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Moliner-Abós C, Calvo-Barceló M, Solé-Gonzalez E, Borrellas Martín A, Fluvià-Brugués P, Sánchez-Vega J, Vime-Jubany J, Vallverdú MF, Taurón Ferrer M, Tobias-Castillo PE, de la Fuente Mancera JC, Vilardell-Rigau P, Vila-Olives R, Diez-López C, Bayés-Genís A, Arzamendi Aizpurua D, Ferreira-Gonzalez I, Mirabet Pérez S. Revascularization and outcomes in ischaemic left ventricular dysfunction after heart failure admission: The RevascHeart study. Eur J Heart Fail 2024. [PMID: 39359034 DOI: 10.1002/ejhf.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 10/04/2024] Open
Abstract
AIMS Despite numerous trials on revascularization in patients with heart failure (HF) and ischaemic left ventricular (LV) dysfunction, its role remains unsettled. Guideline-directed medical therapy (GDMT) for HF has shown benefits on outcomes. This multicentre study aims to compare long-term mortality between revascularization and GDMT in patients with ischaemic LV dysfunction following admission for HF. METHODS AND RESULTS Between 2012 and 2023, 408 patients admitted for HF with a LV ejection fraction (LVEF) of 40% or less and documented coronary artery disease (CAD) were included. Patients were categorized into two groups based on their initial treatment decision: revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) or GDMT. The primary outcome was rate of all-cause or cardiovascular mortality, and secondary outcomes included type of revascularization (PCI vs. CABG) and LV reverse remodelling. After a median 44.6-month follow-up, 100 patients (33%) died in the revascularization group, compared to 44 (43%) in the GDMT group. Multivariate analysis showed no significant benefit of revascularization on all-cause mortality (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.48-1.39, p = 0.45) or cardiovascular mortality (HR 0.97, 95% CI 0.62-1.52, p = 0.90) compared to GDMT. Neither CABG (HR 0.74, 95% CI 0.51-1.08, p = 0.13) nor PCI (HR 0.98, 95% CI 0.62-1.55, p = 0.93) demonstrated a mortality reduction compared to GDMT. Both groups experienced significant reductions in LV size and improvements in LVEF, greater in the revascularization group. CONCLUSION Revascularization did not outperform GDMT in ischaemic LV dysfunction following HF admission in this retrospective analysis. Larger prospective studies are needed to clarify the potential role of revascularization in improving outcomes.
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Affiliation(s)
- Carlos Moliner-Abós
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Eduard Solé-Gonzalez
- Cardiology Department, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Andrea Borrellas Martín
- Cardiology Department, Hospital Universitari Germans Tries i Pujol, Badalona, CIBERCV, Barcelona, Spain
| | | | - Jesús Sánchez-Vega
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Manel Taurón Ferrer
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | - Rosa Vila-Olives
- Cardiology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Carles Diez-López
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germans Tries i Pujol, Badalona, CIBERCV, Barcelona, Spain
| | - Dabit Arzamendi Aizpurua
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Sònia Mirabet Pérez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
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2
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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3
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Baldetti L, Busnardo E, Pazzanese V, Ricchetti G, Barone G, Sacchi S, Calvo F, Gramegna M, Pieri M, Ingallina G, Camici PG, Ajello S, Scandroglio AM. Myocardial viability assessment during Impella support with 18-fluorodesoxyglucose PET imaging. ESC Heart Fail 2024. [PMID: 39239887 DOI: 10.1002/ehf2.15053] [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: 05/29/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024] Open
Abstract
Formal assessment of myocardial viability (MV) is challenging in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients receiving Impella mechanical circulatory support, as the cardiac magnetic resonance gold standard technique is not feasible due to the metallic components of the device. 18-fluorodesoxyglucose metabolic myocardial positron emission tomography (18FDG-PET) may represent a valid and feasible alternative to obtain semi-quantitative and objective evidence of MV during Impella support. We hereby report the first series of sequential AMI-CS patients who received 18FDG-PET scanning to assess MV during Impella support to demonstrate the safety and feasibility of this approach. In this cohort no adverse events occurred during 18FDG-PET scans, and all images were of excellent quality. This study provides a pragmatic guidance on how to perform this imaging modality during Impella support and finally confirms the safety and feasibility of this advanced imaging method also in this vulnerable cohort of patients.
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Affiliation(s)
- Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Nuclear Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Ricchetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Barone
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Gramegna
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Guido Camici
- Cardiovascualr Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ajello
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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4
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Omaygenc MO, Morgan H, Mielniczuk L, Perera D, Panza JA. In search of the answers to the viability questions. J Nucl Cardiol 2024; 39:101912. [PMID: 39370172 DOI: 10.1016/j.nuclcard.2024.101912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Holly Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, United Kingdom.
| | - Lisa Mielniczuk
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, United Kingdom
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and the Department of Medicine, New York Medical College, Valhalla, NY, USA.
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5
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Larsen AI. Tools for timing in heart failure: what-when-how?-the prognostic value of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes score confirmed. Eur J Prev Cardiol 2024; 31:1430-1433. [PMID: 37652028 DOI: 10.1093/eurjpc/zwad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway
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6
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Canton L, Suma N, Amicone S, Impellizzeri A, Bodega F, Marinelli V, Ciarlantini M, Casuso M, Bavuso L, Belà R, Salerno J, Armillotta M, Angeli F, Sansonetti A, Attinà D, Russo V, Lovato L, Tuttolomondo D, Gaibazzi N, Bergamaschi L, Pizzi C. Clinical impact of multimodality assessment of myocardial viability. Echocardiography 2024; 41:e15854. [PMID: 38940225 DOI: 10.1111/echo.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
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Affiliation(s)
- Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jessica Salerno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Russo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Arjomandi Rad A, Tserioti E, Magouliotis DE, Vardanyan R, Samiotis IV, Skoularigis J, Ariff B, Xanthopoulos A, Triposkiadis F, Casula R, Athanasiou T. Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing Coronary Artery Bypass Grafting. Clin Cardiol 2024; 47:e24307. [PMID: 38953367 PMCID: PMC11217808 DOI: 10.1002/clc.24307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG. METHODS A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET). RESULTS A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue. CONCLUSION The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
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Affiliation(s)
- Arian Arjomandi Rad
- Division of Medical SciencesUniversity of OxfordOxfordUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Eleni Tserioti
- Department of Surgery and CancerImperial College LondonLondonUK
| | | | | | - Ilias V. Samiotis
- Department of Cardiothoracic SurgeryUniversity Hospital of LarissaLarissaGreece
| | - John Skoularigis
- Department of CardiologyUniversity Hospital of LarissaLarissaGreece
| | - Ben Ariff
- Department of Radiology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
| | | | | | - Roberto Casula
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of Cardiothoracic Surgery, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
| | - Thanos Athanasiou
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of Cardiothoracic SurgeryUniversity Hospital of LarissaLarissaGreece
- Department of Cardiothoracic Surgery, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
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8
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Masroor M, Wang Y, Zhang C, Dong N. Surgical Management of Ischemic Cardiomyopathy Patients with Severe Left Ventricular Dysfunction: Is It Time to Reconsider Revascularization Surgery? J Cardiovasc Dev Dis 2024; 11:184. [PMID: 39057607 PMCID: PMC11276879 DOI: 10.3390/jcdd11070184] [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: 04/20/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, etc. Despite multiple treatment options, there are no explicit clinical guidelines available to guide surgeons in choosing the most appropriate option and ensuring that the specific patient can benefit from the selected surgical treatment. Heart transplantation is the gold standard treatment for ischemic cardiomyopathy patients with severe left ventricular dysfunction, but it is limited to very few highly equipped centers around the world due to donor shortages, complex perioperative and surgical management, and limited technological and human resources. It is evident from some studies that heart transplant-eligible candidates can benefit from alternative surgical options such as coronary artery bypass surgery alone or combined with surgical ventricular restoration. Therefore, alternative surgical options that are used for most of the population, especially in developing and underdeveloped countries, need to be discussed to improve their outcomes. A challenge in the recent era which has yet to find a solution is to determine which heart transplant candidate can benefit from simple revascularization compared to a complex heart transplantation procedure. Myocardial viability testing was one of the most important determinants in deciding whether a patient should undergo revascularization, but its role in guiding appropriate surgical options has been challenged. This review aims to discuss the available surgical management options and their long-term outcomes for patients with ischemic cardiomyopathy, which will eventually help surgeons when choosing a surgical procedure.
