1
|
Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
| |
Collapse
|
2
|
McMahon SR, Patel EK, Duvall WL. Stress-First Myocardial Perfusion Imaging. Cardiol Clin 2023; 41:163-175. [PMID: 37003674 DOI: 10.1016/j.ccl.2023.01.005] [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: 02/25/2023]
Abstract
Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study while saving time in the imaging laboratory and reducing the radiation exposure to patients and laboratory staff. Unfortunately, implementing a stress-first approach in a nuclear cardiology laboratory involves significant challenges such as the need for attenuation correction, triage of patients to an appropriate protocol, real-time review of stress images, and consideration of differential reimbursement. Despite it being best practice for both the patient and the laboratory, these impediments have kept the proportions of studies performed stress-first relatively unchanged in North America and world-wide in the last 10 years.
Collapse
Affiliation(s)
- Sean R McMahon
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Etee K Patel
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
| |
Collapse
|
3
|
Gaine SP, Sharma G, Tower-Rader A, Botros M, Kovell L, Parakh A, Wood MJ, Harrington CM. Multimodality Imaging in the Detection of Ischemic Heart Disease in Women. J Cardiovasc Dev Dis 2022; 9:350. [PMID: 36286302 PMCID: PMC9604786 DOI: 10.3390/jcdd9100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.
Collapse
Affiliation(s)
- Sean Paul Gaine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Albree Tower-Rader
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Mina Botros
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Colleen M. Harrington
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA 02214, USA
| |
Collapse
|
4
|
Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
Collapse
Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| |
Collapse
|
5
|
Mendoza-Ibañez OI, Martínez-Lucio TS, Alexanderson-Rosas E, Slart RH. SPECT in Ischemic Heart Diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
6
|
Sex-Based Considerations in the Evaluation of Chest Pain and Management of Obstructive Coronary Artery Disease. Curr Atheroscler Rep 2020; 22:39. [DOI: 10.1007/s11883-020-00855-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
7
|
Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| |
Collapse
|
8
|
Left ventricular mechanical dyssynchrony assessment in obese patients using the cadmium-zinc telluride SPECT camera. Int J Cardiovasc Imaging 2020; 36:757-765. [PMID: 31919704 DOI: 10.1007/s10554-019-01762-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
The use of phase analysis techniques to assess left ventricular mechanical dyssynchrony (LVMD) has been well documented. However, artifacts have reduced the accuracy of the assessment due to soft tissue attenuation, so little information is available about the effects of obesity on LVMD. The aim of this study was to evaluate LVMD in patients with simple obesity by SPECT with a new cadmium-zinc telluride (CZT) detector and to explore the effects of obesity on left ventricular wall motion. We retrospectively analyzed 95 patients with myocardial perfusion imaging (MPI) images without perfusion defects, of which 55 were diagnosed with simple obesity (BMI > 30), and 40 non-obese patients (BMI < 25) matched for age and sex were used as controls. The five-point method was used to analyze the MPI images of the two groups, and the complete cardiac function parameters including phase bandwidth (PBW) and phase standard deviation (PSD) were obtained. Although the PBW values of the two groups were within the normal range (cut-off value > 90°), the PBW (35.4 ± 28 vs 24.9 ± 7.5, P < .001; 36.6 ± 18.4 vs 28.7 ± 9.1, P = 0.01) and PSD (8.7 ± 7.6 vs 5.9 ± 2, P = 0.02; 9.2 ± 4.9 vs 7.1 ± 2.7, P = 0.01) of the obese group were larger than the control group under both stressing and resting, and the difference was statistically significant. CZT-SPECT can effectively assess LVMD in obese patients, and they are more likely to develop LVMD, which may be related to their left ventricular volume.
Collapse
|
9
|
Quantitative low-dose rest and stress CT myocardial perfusion imaging with a whole-heart coverage scanner improves functional assessment of coronary artery disease. IJC HEART & VASCULATURE 2019; 24:100381. [PMID: 31763433 PMCID: PMC6859740 DOI: 10.1016/j.ijcha.2019.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 12/02/2022]
Abstract
Objective We evaluated the diagnostic accuracy of myocardial blood flow (MBF) and perfusion reserve (MPR) measured from low-dose dynamic contrast-enhanced (DCE) imaging with a whole-heart coverage CT scanner for detecting functionally significant coronary artery disease (CAD). Methods Twenty one patients with suspected or known CAD had rest and dipyridamole stress MBF measurements with CT and SPECT myocardial perfusion imaging (MPI), and lumen narrowing assessment with coronary angiography (catheter and/or CT based) within 6 weeks. SPECT MBF measurements and coronary angiography were used together as reference to determine the functional significance of coronary artery stenosis. In each CT MPI study, DCE images of the whole heart were acquired with breath-hold using a low-dose acquisition protocol to generate MBF maps. Binomial logistic regression analysis was used to determine the diagnostic accuracy of CT-measured MBF and MPR (ratio of stress to rest MBF) for assessing functionally significant coronary stenosis. Results Mean stress MBF and MPR in ischemic segments were lower than those in non-ischemic segments (1.37 ± 0.34 vs. 2.14 ± 0.64 ml/min/g; 1.56 ± 0.41 vs. 2.53 ± 0.70; p < 0.05 for all). The receiver operating characteristic curve analysis revealed that MPR (AUC 0.916, 95%CI: 0.885–0.947) had a superior power than stress MBF (AUC 0.869, 95%CI: 0.830–0.909) for differentiating non-ischemic and ischemic myocardial segments (p = 0.045). On a per-vessel and per-segment analysis, concomitant use of MPR and stress MBF thresholds further improved the diagnostic accuracy compared to MPR or stress MBF alone for detecting obstructive coronary lesions (per-vessel: 93.4% vs. 83.6% and 88.5%, respectively; per-segment: 90.0% vs. 83.7% and 83.1%, respectively). The estimated effective dose of a rest and stress CT MPI study was 3.04 and 3.19 mSv respectively. Conclusion Quantitative rest and stress myocardial perfusion measurement with a large-coverage CT scanner improves the diagnostic accuracy for detecting functionally significant coronary stenosis.
