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Hijazi W, Feng Y, Southern DA, Chew D, Filipchuk N, Har B, James M, Wilton S, Slomka PJ, Berman D, Miller RJH. Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:482-490. [PMID: 37889992 DOI: 10.1093/ehjci/jead288] [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: 08/21/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) remains one of the most widely used imaging modalities for the diagnosis and prognostication of coronary artery disease (CAD). Despite the extensive prognostic information provided by MPI, little is known about how this influences the prescription of medical therapy for CAD. We evaluated the relationship between MPI with computed tomography (CT) attenuation correction and prescription of acetylsalicylic acid (ASA) and statins. METHODS AND RESULTS We performed a retrospective analysis of consecutive patients who underwent SPECT MPI at a single centre between 2015 and 2021. Myocardial perfusion abnormalities and coronary calcium burden were assessed, with attenuation correction imaging 77.8% of patients. Medication prescriptions before and within 180 days after the test were compared. Associations between abnormal perfusion and calcium burden with ASA and statin prescription were assessed using multivariable logistic regression. In total, 9908 patients were included, with a mean age 66.8 ± 11.7 years and 5337 (53.9%) males. The prescription of statins increased more in patients with abnormal perfusion (increase of 19.2 vs. 12.0%, P < 0.001). Similarly, the presence of extensive CAC led to a greater increase in statin prescription compared with no calcium (increase 12.1 vs. 7.8%, P < 0.001). In multivariable analyses, ischaemia and coronary artery calcium were independently associated with ASA and statin prescription. CONCLUSION Abnormal MPI testing was associated with significant changes in medical therapy. Both calcium burden and perfusion abnormalities were associated with increased prescriptions of medical therapy for CAD.
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Affiliation(s)
- Waseem Hijazi
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Yuanchao Feng
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Danielle A Southern
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Derek Chew
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Neil Filipchuk
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Bryan Har
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Matthew James
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Stephen Wilton
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Daniel Berman
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
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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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3
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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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Pontone G, Rossi A, Gimelli A, Neglia D. Should we choose CT angiography first instead of SPECT/PET first for the diagnosis and management of coronary artery disease? Atherosclerosis 2023; 385:117315. [PMID: 37890440 DOI: 10.1016/j.atherosclerosis.2023.117315] [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: 06/21/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
In patients presenting with chest pain, current guidelines recommend the use of coronary computed tomography angiography and single-photon emission tomography/positron emission tomography, both with equal class 1 indication and level of evidence A. There is no clear recommendation on which test should be used as a first-line test. The choice of the test should be based on individualized clinical risk assessment, patient characteristics, local expertise/availability, and patient preferences. In this context, it is fair to ask which non-invasive imaging test to choose. The debate reproduced in this article answers this question by summarizing the considerations in selecting present state-of-the-art criteria of the right test for the right patient to ensure efficient resource utilization, minimize unnecessary testing, and maximize diagnostic accuracy and therapeutic efficacy.
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Affiliation(s)
- Gianluca Pontone
- Department of Periooperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Danilo Neglia
- Cardiovascular and Imaging Departments, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sant'Anna School of Advanced Studies, Pisa, Italy
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5
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Liga R, Gimelli A. Coronary physiology in the cath lab: is "virtual FFR" ready for the prime time? J Nucl Cardiol 2023; 30:1983-1985. [PMID: 37165115 DOI: 10.1007/s12350-023-03289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Riccardo Liga
- Università di Pisa, Pisa, Italy
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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6
