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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Guan Y, Liu S, Li A, Cheng W. Comparison of the efficacy among different interventions for radiodermatitis: A Bayesian network meta‑analysis of randomized controlled trials. PLoS One 2024; 19:e0298209. [PMID: 38598529 PMCID: PMC11006171 DOI: 10.1371/journal.pone.0298209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Radiation dermatitis (RD) is a prevalent and difficult-to-manage consequence of radiation therapy (RT). A variety of interventions have been proven effective in preventing and treating RD. However, the optimal approach remains unclear. This network meta-analysis (NMA) conducted a comparison and ranking of the effectiveness and patient-reported outcomes (PROs) of the interventions currently utilized in RD. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched to identify pertinent randomized controlled trials (RCTs) focused on the prevention and treatment of RD. The primary outcome measures included the incidence of grade≥2 RD (i.e., percentage of moist desquamation) and RD score. The secondary outcome measures encompassed patients' subjective assessment scores of pains, itching and burning sensations. RESULTS Our meta-analysis encompassed 42 studies and 4884 participants. Regarding the primary outcomes, photobiomodulation treatment (PBMT) ranked first in surface under curve cumulative ranking area (SUCRA:0.92) for reducing the incidence of grade≥2 RD. It demonstrated a significant difference when compared to Trolamine (OR 0.18,95%CrI 0.09-0.33) and Xonrid® (OR 0.28,95%CrI 0.12-0.66). Mepitelfilm (SUCRA: 0.98) achieved the highest rank in reducing the RD score, demonstrating superiority over StrataXRT® (MD -0.89, 95% CrI -1.49, -0.29). Henna (SUCRA: 0.89) demonstrated the highest effectiveness in providing pain relief, with a significant difference compared to Hydrofilm (MD -0.44, 95% CrI -0.84, -0.04) and Mepitelfilm (MD -0.55, 95% CrI -0.91, -0.19). Hydrofilm (SUCRA: 0.84) exhibited the fewest itching sensations, demonstrating superiority over Mepitelfilm (MD -0.50, 95% CrI -0.84, -0.17). No statistically significant difference was observed among various interventions in the assessment of burning sensations. CONCLUSION PBMT and Mepitelfilm demonstrated better efficacy in reducing the incidence of grade≥2 RD and RD score, respectively. In terms of PROs, Henna and Hydrofilm had fewer complaints in pain and itching sensations, respectively. However, studies with larger sample size on different interventions are warranted in the future. TRIAL REGISTRATION PROSPERO registration number CRD42023428598.
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Affiliation(s)
- Ying Guan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | - Shuai Liu
- Department of Radiotherapy Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Anchuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, P. R. China
| | - Wanqin Cheng
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University, Shunde, P. R. China
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Zheng Y, Zhou LF, Qin SW, Guo J, Qin BY. The Impact of Home Cardiac Rehabilitation on Quality of Life and Psychological Well-Being in Patients with Coronary Heart Disease: A Randomized Controlled Study. Med Sci Monit 2024; 30:e942803. [PMID: 38515387 PMCID: PMC10941629 DOI: 10.12659/msm.942803] [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: 10/09/2023] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI), a therapeutic approach to coronary heart disease, significantly alleviates symptoms of coronary heart disease (CHD) and substantially improves quality of life. This study aimed to investigate the effect of home cardiac rehabilitation (HCR) on patients after PCI. MATERIAL AND METHODS We randomly divided 106 patients after PCI into an Intervention group (n=52) and a Control group (n=53). Left ventricular ejection fraction (LVEF), blood pressure, blood glucose, and low-density lipoprotein were measured in both groups before hospital discharge and after 3 months of engaging in the intervention. Patients were assessed using the short-form health survey (SF-12) scale and Hospital Anxiety and Depression Scale (HADS) scale. RESULTS After 3 months of HCR intervention, SF-12 scores of patients in the Intervention group were significantly higher compared to patients in the Control group (physical component summary (PCS): 47.46±9.86 vs 43.28±8.21; and Mental Component Summary (MCS): 50.68±9.82 vs 48.26±9.69) (P.
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Affiliation(s)
- Yan Zheng
- Department of Nursing, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, PR China
| | - Li-fang Zhou
- Quality Control Office, The First Peoples’ Hospital of Jiangxia District, Wuhan, Hubei, PR China
| | - Shu-wen Qin
- Nursing School, Soochow University, Suzhou, Jiangsu, PR China
| | - Jing Guo
- Department of Nursing, The First Peoples’ Hospital of Jiangxia District, Wuhan, Hubei, PR China
| | - Bi-yong Qin
- Neurology Department, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, PR China
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Adnan Z, Panjiyar BK, Mehmood AM, Nanisetty A. Role of non-invasive coronary imaging in stable angina. Glob Cardiol Sci Pract 2024; 2024:e202418. [PMID: 38746064 PMCID: PMC11090183 DOI: 10.21542/gcsp.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Chest pain represents a symptom of significant clinical concern due to the potential for lethal etiologies. Accordingly, it is critical to ascertain the presence of stable angina through various diagnostic tests to inform subsequent therapeutic strategies. Stable angina, while potentially progressing to more severe conditions if left untreated, suffers from a paucity of research regarding its management compared to other more fatal causes of chest pain. Recent advancements in radiological imaging necessitate a re-evaluation of the array and functionality of diagnostic tests, with particular emphasis on prioritizing non-invasive methods such as electrocardiography and echocardiography. This study undertakes a comprehensive review of the literature pertaining to various diagnostic tests for stable angina. We conclude that the management of a patient presenting with chest pain encompasses a continuum of care, beginning with a detailed patient history to estimate pre-test probability and culminating in computed tomography coronary angiography. This continuum is highly individualized, taking into account patient-specific variables, disease burden, and test indications. In an era of rapid research advancement, our findings delineate the optimal sequence of initial diagnostic tests, emphasizing the role of current non-invasive imaging modalities as outlined in standard clinical guidelines.