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Affiliation(s)
- Matiullah Masroor
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd, Kabul 1010, Afghanistan
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
| | - Chao Zhang
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
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Toftholm MH, Højstrup S, Talleruphuus U, Marner L, Bjerking L, Jakobsen L, Christiansen EH, Bouchelouche K, Galatius S, Prescott E, Skak-Hansen KW. 82-rubidium positron emission tomography determined myocardial flow reserve and outcomes following cardiac revascularisation - A multicentre registry study. Int J Cardiol 2024; 405:131865. [PMID: 38365013 DOI: 10.1016/j.ijcard.2024.131865] [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: 12/22/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Finding patients with chronic coronary syndromes (CCS) whom revascularization could benefit, is complicated. Myocardial flow reserve (MFR), a measurement of myocardial perfusion, has proven prognostic value on survival and risk of major adverse cardiac events (MACE). We investigated if MFR identifies who may benefit from revascularization. METHODS Among 7462 patients from Danish hospitals examined with 82Rb PET between January 2018 and August 2020, patients with ≥5% reversible perfusion defects were followed for MACE and all-cause mortality. Associations between revascularisation (within 90 days) and outcomes according to MFR (< and ≥ 2) was assessed by Cox regression adjusted by inverse probability weighting for demographics, cardiovascular risk factors, comorbidities, and 82Rb PET variables. RESULTS Of 1806 patients with ≥5% reversible perfusion defect, 893 (49%) had MFR < 2 and 491 underwent revascularisation (36.6% in MFR < 2 versus 17.9% MFR ≥ 2, p < 0.001). During a median follow-up of 37.0 [31.0-45.8 IQR] months, 251 experienced a MACE and 173 died. Revascularisation was associated with lower adjusted risk of all-cause mortality (hazard ratio [HR], 0.51 [95% CI, 0.30-0.88], p = 0.015) and MACE (HR, 0.54 [0.33-0.87], p = 0.012) in patients with MFR < 2 but not MFR ≥ 2 for all-cause mortality (HR 1.33 [0.52-3.40], p = 0.542) and MACE (HR 1.50 [0.79-2.84], p = 0.211). MFR significantly modified the association between revascularisation and MACE, but not all-cause mortality (interaction p-value 0.021 and 0.094, respectively). CONCLUSIONS Revascularization was associated with improved prognosis among patients with impaired MFR. No association was seen in patients with normal MFR. In patients with regional ischemia, MFR may identify patients with a prognostic benefit from revascularization.
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Affiliation(s)
- M H Toftholm
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - S Højstrup
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - U Talleruphuus
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Marner
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Bjerking
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - L Jakobsen
- Aarhus University Hospital, Department of Cardiology, Denmark
| | | | - K Bouchelouche
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Denmark
| | - S Galatius
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - E Prescott
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - K W Skak-Hansen
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
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10
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Yuan H, Wang F, He S, Xiang Z, Zhang X, Jiang L. SUVmean ratios of liver/muscle and lung/muscle from 13N-NH 3 PET perfusion outperformed traditional myocardial viability parameters in predicting survival after CABG. Jpn J Radiol 2024:10.1007/s11604-024-01611-6. [PMID: 38856879 DOI: 10.1007/s11604-024-01611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Myocardial viability evaluation in predicting survival after coronary artery bypass graft (CABG) remains debatable. Thus, this study aimed to investigate the role of 13N-NH3/18F-FDG PET myocardial viability scan in predicting treatment outcomes and survival. METHODS 90 patients with CABG and pre-surgical PET-based myocardial viability scan were retrospectively reviewed. Perfusion-metabolism features, myocardium motion parameters, and patient characteristics were recorded. Additionally, the SUVmean of blood pool, lung, liver, spleen, and muscle were measured and the SUVmean ratios were calculated. Factors associated with treatment outcomes and survival were analyzed by Logistic and Cox regressions. Nomogram models were subsequently established to predict ejection fraction (EF) improvement and survival outcomes. RESULTS The mean EF of these 90 patients was 38.1 ± 9.5% and 46.0 ± 9.2% before and after CABG surgery, and 35 patients (38.9%) achieved EF improvement ≥ 10%. EF measurements by PET and echocardiogram showed a reasonable linear correlation (R = 0.752). Sex, pre-surgical EF, mismatch of the left ventricle, total perfusion deficit (TPD), and peak ejection rate (PER) were independent predictive factors of EF improvements. Surgery waiting time, valve damage, and SUVmean ratio of Liver/Muscle were independently predictive of event-free survival (EFS), while valve damage, together with SUVmean ratio of either Liver/Muscle or Lung/Muscle, were independently predictive of overall survival (OS). CONCLUSION Although traditional cardiac parameters from PET-based myocardial viability can effectively predict EF improvements after CABG, SUVmean ratios of liver/muscle and lung/muscle from 13N-NH3 PET perfusion outperformed these parameters in predicting survival.
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Affiliation(s)
- Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Fanghu Wang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Shanzhen He
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Zeyin Xiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiaochun Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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11
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Chang AJ, Liang Y, Hamilton SA, Ambrosy AP. Medical Decision-Making and Revascularization in Ischemic Cardiomyopathy. Med Clin North Am 2024; 108:553-566. [PMID: 38548463 DOI: 10.1016/j.mcna.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Ischemic cardiomyopathy (ICM) is the most common underlying etiology of heart failure in the United States and is a significant contributor to deaths due to cardiovascular disease worldwide. The diagnosis and management of ICM has advanced significantly over the past few decades, and the evidence for medical therapy in ICM is both compelling and robust. This contrasts with evidence for coronary revascularization, which is more controversial and favors surgical approaches. This review will examine landmark clinical trial results in detail as well as provide a comprehensive overview of the current epidemiology, diagnostic approaches, and management strategies of ICM.
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Affiliation(s)
- Alex J Chang
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Yilin Liang
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Steven A Hamilton
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA; Clinical Trials Program, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
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12
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Kong H, Cao J, Tian J, Yong J, An J, Zhang L, Song X, He Y. Coronary microvascular dysfunction: prevalence and aetiology in patients with suspected myocardial ischaemia. Clin Radiol 2024; 79:386-392. [PMID: 38433042 DOI: 10.1016/j.crad.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/19/2023] [Accepted: 01/09/2024] [Indexed: 03/05/2024]
Abstract
AIM To evaluate the prevalence, aetiology, and corresponding morbidity of coronary microvascular dysfunction (CMD) in patients with suspected myocardial ischaemia. MATERIALS AND METHODS The present study included 115 patients with suspected myocardial ischaemia who underwent stress perfusion cardiac magnetic resonance imaging. CMD was assessed visually based on the myocardial perfusion results. The CMR-derived myocardial perfusion reserve index (MPRI) and left ventricular (LV) strain parameters obtained using the post-processing software CVI42 were employed to evaluate LV myocardial perfusion and deformation. LV strain parameters included global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS), global systolic/diastolic longitudinal, circumferential, and radial strain rates (SLSR, SCSR, SRSR, DLSR, DCSR, and DRSR). RESULTS Of the 115 patients, 12 patients were excluded and 103 patients were finally included in the study. CMD was observed in 79 % (81 patients, aged 53 ± 12 years) of patients. Regarding aetiology, 91 (88 %) patients had non-obstructive coronary artery disease (CAD), eight (8 %) had obstructive CAD, and four (4 %) had hypertrophic cardiomyopathy (HCM). The incidence of CMD was highest (100 %) in patients with HCM, followed by those with non-obstructive CAD (up to 79 %). There were no statistical differences between CMD and non-CMD groups in GCS, GRS, GLS, SRSR, SCSR, SLSR, DCSR, DRSR and DLSR. CONCLUSION The incidence of CMD was higher in patients with signs and symptoms of ischaemia. CMD occurred with non-obstructive CAD, obstructive CAD, and HCM, with the highest prevalence of CMD in HCM.
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Affiliation(s)
- H Kong
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - J Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - J Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - J Yong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - J An
- Siemens Shenzhen Magnetic Resonance, MR Collaboration NE Asia, Shenzhen, China
| | - L Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - X Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Y He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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13
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Varma PK, Radhakrishnan RM, Gopal K, Krishna N, Jose R. Selecting the appropriate patients for coronary artery bypass grafting in ischemic cardiomyopathy-importance of myocardial viability. Indian J Thorac Cardiovasc Surg 2024; 40:341-352. [PMID: 38681722 PMCID: PMC11045715 DOI: 10.1007/s12055-023-01671-9] [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: 08/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 05/01/2024] Open
Abstract
Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy.