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Miller RJH, Pieszko K, Shanbhag A, Feher A, Lemley M, Killekar A, Kavanagh PB, Van Kriekinge SD, Liang JX, Huang C, Miller EJ, Bateman T, Berman DS, Dey D, Slomka PJ. Deep Learning Coronary Artery Calcium Scores from SPECT/CT Attenuation Maps Improve Prediction of Major Adverse Cardiac Events. J Nucl Med 2023; 64:652-658. [PMID: 36207138 PMCID: PMC10071789 DOI: 10.2967/jnumed.122.264423] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Low-dose ungated CT attenuation correction (CTAC) scans are commonly obtained with SPECT/CT myocardial perfusion imaging. Despite the characteristically low image quality of CTAC, deep learning (DL) can potentially quantify coronary artery calcium (CAC) from these scans in an automatic manner. We evaluated CAC quantification derived with a DL model, including correlation with expert annotations and associations with major adverse cardiovascular events (MACE). Methods: We trained a convolutional long short-term memory DL model to automatically quantify CAC on CTAC scans using 6,608 studies (2 centers) and evaluated the model in an external cohort of patients without known coronary artery disease (n = 2,271) obtained in a separate center. We assessed agreement between DL and expert annotated CAC scores. We also assessed associations between MACE (death, revascularization, myocardial infarction, or unstable angina) and CAC categories (0, 1-100, 101-400, or >400) for scores manually derived by experienced readers and scores obtained fully automatically by DL using multivariable Cox models (adjusted for age, sex, past medical history, perfusion, and ejection fraction) and net reclassification index. Results: In the external testing population, DL CAC was 0 in 908 patients (40.0%), 1-100 in 596 (26.2%), 100-400 in 354 (15.6%), and >400 in 413 (18.2%). Agreement in CAC category by DL CAC and expert annotation was excellent (linear weighted κ, 0.80), but DL CAC was obtained automatically in less than 2 s compared with about 2.5 min for expert CAC. DL CAC category was an independent risk factor for MACE with hazard ratios in comparison to a CAC of zero: CAC of 1-100 (2.20; 95% CI, 1.54-3.14; P < 0.001), CAC of 101-400 (4.58; 95% CI, 3.23-6.48; P < 0.001), and CAC of more than 400 (5.92; 95% CI, 4.27-8.22; P < 0.001). Overall, the net reclassification index was 0.494 for DL CAC, which was similar to expert annotated CAC (0.503). Conclusion: DL CAC from SPECT/CT attenuation maps agrees well with expert CAC annotations and provides a similar risk stratification but can be obtained automatically. DL CAC scores improved classification of a significant proportion of patients as compared with SPECT myocardial perfusion alone.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Góra, Zielona Góra, Poland
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, Missouri
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California;
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Liga R, Colli A, Taggart DP, Boden WE, De Caterina R. Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How. J Am Heart Assoc 2023; 12:e026943. [PMID: 36892041 PMCID: PMC10111551 DOI: 10.1161/jaha.122.026943] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 03/10/2023]
Abstract
Background Myocardial revascularization has been advocated to improve myocardial function and prognosis in ischemic cardiomyopathy (ICM). We discuss the evidence for revascularization in patients with ICM and the role of ischemia and viability detection in guiding treatment. Methods and Results We searched for randomized controlled trials evaluating the prognostic impact of revascularization in ICM and the value of viability imaging for patient management. Out of 1397 publications, 4 randomized controlled trials were included, enrolling 2480 patients. Three trials (HEART [Heart Failure Revascularisation Trial], STICH [Surgical Treatment for Ischemic Heart Failure], and REVIVED [REVascularization for Ischemic VEntricular Dysfunction]-BCIS2) randomized patients to revascularization or optimal medical therapy. HEART was stopped prematurely without showing any significant difference between treatment strategies. STICH showed a 16% lower mortality with bypass surgery compared with optimal medical therapy at a median follow-up of 9.8 years. However, neither the presence/extent of left ventricle viability nor ischemia interacted with treatment outcomes. REVIVED-BCIS2 showed no difference in the primary end point between percutaneous revascularization or optimal medical therapy. PARR-2 (Positron Emission Tomography and Recovery Following Revascularization) randomized patients to imaging-guided revascularization versus standard care, with neutral results overall. Information regarding the consistency of patient management with viability testing results was available in ≈65% of patients (n=1623). No difference in survival was revealed according to adherence or no adherence to viability imaging. Conclusions In ICM, the largest randomized controlled trial, STICH, suggests that surgical revascularization improves patients' prognosis at long-term follow-up, whereas evidence supports no benefit of percutaneous coronary intervention. Data from randomized controlled trials do not support myocardial ischemia or viability testing for treatment guidance. We propose an algorithm for the workup of patients with ICM considering clinical presentation, imaging results, and surgical risk.