Collapse
|
10
|
Hasbek Z, Ertürk SA, Çakmakçılar A, Gül İ, Yılmaz A. Evaluation of Myocardial Perfusion Imaging SPECT Parameters and Pharmacologic Stress Test with Adenosine Versus Coronary Angiography Findings: Are They Diagnostically Concordant? Mol Imaging Radionucl Ther 2019; 28:53-61. [PMID: 31237135 PMCID: PMC6592312 DOI: 10.4274/mirt.galenos.2019.47450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: In this study our first aim was to evaluate the diagnostic concordance of myocardial perfusion scintigraphy (MPS) by pharmacological stress test with adenosine (APST) with coronary angiography (CAG). The secondary aim of this study was to evaluate the correlation between CAG findings and automated analysis parameters such as left ventricular ejection fraction, summed stress score (SSS), summed rest score, summed difference score (SDS), stress MPS defect percentage ratio (extent) and transient ischemic dilation (TID) obtained by myocardial perfusion imaging single-photon emission computed tomography (SPECT). Methods: A total of 129 patients (62 male, 67 female, median age: 60.02) undergoing MPS due to suspicion of coronary ischemia who also underwent subsequent CAG in the last year were included in this study, their MPS data and CAG results were compared. Results: There was no statistically significant diagnostic concordance when visual evaluation of MPS, quantitative MPS parameters and exercise treadmill test (ETT) electrocardiography results were used alone. In fact, diagnostic concordance was higher when automated analysis parameters like TID, SSS and extent values were added to MPS SPECT visual analyses. There was diagnostic concordance in 57.9% of APST patients and 41.7% of ETT patients. There was diagnostic concordance in 75.8% of APST patients and 52.6% of ETT patients who were older than 65 years of age. Conclusion: In our study, we found that the use of APST during MPS increases diagnostic concordance with CAG. Therefore, we think that it would be appropriate to use APST in women and elderly patients with limited exercise habits. The CAG diagnostic mismatch is far above what it should be when MPS reporting is only done with visual data, and it is not supported by quantitative data such as TID, SSS, SDS and extent.
Collapse
Affiliation(s)
- Zekiye Hasbek
- Cumhuriyet University Faculty of Medicine, Department of Nuclear Medicine, Sivas, Turkey
| | - Seyit Ahmet Ertürk
- Cumhuriyet University Faculty of Medicine, Department of Nuclear Medicine, Sivas, Turkey
| | - Ali Çakmakçılar
- Cumhuriyet University Faculty of Medicine, Department of Nuclear Medicine, Sivas, Turkey
| | - İbrahim Gül
- Cumhuriyet University Faculty of Medicine, Department of Cardiology, Sivas, Turkey
| | - Ahmet Yılmaz
- Cumhuriyet University Faculty of Medicine, Department of Cardiology, Sivas, Turkey
| |
Collapse
|
11
|
Henry S, Bond R, Rosen S, Grines C, Mieres J. Challenges in Cardiovascular Risk Prediction and Stratification in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
12
|
Adigun RO, Boler AN, Mankad R. Disparities in Cardiac Care of Women: Current Data and Possible Solutions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:87. [PMID: 30242773 DOI: 10.1007/s11936-018-0688-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease remains the leading cause of death in women. The goal of this review is to address known disparities in cardiovascular care with regard to diagnosis and treatment of heart disease in women. RECENT FINDINGS Gender-specific differences in regard to the incidence, treatment, and outcomes of common cardiovascular pathology are increasingly recognized. Particular attention to ischemic heart disease, arrhythmia, congestive heart failure, and structural heart disease are reviewed in this article. There is a clear racial and ethnic discrepancy among women which is particularly concerning with a progressively diverse patient population. Medical and surgical treatment differences between men and women must be addressed by providers in order to optimize long-term outcomes among all patients. Understanding the unique cardiovascular risk profile and barriers to optimal treatment outcomes in women is imperative to eliminate the current disparities in cardiovascular disease.
Collapse
Affiliation(s)
- Rosalyn O Adigun
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA
| | - Amber N Boler
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA
| | - Rekha Mankad
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA.
| |
Collapse
|
13
|
Chamsi-Pasha MA, Kurrelmeyer KM. Noninvasive Evaluation of Symptomatic Women with Suspected Coronary Artery Disease. Methodist Debakey Cardiovasc J 2018; 13:193-200. [PMID: 29744011 DOI: 10.14797/mdcj-13-4-193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, yet several factors make it challenging to diagnose in women. Although women have more frequent chest pain than men, atypical symptoms such as nausea, dyspnea, and fatigue make it difficult to determine their risk of coronary artery disease (CAD) before testing. Current guidelines recommend exercise electrocardiography (ex-ECG) as the initial test in symptomatic women with intermediate pretest probability who can exercise and have a normal resting ECG; however, treadmill ex-ECG testing has a significantly lower positive predictive value in women. In addition, women often have nonobstructive CAD in conjunction with microvascular dysfunction and other cardiovascular abnormalities that can decrease the accuracy of all noninvasive tests. The following provides an overview of exercise ECG, echocardiography, SPECT imaging, and various other available modalities and examines their effectiveness in diagnosing and managing symptomatic women with suspected CAD.
Collapse
Affiliation(s)
| | - Karla M Kurrelmeyer
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| |
Collapse
|
14
|
Aggarwal NR, Bond RM, Mieres JH. The role of imaging in women with ischemic heart disease. Clin Cardiol 2018; 41:194-202. [PMID: 29505091 DOI: 10.1002/clc.22913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 12/24/2022] Open
Abstract
Substantial advances and insights in medical technology and treatment strategies, and the focus on sex-specific research have contributed to a reduction in cardiovascular mortality in women. Despite these advances, ischemic heart disease (IHD) remains the leading cause of cardiovascular morbidity and mortality of women in the Western world. Advances in cardiovascular imaging, over the past 4 decades, have significantly improved the evaluation and management of the full spectrum of coronary atherosclerosis, which contributes to ischemic heart disease. The development of contemporary and novel diagnostic imaging techniques and tools have assumed an expanded role in the evaluation of symptomatic women to detect not only flow-limiting epicardial coronary stenosis and nonobstructive atherosclerosis, but also ischemia resulting from microvascular dysfunction. IHD is now diagnosed early and with greater accuracy, leading to improved risk assessment and timely therapies in women. In this article, we review the available evidence on the role of contemporary diagnostic imaging techniques in the evaluation of women with suspected IHD.