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Affiliation(s)
- Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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14
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Dauerman HL, Lahoud R. The miracle of left ventricular recovery after transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e463-e464. [PMID: 38629417 PMCID: PMC11017222 DOI: 10.4244/eij-e-24-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Harold L Dauerman
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Rony Lahoud
- University of Vermont Larner College of Medicine, Burlington, VT, USA
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15
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Bolognese L, Reccia MR. Myocardial viability on trial. Eur Heart J Suppl 2024; 26:i15-i18. [PMID: 38867871 PMCID: PMC11167980 DOI: 10.1093/eurheartjsupp/suae005] [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] [Indexed: 06/14/2024]
Abstract
The concept of myocardial viability is usually referred to areas of the myocardium, which show contractile dysfunction at rest and in which contractility is expected to improve after revascularization. The traditional paradigm states that an improvement in function after revascularization leads to improved health outcomes and that assessment of myocardial viability in patients with ischaemic left ventricular dysfunction (ILVD) is a prerequisite for clinical decisions regarding treatment. A range of retrospective observational studies supported this 'viability hypothesis'. However, data from prospective trials have diverged from earlier retrospective studies and challenge this hypothesis. Traditional binary viability assessment may oversimplify ILVD's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centred on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ILVD's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
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16
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Tsai IT, Sun CK. Stem Cell Therapy against Ischemic Heart Disease. Int J Mol Sci 2024; 25:3778. [PMID: 38612587 PMCID: PMC11011361 DOI: 10.3390/ijms25073778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Ischemic heart disease, which is one of the top killers worldwide, encompasses a series of heart problems stemming from a compromised coronary blood supply to the myocardium. The severity of the disease ranges from an unstable manifestation of ischemic symptoms, such as unstable angina, to myocardial death, that is, the immediate life-threatening condition of myocardial infarction. Even though patients may survive myocardial infarction, the resulting ischemia-reperfusion injury triggers a cascade of inflammatory reactions and oxidative stress that poses a significant threat to myocardial function following successful revascularization. Moreover, despite evidence suggesting the presence of cardiac stem cells, the fact that cardiomyocytes are terminally differentiated and cannot significantly regenerate after injury accounts for the subsequent progression to ischemic cardiomyopathy and ischemic heart failure, despite the current advancements in cardiac medicine. In the last two decades, researchers have realized the possibility of utilizing stem cell plasticity for therapeutic purposes. Indeed, stem cells of different origin, such as bone-marrow- and adipose-derived mesenchymal stem cells, circulation-derived progenitor cells, and induced pluripotent stem cells, have all been shown to play therapeutic roles in ischemic heart disease. In addition, the discovery of stem-cell-associated paracrine effects has triggered intense investigations into the actions of exosomes. Notwithstanding the seemingly promising outcomes from both experimental and clinical studies regarding the therapeutic use of stem cells against ischemic heart disease, positive results from fraud or false data interpretation need to be taken into consideration. The current review is aimed at overviewing the therapeutic application of stem cells in different categories of ischemic heart disease, including relevant experimental and clinical outcomes, as well as the proposed mechanisms underpinning such observations.
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Affiliation(s)
- I-Ting Tsai
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City 80794, Taiwan
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17
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McEntegart MB, Oksnes A, Carrillo X, Delgado V. Ischaemic and viability testing for guiding PCI are overrated: pros and cons. EUROINTERVENTION 2024; 20:e341-e343. [PMID: 38506743 PMCID: PMC10941666 DOI: 10.4244/eij-e-24-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
| | - Anja Oksnes
- Haukeland University Hospital, Bergen, Norway
| | - Xavier Carrillo
- Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Victoria Delgado
- Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain
- Centre of Comparative Medicine and Bioimaging, Badalona, Spain
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18
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Javorski MJ, Bauza K, Xiang F, Soltesz E, Chen L, Bakaeen FG, Svensson L, Thuita L, Blackstone EH, Tong MZ. Identifying and mitigating risk of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00191-0. [PMID: 38452888 DOI: 10.1016/j.jtcvs.2024.02.025] [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: 10/09/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To identify preoperative predictors of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy and evaluate trajectory of postoperative ventricular function. METHODS From January 2017 to January 2020, 238 patients with ejection fraction <30% (206/238) or 30% to 34% with at least moderately severe mitral regurgitation (32/238) underwent conventional cardiac surgery at Cleveland Clinic, 125 with ischemic and 113 with nonischemic cardiomyopathy. Preoperative ejection fraction was 25 ± 4.5%. The primary outcome was postcardiotomy cardiogenic shock, defined as need for microaxial temporary left ventricular assist device, extracorporeal membrane oxygenation, or vasoactive-inotropic score >25. RandomForestSRC was used to identify its predictors. RESULTS Postcardiotomy cardiogenic shock occurred in 27% (65/238). Pulmonary artery pulsatility index <3.5 and pulmonary capillary wedge pressure >19 mm Hg were the most important factors predictive of postcardiotomy cardiogenic shock in ischemic cardiomyopathy. Cardiac index <2.2 L·min-1 m-2 and pulmonary capillary wedge pressure >21 mm Hg were the most important predictive factors in nonischemic cardiomyopathy. Operative mortality was 1.7%. Ejection fraction at 12 months after surgery increased to 39% (confidence interval, 35-40%) in the ischemic group and 37% (confidence interval, 35-38%) in the nonischemic cardiomyopathy group. CONCLUSIONS Predictors of postcardiotomy cardiogenic shock were different in ischemic and nonischemic cardiomyopathy. Right heart dysfunction, indicated by low pulmonary artery pulsatility index, was the most important predictor in ischemic cardiomyopathy, whereas greater degree of cardiac decompensation was the most important in nonischemic cardiomyopathy. Therefore, preoperative right heart catheterization will help identify patients with low ejection fraction who are at greater risk of postcardiotomy cardiogenic shock.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karolis Bauza
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fei Xiang
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lin Chen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lucy Thuita
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Michael Z Tong
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio.
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19
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De Caterina R, Liga R. A treatment algorithm for ischemic cardiomyopathy. Vascul Pharmacol 2024; 154:107274. [PMID: 38182081 DOI: 10.1016/j.vph.2023.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
Treatment of ischemic cardiomyopathy has been the focus of increased attention by cardiologists due to recent evidence of an important outcome study comparing percutaneous coronary intervention (PCI) plus optimal medical treatment vs optimal medical treatment alone, concluding for the futility of myocardial revascularization by PCI. A relatively older trial of coronary artery bypass grafting (CABG) in the same condition, on the other hand, had concluded for some prognostic improvement at a long-term follow-up. This short manuscript addresses how to triage such patients, frequently encountered in medical practice and considering clinical presentation, imaging results, and surgical risk, to provide practical guidance to treatment.
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Affiliation(s)
- Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of Cardiology, University of Pisa, Pisa, Italy.
| | - Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of Cardiology, University of Pisa, Pisa, Italy
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20
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Yamada S, Bartunek J, Povsic TJ, Cotter G, Davison BA, Edwards C, Behfar A, Metra M, Filippatos GS, Vanderheyden M, Wijns W, Terzic A. Cell Therapy Improves Quality-of-Life in Heart Failure: Outcomes From a Phase III Clinical Trial. Stem Cells Transl Med 2024; 13:116-124. [PMID: 38006196 PMCID: PMC10872684 DOI: 10.1093/stcltm/szad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/13/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with heart failure experience limitations in daily activity and poor quality-of-life. Prospective surveillance of health-related quality-of-life supplemented traditional death and hospitalization outcomes in the multinational, randomized, double-blinded CHART-1 clinical trial that assessed cardiopoiesis-guided cell therapy in ischemic heart failure patients with reduced left ventricular ejection fraction. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), a Food and Drug Administration qualified instrument for evaluating therapeutic effectiveness, was applied through the 1-year follow-up. Cell treated (n = 109) and sham procedure (n = 140) cohorts reported improved MLHFQ scores comparable between the 2 study arms (mean treatment difference with baseline adjustment -3.2 points, P = .107). Superiority of cell treatment over sham in betterment of the MLHFQ score was demonstrated in patients with pre-existing advanced left ventricular enlargement (baseline-adjusted mean treatment difference -6.4 points, P = .009). In this highly responsive subpopulation, benefit on the MLHFQ score paralleled reduction in death and hospitalization post-cell therapy (adjusted Mann-Whitney odds 1.43, 95% CI, 1.01-2.01; P = .039). The potential of cell therapy in addressing the quality-of-life dimension of heart failure requires further evaluation for disease relief.