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Affiliation(s)
- Zahra Adnan
- Foundation University Medical College, Islamabad, Pakistan
| | | | | | - Alekhya Nanisetty
- Kamineni Academy Of Medical Sciences And Research Centre, Hyderabad, India
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Wang H, Lü M, Li W, Shi J, Peng L. Early Predictive Value of Different Indicators for Persistent Organ Failure in Acute Pancreatitis: A Systematic Review and Network Meta-Analysis. J Clin Gastroenterol 2024; 58:307-314. [PMID: 36930726 PMCID: PMC10855994 DOI: 10.1097/mcg.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/11/2023] [Indexed: 03/19/2023]
Abstract
GOALS In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor. BACKGROUND Persistent organ failure (POF) is one of the determining factors in patients with acute pancreatitis (AP); however, the diagnosis of POF has a long-time lag (>48 h). It is of great clinical significance for the early noninvasive prediction of POF. STUDY We conducted a comprehensive and systematic search in PubMed, Cochrane library, Embase, and Web of Science to identify relevant clinical trials, case-control studies, or cohort studies, extracted the early indicators of POF in studies, and summarized the predictive efficacy of each indicator through network meta-analysis. The diagnostic odds ratio (DOR) was used to rank the prediction efficiency of each indicator. RESULTS We identified 23 studies in this network meta-analysis, including 10,393 patients with AP, of which 2014 patients had POF. A total of 10 early prediction indicators were extracted. The mean and 95% CI lower limit of each predictive indicator were greater than 1.0. Albumin had the largest diagnostic odds ratio, followed by high-density lipoprotein-cholesterol (HDL-C), Ranson Score, beside index for severity in acute pancreatitis Score, acute physiology and chronic health evaluation II, C-reactive protein (CRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Systemic Inflammatory Response Syndrome (SIRS) and blood urea nitrogen. CONCLUSIONS Albumin, high-density lipoprotein-cholesterol, Ranson Score, and beside index for severity in acute pancreatitis Score are effective in the early prediction of POF in patients with AP, which can provide evidence for developing effective prediction systems. However, due to the limitations of the extraction method of predictive indicators in this study, some effective indicators may not be included in this meta-analysis.
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Affiliation(s)
- Huan Wang
- Department of Gastroenterology, Wenjiang District People’s Hospital of Chengdu
| | - Muhan Lü
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University
- Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory
- Cardiovascular and Metabolic Diseases of Sichuan Key Laboratory, Luzhou, China
| | - Wei Li
- Department of Gastroenterology, Wenjiang District People’s Hospital of Chengdu
| | - Jingfen Shi
- Institute for Health Policy and Hospital Management, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lan Peng
- Department of Gastroenterology, Wenjiang District People’s Hospital of Chengdu
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Luo M, Wang D, Shi Y, Yi Q, Wang Z, Zhou B, Yang G, Chen J, Liang C, Wang H, Zeng X, Yang Y, Tan R, Xie Y, Chen J, Tang S, Huang J, Mei Z, Xiao Z. Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants. Heliyon 2024; 10:e24967. [PMID: 38322910 PMCID: PMC10844026 DOI: 10.1016/j.heliyon.2024.e24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
Objectives Postoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. Methods We systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. Results Of 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. Conclusions Conspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.
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Affiliation(s)
- Mingjiang Luo
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Di Wang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi 830054, China
| | - Qilong Yi
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhongze Wang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Beijun Zhou
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Gaigai Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Juemiao Chen
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Haoyun Wang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Xin Zeng
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Ridong Tan
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yudie Xie
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jiang Chen
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Siliang Tang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jinshan Huang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zubing Mei
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Zhihong Xiao
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
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Ainiwaer A, Hou WQ, Qi Q, Kadier K, Qin L, Rehemuding R, Mei M, Wang D, Ma X, Dai JG, Ma YT. Deep learning of heart-sound signals for efficient prediction of obstructive coronary artery disease. Heliyon 2024; 10:e23354. [PMID: 38169906 PMCID: PMC10758826 DOI: 10.1016/j.heliyon.2023.e23354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background Due to the limitations of current methods for detecting obstructive coronary artery disease (CAD), many individuals are mistakenly or unnecessarily referred for coronary angiography (CAG). Objectives Our goal is to create a comprehensive database of heart sounds in CAD and develop accurate deep learning algorithms to efficiently detect obstructive CAD based on heart sound signals. This will enable effective screening before undergoing CAG. Methods We included 320 subjects suspected of CAD who underwent CAG. We employed advanced filtering techniques and state-of-the-art deep learning models (VGG-16, 1D CNN, and ResNet18) to analyze the heart sound signals and identify obstructive CAD (defined as at least one ≥50 % stenosis). To assess the performance of our models, we prospectively recruited an additional 80 subjects for testing. Results In the test set, VGG-16 exhibited the highest performance with an area under the ROC curve (AUC) of 0.834 (95 % CI, 0.736-0.930), while ResNet-18 and CNN-7 achieved AUCs of only 0.755 (95 % CI, 0.614-0.819) and 0.652 (95 % CI, 0.554-0.770) respectively. VGG-16 demonstrated a sensitivity of 80.4 % and specificity of 86.2 % in the test set. The combined diagnostic model of VGG and DF scores achieved an AUC of 0.915 (95 % CI: 0.855-0.974), and the AUC for VGG combined with PTP scores was 0.908 (95 % CI: 0.845-0.971). The sensitivity and specificity of VGG-16 exceeded 0.85 in patients with coronary artery occlusion and those with 3 vascular lesions. Conclusions Our deep learning model, based on heart sounds, offers a non-invasive and efficient screening method for obstructive CAD. It is expected to significantly reduce the number of unnecessary referrals for downstream screening.
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Affiliation(s)
- Aikeliyaer Ainiwaer
- Department of Cardiology, First Afliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, 830000, China
| | - Wen Qing Hou
- School of Information Network Security, Xinjiang University of Political Science and Law, Tumushuke, Xinjiang, 843802, China
| | - Quan Qi
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, 832003, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Afliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, 830000, China
| | - Lian Qin
- Emergency Department, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832003, China
| | - Rena Rehemuding
- Department of Cardiology, First Afliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, 830000, China
| | - Ming Mei
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, 832003, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QU, UK
| | - Xiang Ma
- Department of Cardiology, First Afliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, 830000, China
| | - Jian Guo Dai
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, 832003, China
| | - Yi Tong Ma
- Department of Cardiology, First Afliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, 830000, China
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Varho V, Uusitalo V, Vaara SM, Syväranta S, Rajala H, Sinisalo J. Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines. J Am Heart Assoc 2023; 12:e029933. [PMID: 38038185 PMCID: PMC10727332 DOI: 10.1161/jaha.123.029933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Coronary computed tomography angiography is increasingly used as the first-line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines' PTP estimation and whether imaging could be safely deferred in patients with a low PTP. METHODS AND RESULTS This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow-up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline. CONCLUSIONS The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.
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Affiliation(s)
- Ville Varho
- Cardiology, Heart and Lung CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Valtteri Uusitalo
- Clinical Physiology and Nuclear Medicine, Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Radiology, Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Satu M. Vaara
- Radiology, Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Suvi Syväranta
- Radiology, Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Helena Rajala
- Cardiology, Heart and Lung CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Juha Sinisalo
- Cardiology, Heart and Lung CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Noma H, Hamura Y, Sugasawa S, Furukawa TA. Improved methods to construct prediction intervals for network meta-analysis. Res Synth Methods 2023; 14:794-806. [PMID: 37399809 DOI: 10.1002/jrsm.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/25/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
Network meta-analysis has played an important role in evidence-based medicine for assessing the comparative effectiveness of multiple available treatments. The prediction interval has been one of the standard outputs in recent network meta-analysis as an effective measure that enables simultaneous assessment of uncertainties in treatment effects and heterogeneity among studies. To construct the prediction interval, a large-sample approximating method based on the t-distribution has generally been applied in practice; however, recent studies have shown that similar t-approximation methods for conventional pairwise meta-analyses can substantially underestimate the uncertainty under realistic situations. In this article, we performed simulation studies to assess the validity of the current standard method for network meta-analysis, and we show that its validity can also be violated under realistic situations. To address the invalidity issue, we developed two new methods to construct more accurate prediction intervals through bootstrap and Kenward-Roger-type adjustment. In simulation experiments, the two proposed methods exhibited better coverage performance and generally provided wider prediction intervals than the ordinary t-approximation. We also developed an R package, PINMA (https://cran.r-project.org/web/packages/PINMA/), to perform the proposed methods using simple commands. We illustrate the effectiveness of the proposed methods through applications to two real network meta-analyses.