Collapse
Affiliation(s)
| | - Rachel M Bond
- Zucker School of Medicine at Hofstra Northwell, New York
| | | |
Collapse
|
15
|
Rizvi A, Han D, Danad I, Ó Hartaigh B, Lee JH, Gransar H, Stuijfzand WJ, Roudsari HM, Park MW, Szymonifka J, Chang HJ, Jones EC, Knaapen P, Lin FY, Min JK, Peña JM. Diagnostic Performance of Hybrid Cardiac Imaging Methods for Assessment of Obstructive Coronary Artery Disease Compared With Stand-Alone Coronary Computed Tomography Angiography: A Meta-Analysis. JACC Cardiovasc Imaging 2017; 11:589-599. [PMID: 28823745 DOI: 10.1016/j.jcmg.2017.05.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The current meta-analysis aimed to evaluate the diagnostic performance of hybrid cardiac imaging techniques compared with stand-alone coronary computed tomography angiography (CTA) for assessment of obstructive coronary artery disease (CAD). BACKGROUND The usefulness of coronary CTA for detecting obstructive CAD remains suboptimal at present. Myocardial perfusion imaging encompasses positron emission tomography, single-photon emission computed tomography, and cardiac magnetic resonance, which permit the identification of myocardial perfusion defects to detect significant CAD. A hybrid approach comprising myocardial perfusion imaging and coronary CTA may improve diagnostic performance for detecting obstructive CAD. METHODS PubMed and Web of Knowledge were searched for relevant publications between January 1, 2000 and December 31, 2015. Studies using coronary CTA and hybrid imaging for diagnosis of obstructive CAD (a luminal diameter reduction of >50% or >70% by invasive coronary angiography) were included. In total, 12 articles comprising 951 patients and 1,973 vessels were identified, and a meta-analysis was performed to determine pooled sensitivity, specificity, and summary receiver-operating characteristic curves. RESULTS On a per-patient basis, the pooled sensitivity of hybrid imaging was comparable to that of coronary CTA (91% vs. 90%; p = 0.28). However, specificity was higher for hybrid imaging versus coronary CTA (93% vs. 66%; p < 0.001). On a per-vessel basis, sensitivity for hybrid imaging against coronary CTA was comparable (84% vs. 89%; p = 0.29). Notably, hybrid imaging yielded a specificity of 95% versus 83% for coronary CTA (p < 0.001). Summary receiver-operating characteristic curves displayed improved discrimination for hybrid imaging beyond coronary CTA alone, on a per-vessel basis (area under the curve: 0.97 vs. 0.93; p = 0.047), although not on a per-patient level (area under the curve: 0.97 vs. 0.93; p = 0.132). CONCLUSIONS Hybrid cardiac imaging demonstrated improved diagnostic specificity for detection of obstructive CAD compared with stand-alone coronary CTA, yet improvement in overall diagnostic performance was relatively limited.
Collapse
Affiliation(s)
- Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Donghee Han
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wijnand J Stuijfzand
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Hadi Mirhedayati Roudsari
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Mahn Won Park
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Jackie Szymonifka
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.
| |
Collapse
|
16
|
Murthy VL, Dorbala S. Clinical value of hyperemic left ventricular systolic function in vasodilator stress testing. J Nucl Cardiol 2017; 24:1002-1006. [PMID: 28271412 DOI: 10.1007/s12350-017-0836-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
Exercise results in increased left ventricular contractility in normal individuals. Similar changes can also be seen with vasodilator stress. This article discusses the physiologic basis of these changes as well as reviews the clinical data supporting the use of these parameters for diagnostic and prognostic evaluation. Methodologic limitations as well as other concomitant pathologic processes which may confound interpretation of stress-induced changes in LVEF are also reviewed.
Collapse
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA.
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| |
Collapse
|
17
|
Chikamori T, Goto K, Hida S, Miyagawa M, Ishimura H, Uchida K, Fukuyama T, Mochizuki T, Yamashina A. Diagnostic performance of a semiconductor gamma-camera system as studied by multicenter registry. J Cardiol 2017; 69:449-455. [DOI: 10.1016/j.jjcc.2016.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/02/2016] [Accepted: 02/23/2016] [Indexed: 11/28/2022]
|
18
|
Tailor TD, Kicska GA, Jacobs JE, Pampaloni MH, Litmanovich DE, Reddy GP. Imaging of Heart Disease in Women. Radiology 2017; 282:34-53. [DOI: 10.1148/radiol.2016151643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
19
|
Makrilakis K, Liatis S. Cardiovascular Screening for the Asymptomatic Patient with Diabetes: More Cons Than Pros. J Diabetes Res 2017; 2017:8927473. [PMID: 29387731 PMCID: PMC5745704 DOI: 10.1155/2017/8927473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/17/2017] [Accepted: 11/05/2017] [Indexed: 12/29/2022] Open
Abstract
Diabetes mellitus is associated with an increased risk of coronary heart disease (CHD) morbidity and mortality. Although it frequently coexists with other cardiovascular disease (CVD) risk factors, it confers an increased risk for CVD events on its own. Coronary atherosclerosis is generally more aggressive and widespread in people with diabetes (PWD) and is frequently asymptomatic. Screening for silent myocardial ischaemia can be applied in a wide variety of ways. In nearly all asymptomatic PWD, however, the results of screening will generally not change medical therapy, since aggressive preventive measures, such as control of blood pressure and lipids, would have been already indicated, and above all, invasive revascularization procedures (either with percutaneous coronary intervention or coronary artery bypass grafting) have not been shown in randomized clinical trials to confer any benefit on morbidity and mortality. Still, unresolved issues remain regarding the extent of the underlying ischaemia that might affect the risk and the benefit of revascularization (on top of optimal medical therapy) in ameliorating this risk in patients with moderate to severe ischaemia. The issues related to the detection of coronary atherosclerosis and ischaemia, as well as the studies related to management of CHD in asymptomatic PWD, will be reviewed here.
Collapse
Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| |
Collapse
|
20
|
Duval S, Leroux M, Davienne Y, Brasselet C. [Myocardial ischaemia detection in women]. Ann Cardiol Angeiol (Paris) 2016; 65:433-439. [PMID: 27810095 DOI: 10.1016/j.ancard.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening of myocardial ischemia refers to the use of one or more diagnostic tests for coronary heart disease with a dual objective of appropriateness and promptness. In women, as compared to men, the accuracy of the different tests is worse. Thus, to overcome this sex-related penalty, we must define a diagnosis strategy based on risk stratification, enabling the identification of patients requiring invasive investigations. This review discusses various non-invasive diagnostic tests focusing on a female-specific approach and defines the use of numerous diagnostic tests with respect to both risk stratification and symptoms.