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Affiliation(s)
- Satsuki Yamada
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J Povsic
- Program for Advanced Coronary Disease, Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
- Université Paris Cité; Inserm UMR-S 942, MASCOT, Paris, France
| | - Beth A Davison
- Momentum Research, Inc., Durham, NC, USA
- Université Paris Cité; Inserm UMR-S 942, MASCOT, Paris, France
| | | | - Atta Behfar
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Spedali Civili, Brescia, Italy
| | - Gerasimos S Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | | | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Andre Terzic
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
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21
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Matta A, Ohlmann P, Nader V, Levai L, Kang R, Carrié D, Roncalli J. A review of the conservative versus invasive management of ischemic heart failure with reduced ejection fraction. Curr Probl Cardiol 2024; 49:102347. [PMID: 38103822 DOI: 10.1016/j.cpcardiol.2023.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Heart failure is increasing in terms of prevalence, morbidity, and mortality rates. Clinical trials and studies are focusing on heart failure as it is the destiny end-stage for several cardiovascular disorders. Recently, medical therapy has dramatically progressed with novel classes of medicines providing better quality of life and survival outcomes. However, heart failure remains a heavy impactful factor on societies and populations. Current guidelines from the American and European cardiac societies are not uniform with respect to the class and level of treatment recommendations for coronary artery disease patients with heart failure and reduced ejection fraction. The discrepancy among international recommendations, stemming from the lack of evidence from adequately powered randomized trials, challenges physicians in choosing the optimal strategy. Hybrid therapy including optimal medical therapy with revascularization strategies are commonly used for the management of ischemic heart failure. Coronary artery bypass graft (CABG) has proved its efficacy on improving long term outcome and prognosis while no large randomized clinical trials for percutaneous coronary intervention (PCI) are still available. Regardless of the lack of data and recommendations, the trends of performing PCI in ischemic heart failure prevailed over CABG whereas lesion complexity, chronic total occlusion and complete revascularization achievement are limiting factors. Lastly, regenerative medicine seems a promising approach for advanced heart failure enhancing cardiomyocytes proliferation, reverse remodeling, scar size reduction and cardiac function restoration.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France.
| | - Patrick Ohlmann
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Vanessa Nader
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Laszlo Levai
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Ryeonshi Kang
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
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22
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Heusch G. Myocardial ischemia/reperfusion: Translational pathophysiology of ischemic heart disease. MED 2024; 5:10-31. [PMID: 38218174 DOI: 10.1016/j.medj.2023.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 01/15/2024]
Abstract
Ischemic heart disease is the greatest health burden and most frequent cause of death worldwide. Myocardial ischemia/reperfusion is the pathophysiological substrate of ischemic heart disease. Improvements in prevention and treatment of ischemic heart disease have reduced mortality in developed countries over the last decades, but further progress is now stagnant, and morbidity and mortality from ischemic heart disease in developing countries are increasing. Significant problems remain to be resolved and require a better pathophysiological understanding. The present review attempts to briefly summarize the state of the art in myocardial ischemia/reperfusion research, with a view on both its coronary vascular and myocardial aspects, and to define the cutting edges where further mechanistic knowledge is needed to facilitate translation to clinical practice.
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Affiliation(s)
- Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
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23
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Maigrot JLA, Weiss AJ, Tong MZY, Bakaeen F, Soltesz EG. Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era. Artif Organs 2024; 48:6-15. [PMID: 38013239 DOI: 10.1111/aor.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/13/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
Patients with advanced ischemic cardiomyopathy manifesting as left ventricular dysfunction exist along a spectrum of severity and risk, and thus decision-making surrounding optimal management is challenging. Treatment pathways can include medical therapy as well as revascularization through percutaneous coronary intervention or coronary artery bypass grafting. Additionally, temporary and durable mechanical circulatory support, as well as heart transplantation, may be optimal for select patients. Given this spectrum of risk and the complexity of treatment pathways, patients may not receive appropriate therapy given their perceived risk, which can lead to sub-satisfactory outcomes. In this review, we discuss the identification of high-risk ischemic cardiomyopathy patients, along with our programmatic approach to patient evaluation and perioperative optimization. We also discuss our strategies for therapeutic decision-making designed to optimize both short- and long-term patient outcomes.
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Affiliation(s)
- Jean-Luc A Maigrot
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aaron J Weiss
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Z Y Tong
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Zhang T, Masroor M, Jiang C, Xu L, Wang Y, Deng C, Dong N. Long-term survival of ischemic cardiomyopathy patients with severe left ventricular dysfunction after CABG vs heart transplantation: A single center retrospective analysis. Clin Transplant 2024; 38:e15243. [PMID: 38289883 DOI: 10.1111/ctr.15243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND There are no guidelines on the surgical management for ischemic cardiomyopathy (ICM) patients with severe left ventricular dysfunction. The present study aims to assess the long-term survival of these patients treated with two different surgical techniques, coronary artery bypass grafting (CABG) and heart transplantation (HTx). METHODS This retrospective study included 218 ICM patients with left ventricular ejection fraction (LVEF) ≤35% who underwent CABG (n = 106) and HTx (n = 112) from 2011 to 2021 in a single center. After propensity adjustment analysis each group consisted of 51 patients. Clinical characteristics were evaluated for all-cause follow-up mortality by the Cox proportional hazards regression model. A risk prediction model was generated from multivariable-adjusted Cox regression analysis and applied to stratify patients with different clinical risks. The long-term survival was estimated by Kaplan-Meier analysis for different surgery groups. RESULTS Long-term survival was comparable between CABG and HTx groups. After being stratified into different risk subgroups according to risk predictors, the HTx group exhibited superior survival outcomes compared to the CABG group among the high-risk patients (67.8% vs 44.4%, 64.1% vs 38.9%, and 64.1% vs 33.3%, p = 0.047) at 12, 36, and 60 months respectively, while the survival was comparable between HTx and CABG groups among low-risk patients (87.0% vs 97.0%, 82.4% vs 97.0%, and 70.2% vs 91.6%, p = 0.11) at 12, 36, and 60 months respectively in the PSM cohort. CONCLUSION Long-term survival in ICM patients with severe left ventricular dysfunction who received CABG or HTx was comparable in general. Nonetheless, a favorable outcome of HTx surgery compared to CABG was observed among high-risk patients.
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Affiliation(s)
- Tailong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Matiullah Masroor
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Kabul, Afghanistan
| | - Chen Jiang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cheng Deng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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25
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Affiliation(s)
- Julio A Panza
- Department of Cardiology, Westchester Medical Center, Valhalla, New York
- Department of Medicine, New York Medical College, Valhalla
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26
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Adhaduk M, Paudel B, Liu K, Ashwath M, Gebska MA, Delcour K, Samuelson RJ, Giudici M. Comparison of cardiac magnetic resonance imaging and fluorodeoxyglucose positron emission tomography in the assessment of myocardial viability: meta-analysis and systematic review. J Nucl Cardiol 2023; 30:2514-2524. [PMID: 37758962 DOI: 10.1007/s12350-023-03377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
AIM Contrast-enhanced cardiac magnetic resonance (Ce-CMR) and Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) are frequently utilized in clinical practice to assess myocardial viability. However, studies evaluating direct comparison between Ce-CMR and FDG-PET have a smaller sample size, and no clear distinction between the two imaging modalities has been defined. To address this gap, we conducted a meta-analysis of studies comparing Ce-CMR and FDG-PET for the assessment of myocardial viability. METHODS We searched PubMed, EMBASE, Scopus, and Web of Science databases from their inception to 4/20/2022 with search terms "viability" AND "heart diseases" AND "cardiac magnetic resonance imaging" AND "positron-emission tomography." We extracted patient characteristics, segment level viability assessment according to Ce-CMR and FDG-PET, and change in regional wall motion abnormalities (RWMA) at follow-up. RESULTS We included four studies in the meta-analysis which provided viability assessment with Ce-CMR and FDG-PET in all patients and change in RWMA at follow-up. There were 82 patients among the four included studies, and 585 segments were compared for viability assessment. There were 59 (72%) males, and mean age was 65 years. The sensitivity (95% confidence interval-CI) and specificity (CI) of Ce-CMR for predicting myocardial recovery were 0.88 (0.66-0.96) and 0.64 (0.49-0.77), respectively. The sensitivity (CI) and specificity (CI) of FDG-PET for predicting myocardial recovery were 0.91 (0.63-0.99) and 0.67 (0.49-0.81), respectively. CONCLUSION FDG-PET and Ce-CMR have comparable diagnostic parameters in myocardial viability assessment and are consistent with prior research.
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Affiliation(s)
- Mehul Adhaduk
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA.
