scylla and Charybdis? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:757-60. [DOI: 10.1093/ejechocard/jen136] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
37
|
Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial (RegCOPD trial). J Nucl Cardiol 2008; 15:319-28. [PMID: 18513638 DOI: 10.1016/j.nuclcard.2008.02.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 12/28/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with reactive airways are at risk for adenosine-induced bronchoconstriction, mediated via A(2B) and/or A(3) adenosine receptors. METHODS AND RESULTS In this randomized, double-blind, placebo-controlled crossover trial, we examined the safety of regadenoson, a selective adenosine A(2A) receptor agonist, in patients with moderate chronic obstructive pulmonary disease (COPD) (n = 38) and patients with severe COPD (n = 11) with a baseline mean forced expiratory volume in 1 second (FEV(1)) of 1.74 +/- 0.50 L and 1.0 +/- 0.35 L, respectively, 37% of whom had dyspnea during activities of daily living. Patients receiving glucocorticoids or oxygen and those with pretreatment wheezing were included. Short-acting bronchodilators were withheld for at least 8 hours before treatment. No differences emerged between regadenoson and placebo on multiple lung function parameters, including repeated FEV(1) and forced vital capacity, respiratory rate, pulmonary examinations, and oxygen saturation. The mean maximum decline in FEV(1) was 0.11 +/- 0.02 L and 0.12 +/- 0.02 L (P = .55) in patients after regadenoson and placebo, respectively, and new-onset wheezing was observed in 6% and 12%, respectively (P = .33). No patient required acute treatment with bronchodilators or oxygen. CONCLUSIONS This pilot study showed the overall safety of regadenoson in 49 compromised outpatients with clinically stable moderate and severe chronic obstructive pulmonary disease.
Collapse
|
38
|
Xie F, Hankins J, Mahrous HA, Porter TR. Detection of Coronary Artery Disease with a Continuous Infusion of Definity Ultrasound Contrast during Adenosine Stress Real Time Perfusion Echocardiography. Echocardiography 2007; 24:1044-50. [DOI: 10.1111/j.1540-8175.2007.00543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
39
|
Reyes E, Loong CY, Wechalekar K, Latus K, Anagnostopoulos C, Underwood SR. Side effect profile and tolerability of adenosine myocardial perfusion scintigraphy in patients with mild asthma or chronic obstructive pulmonary disease. J Nucl Cardiol 2007; 14:827-34. [PMID: 18022109 DOI: 10.1016/j.nuclcard.2007.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 07/31/2007] [Accepted: 07/31/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenosine may cause bronchoconstriction in subjects with asthma or chronic obstructive pulmonary disease (COPD). Recent evidence suggests that this effect may be dependent on the severity of disease. This study investigates the tolerability of adenosine stress in patients with mild asthma or COPD undergoing myocardial perfusion scintigraphy. METHODS AND RESULTS In this case-control study patients with known or suspected mild asthma or COPD were pretreated with an inhaled beta(2)-adrenergic agonist and adenosine titrated up to the maximal dose of 140 microg x kg(-1) x min(-1) over a period of 6 minutes. The occurrence of side effects and test tolerability were compared between the airway disease group and 72 control subjects. Of 1261 patients, 124 had known or suspected airway disease; of these, 72 (58%) were suitable for adenosine stress. The proportion of tests completed as per protocol in the asthma/COPD group was similar to that of control subjects (93% vs 100%, P = .06). Dyspnea (n = 38 [53%] in asthma/COPD group vs n = 25 [35%] in control group, P = .03) and chest pain (n = 14 [19%] in asthma/COPD group vs n = 16 [22%] in control group, P = .7) were the most common side effects, and these were mostly mild and well tolerated. Bronchospasm occurred in 5 patients with asthma/COPD but reverted shortly after discontinuation of the adenosine infusion. Aminophylline was not required in any case. CONCLUSIONS A stepwise 6-minute adenosine infusion with prophylactic beta(2)-adrenergic agonist is safe and well tolerated in patients with mild asthma or COPD.