Collapse
Affiliation(s)
- S Duval
- Unité de cardiologie interventionnelle, polyclinique de Courlancy, 38, rue de Courlancy, 51100 Reims, France
| | - M Leroux
- Unité de cardiologie interventionnelle, polyclinique de Courlancy, 38, rue de Courlancy, 51100 Reims, France
| | - Y Davienne
- Unité de cardiologie interventionnelle, polyclinique de Courlancy, 38, rue de Courlancy, 51100 Reims, France
| | - C Brasselet
- Unité de cardiologie interventionnelle, polyclinique de Courlancy, 38, rue de Courlancy, 51100 Reims, France.
| |
Collapse
|
21
|
Rizvi A, Hartaigh BÓ, Knaapen P, Leipsic J, Shaw LJ, Andreini D, Pontone G, Raman S, Khan MA, Ridner M, Nabi F, Gimelli A, Jang J, Cole J, Nakazato R, Zarins C, Han D, Lee JH, Szymonifika J, Gomez MJ, Truong QA, Chang HJ, Lin FY, Min JK. Rationale and Design of the CREDENCE Trial: computed TomogRaphic evaluation of atherosclerotic DEtermiNants of myocardial IsChEmia. BMC Cardiovasc Disord 2016; 16:190. [PMID: 27716131 PMCID: PMC5053174 DOI: 10.1186/s12872-016-0360-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/27/2016] [Indexed: 01/19/2023] Open
Abstract
Background Coronary computed tomography angiography (CCTA) allows for non-invasive assessment of obstructive coronary artery disease (CAD) beyond measures of stenosis severity alone. This assessment includes atherosclerotic plaque characteristics (APCs) and calculation of fractional flow reserve (FFR) from CCTA (FFRCT). Similarly, stress imaging by myocardial perfusion scintigraphy (MPS) provides vital information. To date, the diagnostic performance of integrated CCTA assessment versus integrated MPS assessment for diagnosis of vessel-specific ischemia remains underexplored. Methods CREDENCE will enroll adult individuals with symptoms suspicious of CAD referred for non-emergent invasive coronary angiography (ICA), but without known CAD. All participants will undergo CCTA, MPS, ICA and FFR. FFR will be performed for lesions identified at the time of ICA to be ≥40 and <90 % stenosis, or those clinically indicated for evaluation. Study analyses will focus on diagnostic performance of CCTA versus MPS against invasive FFR reference standard. An integrated stenosis-APC-FFRCT metric by CCTA for vessel-specific ischemia will be developed from derivation cohort and tested against a validation cohort. Similarly, integrated metric by MPS for vessel-specific ischemia will be developed, validated and compared. An FFR value of ≤0.80 will be considered as ischemia causing. The primary endpoint will be the diagnostic accuracy of vessel territory-specific ischemia of integrated stenosis-APC-FFRCT measure by CCTA, compared with perfusion or perfusion–myocardial blood flow stress imaging testing, against invasive FFR. Discussion CREDENCE will determine the performance of integrated CCTA metric compared to integrated MPS measure for diagnosis of vessel-specific ischemia. If proven successful, this study may reduce the number of missed diagnoses and help to optimally predict ischemia-causing lesions. Trial registration ClinicalTrials.gov, NCT02173275. Registered on June 23, 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0360-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jonathon Leipsic
- Department of Medical Imaging, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Leslee J Shaw
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Gianluca Pontone
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro Cardiologico Monzino, Milan, Italy
| | - Subha Raman
- Davis Heart and Lung Research Institute and Heart Center, The Ohio State University, Columbus, OH, USA
| | | | | | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - James Jang
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, AL, USA
| | - Ryo Nakazato
- Cardiovascular Imaging Lab, St. Luke's International Hospital, Tokyo, Japan
| | - Christopher Zarins
- Heart Flow, Inc., Redwood City, CA, USA.,Department of Surgery, Stanford University, Stanford, CA, USA
| | - Donghee Han
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jackie Szymonifika
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Millie J Gomez
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Quynh A Truong
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA. .,Department of Radiology, Weill Cornell Medical College, New York, NY, USA. .,Radiology and Medicine, New York-Presbyterian Hospital and Weill Cornell Medical College, 413 E. 69th Street, Suite 108, New York, NY, 10021, USA.
| |
Collapse
|
22
|
Sagarad SV, Sukhani N, Machanur B, Patil S. Study to Evaluate Current Trends in Appropriate Usage of Tread Mill Exercise Testing. J Clin Diagn Res 2016; 10:OC40-OC42. [PMID: 27790492 PMCID: PMC5071992 DOI: 10.7860/jcdr/2016/21281.8581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-invasive tests are used to diagnose and prognosticate Coronary Artery Disease (CAD) patients and also in pre-operative evaluation and rehabilitation. Millions of these tests are performed worldwide in these situations. However, previous studies have shown inappropriate use of these tests. AIM The study was to evaluate the appropriate use of treadmill exercise test. MATERIALS AND METHODS The present retrospective study was done in Rajiv Gandhi Super Speciality Hospital, Raichur and Institute of Medical sciences and RKB Super Speciality Clinic, Raichur, Karnataka, India. Tread Mill Tests (TMT) which were done between November 2013 and February 2016 were included in the study. A total of 600 tests were evaluated for appropriateness. Demographic, clinical and risk factors, indications were studied. RESULTS Overall 298 (49.66%) tests were found to be inappro-priate. Younger age, female sex, pre-operative evaluation, evaluation in master health check up and insurance were predictors of inappropriate use (p<0.05) in this study. CONCLUSION The treadmill exercise testing appears to be particularly vulnerable to overuse in clinical setting due to its wide availability, affordability and awareness. The inappropriate use of the method, however, may result in additional unnecessary cost to health care system.