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Affiliation(s)
- Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yasuyuki Hamura
- Graduate School of Economics, Kyoto University, Kyoto, Japan
| | | | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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11
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Chiocchia V, Holloway A, Salanti G. Semi-automated assessment of the risk of bias due to missing evidence in network meta-analysis: a guidance paper for the ROB-MEN web-application. BMC Med Res Methodol 2023; 23:223. [PMID: 37805460 PMCID: PMC10559514 DOI: 10.1186/s12874-023-02038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023] Open
Abstract
Network meta-analysis compares multiple interventions and estimates the relative treatment effects between all interventions, combining both direct and indirect evidence. Recently, a framework was developed to assess the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN) which is part of the more comprehensive framework to evaluate the Confidence In the evidence for Network Meta-Analysis (CINeMA). To produce an overall risk of bias judgement for each network estimate, ROB-MEN: performs an assessment of the bias due to missing evidence in each possible pairwise comparison; combines the assessment with the contribution from the direct pairwise comparisons; considers the potential for small-study effects. To facilitate and semi-automate this process, ROB-MEN has been implemented in a user-friendly web-application ( https://cinema.ispm.unibe.ch/rob-men ). Here we provide a tutorial detailing the functionality and use of the application consisting of data upload, analysis configuration, output visualisation, and production of the tool's output tables for recording the risk of bias assessment. We also illustrate an example application using the demo dataset available for download on the application's homepage. The ROB-MEN web-application is open-source and freely available ( https://github.com/esm-ispm-unibe-ch/rob-men ).
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Affiliation(s)
- Virginia Chiocchia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - Alexander Holloway
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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12
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Noma H, Hamura Y, Gosho M, Furukawa TA. Kenward-Roger-type corrections for inference methods of network meta-analysis and meta-regression. Res Synth Methods 2023; 14:731-741. [PMID: 37399845 DOI: 10.1002/jrsm.1652] [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] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Network meta-analysis has been an essential methodology of systematic reviews for comparative effectiveness research. The restricted maximum likelihood (REML) method is one of the current standard inference methods for multivariate, contrast-based meta-analysis models, but recent studies have revealed the resultant confidence intervals of average treatment effect parameters in random-effects models can seriously underestimate statistical errors; that is, the actual coverage probability of a true parameter cannot retain the nominal level (e.g., 95%). In this article, we provided improved inference methods for the network meta-analysis and meta-regression models using higher-order asymptotic approximations based on the approach of Kenward and Roger (Biometrics 1997;53:983-997). We provided two corrected covariance matrix estimators for the REML estimator and improved approximations for its sample distribution using a t-distribution with adequate degrees of freedom. All of the proposed procedures can be implemented using only simple matrix calculations. In simulation studies under various settings, the REML-based Wald-type confidence intervals seriously underestimated the statistical errors, especially in cases of small numbers of trials meta-analyzed. By contrast, the proposed Kenward-Roger-type inference methods consistently showed accurate coverage properties under all the settings considered in our experiments. We also illustrated the effectiveness of the proposed methods through applications to two real network meta-analysis datasets.
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Affiliation(s)
- Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yasuyuki Hamura
- Graduate School of Economics, Kyoto University, Kyoto, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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13
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Shah BN, Senior R. Sensitivity and specificity of non-invasive stress imaging techniques-an outdated paradigm in contemporary clinical cardiology? Eur Heart J Cardiovasc Imaging 2023; 24:e276-e277. [PMID: 37341549 DOI: 10.1093/ehjci/jead144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 06/22/2023] Open
Affiliation(s)
- Benoy Nalin Shah
- Wessex Cardiac Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, UK
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14
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Mancini GBJ. Reframing the Paradigm for Assessing Optimal Test Selection When Suspecting Chronic Coronary Disease. J Am Heart Assoc 2023; 12:e031027. [PMID: 37548157 PMCID: PMC10492944 DOI: 10.1161/jaha.123.031027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- G. B. John Mancini
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Laudani C, Capodanno D, Angiolillo DJ. Bleeding in acute coronary syndrome: from definitions, incidence, and prognosis to prevention and management. Expert Opin Drug Saf 2023; 22:1193-1212. [PMID: 38048099 DOI: 10.1080/14740338.2023.2291865] [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: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In patients with acute coronary syndrome (ACS), the ischemic benefit of antithrombotic treatment is counterbalanced by the risk of bleeding. The recognition that bleeding events have prognostic implications (i.e. mortality) similar to recurrent ischemic events led to the development of treatment regimens aimed at balancing both ischemic and bleeding risks. AREAS COVERED This review aims at describing definitions, incidence, and prognosis related to bleeding events in ACS patients as well as bleeding-avoidance strategies for their prevention and management of bleeding complications. EXPERT OPINION Management of ACS patients has witnessed remarkable progress after the shift in focusing on the trade-off between ischemia and bleeding. Efforts in standardizing bleeding definitions will allow for better defining the prognostic impact of different types of bleeding events and enable to identify the high-bleeding risk patient. Such efforts will allow to balance the trade-off between the thrombotic and bleeding risk of the individual patient translating into better downward diagnostic and therapeutic decision-making. Novel strategies aiming at maximizing the safety and efficacy of antithrombotic regimens as well as the development of novel antithrombotic drugs and reversal agents and technological advances will allow for optimization of bleeding-avoidance strategies and management of bleeding complications.