Collapse
Affiliation(s)
- Eliana Reyes
- National Heart and Lung Institute, Imperial College London, London, England.
| | | | | | | | | | | |
Collapse
|
40
|
Patel RN, Arteaga RB, Mandawat MK, Thornton JW, Robinson VJB. Pharmacologic Stress Myocardial Perfusion Imaging. South Med J 2007; 100:1006-14; quiz 1004. [PMID: 17943047 DOI: 10.1097/smj.0b013e318153f9c6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Nadig MR, Patel CD, Malhotra A. Comparison between dobutamine stress and combination of handgrip exercise with dobutamine stress in myocardial perfusion SPECT. Nucl Med Commun 2007; 28:301-4. [PMID: 17325594 DOI: 10.1097/mnm.0b013e328014a15e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM We compared the efficacy, side effects of combined handgrip exercise and dobutamine stress with dobutamine stress alone during myocardial perfusion imaging in patients unable to exercise, and in whom vasodilator stress was contraindicated. METHODS We studied 126 consecutive patients (89 male, 37 female; mean age 63+/-8 years) referred for dobutamine stress myocardial perfusion SPECT. Patients were divided into Group A (n=63), who underwent only dobutamine stress and group B (n=63) who were subjected to combined handgrip exercise and dobutamine infusion. In group A patients, dobutamine was administered at a starting dose of 5 microg x kg(-1) x min(-1) increased to 10, 20 and 30 microg x kg(-1) x min(-1) to a maximum dose of 40 microg x kg(-1) x min(-1) at 3 min intervals until the target heart rate (THR, 85% of age predicted maximum heart rate) or other standard end point criteria were achieved. Group B patients were made to perform handgrip exercise 3 min prior to dobutamine infusion and continued throughout the administration of dobutamine. RESULTS In group A, 11 (17.6%) patients failed to achieve target heart rate even with infusion of maximum dose of dobutamine compared to two (3.2%) in group B (P<0.01). The mean dose of dobutamine infused in group A was significantly higher than in group B (36.2 vs. 23.5 microg x kg(-1) x min(-1), P<0.01). Minor non-cardiac side effects like anxiety; flushing and nausea were observed in 25% of group A and in 11% of group B (P<0.05). Cardiac side effects and arrhythmias in group A and B were observed in 22% vs. 14.3% and 9.5% vs. 1.6% respectively (statistically insignificant). CONCLUSION Combination of handgrip exercise with dobutamine reduces the total dose of dobutamine required to achieve target heart rate and likely to minimize the side effects associated with dobutamine.
Collapse
Affiliation(s)
- Murali R Nadig
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
42
|
Leão Lima RDS, De Lorenzo A, Issa A. Reduced adverse effects with an accelerated dobutamine stress protocol compared with the conventional protocol: a prospective, randomized myocardial perfusion scintigraphy study. Int J Cardiovasc Imaging 2007; 24:55-9. [PMID: 17429754 DOI: 10.1007/s10554-007-9225-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Accepted: 03/26/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dobutamine (Dob) stress myocardial perfusion scintigraphy (MPS) has been shown to have diagnostic and prognostic value. However, the protocol recommended for Dob-MPS is long and frequently associated with adverse effects. We sought to compare two stress protocols with Dob in patients undergoing MPS. METHODS AND RESULTS 168 patients undergoing Dob-MPS were consecutively studied. Two protocols were randomly used: progressive doses of Dob (steps of 10 microg/kg/min at 3-min intervals) up to 40 microg/kg/min, aiming at reaching a minimum of 85% of the age-corrected maximal predicted heart rate (HR), possibly adding atropine to maximal Dob dose in case HR was not achieved (conventional protocol) or progressive doses of Dob aiming at the same HR, but adding atropine at the end of the first stage (accelerated protocol). We compared age, gender, coronary risk factors, history of MI or revascularization, Dob infusion and total stress times, maximal HR, percentage of maximal predicted HR, rate-pressure product, ST changes, MPS scores and incidence of adverse effects. In the 84 patients who underwent the accelerated protocol, the incidence of adverse effects was reduced (34.5%) compared to the conventional protocol (54.8%; P < 0.05), as well as Dob infusion duration (508 +/- 130 vs. 715 +/- 142 sec; P < 0.001). We did not observe significant differences between the groups as to age, gender, clinical aspects, maximal HR, percentage of achieved maximal HR, rate-pressure product, ST changes and perfusion scores. CONCLUSION Early administration of atropine makes stress faster and reduces incidence of adverse effects, without reducing efficacy towards achieving the proposed goals.