Collapse
Affiliation(s)
- Suresh V Sagarad
- Assistant Professor, Department of Cardiology, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Neha Sukhani
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Basavaraj Machanur
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Shashidhar Patil
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| |
Collapse
|
23
|
Ejlersen JA, Poulsen SH, Mortensen J, May O. A comparison of the diagnostic value of 2D strain stress echocardiography, myocardial perfusion scintigraphy, and Duke treadmill score in patients suspected of coronary artery disease. Echocardiography 2016; 33:1523-1531. [DOI: 10.1111/echo.13297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- June A. Ejlersen
- Cardiovascular Research Unit; Regional Hospital Herning; Herning Denmark
- Department of Nuclear Medicine; Regional Hospital Herning; Herning Denmark
| | - Steen H. Poulsen
- Department of Cardiology; Skejby University Hospital; Aarhus Denmark
| | - Jesper Mortensen
- Department of Nuclear Medicine; Regional Hospital Herning; Herning Denmark
| | - Ole May
- Cardiovascular Research Unit; Regional Hospital Herning; Herning Denmark
| |
Collapse
|
24
|
Brewer LC, Svatikova A, Mulvagh SL. The Challenges of Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women. Cardiovasc Drugs Ther 2016. [PMID: 26210899 DOI: 10.1007/s10557-015-6607-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence suggests that there are significant differences in the presentation, diagnosis and treatment of ischemic heart disease in women compared to men. Women often present with atypical symptoms, and this, in association with a consistent underestimation of their risk for ischemic heart disease, leads to underdiagnosis and undertreatment in women. Cardiovascular risk factors unique to women have only recently been recognized, and moreover, traditional risk factors have recently been shown to have greater impacts on women. Consequently, women suffer more disability and poorer clinical outcomes, with higher cardiovascular morbidity and mortality. These discrepancies may in part be secondary to the higher prevalence of nonobstructive coronary artery disease in women with persistent chest pain symptoms as compared to men when evaluated invasively. Focused diagnostic and therapeutic strategies unique to women are thus needed, but unfortunately, such sex-specific guidelines do not yet exist, largely due to lack of awareness, both on the part of providers and patients, as well as a paucity of evidence-based research specific to women. Although underutilized in women, diagnostic modalities, including functional and anatomic cardiac tests as well as physiologic assessments of endothelial and microvascular function, are useful for establishing the diagnosis and prognosis of suspected ischemic heart disease in women. This review discusses the current challenges of prevention, diagnosis and treatment of ischemic heart disease in women.
Collapse
|
25
|
Boiten HJ, van Domburg RT, Valkema R, Zijlstra F, Schinkel AFL. Dobutamine stress myocardial perfusion imaging: 8-year outcomes in patients with diabetes mellitus. Eur Heart J Cardiovasc Imaging 2016; 17:871-6. [PMID: 26792936 DOI: 10.1093/ehjci/jev351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/13/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Many studies have examined the prognostic value of myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) for the prediction of short- to medium-term outcomes. However, the long-term prognostic value of MPI in patients with diabetes mellitus remains unclear. Therefore, this study assessed the long-term prognostic value of MPI in a high-risk cohort of patients with diabetes mellitus. METHODS AND RESULTS A high-risk cohort of 207 patients with diabetes mellitus who were unable to undergo exercise testing underwent dobutamine stress MPI. Follow-up was successful in 206 patients; 12 patients were excluded due to early revascularization. The current data are based on the remaining 194 patients. Follow-up end points were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. The Kaplan-Meier survival curves were constructed, and univariable and multivariable analyses were performed to identify predictors of long-term outcome. During a mean follow-up of 8.1 ± 5.9 years, 134 (69%) patients died of which 68 (35%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 24 patients (12%), and late (>60 days) coronary revascularization was performed in 61 (13%) patients. Survival analysis showed that MPI provided optimal risk stratification up to 4 years after testing. After that period, the outcome was comparable in patients with normal and abnormal MPI. Multivariable analyses showed that MPI provided incremental prognostic value up to 4 years after testing. CONCLUSION In high-risk patients with diabetes mellitus, dobutamine MPI provides incremental prognostic information in addition to clinical data for a 4-year period after testing.
Collapse
Affiliation(s)
- Hendrik J Boiten
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
26
|
Novel plasma and imaging biomarkers in heart failure with preserved ejection fraction. IJC HEART & VASCULATURE 2015; 9:55-62. [PMID: 28785707 PMCID: PMC5497340 DOI: 10.1016/j.ijcha.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/25/2015] [Indexed: 12/17/2022]
Abstract
Existing diagnostic guidelines for heart failure with preserved ejection fraction (HFPEF) primarily comprise natriuretic peptides and echocardiographic assessment, highlighting the role of diastolic dysfunction. However, recent discoveries of novel plasma markers implicated in pathophysiology of heart failure and technological advances in imaging provide additional biomarkers which are potentially applicable to HFPEF. The evidence base for plasma extra-cellular matrix (ECM) peptides, galectin-3, ST2, GDF-15 and pentraxin-3 is reviewed. Furthermore, the capabilities of novel imaging techniques to assess existing parameters (e.g. left ventricular ejection fraction, systolic & diastolic function, chamber size) and additional derangements of the ECM, myocardial mechanics and ischaemia evaluation are addressed.
Collapse
|
27
|
Argulian E, Chaudhry FA. Evaluating left ventricular systolic dysfunction: Stress echocardiography. J Nucl Cardiol 2015; 22:957-60. [PMID: 26153256 DOI: 10.1007/s12350-015-0116-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Edgar Argulian
- Mount Sinai St Luke's Hospital, 1111 Amsterdam Ave, New York, NY, USA.
| | - Farooq A Chaudhry
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, USA.
| |
Collapse
|
28
|
Chatal JF, Rouzet F, Haddad F, Bourdeau C, Mathieu C, Le Guludec D. Story of Rubidium-82 and Advantages for Myocardial Perfusion PET Imaging. Front Med (Lausanne) 2015; 2:65. [PMID: 26442267 PMCID: PMC4566054 DOI: 10.3389/fmed.2015.00065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/26/2015] [Indexed: 01/07/2023] Open
Abstract
Rubidium-82 has a long story, starting in 1954. After preclinical studies in dogs showing that myocardial uptake of this radionuclide was directly proportional to myocardial blood flow (MBF), clinical studies were performed in the 80s leading to an approval in the USA in 1989. From that time, thousands of patients have been tested and their results have been reported in three meta-analyses. Pooled patient-based sensitivity and specificity were, respectively, 0.91 and 0.90. By comparison with 99mTc-SPECT, 82Rb PET had a much better diagnostic accuracy, especially in obese patients with body mass index ≥30 kg/m2 (85 versus 67% with SPECT) and in women with large breasts. A great advantage of 82Rb PET is its capacity to accurately quantify MBF. Quite importantly, it has been recently shown that coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity. Moreover, coronary flow reserve is a functional parameter particularly useful in the estimate of microvascular dysfunction, such as in diabetes mellitus. Due to the very short half-life of rubidium-82, the effective dose calculated for a rest/stress test is roughly equivalent to the annual natural exposure and even less when stress-only is performed with a low activity compatible with a good image quality with the last generation 3D PET scanners. There is still some debate on the relative advantages of 82Rb PET with regard to 99mTc-SPECT. For the last 10 years, great technological advances substantially improved performances of SPECT with its accuracy getting closer to this of 82Rb/PET. Currently, the main advantages of PET are its capacity to accurately quantify MBF and to deliver a low radiation exposure.