| | - Bishow Paudel
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
| | - Kan Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
| | - Mahi Ashwath
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
| | - Milena A Gebska
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
| | - Kimberly Delcour
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
| | | | - Michael Giudici
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, USA
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27
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Perera D, Ryan M, Morgan HP, Greenwood JP, Petrie MC, Dodd M, Weerackody R, O’Kane PD, Masci PG, Nazir MS, Papachristidis A, Chahal N, Khattar R, Ezad SM, Kapetanakis S, Dixon LJ, De Silva K, McDiarmid AK, Marber MS, McDonagh T, McCann GP, Clayton TC, Senior R, Chiribiri A. Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction: A Prespecified Secondary Analysis of the REVIVED-BCIS2 Trial. JAMA Cardiol 2023; 8:1154-1161. [PMID: 37878295 PMCID: PMC10600721 DOI: 10.1001/jamacardio.2023.3803] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023]
Abstract
Importance In the Revascularization for Ischemic Ventricular Dysfunction (REVIVED-BCIS2) trial, percutaneous coronary intervention (PCI) did not improve outcomes for patients with ischemic left ventricular dysfunction. Whether myocardial viability testing had prognostic utility for these patients or identified a subpopulation who may benefit from PCI remained unclear. Objective To determine the effect of the extent of viable and nonviable myocardium on the effectiveness of PCI, prognosis, and improvement in left ventricular function. Design, Setting, and Participants Prospective open-label randomized clinical trial recruiting between August 28, 2013, and March 19, 2020, with a median follow-up of 3.4 years (IQR, 2.3-5.0 years). A total of 40 secondary and tertiary care centers in the United Kingdom were included. Of 700 randomly assigned patients, 610 with left ventricular ejection fraction less than or equal to 35%, extensive coronary artery disease, and evidence of viability in at least 4 myocardial segments that were dysfunctional at rest and who underwent blinded core laboratory viability characterization were included. Data analysis was conducted from March 31, 2022, to May 1, 2023. Intervention Percutaneous coronary intervention in addition to optimal medical therapy. Main Outcomes and Measures Blinded core laboratory analysis was performed of cardiac magnetic resonance imaging scans and dobutamine stress echocardiograms to quantify the extent of viable and nonviable myocardium, expressed as an absolute percentage of left ventricular mass. The primary outcome of this subgroup analysis was the composite of all-cause death or hospitalization for heart failure. Secondary outcomes were all-cause death, cardiovascular death, hospitalization for heart failure, and improved left ventricular function at 6 months. Results The mean (SD) age of the participants was 69.3 (9.0) years. In the PCI group, 258 (87%) were male, and in the optimal medical therapy group, 277 (88%) were male. The primary outcome occurred in 107 of 295 participants assigned to PCI and 114 of 315 participants assigned to optimal medical therapy alone. There was no interaction between the extent of viable or nonviable myocardium and the effect of PCI on the primary or any secondary outcome. Across the study population, the extent of viable myocardium was not associated with the primary outcome (hazard ratio per 10% increase, 0.98; 95% CI, 0.93-1.04) or any secondary outcome. The extent of nonviable myocardium was associated with the primary outcome (hazard ratio, 1.07; 95% CI, 1.00-1.15), all-cause death, cardiovascular death, and improvement in left ventricular function. Conclusions and Relevance This study found that viability testing does not identify patients with ischemic cardiomyopathy who benefit from PCI. The extent of nonviable myocardium, but not the extent of viable myocardium, is associated with event-free survival and likelihood of improvement of left ventricular function. Trial Registration ClinicalTrials.gov Identifier: NCT01920048.
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Affiliation(s)
- Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Holly P. Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - John P. Greenwood
- Leeds Institute for Cardiometabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Peter D. O’Kane
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Alexandros Papachristidis
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Navtej Chahal
- London Northwest Health NHS Trust, London, United Kingdom
| | | | - Saad M. Ezad
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Stam Kapetanakis
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lana J. Dixon
- Belfast Health and Social Care NHS Trust, Belfast, United Kingdom
| | - Kalpa De Silva
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Michael S. Marber
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Theresa McDonagh
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerry P. McCann
- University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Tim C. Clayton
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roxy Senior
- Royal Brompton Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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28
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Guinn MT, Rosengart TK. Commentary: The power of a patch: Utilizing exosome therapy to treat heart disease. J Thorac Cardiovasc Surg 2023; 166:e533-e534. [PMID: 37572953 DOI: 10.1016/j.jtcvs.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Michael Tyler Guinn
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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29
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Ciampi Q, Cortigiani L, Gaibazzi N, Rigo F, Zagatina A, Wierzbowska-Drabik K, Kasprzak JD, Djordjevic-Dikic A, Haberka M, Barbieri A, Bartolacelli Y, Pepi M, Carerj S, Villari B, Pellikka PA, Picano E. Echocardiographic functional determinants of survival in heart failure with abnormal ejection fraction. Front Cardiovasc Med 2023; 10:1290366. [PMID: 38075970 PMCID: PMC10699198 DOI: 10.3389/fcvm.2023.1290366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/30/2023] [Indexed: 10/16/2024] Open
Abstract
Background and Aims Patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF) have a heterogeneous prognosis, and assessment of coronary physiology with coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) may complement established predictors based on wall motion and EF. Methods and results In a prospective multicenter study design, we enrolled 1,408 HF patients (age 66 ± 12 years, 1,035 men), with EF <50%, 743 (53%) with coronary artery disease, and 665 (47%) with normal coronary arteries. Recruitment (years 2004-2022) involved 8 accredited laboratories, with inter-observer variability <10% for CFV measurement. Baseline CFV (abnormal value >31 cm/s) was obtained by pulsed-wave Doppler in mid-distal LAD. CFVR (abnormal value ≤2.0) was assessed with exercise (n = 99), dobutamine (n = 100), and vasodilator stress (dipyridamole in 1,149, adenosine in 60). Inducible myocardial ischemia was identified with wall motion score index (WMSI) stress > rest (cut-off Δ ≥ 0.12). LV contractile reserve (CR) was identified with WMSI stress < rest (cutoff Δ ≥ 0.25). Test response ranged from score 0 (EF > 30%, CFV ≥ 32 cm/s, CFVR > 2.0, LVCR present, ischemia absent) to score 5 (all steps abnormal). All-cause death was the only endpoint. Results. During a median follow-up of 990 days, 253 patients died. Independent predictors of death were EF (HR: 0.956, 95% CI: 0.943-0.968, p < 0.0001), CFV (HR: 2.407, 95% CI: 1.871-3.096, p < 0.001), CFVR (HR: 3.908, 95% CI: 2.903-5.260, p < 0.001), stress-induced ischemia (HR: 2.223, 95% CI: 1.642-3.009, p < 0.001), and LVCR (HR: 0.524, 95% CI: 0.324-.647, p = 0.008). The annual mortality rate was lowest (1.2%) in patients with a score of 0 (n = 61) and highest (31.9%) in patients with a score of 5 (n = 15, p < 0.001). Conclusion High resting CFV is associated with worse survival in ischemic and nonischemic HF with reduced EF. The value is independent and additive to resting EF, CFVR, LVCR, and inducible ischemia.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Department, Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | | | - Nicola Gaibazzi
- Cardiology Department, Villa Salus Foundation/IRCCS San Camillo Hospital, Venice, Italy
| | - Fausto Rigo
- Cardiology Department, University of Parma, Parma, Italy
| | - Angela Zagatina
- Cardiology Department, Research Cardiology Center “Medika”, Saint Petersburg, Russian Federation
| | | | - Jaroslaw D. Kasprzak
- Department of Cardiology, Medical University of Lodz, BieganskiSpecialty Hospital, Lodz, Poland
| | - Ana Djordjevic-Dikic
- Clinical Center of Serbia and School of Medicine, University of Belgrade, Cardiology Clinic, Belgrade, Serbia
| | - Maciej Haberka
- Cardiology Department, University of Silesia, Katowice, Poland
| | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Bruno Villari
- Cardiology Department, Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
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30
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Iacona GM, Bakhos JJ, Tong MZ, Bakaeen FG. Coronary artery bypass grafting in left ventricular dysfunction: when and how. Curr Opin Cardiol 2023; 38:464-470. [PMID: 37751395 DOI: 10.1097/hco.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The surgical management of patients undergoing coronary artery bypass grafting (CABG) with low ejection fraction presents unique challenges that require meticulous attention to details and good surgical technique and judgement. This review details the latest evidence and best practices in the care of such patients. RECENT FINDINGS CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity related to the development of postcardiotomy shock. Preoperative optimization with pharmacological or mechanical support is required, especially in patients with cardiogenic shock. Rapid and complete revascularization is what CABG surgeons aim to achieve. Multiple arterial revascularization should be reserved to selected patients. Off-pump CABG, on-pump breathing heart CABG, and new cardioplegic solutions remain of uncertain benefit compared with traditional CABG. SUMMARY Tremendous advancements in CABG allowed surgeons to offer revascularization to patients with severe left ventricular dysfunction and multivessel disease with acceptable risk. Despite that, there is a lack of comprehensive and robust studies particularly on long-term outcomes. Individualized patient assessment and a heart team approach should be used to determine the optimal surgical strategy for each patient.
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Affiliation(s)
- Gabriele M Iacona
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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31
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Lee Chuy K, Velazquez EJ, Lansky AJ, Jamil Y, Ahmad Y. Current Landscape and Future Directions of Coronary Revascularization in Ischemic Systolic Heart Failure: A Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101197. [PMID: 39131064 PMCID: PMC11307589 DOI: 10.1016/j.jscai.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 08/13/2024]
Abstract
Ischemic heart disease is the largest cause of death worldwide and the most common cause of heart failure (HF). The incidence and prevalence of HF are increasing owing to an aging population and improvements in the acute cardiac care of previously fatal conditions such as myocardial infarction. Strategies to improve outcomes in patients with ischemic systolic HF are urgently needed. There is systematic underutilization of testing for coronary artery disease in patients with HF, and revascularization is performed in an even smaller minority despite evidence for reduced mortality with coronary artery bypass grafting (CABG) over medical therapy in the Surgical Treatment for Ischemic Heart Failure Extension Study. Percutaneous coronary intervention (PCI) is a less-invasive approach to coronary revascularization; however, the recent Revascularization for Ischemic Ventricular Dysfunction (REVIVED)-British Cardiovascular Intervention Society (BCIS2) trial failed to demonstrate a benefit of PCI compared with that of medical therapy in patients with ischemic systolic HF. The comparative effectiveness of PCI and CABG for patients with ischemic systolic HF remains unknown, particularly in the era of contemporary medical therapy. In this review, we discuss the benefit of CABG in ischemic systolic HF, its underutilization, and the unmet clinical need. We also review the recent REVIVED-BCIS2 trial comparing PCI to medical therapy, as well as upcoming randomized controlled trials of PCI for ischemic systolic HF and persistent evidence gaps that will exist despite anticipated data from ongoing trials. There remains a need for an adequately powered randomized controlled trials to establish the comparative clinical effectiveness of PCI vs CABG in ischemic systolic HF in the era of contemporary revascularization approaches and medical therapy, as well as trials of coronary revascularization in patients with HF with preserved ejection fraction or less severe forms of left ventricular systolic dysfunction.