Collapse
Affiliation(s)
- Ronaldo de Souza Leão Lima
- Cardiovascular Division, Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rua Rui Vaz Pinto, 220/301, Rio de Janeiro 21931-390, Brazil.
| | | | | |
Collapse
|
43
|
Abstract
Heart disease causes more than 30% of US deaths. Evidence-based screening allows a primary care physician to identify patients at risk before symptom onset. Estimating disease probability before screening affects which tests are appropriate. Low-risk adults should not be screened. ECG, exercise treadmill testing, cardiac stress imaging, electron beam computed tomography, and angiography are possible screening tests. Special populations may have additional screening indications. Management of patients who have coronary artery disease includes antiplatelet therapy; aggressive lipid lowering; management of hypertension with beta blockers and angiotensin-converting enzyme inhibitors; risk factor management, including smoking cessation, diet, and exercise; symptom management; and sometimes revascularization. Primary care physicians are well-suited to the monitoring and care of patients who have known coronary artery disease.
Collapse
Affiliation(s)
- Jennifer L Junnila
- Department of Medical Science, Army Medical Department Center and School, Fort Sam Houston, TX 78234, USA
| | | |
Collapse
|
44
|
Sarullo FM, Ventimiglia C, Taormina A, Azzarello V, Felice F, Martino A, Paterna S, Di Pasquale P. Safety and feasibility of atropine added in patients with sub-maximal heart rate during exercise myocardial perfusion SPECT. Int J Cardiovasc Imaging 2006; 23:511-8. [PMID: 17109201 DOI: 10.1007/s10554-006-9169-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 09/16/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Failure to reach 80% of maximal predicted heart rate (HR) during exercise may render a myocardial perfusion single photon emission computed tomography (SPECT) study non-diagnostic for ischemia detection. We sought to investigate the injection of atropine in patients who fail to achieve 80% of age-predicted HR during exercise performed for myocardial perfusion SPECT (MPS), defining its safety and efficacy to raise HR to adequate levels as well as its effect on MPS interpretation. METHODS AND RESULTS Between January 2002 and December 2004, we studied 3,150 consecutive patients (2,253 men and 897 women, mean age 55 +/- 6 years) who were referred to a single office-based nuclear cardiology laboratory for MPS using SPECT imaging. One milligram of atropine was administered to patients that were unable to continue because of fatigue before reaching minimal HR, without an ischemic response (group A, n = 397). The scintigraphic results for group A were compared with those of patients who spontaneously achieved target HR (group B, n = 2,753). In group A, mean HR before atropine injection was 119.5 +/- 13.6 beats per minute (bpm), and it increased up to 137.3 +/- 13.5 bpm after drug administration, with an incremental of 17.8 +/- 6.9 bpm (P < 0.0001). The mean percentage of age-related HR achieved in this group was 83.5 +/- 8.1%. In 302 of this patients (76.1%) more than 80% of their aged-related HR (86.9 +/- 5.1%) was attained. No major adverse effects occurred. When groups A and B were compared, baseline and peak HR, rate pressure product, and maximal metabolic equivalents achieved were higher in group B. There were no significant differences in the percentage of total positive perfusion studies between both groups: 210/397 patients (52.9%) in group A and 1,342/2,753 patients (48.7%) in group B (P = 0.39). Ischemia or ischemia plus scar was found in 112/397 patients (28.2%) in group A and in 923/2,753 patients (33.5%) of group B (P = 0.14). CONCLUSION Atropine added to exercise stress testing in patients who cannot achieve their 80% age-related HR is a safe, well-tolerated, and feasible method for MPS.