Collapse
Affiliation(s)
- Jean-François Chatal
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - François Rouzet
- UMR 1148, Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases), Paris-Diderot University , Paris , France
| | - Ferid Haddad
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - Cécile Bourdeau
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - Cédric Mathieu
- Department of Nuclear Medicine, Nantes University Hospital , Nantes , France
| | - Dominique Le Guludec
- UMR 1148, Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases), Paris-Diderot University , Paris , France
| |
Collapse
|
29
|
Abstract
Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study, save time in the imaging laboratory, and reduce the radiation exposure to patients and laboratory staff. Converting a nuclear cardiology laboratory from a conventional rest-stress strategy to a stress-first approach involves challenges such as the need for attenuation correction, triage of patients to an appropriate protocol, real-time review of stress images, and consideration of differential reimbursement.
Collapse
Affiliation(s)
- Nasir Hussain
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Matthew W Parker
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Milena J Henzlova
- Mount Sinai Heart, Mount Hospital, One Gustave L Levy Place, New York, NY 10029, USA
| | - William Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
| |
Collapse
|
30
|
Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015; 8. [PMID: 26500716 DOI: 10.1007/s12410-015-9344-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.
Collapse
|
31
|
Al-Mallah MH, Aljizeeri A. An Increasing Population with Metabolic Syndrome and/or Diabetes Mellitus in the Middle East—Is There an Added Value of Coronary Calcium Scoring to Myocardial Perfusion Imaging? CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Echocardiographic Evaluation of Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Shah N, Soon K, Wong C, Kelly AM. Screening for asymptomatic coronary heart disease in the young 'at risk' population: Who and how? IJC HEART & VASCULATURE 2014; 6:60-65. [PMID: 28785628 PMCID: PMC5497146 DOI: 10.1016/j.ijcha.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/20/2014] [Indexed: 01/13/2023]
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
Collapse
|
34
|
Becker M, Hundemer A, Zwicker C, Altiok E, Krohn T, Mottaghy FM, Lente C, Kelm M, Marx N, Hoffmann R. Detection of coronary artery disease in postmenopausal women: the significance of integrated stress imaging tests in a 4-year prognostic study. Clin Res Cardiol 2014; 104:258-71. [PMID: 25367244 DOI: 10.1007/s00392-014-0780-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The present prospective study investigated whether a combined approach integrating two different stress imaging modalities may improve the diagnostic accuracy and prognostic impact of non-invasive coronary artery disease (CAD) tests in postmenopausal women. In women non-invasive tests for detecting CAD are less accurate than in men, leading to a high proportion of unnecessary coronary angiographies (CAs). METHODS 424 consecutive postmenopausal women (mean 61 ± 7 years, mean Reynolds Risk Score 13 ± 3 %) with symptoms suggestive of CAD were prospectively included and followed up for 4 ± 1 years. Each patient underwent CA, stress cardiovascular magnetic resonance (CMR) by adenosine, dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) within 7 ± 3 days. RESULTS Anatomically obstructive coronary artery disease (≥50 % diameter stenosis) was present in 157 women (37 %). The combination of two stress imaging modalities significantly increased the positive predictive values (PPV) to 90 ± 3, 88 ± 3 and 87 ± 2 % for CMR/DSE, DSE/SPECT and CMR/SPECT, respectively. For patients with negative combined test results, the survival analysis showed a 4-year cumulative event-free survival rate of 96-97 % for all combinations. This new approach is cost effective due to the resulting reduction in unnecessary CAs (with potential side effects and corresponding therapies) as well as reducing hospitalization time. CONCLUSIONS In symptomatic postmenopausal women, combination of two negative stress imaging results significantly increases the PPV for detection of CAD and excludes future cardiovascular events with high accuracy. This approach may be applied to improve the prognostic precision of non-invasive CAD tests and to avoid unnecessary CAs.
Collapse
Affiliation(s)
- Michael Becker
- Department of Cardiology, RWTH Aachen University, Aachen, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Conti A, Mariannini Y, Canuti E, Petrova T, Innocenti F, Zanobetti M, Gallini C, Costanzo E. Nuclear scan strategy and outcomes in chest pain patients value of stress testing with dipyridamole or adenosine. World J Nucl Med 2014; 13:94-101. [PMID: 25191123 PMCID: PMC4150166 DOI: 10.4103/1450-1147.139138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective: To update the prognostic value of scan strategy with pharmacological stress agent in chest pain (CP) patients presenting with normal electrocardiography (ECG) and troponin. Methods: Two consecutive nonrandomized series of patients with CP and negative first-line workup inclusive of serial ECG, serial troponin, and echocardiography underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) in the emergency department. Of 170 patients enrolled, 52 patients underwent dipyridamole-SPECT and 118 adenosine-SPECT. Patients with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed-up. Primary endpoint was the composite of nonfatal myocardial infarction, unstable angina, revascularization, and cardiovascular death at follow-up or the presence of coronary stenosis > 50% at angiography. Results: At multivariate analysis, the presence of perfusion defects or hypertension was independent predictor of the primary endpoint. Sensitivity and negative predictive value were higher in patients subjected to adenosine-SPECT (95% and 99%, respectively) versus dipyridamole-SPECT (56% and 89%; yield 70% and 11%, respectively; P < 0.03). Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively). Conclusions: In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT. Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.
Collapse
Affiliation(s)
- Alberto Conti
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Yuri Mariannini
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Erica Canuti
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Tetyana Petrova
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Francesca Innocenti
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Maurizio Zanobetti
- Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Chiara Gallini
- Department of Nuclear Medicine, Careggi University Hospital, Florence, Italy
| | - Egidio Costanzo
- Department of Nuclear Medicine, Careggi University Hospital, Florence, Italy
| |
Collapse
|
36
|
Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
37
|
Ben-Haim S, Almukhailed O, Neill J, Slomka P, Allie R, Shiti D, Berman DS, Bomanji J. Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera. J Nucl Cardiol 2014; 21:478-85. [PMID: 24477404 DOI: 10.1007/s12350-014-9853-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients. METHODS AND RESULTS Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001). CONCLUSION Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.