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Affiliation(s)
- Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - Andrea Colli
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - David P. Taggart
- Nuffield Department of Surgical SciencesOxford University John Radcliffe HospitalOxfordUnited Kingdom
| | - William E. Boden
- VA Boston Healthcare SystemBoston University School of MedicineBostonMA
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
- Fondazione VillaSerena per la Ricerca, Città Sant'AngeloItaly
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Miller RJH, Rozanski A, Slomka PJ, Han D, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Development and validation of ischemia risk scores. J Nucl Cardiol 2023; 30:324-334. [PMID: 35484468 DOI: 10.1007/s12350-022-02976-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The likelihood of ischemia on myocardial perfusion imaging is central to physician decisions regarding test selection, but dedicated risk scores are lacking. We derived and validated two novel ischemia risk scores to support physician decision making. METHODS Risk scores were derived using 15,186 patients and validated with 2,995 patients from a different center. Logistic regression was used to assess associations with ischemia to derive point-based and calculated ischemia scores. Predictive performance for ischemia was assessed using area under the receiver operating characteristic curve (AUC) and compared with the CAD consortium basic and clinical models. RESULTS During derivation, the calculated ischemia risk score (0.801) had higher AUC compared to the point-based score (0.786, p < 0.001). During validation, the calculated ischemia score (0.716, 95% CI 0.684- 0.748) had higher AUC compared to the point-based ischemia score (0.699, 95% CI 0.666- 0.732, p = 0.016) and the clinical CAD model (AUC 0.667, 95% CI 0.633- 0.701, p = 0.002). Calibration for both ischemia scores was good in both populations (Brier score < 0.100). CONCLUSIONS We developed two novel risk scores for predicting probability of ischemia on MPI which demonstrated high accuracy during model derivation and in external testing. These scores could support physician decisions regarding diagnostic testing strategies.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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9
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Singh A, Miller RJH, Otaki Y, Kavanagh P, Hauser MT, Tzolos E, Kwiecinski J, Van Kriekinge S, Wei CC, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Liang JX, Huang C, Han D, Dey D, Berman DS, Slomka PJ. Direct Risk Assessment From Myocardial Perfusion Imaging Using Explainable Deep Learning. JACC Cardiovasc Imaging 2023; 16:209-220. [PMID: 36274041 PMCID: PMC10980287 DOI: 10.1016/j.jcmg.2022.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 07/21/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is frequently used to provide risk stratification, but methods to improve the accuracy of these predictions are needed. OBJECTIVES The authors developed an explainable deep learning (DL) model (HARD MACE [major adverse cardiac events]-DL) for the prediction of death or nonfatal myocardial infarction (MI) and validated its performance in large internal and external testing groups. METHODS Patients undergoing single-photon emission computed tomography MPI were included, with 20,401 patients in the training and internal testing group (5 sites) and 9,019 in the external testing group (2 different sites). HARD MACE-DL uses myocardial perfusion, motion, thickening, and phase polar maps combined with age, sex, and cardiac volumes. The primary outcome was all-cause mortality or nonfatal MI. Prognostic accuracy was evaluated using area under the receiver-operating characteristic curve (AUC). RESULTS During internal testing, patients with normal perfusion and elevated HARD MACE-DL risk were at higher risk than patients with abnormal perfusion and low HARD MACE-DL risk (annualized event rate, 2.9% vs 1.2%; P < 0.001). Patients in the highest quartile of HARD MACE-DL score had an annual rate of death or MI (4.8%) 10-fold higher than patients in the lowest quartile (0.48% per year). In external testing, the AUC for HARD MACE-DL (0.73; 95% CI: 0.71-0.75) was higher than a logistic regression model (AUC: 0.70), stress total perfusion deficit (TPD) (AUC: 0.65), and ischemic TPD (AUC: 0.63; all P < 0.01). Calibration, a measure of how well predicted risk matches actual risk, was excellent in both groups (Brier score, 0.079 for internal and 0.070 for external). CONCLUSIONS The DL model predicts death or MI directly from MPI, by estimating patient-level risk with good calibration and improved accuracy compared with traditional quantitative approaches. The model incorporates mechanisms to explain to the physician which image regions contribute to the adverse event prediction.
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Affiliation(s)
- Ananya Singh
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J H Miller
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Yuka Otaki
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Paul Kavanagh
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael T Hauser
- Department of Nuclear Cardiology, Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Serge Van Kriekinge
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chih-Chun Wei
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel; Department of Nuclear Cardiology, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, Oregon, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Philipp A Kaufmann
- Division of Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joanna X Liang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Cathleen Huang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Donghee Han
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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10
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Gimelli A, Lakshmanan S, Della Tommasina V, Liga R. What Is New in Risk Assessment in Nuclear Cardiology? Cardiol Clin 2023; 41:197-205. [PMID: 37003677 DOI: 10.1016/j.ccl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Nuclear cardiology techniques allow in-depth evaluation of cardiac patients. A body of literature has established the use of nuclear cardiology. The results obtained with traditional cameras have been reinforced by those obtained with a series of innovations that have revolutionized the field of nuclear cardiology. This article highlights the role of nuclear cardiology in the risk assessment of patients with cardiac disease and sheds light on advancements of nuclear imaging techniques in the cardiovascular field. Patient risk stratification has a key role in modern precision medicine. Nuclear cardiac imaging techniques may quantitatively investigate major disease mechanisms of different cardiac pathologies.