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Affiliation(s)
- Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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17
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Zito A, Galli M, Biondi-Zoccai G, Abbate A, Douglas PS, Princi G, D'Amario D, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis. Ann Intern Med 2023; 176:817-826. [PMID: 37276592 DOI: 10.7326/m23-0231] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND There is uncertainty about which diagnostic strategy for detecting coronary artery disease (CAD) provides better outcomes. PURPOSE To compare the effect on clinical management and subsequent health effects of alternative diagnostic strategies for the initial assessment of suspected stable CAD. DATA SOURCES PubMed, Embase, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized clinical trials comparing diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD. DATA EXTRACTION Three investigators independently extracted study data. DATA SYNTHESIS The strongest available evidence was for 3 of the 6 comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) (4 trials), CCTA versus exercise electrocardiography (ECG) (2 trials), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) (5 trials). Compared with direct ICA referral, CCTA was associated with no difference in cardiovascular death and myocardial infarction (relative risk [RR], 0.84 [95% CI, 0.52 to 1.35]; low certainty) but less index ICA (RR, 0.23 [CI, 0.22 to 0.25]; high certainty) and index revascularization (RR, 0.71 [CI, 0.63 to 0.80]; moderate certainty). Moreover, CCTA was associated with a reduction in cardiovascular death and myocardial infarction compared with exercise ECG (RR, 0.66 [CI, 0.44 to 0.99]; moderate certainty) and SPECT-MPI (RR, 0.64 [CI, 0.45 to 0.90]; high certainty). However, CCTA was associated with more index revascularization (RR, 1.78 [CI, 1.33 to 2.38]; moderate certainty) but less downstream testing (RR, 0.56 [CI, 0.45 to 0.71]; very low certainty) than exercise ECG. Low-certainty evidence compared SPECT-MPI versus exercise ECG (2 trials), SPECT-MPI versus stress cardiovascular magnetic resonance imaging (1 trial), and stress echocardiography versus exercise ECG (1 trial). LIMITATION Most comparisons primarily rely on a single study, many studies were underpowered to detect potential differences in direct health outcomes, and individual patient data were lacking. CONCLUSION For the initial assessment of patients with suspected stable CAD, CCTA was associated with similar health effects to direct ICA referral, and with a health benefit compared with exercise ECG and SPECT-MPI. Further research is needed to better assess the relative performance of each diagnostic strategy. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42022329635).
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (M.G.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (G.B.)
| | - Antonio Abbate
- Mediterranea Cardiocentro, Napoli, Italy (G.B.); Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia (A.A.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (P.S.D.)
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy (D.D.)
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
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18
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Everett CC, Berry C, McCann GP, Fernandez C, Reynolds C, Bucciarelli-Ducci C, Dall'Armellina E, Prasad A, Foley JR, Mangion K, Bijsterveld P, Brown J, Stocken D, Walker S, Sculpher M, Plein S, Greenwood JP. Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2. Open Heart 2023; 10:openhrt-2022-002221. [PMID: 37130657 PMCID: PMC10163591 DOI: 10.1136/openhrt-2022-002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
AIMS Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures. METHODS CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded. RESULTS 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains. CONCLUSION Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01664858).
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Affiliation(s)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Erica Dall'Armellina
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Abhiram Prasad
- Cardiovascular Diseases, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - James R Foley
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Julia Brown
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Sven Plein
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John P Greenwood
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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20
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Zhang H, Sheng J, Li G, Liu F, Bian H, Niu X, Kang L. The value of CMR Left ventricular strain analysis in evaluating ICM. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:651-657. [PMID: 36460876 DOI: 10.1007/s10554-022-02761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
The purpose of this article is to investigate the value of cardiac magnetic resonance imaging (CMR) derived left ventricular strain parameters in evaluation of ischemic cardiomyopathy (ICM). Thirty-one ICM patients and nineteen non-cardiomyopathy (non-CM) patients who performed CMR examinations during the same period were selected for this retrospective study. The basic clinical data, CMR left ventricular function parameters, left ventricular strain parameters were compared among the left ventricular ejection fraction (LVEF) preserved ICM group, the LVEF impaired ICM group and the non-CM group. The differences of MyoGCS (-21.9 ± 1.9 vs. -18.9 ± 2.7 P<0.001), MyoGLS (-20.8 ± 2.3 vs. -17.0 ± 2.9 P<0.001) and EndoGLS (-22.2 ± 3.1 vs. -17.6 ± 3.7 P<0.001) between LVEF preserved ICM group and non-CM group were statistically significant, while the differences of left heart function parameters between the two groups were not statistically significant (P > 0.05). The left ventricular strain analysis can be used to assess cardiac functional and morphological alterations in ICM patients prior to changes of left ventricular function parameters, which has high clinical significance.
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Affiliation(s)
- Houning Zhang
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Magnetic Resonance Imaging, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Jiaxi Sheng
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Endocrinology, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Guoce Li
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
| | - Fenghai Liu
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
| | - Hao Bian
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
| | - Xiqing Niu
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
| | - Liqing Kang
- Graduate School, Tianjin Medical University, Tianjin, China. .,Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China.
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21
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Ihdayhid AR, Lan NSR, Figtree GA, Patel S, Arnott C, Hamilton-Craig C, Psaltis PJ, Leipsic J, Fairbairn T, Wahi S, Hillis GS, Rankin JM, Dwivedi G, Nicholls SJ. Contemporary Chest Pain Evaluation: The Australian Case for Cardiac CT. Heart Lung Circ 2023; 32:297-306. [PMID: 36610819 DOI: 10.1016/j.hlc.2022.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/07/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023]
Abstract
Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allow for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Curtin University, Perth, WA, Australia.
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sanjay Patel
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Cardiovascular Division, The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Peter J Psaltis
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jonathon Leipsic
- University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | | | - Sudhir Wahi
- Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Graham S Hillis
- Department of Cardiology and University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
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22
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Spirito A, Sticchi A, Praz F, Gräni C, Messerli F, Siontis GC. Impact of design characteristics among studies comparing coronary computed tomography angiography to noninvasive functional testing in chronic coronary syndromes. Am Heart J 2023; 256:104-116. [PMID: 36400186 DOI: 10.1016/j.ahj.2022.10.087] [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] [Received: 03/12/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is widely adopted to detect obstructive coronary artery disease (CAD) in patients with chronic coronary syndromes (CCS). However, it is unknown to which extent study-specific characteristics yield different conclusions. METHODS We summarized non-randomized and randomized studies comparing CCTA and noninvasive functional testing for CCS with information on the outcome of myocardial infarction (MI). We evaluated the differential effect according to study characteristics using random-effect meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustments. RESULTS Fifteen studies (8 non-randomized, 7 randomized) were included. CCTA was associated with decrease in relative (odds ratio (OR) 0.54, 95%CI 0.47 to 0.62, P < .001) and absolute MI risk (risk difference (RD) -0.4%, 95%CI -0.6 to -0.1, P = .005). The results remained consistent among the non-randomized (RD -0.4%, 95%CI -0.7 to -0.1, P=.029), but not among the randomized trials where there was no difference in the observed risk (RD 0.2%, 95%CI -0.6 to 0.1, P = .158). CCTA was not associated with MI reduction in studies with clinical outcome definition (OR 0.77, 95%CI 0.41 to 1.44, P = .212), research driven follow-up (OR 0.54, 95%CI 0.24 to 1.21, P = .090), central event assessment (OR 0.63, 95%CI 0.21 to 1.86, P = .207), outcome adjudication (OR 0.74, 95%CI 0.24 to 2.23, P = .178), or at low-risk of bias (OR 0.74, 95%CI 0.24 to 2.23, P = .178). CONCLUSIONS Among studies of any design, CCTA was associated with lower risk of MI in CCS compared to noninvasive functional testing. This benefit was diminished among studies with clinical outcome definition, central outcome assessment/adjudication or at low-risk of bias.