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Affiliation(s)
- Katherine Lee Chuy
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric J. Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yasser Jamil
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
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32
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Acerbo V, Cesaro A, Scherillo G, Signore G, Rotolo FP, De Michele G, Scialla F, Raucci G, Panico D, Fimiani F, Moscarella E, Gragnano F, Calabrò P. Understanding the role of coronary artery revascularization in patients with left ventricular dysfunction and multivessel disease. Heart Fail Rev 2023; 28:1325-1334. [PMID: 37493869 PMCID: PMC10575800 DOI: 10.1007/s10741-023-10335-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
Coronary artery disease (CAD) is the most common cause of heart failure with reduced ejection fraction (HFrEF). Advances and innovations in medical therapy have been shown to play a crucial role in improving the prognosis of patients with CAD and HFrEF; however, mortality rate in these patients remains high, and the role of surgical and/or percutaneous revascularization strategy is still debated. The Surgical Treatment for Ischemic Heart Failure (STICH) trial and the Revascularization for Ischemic Ventricular Dysfunction (REVIVED) trial have attempted to provide an answer to this issue. Nevertheless, the results of these two trials have generated further uncertainties. Their findings do not provide a definitive answer about the ideal clinical phenotype for surgical or percutaneous coronary revascularization and dispute the historical dogma on myocardial viability and the theory of myocardial hibernation, raising new questions about the proper selection of patients who are candidates for coronary revascularization. The aim of this review is to provide an overview on the actual available evidence of coronary artery revascularization in patients with CAD and left ventricular dysfunction and to suggest new insights on the proper selection and management strategies in this high-risk clinical setting.
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Affiliation(s)
- Vincenzo Acerbo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Gianmaria Scherillo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Giovanni Signore
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Francesco Paolo Rotolo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Gianantonio De Michele
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Francesco Scialla
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Giuseppe Raucci
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Domenico Panico
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Fabio Fimiani
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy
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Keeling WB, Binongo J, Wei J, Leshnower BG, Farrington W, Halkos ME. National trends in emergency coronary artery bypass grafting. Eur J Cardiothorac Surg 2023; 64:ezad352. [PMID: 37878803 DOI: 10.1093/ejcts/ezad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Emergency coronary artery bypass grafting (CABG) is often omitted from current research, and volumes as well as outcomes are unknown. The purpose of this research is to examine national trends in emergency CABG. METHODS The Society of Thoracic Surgeons national adult cardiac surgical database was queried from 2005 to 2017 for patients who underwent emergency and emergency salvage isolated CABG procedures, and 92 607 patients were included for analysis. Generalized linear mixed models were used to assess time trends, taking into account the clustering effect of region. RESULTS Over the study period, volumes of emergency and emergency salvage CABG declined from 7991 to 6916 cases/year. Emergency and emergency salvage cases accounted for ∼4.9% of all CABG procedures performed nationwide in 2005 and 4.1% in 2017. The predicted risk of mortality (PROM) declined in the entire patient cohort over time from 12% to 8% (P < 0.0001). Rates of important postoperative morbidities also declined including prolonged intubation, re-exploration for haemorrhage and postoperative pneumonia (P < 0.001). Observed-to-expected mortality rates rose over the study period from 0.81 to 1.06 as the overall PROM declined from 9.3% to 7.6%. Emergency salvage CABG rates also declined over the course of the study from 358 to 323 cases/year. The observed-to-expected ratios for mortality increased for emergency salvage CABG during the study from 1.16 to 1.66, and emergency salvage mortality rates averaged 46.5%. CONCLUSIONS The volume of patients undergoing emergency and emergency salvage CABG in the USA has declined. Increases in mortality are largely driven by emergency salvage cases, and the PROM algorithm may not accurately reflect the risk involved for these patients.
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Affiliation(s)
- William B Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jane Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Woodrow Farrington
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Hervier E, Glessgen C, Nkoulou R, François Deux J, Vallee JP, Adamopoulos D. Hybrid PET/MR in Cardiac Imaging. Magn Reson Imaging Clin N Am 2023; 31:613-624. [PMID: 37741645 DOI: 10.1016/j.mric.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In the last few years, technological advances in MR imaging, PET detectors, and attenuation correction algorithms have allowed the creation of truly integrated PET/MR imaging systems, for both clinical and research applications. These machines allow a comprehensive investigation of cardiovascular diseases, by offering a wide variety of detailed anatomical and functional data in combination. Despite significant pathophysiologic mechanisms being clarified by this new data, its clinical relevance and prognostic significance have not been demonstrated yet.
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Affiliation(s)
- Elsa Hervier
- Diagnostics Department, Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Carl Glessgen
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - René Nkoulou
- Diagnostics Department, Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Jean François Deux
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Jean-Paul Vallee
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Dionysios Adamopoulos
- Department of Medical Specialties, Cardiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland.
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Isath A, Panza JA. The Evolving Paradigm of Revascularization in Ischemic Cardiomyopathy: from Recovery of Systolic Function to Protection Against Future Ischemic Events. Curr Cardiol Rep 2023; 25:1513-1521. [PMID: 37874470 DOI: 10.1007/s11886-023-01977-5] [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] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW We aim to reevaluate how the assessment of myocardial viability can guide optimal treatment strategies for patients with ischemic cardiomyopathy (ICM) based on a more contemporary understanding of the mechanism of benefit of revascularization. RECENT FINDINGS The assessment of viability in left ventricular (LV) segments with diminished contraction has been proposed as key to predict the benefit of revascularization and, therefore, as a requisite for the selection of patients to undergo this form of treatment. However, data from prospective trials have diverged from earlier retrospective studies. Traditional binary viability assessment may oversimplify ICM's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centered on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ICM's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA.
- Department of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, USA.
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Rohde LE, McMurray JJV. REVIV(E)ing the ischaemic paradigm in heart failure: STICHes are needed. Eur Heart J 2023; 44:3652-3654. [PMID: 37525996 DOI: 10.1093/eurheartj/ehad488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
- Luis E Rohde
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, Brazil
- British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health at the University of Glasgow, Glasgow, UK
| | - John J V McMurray
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, Brazil
- British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health at the University of Glasgow, Glasgow, UK
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37
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Tsigkriki L, Kleitsioti P, Dimitriadis F, Sidiropoulos G, Alkagiet S, Efstratiou D, Kalaitzoglou M, Charisopoulou D, Siarkos M, Mavrogianni AD, Giannakopoulou P, Zarifis J, Koulaouzidis G. The Utility of Low-Dose-Dobutamine Stress Echocardiography in Patients with Heart Failure with Reduced Ejection Fraction: An Update. Diagnostics (Basel) 2023; 13:2920. [PMID: 37761286 PMCID: PMC10527914 DOI: 10.3390/diagnostics13182920] [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: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Despite significant advancements in medical therapy, heart failure with reduced ejection fraction (HFrEF) continues to be a significant cause of death and disability. Reversible ischaemic left ventricular dysfunction due to viable myocardium is one such contributing factor. In these cases, coronary revascularization has shown promise in improving left ventricular function and prognosis. For patients with HFrEF and wide QRS, cardiac resynchronization therapy (CRT) is an effective option to address electromechanical dyssynchrony. However, approximately 30% of patients do not respond positively to CRT, highlighting the need to refine candidate selection for this treatment. In some patients with reduced HFrEF, there is a condition known as classical low-flow, low-gradient aortic stenosis (AS) that may be observed. This condition is characterized by a low transaortic flow, which leads to reductions in both the transaortic mean gradient and aortic valve area. Decision-making regarding revascularization, CRT, and pharmacological treatment play a crucial role in managing HFrEF. Cardiac imaging can be valuable in guiding decision-making processes and assessing the prognosis of patients with HFrEF. Among the imaging modalities, dobutamine stress echocardiography has come a long way in establishing itself as a feasible, safe, effective, relatively cheap non-invasive technique. The aim of this review is to explore the current literature on the utility of low-dose stress echocardiography in diagnosing and prognosticating patients with HFrEF.