Collapse
Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, UK,
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Shaikh K, Wang DD, Saad H, Alam M, Khandelwal A, Brooks K, Iyer H, Nguyen P, Boedeker S, Ananthasubramaniam K. Feasibility, safety and accuracy of regadenoson-atropine (REGAT) stress echocardiography for the diagnosis of coronary artery disease: an angiographic correlative study. Int J Cardiovasc Imaging 2014; 30:515-22. [PMID: 24463854 DOI: 10.1007/s10554-014-0363-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/04/2014] [Indexed: 11/25/2022]
Abstract
Regadenoson (REG), a selective A2A receptor vasodilator, has not been widely evaluated in stress echocardiography (SE). We report results of 45 patients participating in REG + atropine (REGAT) SE protocol conducted in a single-center prospective trial. The REGAT study enrolled subjects before a clinically indicated cardiac catheterization for suspected coronary artery disease (CAD). After rest imaging, a 2 mg Atropine (AT) bolus followed by 400 mcg of REG was given. Standard stress imaging views were obtained and interpreted in blinded fashion. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated using cardiac catheterization >70 % stenosis as gold standard. Additional endpoints included major adverse cardiac events (MACE) and patient questionnaire responses. The mean duration of REGAT was 18 ± 7.2 min. There were no MACE, with only transient side-effects of dry mouth, shortness of breath, and headache. The incidence of significant CAD was 51.1 %. The sensitivity and specificity for significant stenosis was 60.9 and 86.4 %, with a PPV and NPV of 82.4 and 67.9 %. By coronary territories, the sensitivity, specificity, PPV, and NPV were: left anterior descending artery 58.8, 92.9, 83.3, and 78.8 %; left circumflex artery 6.7, 93.3, 33.3, and 67.7 %; and right coronary artery 16.7, 93.9, 50, and 75.6 %. Over 90 % of subjects reported feeling comfortable, with 83 % preferring REGAT as a future stress modality. The REGAT protocol is fast, safe, and well-tolerated with good specificity for CAD detection, but its low sensitivity and NPV precludes it from being an imaging modality for routine use.
Collapse
Affiliation(s)
- Kamran Shaikh
- Seton Heart Institute, Seton Medical Center, Kyle, TX, 78640, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Supariwala A, Makani H, Kahan J, Pierce M, Bajwa F, Dukkipati SS, Teixeira J, Chaudhry FA. Feasibility and prognostic value of stress echocardiography in obese, morbidly obese, and super obese patients referred for bariatric surgery. Echocardiography 2013; 31:879-85. [PMID: 24341900 DOI: 10.1111/echo.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stress echocardiography (SE) is clinically used in the risk stratification and prognosis of patients with coronary artery disease. Due to multiple comorbidities, obese patients have increased risk of adverse cardiovascular events perioperatively in noncardiac surgery. The aim of this study was to investigate the feasibility of SE in morbidly obese patients undergoing bariatric surgery. METHODS Consecutive patients referred for SE for preoperative evaluation prior to bariatric surgery from January 2002 to July 2011 formed the study cohort. Contrast was used to define the endocardial border in patients with poor acoustic windows. All-cause mortality data were obtained from Social Security Death Index. RESULTS Six hundred fifty-two patients (47 ± 10 years, 84% females) with the mean follow-up of 3.0 ± 2.7 years and mean body mass index (BMI) of 47 ± 9 kg/m² were included in this analysis. Dobutamine SE was performed in 65% of patients compared to exercise SE in 35%. Patients with higher BMI were more likely to undergo dobutamine SE (P < 0.0001). Similarly, incidence of poor acoustic windows and contrast use was higher in those with increased BMI (P < 0.001). Contrast use was higher in patients undergoing dobutamine SE (39%) versus exercise (25%), (P = 0.002). 19 patients (3%) had an abnormal SE and 8 patients (1.2%) died during the follow-up period. CONCLUSION Stress echocardiography is feasible in the morbidly obese patients. Patients with higher BMI were more likely to undergo dobutamine SE and have higher incidence of poor acoustic windows and contrast use.
Collapse
Affiliation(s)
- Azhar Supariwala
- Division of Cardiology, Department of Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is associated with significant morbidity, mortality, and costs. Prompt diagnosis may help decrease mortality, hospital stay, and costs related to treatment. A complete heart failure evaluation comprises a comprehensive history and physical examination, echocardiogram, and diagnostic tools that provide information regarding the etiology of heart failure, related complications, and prognosis in order to prescribe appropriate therapy, monitor response to therapy, and transition expeditiously to advanced therapies when needed. Emerging technologies and biomarkers may provide better risk stratification and more accurate determination of cause and progression.
Collapse
Affiliation(s)
- Maria Patarroyo-Aponte
- Division of Cardiovascular Medicine, University of Minnesota Medical Center, Lillehei Heart Institute, University of Minnesota, 420 Delaware Street Southeast, MMC 508, Minneapolis, MN 55455, USA
| | | |
Collapse
|
41
|
Pharmacologic manipulation of coronary vascular physiology for the evaluation of coronary artery disease. Pharmacol Ther 2013; 140:121-32. [DOI: 10.1016/j.pharmthera.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/24/2022]
|
42
|
Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, Clark TPR, Sapsford RJ, Dickinson CJ, Patel CN, Thorley PJ. Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: prognostic value and diagnostic accuracy in a 'real-world' nuclear cardiology service. Eur Heart J Cardiovasc Imaging 2013; 15:275-83. [DOI: 10.1093/ehjci/jet149] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
43
|
Leeflang MMG, Rutjes AWS, Reitsma JB, Hooft L, Bossuyt PMM. Variation of a test's sensitivity and specificity with disease prevalence. CMAJ 2013; 185:E537-44. [PMID: 23798453 DOI: 10.1503/cmaj.121286] [Citation(s) in RCA: 342] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anecdotal evidence suggests that the sensitivity and specificity of a diagnostic test may vary with disease prevalence. Our objective was to investigate the associations between disease prevalence and test sensitivity and specificity using studies of diagnostic accuracy. METHODS We used data from 23 meta-analyses, each of which included 10-39 studies (416 total). The median prevalence per review ranged from 1% to 77%. We evaluated the effects of prevalence on sensitivity and specificity using a bivariate random-effects model for each meta-analysis, with prevalence as a covariate. We estimated the overall effect of prevalence by pooling the effects using the inverse variance method. RESULTS Within a given review, a change in prevalence from the lowest to highest value resulted in a corresponding change in sensitivity or specificity from 0 to 40 percentage points. This effect was statistically significant (p < 0.05) for either sensitivity or specificity in 8 meta-analyses (35%). Overall, specificity tended to be lower with higher disease prevalence; there was no such systematic effect for sensitivity. INTERPRETATION The sensitivity and specificity of a test often vary with disease prevalence; this effect is likely to be the result of mechanisms, such as patient spectrum, that affect prevalence, sensitivity and specificity. Because it may be difficult to identify such mechanisms, clinicians should use prevalence as a guide when selecting studies that most closely match their situation.