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Affiliation(s)
- Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessandro Sticchi
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franz Messerli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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23
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Chen M, Li P, Huang Y, Li S, Ruan Z, Qin C, Huang J, Wang R, Lin Z, Liu P, Xu L. Development and validation of a nomogram for predicting significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary artery syndrome with low-to-intermediate risk stratification. Front Cardiovasc Med 2022; 9:1013563. [PMID: 36601070 PMCID: PMC9807079 DOI: 10.3389/fcvm.2022.1013563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Patients with non-ST-segment coronary artery syndrome (NSTE-ACS) have significant heterogeneity in their coronary arteries. A better assessment of significant coronary artery stenosis (SCAS) in low-to-intermediate risk NSTE-ACS patients would help identify who might benefit from invasive coronary angiography (ICA). Our study aimed to develop a multivariable-based model for pretesting SCAS in suspected NSTE-ACS with low-to-intermediate risk. Methods This prediction nomogram was constructed retrospectively in 469 suspected NSTE-ACS patients with low-to-intermediate risk. Patients were divided into a development group (n = 331, patients admitted to hospital before 1 May 2021) and a temporal validation group (n = 138, patients admitted to hospital since 1 May 2021). The outcome was existing SCAS, including left main artery stenosis ≥50% or any subepicardial coronary artery stenosis ≥70%, all confirmed by invasive coronary angiography. Pretest predictors were selected using Least Absolute Shrinkage and Selection Operator (LASSO) and stepwise logistic regression. Results Derivation analyses from the development group (n = 331, admitted before 1 May 2021) generated the 7 strongest predictors out of 25 candidate variables comprising smoker, diabetes, heart rate, cardiac troponin T, N-terminal pro-B-type natriuretic peptide, high-density lipoprotein cholesterol, and left atrial diameter. This nomogram model showed excellent discrimination ability with an area under the receiver operating characteristic curve (AUC) of 0.83 in the development set and 0.79 in the validation dataset. Good calibration was generally displayed, although it slightly overestimated patients' SCAS risk in the validation group. Decision curve analysis demonstrated the clinical benefit of this model, indicating its value in clinical practice. Furthermore, an optimal cut-off of prediction probability was assigned as 0.61 according to the Youden index. Conclusion A prediction nomogram consisting of seven readily available clinical parameters was established to pretest the probability of SCAS in suspected NSTE-ACS patients with low-to-intermediate risk, which may serve as a cost-effective risk stratification tool and thus assist in initial decision making.
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Affiliation(s)
- Meixiang Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Pengfei Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuekang Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shuang Li
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China
| | - Zheng Ruan
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China
| | - Changyu Qin
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianyu Huang
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China
| | - Ruixin Wang
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China
| | - Zhongqiu Lin
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China
| | - Peng Liu
- Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China,Peng Liu,
| | - Lin Xu
- General Hospital of the Southern Theatre Command, Chinese People’s Liberation Army (PLA), Guangzhou, Guangdong, China,Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, Guangdong, China,*Correspondence: Lin Xu,
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24
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AlShammeri O, AL Saif S, Al Shehri H, Alasng M, Qaddoura F, Al Shehri M, Turkistani Y, Tash A, Alharbi W, Al Qahtani F, Diaz R, Mahaimeed W, Al habeeb W, Alfaraidy K. Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes. J Saudi Heart Assoc 2022; 34:182-211. [PMID: 36578770 PMCID: PMC9762239 DOI: 10.37616/2212-5043.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.
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Affiliation(s)
| | | | - Halia Al Shehri
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Mirvat Alasng
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah,
Saudi Arabia
| | | | | | | | - Adel Tash
- National Heart Center, Saudi Health Council,
Saudi Arabia
| | - Walid Alharbi
- King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | - Fahad Al Qahtani
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Rafael Diaz
- ECLA (Estudios Clínicos Latino América), Instituto Cardiovascular de Rosario, Rosario,
Argentina
| | - Wael Mahaimeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
| | - Waleed Al habeeb
- Saudi Heart Association, Department of Cardiac Sciences, King Saud University Riyadh,
Saudi Arabia
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25
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Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease. Life (Basel) 2022; 12:life12111803. [PMID: 36362957 PMCID: PMC9696378 DOI: 10.3390/life12111803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Over the last decades, significant advances have been achieved in the treatment of coronary artery disease (CAD). Proper non-invasive diagnosis and appropriate management based on functional information and the extension of ischemia or viability remain the cornerstone in the fight against adverse CAD events. Stress echocardiography and single photon emission computed tomography are often used for the evaluation of ischemia. Advancements in non-invasive imaging modalities such as computed tomography (CT) coronary angiography and cardiac magnetic resonance imaging (MRI) have not only allowed non-invasive imaging of coronary artery lumen but also provide additional functional information. Other characteristics regarding the plaque morphology can be further evaluated with the latest modalities achieving a morpho-functional evaluation of CAD. Advances in the utilization of positron emission tomography (PET), as well as software advancements especially regarding cardiac CT, may provide additional prognostic information to a more evidence-based treatment decision. Since the armamentarium on non-invasive imaging modalities has evolved, the knowledge of the capabilities and limitations of each imaging modality should be evaluated in a case-by-case basis to achieve the best diagnosis and treatment decision. In this review article, we present the most recent advances in the noninvasive anatomical and functional evaluation of CAD.
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26
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Qiu L, Zhang M, Zhu W, Wang L. A lightweight U-net for ECG denoising using knowledge distillation. Physiol Meas 2022; 43. [PMID: 36179721 DOI: 10.1088/1361-6579/ac96cd] [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: 06/18/2022] [Accepted: 09/30/2022] [Indexed: 02/07/2023]
Abstract
Objective.Electrocardiogram (ECG) signals are easily polluted by various noises which are likely to have adverse effects on subsequent interpretations. Research on model lightweighting can promote the practical application of deep learning-based ECG denoising methods in real-time processing.Approach.Firstly, grouped convolution and conventional convolution are combined to replace the continuous conventional convolution in the model, and the depthwise convolution with stride is used to compress the feature map in the encoder modules. Secondly, additional identity connections and a local maximum and minimum enhancement module are designed, which can retain the detailed information and characteristic waveform in the ECG waveform while effectively denoising. Finally, we develop knowledge distillation in the experiments, which further improves the ECG denoising performance without increasing the model complexity. The ground-truth ECG is from The China Physiological Signal Challenge (CPSC) 2018, and the noise signal is from the MIT-BIH Noise Stress Test Database (NSTDB). We evaluate denoising performance using the signal-to-noise ratio (SNR), the root mean square error (RMSE) and the Pearson correlation coefficient (P). We use the floating point of operations (FLOPs) and parameters to calculate computational complexity.Main Results.Different data generation processes are used to conduct experiments: group 1, group 2 and group 3. The results show that the proposed model (ULde-net) can improve SNRs by 10.30 dB, 12.16 dB and 12.61 dB; reduce RMSEs by 9.88 × 10-2, 20.63 × 10-2and 15.25 × 10-2; and increasePs by 14.77 × 10-2, 27.74 × 10-2and 21.32 × 10-2. Moreover, the denoising performance after knowledge distillation is further improved. The ULde-net has parameters of 6.9 K and FLOPs of 6.6 M, which are much smaller than the compared models.Significance.We designed a lightweight model, but also retain adequate ECG denoising performance. We believe that this method can be successfully applied to practical applications under time or memory limits.