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11
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Georgiopoulos G, Mavraganis G, Aimo A, Giorgetti A, Cavaleri S, Fabiani I, Giannoni A, Emdin M, Gimelli A. Sex-specific associations of myocardial perfusion imaging with outcomes in patients with suspected chronic coronary syndrome. Hellenic J Cardiol 2022; 71:8-15. [PMID: 36566838 DOI: 10.1016/j.hjc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) is an established diagnostic technique for inducible ischemia in patients with suspected chronic coronary syndrome (CCS). Some MPS findings, most notably an ischemia extent>10% of the left ventricle (LV), hold prognostic significance and support maximization of anti-ischemic treatment. We aimed to assess sex-specific associations of MPS findings with cardiovascular (CV) events in a population at high risk of CCS. METHODS In a prospective cohort study, 1,229 consecutive patients (age 70 ± 9.5 years, 73.5% males) without known CCS were referred to stress-rest MPS. All patients were followed for a median of 4.6 years for CV events. RESULTS Men and women had comparable risk profiles and incidence rates of CV events (6.6% vs. 4.6% respectively, P = 0.186). A summed stress score (SSS) > 7 was associated with the primary endpoint, including CV death and/or nonfatal myocardial infarction (MI) (adjusted hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.79-5.46; P = 0.001), all-cause mortality (HR, 3.01; 95% CI, 1.31-6.93; P = 0.01), and incidence of late revascularization (HR, 1.84; 95% CI, 1.22-2.78; P = 0.004) in men but not women. A summed difference score (SDS) > 6 was related to a higher rate of the primary endpoint only in men (adjusted HR, 1.97; 95% CI, 1.18-3.30; P = 0.009). CONCLUSIONS Among patients undergoing a diagnostic workup for suspected CCS, stress perfusion and reversible ischemia abnormalities may independently predict worse survival and more CV events in men. However, the obtained results indicated the need for sex-specific cutoffs to refine risk stratification and assist in clinical decisions on anti-ischemic therapy beyond coronary artery anatomy.
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Affiliation(s)
- Georgios Georgiopoulos
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, Strand, London WC2R 2LS, London, UK.
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Assuero Giorgetti
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Samuele Cavaleri
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Iacopo Fabiani
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
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12
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Kuronuma K, Han D, Miller RJH, Rozanski A, Gransar H, Dey D, Hayes SW, Friedman JD, Thomson L, Slomka PJ, Berman DS. Long-term Survival Benefit From Revascularization Compared With Medical Therapy in Patients With or Without Diabetes Undergoing Myocardial Perfusion Single Photon Emission Computed Tomography. Diabetes Care 2022; 45:3016-3023. [PMID: 36001757 DOI: 10.2337/dc22-0454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the long-term association of survival benefit from early revascularization with the magnitude of ischemia in patients with diabetes compared with those without diabetes using a large observational cohort of patients undergoing single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). RESEARCH DESIGN AND METHODS Of 41,982 patients who underwent stress and rest SPECT-MPI from 1998 to 2017, 8,328 (19.8%) had diabetes. A propensity score was used to match 8,046 patients with diabetes to 8,046 patients without diabetes. Early revascularization was defined as occurring within 90 days after SPECT-MPI. The percentage of myocardial ischemia was assessed from the magnitude of reversible myocardial perfusion defect on SPECT-MPI. RESULTS Over a median 10.3-year follow-up, the annualized mortality rate was higher for the patients with diabetes compared with those without diabetes (4.7 vs. 3.6%; P < 0.001). There were significant interactions between early revascularization and percent myocardial ischemia in patients with and without diabetes (all interaction P values <0.05). After adjusting for confounding variables, survival benefit from early revascularization was observed in patients with diabetes above a threshold of >8.6% ischemia and in patients without diabetes above a threshold of >12.1%. Patients with diabetes receiving insulin had a higher mortality rate (6.2 vs. 4.1%; P < 0.001), but there was no interaction between revascularization and insulin use (interaction P value = 0.405). CONCLUSIONS Patients with diabetes, especially those on insulin treatment, had higher mortality rate compared with patients without diabetes. Early revascularization was associated with a mortality benefit at a lower ischemic threshold in patients with diabetes compared with those without diabetes.
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Affiliation(s)
- Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Cardiology, Nihon University, Tokyo, Japan
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, NY
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
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13
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Liga R, Gimelli A. Management of patients with ischaemic cardiomyopathy: is there still a role for ischaemia-guided revascularization? Eur Heart J Cardiovasc Imaging 2022; 23:1312-1313. [PMID: 35909077 DOI: 10.1093/ehjci/jeac154] [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: 11/13/2022] Open
Affiliation(s)
- Riccardo Liga
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Savi 10, 56100 Pisa, Italy
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124 Pisa, Italy
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14
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Maaniitty T, Knuuti J, Saraste A. Stress myocardial blood flow and revascularization in chronic coronary artery disease. J Nucl Cardiol 2022; 29:1900-1902. [PMID: 34105039 DOI: 10.1007/s12350-021-02687-7] [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: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland.