Collapse
Affiliation(s)
- Mariska M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
44
|
Diagnostik und Therapie der chronischen Myokardischämie. Herz 2013; 38:334-43. [DOI: 10.1007/s00059-013-3813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Sharma K, Gulati M. Coronary artery disease in women: a 2013 update. Glob Heart 2013; 8:105-12. [PMID: 25690374 DOI: 10.1016/j.gheart.2013.02.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. CAD's impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. Trial data indicate that CAD should be managed differently in women. In this review, we will examine risk assessment for CAD in women, CAD's impact on women, as well as CAD's female-specific presentation and management strategies.
Collapse
Affiliation(s)
- Kavita Sharma
- Department of Medicine (Cardiology), The Ohio State University, Columbus, OH, USA
| | - Martha Gulati
- Department of Medicine (Cardiology), The Ohio State University, Columbus, OH, USA; School of Clinical Public Health (Epidemiology), The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
46
|
Paterson I, Mielniczuk LM, O'Meara E, So A, White JA. Imaging Heart Failure: Current and Future Applications. Can J Cardiol 2013; 29:317-28. [DOI: 10.1016/j.cjca.2013.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 01/11/2023] Open
|
47
|
1,25-Dihydroxy vitamin D and coronary microvascular function. Eur J Nucl Med Mol Imaging 2012; 40:280-9. [DOI: 10.1007/s00259-012-2271-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/01/2012] [Indexed: 12/19/2022]
|
48
|
Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, Calamari B, Coleman CI, Heller GV. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging 2012; 5:700-7. [PMID: 23051888 DOI: 10.1161/circimaging.112.978270] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Positron emission tomography (PET) myocardial perfusion imaging (MPI) offers technical benefits compared with single photon emission computed tomography (SPECT) MPI, but there has been no systematic comparison of their diagnostic accuracy for coronary artery disease. We performed a bivariate meta-analysis of the published literature to compare the sensitivity and specificity of PET versus SPECT stress MPI for ≥50% stenosis of any epicardial coronary artery in patients with known or suspected coronary artery disease. METHODS AND RESULTS We searched MEDLINE and EMBASE from inception through January 2012 and the references of identified studies for prospective, English language studies that evaluated the sensitivity and specificity of PET and/or SPECT MPI with coronary angiography as the reference standard and reported sufficient data to calculate patient-level true and false positives and negatives. Two investigators independently extracted patient and study characteristics; a third investigator resolved any disagreements. We identified 117 studies, including 108 evaluating SPECT MPI, 4 evaluating PET MPI, and 5 evaluating both modalities. Bivariate meta-analysis demonstrated a significantly higher pooled mean sensitivity with PET (92.6% [95% Confidence Interval, 88.3% to 95.5%]) compared with SPECT (88.3% [95% confidence interval, 86.4% to 90.0%]) (P=0.035). No significant difference in specificity was observed between PET (81.3% [95% confidence interval, 66.6% to 90.4%]) and SPECT (75.8% [95% confidence interval, 72.1% to 79.1%]) (P=0.39). Few studies investigated coronary angiography with PET. Only 5 studies directly compared SPECT and PET. CONCLUSIONS In a meta-analysis of 11,862 patients, PET MPI demonstrated a higher sensitivity for coronary artery disease than SPECT MPI. No difference in specificity was detected in the pooled analysis of PET and SPECT MPI.
Collapse
Affiliation(s)
- Matthew W Parker
- Departments of Medicine, University of Connecticut School of Medicine, Farmington, CT 06102, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Bivariate meta-analysis of predictive values of diagnostic tests can be an alternative to bivariate meta-analysis of sensitivity and specificity. J Clin Epidemiol 2012; 65:1088-97. [DOI: 10.1016/j.jclinepi.2012.03.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/20/2012] [Accepted: 03/26/2012] [Indexed: 01/05/2023]
|
50
|
Wang Y, Guo T, Ma TK, Cai HY, Tao SM, Peng YZ, Yang P, Chen MQ, Gu Y. A modified regimen of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease. Cardiovasc Ultrasound 2012; 10:35. [PMID: 22898340 PMCID: PMC3537548 DOI: 10.1186/1476-7120-10-35] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/09/2012] [Indexed: 11/16/2022] Open
Abstract
Background Cardiac shock wave therapy (CSWT) improves cardiac function in patients with severe coronary artery disease (CAD). We aimed to evaluate the clinical outcomes of a new CSWT treatment regimen. Methods The 55 patients with severe CAD were randomly divided into 3 treatment groups. The control group (n = 14) received only medical therapy. In group A ( n = 20), CSWT was performed 3 times within 3 months. In group B ( n = 21), patients underwent 3 CSWT sessions/week, and 9 treatment sessions were completed within 1 month. Primary outcome measurement was 6-minute walk test (6MWT). Other measurements were also evaluated. Results The 6MWT, CCS grading of angina, dosage of nitroglycerin, NYHA classification, and SAQ scores were improved in group A and B compared to control group. Conclusions A CSWT protocol with 1 month treatment duration showed similar therapeutic efficacy compared to a protocol of 3 months duration. Clinical trial registry We have registered on ClinicalTrials.gov, the protocol ID is CSWT IN CHINA.
Collapse
Affiliation(s)
- Yu Wang
- Department of Cardiology, 1st Hospital of Kunming Medical University, Kunming, Yunnan, PRC
| | | | | | | | | | | | | | | | | |
Collapse
|