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Affiliation(s)
- Lishen Qiu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, People's Republic of China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, People's Republic of China
| | - Miao Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, People's Republic of China
| | - Wenliang Zhu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, People's Republic of China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, People's Republic of China
| | - Lirong Wang
- School of Electronics and Information Technology, Soochow University, People's Republic of China
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27
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Zheng C, Sun BC, Wu YL, Ferencik M, Lee MS, Redberg RF, Kawatkar AA, Musigdilok VV, Sharp AL. Automated interpretation of stress echocardiography reports using natural language processing. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:626-637. [PMID: 36710893 PMCID: PMC9779789 DOI: 10.1093/ehjdh/ztac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/08/2022] [Indexed: 02/01/2023]
Abstract
Aims Stress echocardiography (SE) findings and interpretations are commonly documented in free-text reports. Reusing SE results requires laborious manual reviews. This study aimed to develop and validate an automated method for abstracting SE reports in a large cohort. Methods and results This study included adult patients who had SE within 30 days of their emergency department visit for suspected acute coronary syndrome in a large integrated healthcare system. An automated natural language processing (NLP) algorithm was developed to abstract SE reports and classify overall SE results into normal, non-diagnostic, infarction, and ischaemia categories. Randomly selected reports (n = 140) were double-blindly reviewed by cardiologists to perform criterion validity of the NLP algorithm. Construct validity was tested on the entire cohort using abstracted SE data and additional clinical variables. The NLP algorithm abstracted 6346 consecutive SE reports. Cardiologists had good agreements on the overall SE results on the 140 reports: Kappa (0.83) and intraclass correlation coefficient (0.89). The NLP algorithm achieved 98.6% specificity and negative predictive value, 95.7% sensitivity, positive predictive value, and F-score on the overall SE results and near-perfect scores on ischaemia findings. The 30-day acute myocardial infarction or death outcomes were highest among patients with ischaemia (5.0%), followed by infarction (1.4%), non-diagnostic (0.8%), and normal (0.3%) results. We found substantial variations in the format and quality of SE reports, even within the same institution. Conclusions Natural language processing is an accurate and efficient method for abstracting unstructured SE reports. This approach creates new opportunities for research, public health measures, and care improvement.
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Affiliation(s)
- Chengyi Zheng
- Corresponding author. Tel: 1-626-376-7029, Fax: 626-564-3694,
| | - Benjamin C Sun
- Department of Emergency Medicine and Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yi-Lin Wu
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA
| | - Maros Ferencik
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR 97239, USA
| | - Ming-Sum Lee
- Division of Cardiology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA 90027, USA
| | - Rita F Redberg
- Division of Cardiology, University of California, San Francisco, CA 94143, USA
| | - Aniket A Kawatkar
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA
| | - Visanee V Musigdilok
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA
| | - Adam L Sharp
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA,Clinical Science Department, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
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28
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Ananthasubramaniam K, Kitt TM, Saxena A, Feng Q, Nimke D, Spalding JR, Xu Y. Healthcare resource utilization among patients receiving non-invasive testing for coronary artery disease in an outpatient setting: A cohort study reflecting daily practice trends. J Nucl Cardiol 2022; 29:1776-1787. [PMID: 33660216 DOI: 10.1007/s12350-021-02549-2] [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: 09/02/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accurate, early diagnosis and the initiation of appropriate treatment is central to reducing the clinical burden of coronary artery disease (CAD); however, real-world evidence characterizing healthcare resource utilization (HCRU) associated with testing for CAD is lacking. METHODS AND RESULTS Using a non-interventional, retrospective, secondary database analysis, patients aged ≥18 years who underwent outpatient non-invasive cardiac diagnostic testing were identified. The primary objective was to gain an understanding of pre- and post-assessment care pathways and the associated interventions for patients who underwent non-invasive testing for CAD in either an outpatient or emergency department setting. Overall, chest pain was the primary reason for the index visit (54.8%), followed by shortness of breath (23.7%), myocardial infarction (MI), coronary artery disease (CAD) or congestive heart failure (CHF) (3.8%), and other (46.8%); 3.0% of patients had no apparent reason for testing in the last 45 days. Single-photon emission computed tomography (SPECT) was the dominant diagnostic testing modality (40.3%). During the 90-day follow-up, 7.3% (n = 22,083) of patients were diagnosed with CAD; among these patients, 19.4% had repeat diagnostic testing, 26.0% of patients had a revascularization procedure, and 65.6% underwent cardiac catheterization. These rates varied by testing modality. CONCLUSIONS In this study of a large real-world data sample, variability in the use of non-invasive tests and HCRU were evident. These results may assist efforts to optimize system-wide care/diagnostic pathways and value-based treatment decisions for patients.
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Affiliation(s)
| | - Therese M Kitt
- Astellas Pharma Global Development, Inc, Northbrook, IL, 60062, USA
| | | | - Qi Feng
- Astellas US LLC, Northbrook, IL, USA
| | | | - James R Spalding
- Astellas Pharma Global Development, Inc, Northbrook, IL, 60062, USA
| | - Yanqing Xu
- Astellas Pharma Global Development, Inc, Northbrook, IL, 60062, USA
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29
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 2022; 16:362-383. [PMID: 35729014 DOI: 10.1016/j.jcct.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant Anna Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila Euroecolab, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania
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30
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Ling HQ, Chen ZH, He L, Feng F, Weng CG, Cheng SJ, Rong LM, Xie PG. Comparative Efficacy and Safety of 11 Drugs as Therapies for Adults With Neuropathic Pain After Spinal Cord Injury: A Bayesian Network Analysis Based on 20 Randomized Controlled Trials. Front Neurol 2022; 13:818522. [PMID: 35386408 PMCID: PMC8977449 DOI: 10.3389/fneur.2022.818522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To provide an updated analysis of the efficacy and safety of drugs for the management of neuropathic pain (NP) after spinal cord injury (SCI) based on Bayesian network analysis. Methods A Bayesian network meta-analysis of literature searches within PubMed, Cochrane Library, Embase, and Web of Science databases from their inception to February 21 2021 was conducted without language restrictions. Paired and network meta-analyses of random effects were used to estimate the total standardized mean deviations (SMDs) and odds ratios (ORs). Results A total of 1,133 citations were identified and 20 RCTs (including 1,198 patients) involving 11 drugs and placebos for post-SCI NP selected. The 5 outcomes from all 11 drugs and placebos had no inconsistencies after Bayesian network analysis. BTX-A gave the most effective pain relief for the 4 weeks, following a primary outcome. No significant differences were found among drugs with regard to adverse events of the primary outcome. Gabapentin, BTX-A, and pregabalin were found to be the most helpful in relieving secondary outcomes of mental or sleep-related symptoms with differences in SMDs, ranging from −0.63 to −0.86. Tramadol triggered more serious adverse events than any of the other drugs with differences in ORs ranging from 0.09 to 0.11. Conclusion BTX-A, gabapentin, pregabalin, amitriptyline, ketamine, lamotrigine, and duloxetine were all effective for NP management following SCI. Lamotrigine and gabapentin caused fewer side effects and had better efficacy in relieving mental or sleep-related symptoms caused by SCI-related NP. Tramadol, levetiracetam, carbamazepine, and cannabinoids could not be recommended due to inferior safety or efficacy. Systematic Review Registration [https://inplasy.com/inplasy-2020-7-0061/], identifier [INPLASY202070061].