Collapse
Affiliation(s)
- Filippo Maria Sarullo
- Division of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Via Salvatore Puglisi n.15, 90143 Palermo, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Chua SC, Ganatra RH, Green DJ, Groves AM. Nuclear cardiology: myocardial perfusion imaging with SPECT and PET. IMAGING 2006. [DOI: 10.1259/imaging/20803801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
46
|
Gerson MC. President's message: Ensuring appropriate ordering of tests and eliminating inconclusive test results. J Nucl Cardiol 2006; 13:593-4. [PMID: 27518054 DOI: 10.1016/j.nuclcard.2006.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
47
|
Boger LA, Volker LL, Hertenstein GK, Bateman TM. Best patient preparation before and during radionuclide myocardial perfusion imaging studies. J Nucl Cardiol 2006; 13:98-110. [PMID: 16464724 DOI: 10.1016/j.nuclcard.2005.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa A Boger
- Cardiovascular Consultants, PC, Kansas City, MO 64111, USA
| | | | | | | |
Collapse
|
48
|
Carley SD, Jenkins M, Mackway Jones K. Body surface mapping versus the standard 12 lead ECG in the detection of myocardial infarction amongst emergency department patients: a Bayesian approach. Resuscitation 2006; 64:309-14. [PMID: 15733759 DOI: 10.1016/j.resuscitation.2004.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 09/22/2004] [Accepted: 10/02/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients. SETTING A University affiliated inner-city emergency department. PARTICIPANTS People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction. MAIN OUTCOME MEASURES Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction. RESULTS BSM had an overall sensitivity of 47.1% versus 40% for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6% versus 93.7% for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients. CONCLUSIONS BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.
Collapse
|
49
|
Alsaileek AA, Osranek M, Fatema K, McCully RB, Tsang TS, Seward JB. Predictive Value of Normal Left Atrial Volume in Stress Echocardiography. J Am Coll Cardiol 2006; 47:1024-8. [PMID: 16516088 DOI: 10.1016/j.jacc.2005.09.069] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 08/16/2005] [Accepted: 09/19/2005] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Our objective was to evaluate whether normal left atrial volume index (LAVI) is a predictor of a normal stress echocardiogram and thus a predictor of low ischemic risk. BACKGROUND Left atrial enlargement is closely related to the chronicity and intensity of the burden of increased ventricular filling pressure. Typically ischemic heart disease (IHD) has a long period of subclinical dysfunction. Increased filling pressure, reflected by enlarged LAVI, is hypothesized to mirror the burden of subclinical and overt IHD. We hypothesized that a normal LAVI might also be useful in predicting low IHD risk. METHODS One hundred eighty randomly selected patients (mean age, 63 +/- 15 years; 53% men) underwent outpatient exercise or dobutamine stress echocardiography for known or suspected coronary artery disease. Left atrial volume index was measured retrospectively with the biplane area-length method. The stress echocardiogram was interpreted as abnormal if wall motion abnormalities (WMAs) were noted at rest and/or with stress. RESULTS Left atrial volume index was categorized as < or =28 ml/m2 (normal), 28.1 to 32 ml/m2, 32.1 to 36 ml/m2, and >36 ml/m2. Abnormal stress echocardiography was identified in 57 patients (31.7%). The percentage of abnormal stress echocardiograms in each LAVI category was 5.7%, 21.9%, 38.7%, and 54.7%, respectively. The negative predictive value for LAVI < or =28 ml/m2 was 94.3%. CONCLUSIONS Normal resting LAVI (< or =28 ml/m2) was strongly predictive of a normal stress echocardiogram. Left atrial volume index might be a simple means of identifying patients with low ischemic risk and should be further evaluated as a complement to the assessment of ischemic risk.
Collapse
Affiliation(s)
- Ahmed A Alsaileek
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | | | | | |
Collapse
|
50
|
Hatrick R, Teece S, Curzen N. Seeing transient regional myocardial ischaemia through new eyes. ACTA ACUST UNITED AC 2006; 7:155-8. [PMID: 16243739 DOI: 10.1080/14628840510039522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Robert Hatrick
- Wessex Cardiac Unit, Southampton University Hospitals Trust, Southampton, UK
| | | | | |
Collapse
|