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20520, Turku, Finland.
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15
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Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction. J Am Coll Cardiol 2022; 80:202-215. [PMID: 35835493 DOI: 10.1016/j.jacc.2022.04.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The utility of performing early myocardial revascularization among patients presenting with inducible myocardial ischemia and low left ventricular ejection fraction (LVEF) is currently unknown. OBJECTIVES In this study, we sought to assess the relationship between stress-induced myocardial ischemia, revascularization, and all-cause mortality (ACM) among patients with normal vs low LVEF. METHODS We evaluated 43,443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017. Median follow-up was 11.4 years. Myocardial ischemia was assessed for its interaction between early revascularization and mortality. A propensity score was used to adjust for nonrandomization to revascularization, followed by multivariable Cox modeling adjusted for the propensity score and clinical variables to predict ACM. RESULTS The frequency of myocardial ischemia varied markedly according to LVEF and angina, ranging from 6.7% among patients with LVEF ≥55% and no typical angina to 64.0% among patients with LVEF <45% and typical angina (P < 0.001). Among 39,883 patients with LVEF ≥45%, early revascularization was associated with increased mortality risk among patients without ischemia and lower mortality risk among patients with severe (≥15%) ischemia (HR: 0.70; 95% CI: 0.52-0.95). Among 3,560 patients with LVEF <45%, revascularization was not associated with mortality benefit among patients with no or mild ischemia, and was associated with decreased mortality among patients with moderate (10%-14%) (HR: 0.67; 95% CI: 0.49-0.91) and severe (≥15%) (HR: 0.55; 95% CI: 0.38-0.80) ischemia. CONCLUSIONS Within this cohort, early myocardial revascularization was associated with a significant reduction in mortality among both patients with normal LVEF and severe inducible myocardial ischemia and patients with low LVEF and moderate or severe inducible myocardial ischemia.
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16
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Ramsaran E, Dai Q, Sundaresan D, Leblanc M, Amblihalli V, Muthyala A, Preusse P, Leblanc C, Li P, Andries N, Cai P, Shah N. Mortality in Stable Coronary Disease in Patients With Intermediate- or High-Risk Myocardial Perfusion Imaging. Am J Cardiol 2022; 168:1-10. [PMID: 35074212 DOI: 10.1016/j.amjcard.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/01/2022]
Abstract
The management of patients with stable coronary disease and intermediate- or high-risk features on single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) continues to be controversial as to whether they should be treated with an initial invasive strategy (catheterization and revascularization when feasible) or medical therapy alone to improve mortality. We performed a retrospective observational study of 1,946 patients with intermediate- or high-risk SPECT MPI scans performed over a 6-year period (from 2014 to 2019). Each patient was followed from the time of SPECT MPI to 16 months after the last patient was enrolled. The primary end point was all-cause mortality and the secondary end point cardiovascular mortality. Of the eligible 1,697 patients, 1,144 had an intermediate-risk scan, 553 a high-risk scan, 915 had medical therapy alone, and 782 went on an initial invasive strategy. All patients were divided into the following three groups: combined SPECT MPI (both intermediate- and high-risk), high-risk SPECT MPI, and intermediate-risk SPECT MPI groups. After propensity score matching, there was a statistically significant difference in cardiovascular death (5.9% vs 2.7%; p = 0.038) in the medical therapy cohort compared with initial invasive cohort in the combined SPECT MPI group, but no difference in all-cause death (15.7% vs 13%; p = 0.318). On subgroup analysis, in intermediate-risk SPECT MPI group, there was no significant difference in either all-cause death (13.8 vs 11.7%; p = 0.583) or cardiac death (5.4% vs 2.5%; p = 0.16) in conservative cohort compared with invasive strategy cohort. In high-risk SPECT MPI group, conservative therapy cohort had higher cardiac death (11.7% vs 2.5%; p = 0.002) compared with initial invasive strategy cohort, but there was no significant difference in all-cause death (24.5% vs 15.3%; p = 0.052). In conclusion, this study supports that patients with intermediate- or high-risk SPECT MPI scans when considered together or only with high-risk features, derive a cardiovascular mortality benefit with an initial invasive strategy. Patients who had undergone intermediate-risk SPECT MPI had similar outcomes with either medical therapy alone or initial invasive evaluation.