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Affiliation(s)
- Hai-Qian Ling
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.,Department of Orthopedics, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, China
| | - Zi-Hao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Lei He
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Chuang-Gui Weng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Si-Jin Cheng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Li-Min Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Pei-Gen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2022; 35:329-354. [PMID: 35379446 DOI: 10.1016/j.echo.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant'Anna - Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Budoff MJ, Lakshmanan S, Toth PP, Hecht HS, Shaw LJ, Maron DJ, Michos ED, Williams KA, Nasir K, Choi AD, Chinnaiyan K, Min J, Blaha M. Cardiac CT angiography in current practice: An American society for preventive cardiology clinical practice statement ✰. Am J Prev Cardiol 2022; 9:100318. [PMID: 35146468 PMCID: PMC8802838 DOI: 10.1016/j.ajpc.2022.100318] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
In this clinical practice statement, we represent a summary of the current evidence and clinical applications of cardiac computed tomography (CT) in evaluation of coronary artery disease (CAD), from an expert panel organized by the American Society for Preventive Cardiology (ASPC), and appraises the current use and indications of cardiac CT in clinical practice. Cardiac CT is emerging as a front line non-invasive diagnostic test for CAD, with evidence supporting the clinical utility of cardiac CT in diagnosis and prevention. CCTA offers several advantages beyond other testing modalities, due to its ability to identify and characterize coronary stenosis severity and pathophysiological changes in coronary atherosclerosis and stenosis, aiding in early diagnosis, prognosis and management of CAD. This document further explores the emerging applications of CCTA based on functional assessment using CT derived fractional flow reserve, peri‑coronary inflammation and artificial intelligence (AI) that can provide personalized risk assessment and guide targeted treatment. We sought to provide an expert consensus based on the latest evidence and best available clinical practice guidelines regarding the role of CCTA as an essential tool in cardiovascular prevention - applicable to risk assessment and early diagnosis and management, noting potential areas for future investigation.
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Affiliation(s)
- Matthew J. Budoff
- Division of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance CA, USA
| | - Suvasini Lakshmanan
- Division of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance CA, USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harvey S. Hecht
- Department of Medicine, Mount Sinai Medical Center, New York, NY
| | - Leslee J. Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J. Maron
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kim A. Williams
- Division of Cardiology, Rush University Medical Center, Chicago IL
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Andrew D. Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Kavitha Chinnaiyan
- Division of Cardiology, Department of Medicine, Beaumont Hospital, Royal Oak, MI
| | - James Min
- Chief Executive Officer Cleerly Inc., New York, NY
| | - Michael Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Bertrand T, Bartlett-Esquilant G, Fischer K, Friedrich MG. Patient and physician preferences for non-invasive diagnostic cardiovascular imaging technologies: a discrete choice experiment. J Patient Rep Outcomes 2022; 6:15. [PMID: 35182263 PMCID: PMC8858356 DOI: 10.1186/s41687-022-00419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Diagnostic imaging techniques have to be selected for their accuracy, efficiency, cost-efficiency, and impact on outcome. But beyond that, the choice of non-invasive cardiovascular imaging tests for diagnosing coronary artery disease also has to respect patient safety and comfort. In this study, we investigated patient and physician preference in relation to the choice of cardiovascular imaging tests. Results A total of 211 subjects (148 cardiac patients and 63 physicians) were enrolled and completed a discrete choice experiment. Tests and modalities were deconstructed into 6 attributes (risks and side effects, diagnostic accuracy, patient out-of-pocket cost, type of procedure, type of scanner and test duration). A Sawtooth software choice-based conjoint analysis with hierarchical Bayes estimation was performed and showed the risks and side effects attribute was assigned the most relative importance (30%) when considering patients’ preference. Patients gave notably high value to tests with milder side effects, while preferring to avoid exposure to ionizing radiation and risks associated the use of pharmacological agents inducing direct coronary arteriolar vasodilation. Physicians allocated more importance to the patient out-of-pocket cost attribute (29%). Both patients and physicians valued tests’ risks and side effects, diagnostic accuracy, patient out-of-pocket cost as the three most important attributes, but in diverging order. A market simulation comparing current cardiovascular imaging tests revealed breathing maneuver-enhanced cardiac magnetic resonance had the highest shares of preference in both patients (59.6%) and physicians (32.7%). Conclusion A patients’ preference for a particular cardiovascular imaging test was most determined by the risks and side effects, while physicians prioritized less costly tests for their patients. In shared decision-making with patients, physicians should therefore focus on a balanced discussion of risks and side effects associated with cardiovascular imaging tests. Both, patients and physicians would prefer a cardiovascular MR imaging test using a vasoactive breathing maneuver instead of currently used alternatives that require intravenous contrast agents, pharmacological stress, or radiation.