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Affiliation(s)
- Lamprini Tsigkriki
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Panagiota Kleitsioti
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Fotis Dimitriadis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - George Sidiropoulos
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Stelina Alkagiet
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Dimitris Efstratiou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Maria Kalaitzoglou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | | | - Michail Siarkos
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Angeliki-Despoina Mavrogianni
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - Pinelopi Giannakopoulou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - John Zarifis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (L.T.); (P.K.); (F.D.); (G.S.); (S.A.); (D.E.); (M.K.); (M.S.); (A.-D.M.); (P.G.); (J.Z.)
| | - George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland
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Chew DP, Zaman S. Coronary stenting for stable coronary ischaemia: ain't misbehaving, just misunderstood. Med J Aust 2023; 219:140-141. [PMID: 37474128 DOI: 10.5694/mja2.52050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Derek P Chew
- Victorian Heart Hospital, Monash University, Melbourne, VIC
| | - Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW
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39
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Li Kam Wa ME, Assar SZ, Kirtane AJ, Perera D. Revascularisation for Ischaemic Cardiomyopathy. Interv Cardiol 2023; 18:e24. [PMID: 37655258 PMCID: PMC10466461 DOI: 10.15420/icr.2023.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 09/02/2023] Open
Abstract
Coronary artery disease is a leading cause of heart failure with reduced ejection fraction. Coronary artery bypass grafting appears to provide clinical benefits such as improvements in quality of life, reductions in readmissions and MI, and favourable effects on long-term mortality; however, there is a significant short-term procedural risk when left ventricular function is severely impaired, which poses a conundrum for many patients. Could percutaneous coronary intervention provide the same benefits without the hazard of surgery? There have been no randomised studies to support this practice until recently. The REVIVED-BCIS2 trial (NCT01920048) assessed the outcomes of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular dysfunction and stable coronary artery disease. This review examines the trial results in detail, suggests a pathway for investigation and revascularisation in ischaemic cardiomyopathy, and explores some of the remaining unanswered questions.
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Affiliation(s)
- Matthew E Li Kam Wa
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
| | - Saba Z Assar
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
- Cardiovascular Research Foundation New York, NY, US
| | - Divaka Perera
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust London, UK
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40
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Fremes SE, Marquis-Gravel G, Gaudino MFL, Jolicoeur EM, Bédard S, Masterson Creber R, Ruel M, Vervoort D, Wijeysundera HC, Farkouh ME, Rouleau JL. STICH3C: Rationale and Study Protocol. Circ Cardiovasc Interv 2023; 16:e012527. [PMID: 37582169 DOI: 10.1161/circinterventions.122.012527] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is the recommended mode of revascularization in patients with ischemic left ventricular dysfunction (iLVSD) and multivessel disease. However, contemporary percutaneous coronary intervention (PCI) outcomes have improved with the integration of novel technologies and refinement of revascularization strategies, and PCI is often used in clinical practice in this population. There is a lack of evidence from randomized trials comparing contemporary state-of-the-art PCI versus CABG for the treatment of iLVSD and multivessel disease. This was the impetus for the STICH3C trial (Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy), described here. METHODS The STICH3C trial is a prospective, unblinded, international, multicenter trial with an expected sample size of 754 participants from ≈45 centers. Patients with multivessel/left main coronary artery disease and iLVSD with left ventricular ejection fraction ≤40% considered by the local Heart Team appropriate for and amenable to revascularization by both modes of revascularization will be randomized in a 1:1 ratio to state-of-the-art PCI or CABG. RESULTS The primary end point is the composite of death from any cause, stroke, spontaneous myocardial infarction, urgent repeat revascularization, or heart failure readmission, summarized as a time-to-event outcome. The key hierarchical end point is time to death and frequency of hospitalizations for heart failure. The key safety outcome is a composite of major adverse events. Disease-specific quality-of-life and health economics measures will be compared between groups. Participants will be followed for a median of 5 years, with a minimum follow-up of 4 years. CONCLUSIONS STICH3C will directly inform patients, clinicians, and international practice guidelines about the efficacy and safety of CABG versus PCI in patients with iLVSD. The results will provide novel and broad evidence, including clinical events, health status, and economic assessments, to guide care for patients with iLVSD and severe coronary artery disease. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier: NCT05427370.
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Affiliation(s)
- Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - E Marc Jolicoeur
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - Sylvain Bédard
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, Quebec, Canada (S.B.)
| | | | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (M.R.)
| | - Dominique Vervoort
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Michael E Farkouh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ontario, Canada (M.E.F.)
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, University of Montreal, Quebec, Canada (G.M.-G., E.M.J., J.-L.R.)
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41
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Zhang C, Li H, Han M. Effect of atrial fibrillation on plasma galectin-3 and soluble CD40 ligand levels in patients with ischemic cardiomyopathy. J Int Med Res 2023; 51:3000605231194457. [PMID: 37656969 PMCID: PMC10585127 DOI: 10.1177/03000605231194457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To reveal the significance of plasma galectin-3 and soluble CD40 ligand (sCD40L) levels in patients with ischemic cardiomyopathy (ICM) combined with atrial fibrillation. METHODS In this case-control study, the case group comprised 60 patients with ICM combined with atrial fibrillation and the control group comprised patients with ICM without atrial fibrillation. Plasma galectin-3 and sCD40L levels, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), and left ventricular diameter (LVD) were compared. RESULTS The plasma galectin-3 and sCD40L levels, LAD, and LVD were higher and the LVEF was lower in the case than control group. In the case group, the plasma galectin-3 and sCD40L levels were positively correlated with the LAD and LVD but negatively correlated with the LVEF. The area under the receiver operating characteristic curve of the plasma galectin-3 and sCD40L levels in the diagnosis of ICM combined with atrial fibrillation was 0.857 (95% confidence interval, 0.792-0.923) and 0.724 (95% confidence interval, 0.634-0.814), respectively. CONCLUSION The plasma galectin-3 and sCD40L levels are significantly elevated in patients with ICM combined with atrial fibrillation. Although both may have predictive value in the diagnosis of ICM combined with atrial fibrillation, galectin-3 may have the higher predictive value.
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Affiliation(s)
- Chi Zhang
- Department of Cardiovascular Medicine, The Eighth Hospital of Wuhan, Wuhan City, Hubei Province, China
| | - HongJun Li
- Department of Surgery, The Eighth Hospital of Wuhan, Wuhan City, Hubei Province, China
| | - Mei Han
- Department of Cardiovascular Medicine, The Eighth Hospital of Wuhan, Wuhan City, Hubei Province, China
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42
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Iaconelli A, Pellicori P, Dolce P, Busti M, Ruggio A, Aspromonte N, D'Amario D, Galli M, Princi G, Caiazzo E, Rezig AOM, Maffia P, Pecorini G, Crea F, Cleland JGF. Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of randomized trials. Eur J Heart Fail 2023; 25:1094-1104. [PMID: 37211964 DOI: 10.1002/ejhf.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). METHODS AND RESULTS We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79-0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70-0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74-1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed. CONCLUSIONS For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.
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Affiliation(s)
- Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Matteo Busti
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Aureliano Ruggio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore della Carità', Novara, Italy
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Princi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisabetta Caiazzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Asma O M Rezig
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pasquale Maffia
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Giovanni Pecorini
- Cardiovascular Internal Medicine Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Nappi C, Panico M, Falzarano M, Vallone C, Ponsiglione A, Cutillo P, Zampella E, Petretta M, Cuocolo A. Tracers for Cardiac Imaging: Targeting the Future of Viable Myocardium. Pharmaceutics 2023; 15:pharmaceutics15051532. [PMID: 37242772 DOI: 10.3390/pharmaceutics15051532] [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: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Ischemic heart disease is the leading cause of mortality worldwide. In this context, myocardial viability is defined as the amount of myocardium that, despite contractile dysfunction, maintains metabolic and electrical function, having the potential for functional enhancement upon revascularization. Recent advances have improved methods to detect myocardial viability. The current paper summarizes the pathophysiological basis of the current methods used to detect myocardial viability in light of the advancements in the development of new radiotracers for cardiac imaging.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, 80131 Naples, Italy
| | - Maria Falzarano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Carlo Vallone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Paolo Cutillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Petretta
- IRCCS SYNLAB SDN, Via Gianturco 113, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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44
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Iannaccone M, Franchin L, Burzotta F, Botti G, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Masiero G, Di Biasi M, Pagnotta P, Casu G, Scandroglio AM, Tarantini G, Chieffo A. Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry. J Pers Med 2023; 13:826. [PMID: 37240996 PMCID: PMC10222801 DOI: 10.3390/jpm13050826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7-8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08-0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.