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17
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1423-1433. [DOI: 10.1093/ehjci/jeac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
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18
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1155-1161. [DOI: 10.1093/ejcts/ezac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 01/09/2023] Open
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Neglia D, Maroz-Vadalazhskaya N, Carrabba N, Liga R. Coronary Revascularization in Patients With Stable Coronary Artery Disease: The Role of Imaging. Front Cardiovasc Med 2021; 8:716832. [PMID: 34778391 PMCID: PMC8581143 DOI: 10.3389/fcvm.2021.716832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
In the last decades, the effective management of some cardiovascular risk factors in the general population has led to a progressive decrease in the prevalence of coronary artery disease (CAD). Nevertheless, coronary heart disease remains the major cause of death in developed and developing countries and chronic coronary syndromes (CCS) are still a major target of utilization of non-invasive cardiac imaging and invasive procedures. Current guidelines recommend the use of non-invasive imaging in patients with CCS to identify subjects at higher risk to be referred for invasive coronary angiography and possible revascularization. These recommendations are challenged by two opposite lines of evidence. Recent trials have somewhat questioned the efficacy of coronary revascularization as compared with optimal medical therapy in CCS. As a consequence the role of imaging in these patients and in in patients with ischemic cardiomyopathy is under debate. On the other hand, real-life data indicate that a consistent proportion of patients undergo invasive procedure and are revascularized without any previous non-invasive imaging characterization. On top of this, the impact of COVID-19 pandemic on the sanitary systems caused a change in the current management of patients with CAD. In the present review we will discuss these conflicting data analyzing the evidence which has been recently accumulated as well as the gaps of knowledge which should still be filled.
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Affiliation(s)
- Danilo Neglia
- Cardiovascular Department, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy.,Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Nazario Carrabba
- Cardiothoracovascular Department, Careggi Hospital, Florence, Italy
| | - Riccardo Liga
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.,Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
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20
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Pezel T, Unterseeh T, Garot P, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Long-Term Prognostic Value of Stress Cardiovascular Magnetic Resonance-Related Coronary Revascularization to Predict Death: A Large Registry With >200 000 Patient-Years of Follow-Up. Circ Cardiovasc Imaging 2021; 14:e012789. [PMID: 34612046 DOI: 10.1161/circimaging.121.012789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the benefit of coronary revascularization in patients with stable coronary disease is debated, data assessing the potential interest of stress cardiovascular magnetic resonance (CMR) to guide coronary revascularization are limited. We aimed to assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry. METHODS Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range, 5.0-8.0) included all consecutive patients referred for stress CMR. CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the National Death Registry. RESULTS Among the 31 762 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2679 (8.4%) died at 206 453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement by CMR were associated with death (both P<0.001). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of death (hazard ratio, 1.61 [99.5% CI, 1.41-1.84]; hazard ratio, 1.62 [99.5% CI, 1.41-1.86], respectively; P<0.001). In the overall population, CMR-related coronary revascularization was an independent predictor of greater survival (hazard ratio, 0.58 [99.5% CI, 0.46-0.74]; P<0.001). In 1680, 1:1 matched patients using a limited number of variables (840 revascularized, 840 nonrevascularized), CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (≥6 segments, P<0.001) but showed no benefit in patients with mild or moderate ischemia (<6 segments, P=0.109). Using multivariable analysis in the propensity-matched population, CMR-related revascularization remained an independent predictor of a lower incidence of all-cause mortality (hazard ratio, 0.66 [99.5% CI, 0.54-0.80], P<0.001). CONCLUSIONS In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.
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Affiliation(s)
- Théo Pezel
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.).,Division of Cardiology, Johns Hopkins University, Baltimore, MD (T.P.)
| | - Thierry Unterseeh
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Thomas Hovasse
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Francesca Sanguineti
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Solenn Toupin
- Siemens Healthcare France, Saint-Denis, France (S.T.)