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Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Luca Franchin
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Giulia Botti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, 80100 Naples, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Federico De Marco
- Valvular and Structural Heart Cardiology, Centro Cardiologico Monzino, 20100 Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Luigi Sacco, 20100 Milan, Italy
| | - Paolo Pagnotta
- Cardiovascular Department, Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Gavino Casu
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | - Anna Mara Scandroglio
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, 20100 Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
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45
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Vicent L, Álvarez-García J, Vazquez-Garcia R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Fernández-Avilés F, Ariza-Sole A, Martínez-Sellés M. Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction. J Clin Med 2023; 12:3028. [PMID: 37109365 PMCID: PMC10143946 DOI: 10.3390/jcm12083028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, 08025 Barcelona, Spain
| | | | - José R. González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago, CIBERCV, 15076 Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, 46026 Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, 28222 Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Department of Medicine, University of Murcia, 30120 Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Worner
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Cardiology Department, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Albert Ariza-Sole
- Cardiology Department, Bellvitge University Hospital General, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
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46
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Sperry BW, Bateman TM, Akin EA, Bravo PE, Chen W, Dilsizian V, Hyafil F, Khor YM, Miller RJH, Slart RHJA, Slomka P, Verberne H, Miller EJ, Liu C. Hot spot imaging in cardiovascular diseases: an information statement from SNMMI, ASNC, and EANM. J Nucl Cardiol 2023; 30:626-652. [PMID: 35864433 DOI: 10.1007/s12350-022-02985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.
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Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA.
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA
| | - Esma A Akin
- George Washington University Hospital, Washington, DC, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Européen Georges-Pompidou, DMU IMAGINA, Assistance Publique -Hôpitaux de Paris, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hein Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA.
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47
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Park H, Kang DY, Ahn JM, Yang DH, Koo HJ, Kang JW, Lee PH, Lee SE, Kim MS, Kang SJ, Park DW, Lee SW, Kim YH, Lee CW, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JJ, Park SW, Park SJ. Myocardial Scar and Revascularization on Mortality in Ischemic Cardiomyopathy (from the Late Gadolinium Enhancement Cardiac Magnetic Resonance Study). Am J Cardiol 2023; 192:212-220. [PMID: 36848690 DOI: 10.1016/j.amjcard.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023]
Abstract
Myocardial viability test to guide revascularization remains uncertain in patients with ischemic cardiomyopathy. We evaluated the different impacts of revascularization on cardiac mortality according to the extent of myocardial scar assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients with ischemic cardiomyopathy. A total of 404 consecutive patients with significant coronary artery disease and an ejection fraction ≤35% were assessed by LGE-CMR before revascularization. Of them, 306 patients underwent revascularization and 98 patients received medical treatment alone. The primary outcome was cardiac death. During a median follow-up of 6.3 years, cardiac death occurred in 158 patients (39.1%). Revascularization was associated with a significantly lower risk of cardiac death than medical treatment alone in the overall population (adjusted hazard ratio [aHR] 0.29, 95% confidence interval (CI) 0.19 to 0.45, p <0.001). There was a significant interaction between the number of segments with >75% transmural LGE and revascularization on the risk of cardiac death (p = 0.037 for interaction). In patients with limited myocardial scar (<6 segments with >75% transmural LGE, n = 354), revascularization had a significantly lower risk of cardiac death than medical treatment alone (aHR 0.24, 95% CI 0.15 to 0.37, p <0.001); in patients with extensive myocardial scar (≥6 segments with >75% transmural LGE, n = 50), there was no significant difference between revascularization and medical treatment alone regarding the risk of cardiac death (aHR 1.33, 95% CI 0.46 to 3.80, p = 0.60). In conclusion, the assessment of myocardial scar by LGE-CMR may be helpful in the decision-making process for revascularization in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Hanbit Park
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea
| | - Do-Yoon Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Jung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol-Hyun Chung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Lee
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Alzahrani A, Mufti H, Alswat A, Altirkistani B, Aljehani M, Jazzar A, Alutaibi F, Abushouk A, Rahimi JA, Kashkari WA, Althobaiti M. The impact of viability assessment using cardiac MRI and echocardiogram on the outcome of revascularization in patients with multi-vessels coronary artery disease and moderate to severe ischemic cardiomyopathy. Saudi Med J 2023; 44:373-378. [PMID: 37062545 PMCID: PMC10153613 DOI: 10.15537/smj.2023.44.4.20220133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/18/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To investigate the influence of viability assessment in the management of patients with ischemic cardiomyopathy (ICM). METHODS This retrospective cohort study included all patients with ICM with moderate to severely reduced left ventricular ejection fraction (LVEF) who underwent viability assessment using cardiac magnetic resonance imaging (MRI) and echocardiogram as modalities of imaging. In addition, LVEF, modality of choice, and treatment plans were all extracted as main variables from the electronic database. One hundred 6 patients who met the inclusion criteria from December 2014 to December 2019 were included. RESULTS Posttreatment LVEF improved by 5% in the viable group compared to the nonviable group (p=0.016). Regardless of the treatment received, 6 (8.8%) patients in the viable group died due to cardiac causes after an 18-month follow-up period; in contrast, 7 (18.4%) patients died due to cardiac causes in the nonviable group. However, despite that difference, this was not statistically significant (p=0.153). Medical therapy alone was observed in 32 (84.2%) patients in the nonviable group compared to 32 (47.1%) in the viable group (p<0.001). Although the reduction in hospitalization for cardiac reasons was not statistically significant, the viable arm had 50% fewer hospitalizations than the nonviable arm (p=0.051). CONCLUSION Patients with viable myocardium had better outcomes in which LVEF significantly improved posttreatment. Additionally, there was a reduction in the number of hospitalizations for cardiac reasons in the viable group compared to the nonviable group, even though the difference was not statistically significant. However, further studies with a larger number of patients are needed to determine a definite conclusion.
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Affiliation(s)
- Atif Alzahrani
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Hani Mufti
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Anas Alswat
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Bsaim Altirkistani
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammed Aljehani
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Ahmed Jazzar
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Fahad Alutaibi
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Amir Abushouk
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Jamilah Al Rahimi
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Wail Al Kashkari
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammed Althobaiti
- From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
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Radesich C, Cappelletto C, Indennidate C, Perotto M, Di Lenarda A. Predicting left ventricular functional recovery in ischaemic cardiomyopathy: needs and challenges. Eur Heart J Suppl 2023; 25:B69-B74. [PMID: 37091642 PMCID: PMC10120944 DOI: 10.1093/eurheartjsupp/suad071] [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] [Indexed: 04/25/2023]
Abstract
Left ventricular (LV) systolic function is an essential parameter for the evaluation of patients with ischaemic heart disease, and therapeutic choices are significantly driven by LV ejection fraction (LVEF) in the early stage of the disease and during follow-up. After an acute coronary syndrome, ventricular dysfunction may be reversible when caused by transient myocardial stunning. Therefore, the identification of clinical, laboratory, and instrumental predictors of improvement in LV systolic function (in addition to LVEF) is essential for an adequate prognostic stratification. In the setting of chronic ischaemic heart disease, there is no evidence that an improvement in LV systolic function is invariably associated with a better prognosis and LVEF is only one of many parameters that should be considered for the risk stratification. This state-of-the-art review will critically analyse the scientific evidence regarding known predictors of LVEF recovery, trying to elucidate their pathophysiological principles and clinical value.
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Affiliation(s)
- Cinzia Radesich
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste
| | - Chiara Cappelletto
- Territorial Specialist Department, SC Cardiovascular Pathologies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
| | - Carla Indennidate
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste
| | - Maria Perotto
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste
| | - Andrea Di Lenarda
- Territorial Specialist Department, SC Cardiovascular Pathologies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
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Vassiliki’ Cousoumbas G, Casella G, Di Pasquale G. What is the role of coronary revascularization to recover the contractility of the dysfunctional heart? Eur Heart J Suppl 2023; 25:B75-B78. [PMID: 37091666 PMCID: PMC10120954 DOI: 10.1093/eurheartjsupp/suad072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Coronary artery disease is the predominant aetiology of heart failure and left ventricular dysfunction in industrialized countries. The pathophysiological substrate of hibernating myocardium constitutes the conceptual target of coronary revascularization by coronary artery bypass graft (CABG) or coronary angioplasty or percutaneous coronary intervention (PCI). Studies, mainly observational, conducted in the past have demonstrated a prognostic benefit of CABG on survival. These findings were confirmed by the long-term follow-up of the STICH study in which, however, documentation of inducible ischaemia or myocardial viability was not predictive of a prognostic benefit of CABG. Revascularization via PCI in the recent REVIVED-BCIS2 study did not demonstrate a significant benefit in terms of death or heart failure hospitalization compared with optimal medical therapy. Pending the long-term follow-up of the REVIVED-BCIS2 study, optimized medical therapy, cardiac resynchronization therapy, and the implantable cardioverter defibrillator, where indicated, are the mainstay of treatment in patients with dilated ischaemic cardiomyopathy. The decision for coronary revascularization is made in the individual patient, possibly with a higher bias in patients with angina, three-vessel coronary artery disease, severe left ventricular dysfunction, and cardiac remodelling.
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Affiliation(s)
| | | | - Giuseppe Di Pasquale
- Coordination of the Cardiological and Cardiovascular Surgical Network, Emilia-Romagna
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