| | | | - Stéphane Champagne
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Jérôme Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
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Doenst T, Caldonazo T, Schneider U, Moschovas A, Tkebuchava S, Safarov R, Diab M, Färber G, Kirov H. Cardiac Surgery 2020 Reviewed. Thorac Cardiovasc Surg 2021. [PMID: 34327692 DOI: 10.1055/s-0041-1729762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2020, nearly 30,000 published references appeared in the PubMed for the search term "cardiac surgery." While SARS-CoV-2 affected the number of surgical procedures, it did not affect outcomes reporting. Using the PRISMA approach, we selected relevant publications and prepared a results-oriented summary. We reviewed primarily the fields of coronary and conventional valve surgery and their overlap with interventional alternatives. The coronary field started with a discussion on trial data value and their interpretation. Registry comparisons of coronary artery bypass surgery (CABG) and percutaneous coronary intervention confirmed outcomes for severe coronary artery disease and advanced comorbidities with CABG. Multiple arterial grafting was best. In aortic valve surgery, meta-analyses of randomized trials report that transcatheter aortic valve implantation may provide a short-term advantage but long-term survival may be better with classic aortic valve replacement (AVR). Minimally invasive AVR and decellularized homografts emerged as hopeful techniques. In mitral and tricuspid valve surgery, excellent perioperative and long-term outcomes were presented for structural mitral regurgitation. For both, coronary and valve surgery, outcomes are strongly dependent on surgeon expertise. Kidney disease increases perioperative risk, but does not limit the surgical treatment effect. Finally, a cursory look is thrown on aortic, transplant, and assist-device surgery with a glimpse into the current stand of xenotransplantation. As in recent years, this article summarizes publications perceived as important by us. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Sophie Tkebuchava
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Rauf Safarov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
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22
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Improving Terminology to Describe Coronary Artery Procedures: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:180-188. [PMID: 34238439 DOI: 10.1016/j.jacc.2021.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022]
Abstract
Coronary artery disease (CAD) is treated with medical therapy with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The latter 2 options are commonly referred to as "myocardial revascularization" procedures. We reason that this term is inappropriate because it is suggestive of a single treatment effect of PCI and CABG (ie, the reestablishment of blood flow to ischemic myocardium) and obscures key mechanisms, such as the improvement in coronary flow capability in the absence of ongoing ischemia, the reperfusion in the presence of ischemia, and the prevention of myocardial infarction from CAD progression. We review the current evidence on the topic and suggest the use of a purely descriptive terminology ("invasive treatment by PCI or CABG") which has the potential to improve clinical decision making and guide future trial design.
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23
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Trpkov C, Savtchenko A, Liang Z, Feng P, Southern DA, Wilton SB, James MT, Feil E, Mylonas I, Miller RJH. Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification. IJC HEART & VASCULATURE 2021; 35:100827. [PMID: 34195354 PMCID: PMC8233133 DOI: 10.1016/j.ijcha.2021.100827] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
Aims Computed tomographic attenuation correction (CTAC) scans for single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) may reveal coronary artery calcification. The independent prognostic value of a visually estimated coronary artery calcium score (VECACS) from these low-dose, non-gated scans is not established. Methods & Results VECACS was evaluated in 4,720 patients undergoing SPECT-MPI with CTAC using a 4-point scale. Major adverse cardiac events (MACE) were defined as all-cause mortality, acute coronary syndrome, or revascularization > 90 days after SPECT-MPI. Independent associations with MACE were determined with multivariable Cox proportional hazards analyses adjusted for age, sex, past medical history, perfusion findings, and left ventricular ejection fraction. During a median follow up of 2.9 years (interquartile range 1.8 - 4.2), 494 (10.5%) patients experienced MACE. Compared to absent VECACS, patients with increased VECACS were more likely to experience MACE (all log-rank p < 0.001), and findings were similar when stratified by normal or abnormal perfusion. Multivariable analysis showed an increased MACE risk associated with VECACS categories of equivocal (adjusted hazard ratio [HR] 2.54, 95% CI 1.45-4.45, p = 0.001), present (adjusted HR 2.44, 95% CI 1.74-3.42, p < 0.001) and extensive (adjusted HR 3.47, 95% CI 2.41-5.00, p < 0.001) compared to absent. Addition of VECACS to the multivariable model improved risk classification (continuous net reclassification index 0.207, 95% CI 0.131 - 0.310). Conclusion VECACS was an independent predictor of MACE in this large SPECT-MPI patient cohort. VECACS from CTAC can be used to improve risk stratification with SPECT-MPI without additional radiation.
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Affiliation(s)
- Cvetan Trpkov
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Alexei Savtchenko
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Zhiying Liang
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Patrick Feng
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Danielle A Southern
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Matthew T James
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erin Feil
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Ilias Mylonas
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Robert J H Miller
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
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Doenst T, Sigusch H. Surgical collateralization: The hidden mechanism for improving prognosis in chronic coronary syndromes. J Thorac Cardiovasc Surg 2020; 163:703-708.e2. [PMID: 33323199 DOI: 10.1016/j.jtcvs.2020.10.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
| | - Holger Sigusch
- Department of Cardiology, Heinrich-Braun Klinikum, Zwickau, Germany
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25
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Ortiz Zegarra CA, Custodio Sánchez P, Rojas de la Cuba P, Mori Pinedo GE, Coloma Araniya R, Gonzales Álvarez BA, Nolte Rickards C. [Should i treat a high risk chronic coronary syndrome invasively from the beginning? Yes, in most cases]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:222-228. [PMID: 38268509 PMCID: PMC10804820 DOI: 10.47487/apcyccv.v1i4.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/19/2020] [Indexed: 01/26/2024]
Abstract
Chronic coronary syndrome (SCC) previously known as stable coronary disease, is the main cause of mortality in the world, and it is one of the most important in Peru. This pathology has a dynamic nature that results in different clinical scenarios that can be modified through various therapeutic options, one of which is coronary interventional treatment, mainly in patients with high ischemic risk defined as ischemia greater than 10% of the entire left ventricular mass. For this reason, we have analyzed the most relevant and current information available, concluding that the treatment of high ischemic risk´s chronic coronary syndrome, after an individual evaluation, would correspond to an invasive management from the beginning, although it would not impact on mortality or cardiovascular events, it would contribute to improve quality of life; also we should consider the incomplete availability of all the therapeutic options for the symptomatic management of this disease, the limited access to the management of acute cardiovascular events in our country, as well as the risk of adverse effects and drug interactions.
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Affiliation(s)
- César Antonio Ortiz Zegarra
- Médico asistente del Servicio de Cardiología Intervencionista. Instituto Nacional Cardiovascular - INCOR. Lima. Perú. Servicio de Cardiología Intervencionista Instituto Nacional Cardiovascular - INCOR Lima Perú
- Secretario de ética de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Piero Custodio Sánchez
- Médico asistente del Servicio de Cardiología Intervencionista. Hospital Nacional Almanzor Aguinaga Asenjo. Chiclayo, Perú. Servicio de Cardiología Intervencionista Hospital Nacional Almanzor Aguinaga Asenjo Chiclayo Perú
- Secretario de filiales de Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Paol Rojas de la Cuba
- Médico asistente del Servicio de Cardiología Intervencionista. Hospital Nacional Guillermo Almenara. Lima, Perú. Servicio de Cardiología Intervencionista Hospital Nacional Guillermo Almenara Lima Perú
- Secretario de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Gorki E Mori Pinedo
- Coordinador CDTE Clínica San Felipe. Lima, Perú. CDTE Clínica San Felipe Lima Perú
- Vicepresidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Ricardo Coloma Araniya
- Jefe de la Unidad de Hemodinámica del Hospital Central FAP. Lima, Perú. Unidad de Hemodinámica del Hospital Central FAP Lima Perú
- Expresidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Bertha Aidee Gonzales Álvarez
- Cardióloga de la Clínica Tezza. Lima, Perú. Clínica Tezza Lima Perú
- Secretaria de Economía de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
| | - Christian Nolte Rickards
- Médico asistente del servicio de cardiología intervencionista. Instituto Nacional Cardiovascular - INCOR. Lima, Perú. servicio de cardiología intervencionista Instituto Nacional Cardiovascular - INCOR Lima Perú
- Presidente de la Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE). Sociedad Peruana de Hemodinámica e Intervencionismo Endovascular (SOPHIE)
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26
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Carrasco Rueda JM, Rodríguez Olivares RR, Murillo Pérez L, Muñoz Moreno JM, Alberto ALC. [Should I treat a high-risk chronic coronary syndrome in an invasive way from the beginning? No, in most cases]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:229-239. [PMID: 38268508 PMCID: PMC10804823 DOI: 10.47487/apcyccv.v1i4.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/27/2020] [Indexed: 01/26/2024]
Abstract
The definition of the high-risk chronic coronary syndrome varies depending on the noninvasive test used to trigger ischemia. The triggering occurs through increased myocardial work and oxygen demand, either through exercise or drugs. The initial approach to the chronic coronary syndrome leads us to discuss in which cases to prioritize an optimal initial medical therapy or to perform an initial invasive procedure of myocardial revascularization. In this article, we analyze both approaches based on previous studies carried out to date, where the initial invasive management has not been shown to be superior to initial optimal medical therapy in outcomes such as death or major adverse cardiovascular events.
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Affiliation(s)
- José María Carrasco Rueda
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular - INCOR. Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular - INCORLimaPerú
| | - René Ricardo Rodríguez Olivares
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular - INCOR. Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular - INCORLimaPerú
| | - Luis Murillo Pérez
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular - INCOR. Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular - INCORLimaPerú
| | - Juan Manuel Muñoz Moreno
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular - INCOR. Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular - INCORLimaPerú
| | - Alayo Lizana, Carlos Alberto
- Servicio de Cardiología clínica, Instituto Nacional Cardiovascular - INCOR. Lima, Perú.Servicio de Cardiología clínicaInstituto Nacional Cardiovascular - INCORLimaPerú
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27
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Neglia D, Liga R. Revascularization of ischaemic myocardium: still valuable in patients with stable CAD? Eur Heart J Cardiovasc Imaging 2020; 21:971-972. [PMID: 32501485 DOI: 10.1093/ehjci/jeaa130] [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: 11/15/2022] Open
Affiliation(s)
- Danilo Neglia
- Cardiovascular Department, Fondazione CNR Regione Toscana G. Monasterio, Via G Moruzzi 1, 56124 Pisa, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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