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Affiliation(s)
- Thomas Bertrand
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada.,Departments of Medicine and Diagnostic Radiology, Research Institute of the McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Gillian Bartlett-Esquilant
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Kady Fischer
- Departments of Medicine and Diagnostic Radiology, Research Institute of the McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Matthias G Friedrich
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada. .,Departments of Medicine and Diagnostic Radiology, Research Institute of the McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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34
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Verdoia M, Pipan P, Viola O, Francesca Brancati M, La Cognata S, Novara F, Bristot F, D'Amico G, Ravetto C, Fusco M, Giachino P, Tonella M, Maccagni D, Soldà PL, Marcolongo M. Impact of Different Measures of Body Size on the Radiation Dose During Coronary Angiography and Percutaneous Coronary Intervention: Results from a Large Single Center Cohort. Angiology 2022; 73:478-484. [PMID: 35049400 DOI: 10.1177/00033197211053133] [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: 11/15/2022]
Abstract
Efforts to reduce and optimize the radiation exposure during coronary angiography and intervention have pointed at patients' body size as a major determinant of irradiation for the patients and operators. We aimed at comparing body weight and body mass index (BMI) among consecutive patients undergoing angiographic procedures (coronary angiography and/or interventions) in a single center. Patients were divided in normal weight (NW, BMI <25 Kg/m2) and overweight (OW, BMI ≥25 Kg/m2). Patients' dose exposure was evaluated as dose area product (DAP), time of exposure (fluoroscopy duration), and relative DAP (DAP/minutes of exposure). We included 748 patients, 61.6% undergoing percutaneous coronary interventions and 56.8% classified as OW. OW patients were more often men (P < .001), with history of hypertension (P < .001) and diabetes (P = .001). Mean DAP and relative DAP were significantly higher among OW compared with NW patients (P < .001). DAP and relative DAP were directly related with body weight (both r = .22, P < .001); a similar linear association was also described for BMI (r = .18, P < .001 and r = .19, P < .001, respectively). At multivariate analysis, however, body weight, but not BMI, independently predicted the DAP. Therefore, body weight should be considered as the preferred indicator of body size in the setting and optimization of radiation exposure during coronary diagnostic and intervention procedures.
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Affiliation(s)
- Monica Verdoia
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Pierpaolo Pipan
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Orazio Viola
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | | | - Sara La Cognata
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Francesca Novara
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Filippo Bristot
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Giuseppina D'Amico
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Cinzia Ravetto
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Massimo Fusco
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Paolo Giachino
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Manuela Tonella
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Davide Maccagni
- Cardio-Thoracic-Vascular Department, 9372San Raffaele Hospital, Milan, Italy
| | - Pier Luigi Soldà
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
| | - Marco Marcolongo
- Cardiologia e Unità Coronarica, Ospedale Degli Infermi, 9237ASL Biella, Italy
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35
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Javaid A, Saleh Y, Ahmed AI, Saad JM, Malahfji M, Al-Mallah MH. Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain. Methodist Debakey Cardiovasc J 2022; 17:5-15. [PMID: 34992719 PMCID: PMC8680163 DOI: 10.14797/mdcvj.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
Acute chest pain is a common presentation in patients with COVID-19. Although noninvasive cardiac imaging modalities continue to be important cornerstones of management, the pandemic has brought forth difficult and unprecedented challenges in the provision of timely care while ensuring the safety of patients and providers. Clinical practice has adapted to these challenges, with several recommendations and societal guidelines emerging on the appropriate use of imaging modalities. In this review, we summarize the current evidence base on the use of noninvasive cardiac imaging modalities in COVID-19 patients with acute chest pain, with a focus on acute coronary syndromes.
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Affiliation(s)
- Awad Javaid
- Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas School of Medicine, Las Vegas, NV, US
| | - Yehia Saleh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | | | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 346] [Impact Index Per Article: 115.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:2218-2261. [PMID: 34756652 DOI: 10.1016/j.jacc.2021.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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40
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709928 DOI: 10.1161/cir.0000000000001030] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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ROB-MEN: a tool to assess risk of bias due to missing evidence in network meta-analysis. BMC Med 2021; 19:304. [PMID: 34809639 PMCID: PMC8609747 DOI: 10.1186/s12916-021-02166-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Selective outcome reporting and publication bias threaten the validity of systematic reviews and meta-analyses and can affect clinical decision-making. A rigorous method to evaluate the impact of this bias on the results of network meta-analyses of interventions is lacking. We present a tool to assess the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN). METHODS ROB-MEN first evaluates the risk of bias due to missing evidence for each of the possible pairwise comparison that can be made between the interventions in the network. This step considers possible bias due to the presence of studies with unavailable results (within-study assessment of bias) and the potential for unpublished studies (across-study assessment of bias). The second step combines the judgements about the risk of bias due to missing evidence in pairwise comparisons with (i) the contribution of direct comparisons to the network meta-analysis estimates, (ii) possible small-study effects evaluated by network meta-regression, and (iii) any bias from unobserved comparisons. Then, a level of "low risk", "some concerns", or "high risk" for the bias due to missing evidence is assigned to each estimate, which is our tool's final output. RESULTS We describe the methodology of ROB-MEN step-by-step using an illustrative example from a published NMA of non-diagnostic modalities for the detection of coronary artery disease in patients with low risk acute coronary syndrome. We also report a full application of the tool on a larger and more complex published network of 18 drugs from head-to-head studies for the acute treatment of adults with major depressive disorder. CONCLUSIONS ROB-MEN is the first tool for evaluating the risk of bias due to missing evidence in network meta-analysis and applies to networks of all sizes and geometry. The use of ROB-MEN is facilitated by an R Shiny web application that produces the Pairwise Comparisons and ROB-MEN Table and is incorporated in the reporting bias domain of the CINeMA framework and software.
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-invasive Imaging in Coronary Syndromes - Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. Eur Heart J Cardiovasc Imaging 2021; 23:e6-e33. [PMID: 34751391 DOI: 10.1093/ehjci/jeab244] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact.(1) Non-invasive imaging modalities play a fundamental role in the evaluation and management of patients with known or suspected CAD. Imaging end-points have served as surrogate markers in many observational studies and randomized clinical trials that evaluated the benefits of specific therapies for CAD.(2) A number of guidelines and recommendations have been published about coronary syndromes by cardiology societies and associations, but have not focused on the excellent opportunities with cardiac imaging. The recent European Society of Cardiology (ESC) 2019 guideline on chronic coronary syndromes (CCS) and 2020 guideline on acute coronary syndromes in patients presenting with non-ST-segment elevation (NSTE-ACS) highlight the importance of non-invasive imaging in the diagnosis, treatment, and risk assessment of the disease.(3)(4) The purpose of the current recommendations is to present the significant role of non-invasive imaging in coronary syndromes in more detail. These recommendations have been developed by the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), in collaboration with the American Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance, all of which have approved the final document.
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Affiliation(s)
- Thor Edvardsen
- Dept of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway, and University of Oslo, Norway
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, DC, . USA
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University; VA Portland Health Care System, Portland, OR, USA
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, 2300RC, Leiden, The Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, USA
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, 111 East 210th Street, Bronx, New York, 10467, USA
| | - Otto Kamp
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danilo Neglia
- Department of Cardiology, Fondazione Toscana G. Monastrerio, Pisa, Italy
| | - Aleksandar N Neskovic
- Dept of Cardiology, Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, California, ., USA
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa and Milan, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Esposito A, Francone M, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Pontone G, Carrabba N. SIRM-SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis. LA RADIOLOGIA MEDICA 2021; 126:1236-1248. [PMID: 34160775 PMCID: PMC8370938 DOI: 10.1007/s11547-021-01378-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022]
Abstract
In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric "one-stop-shop" approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.
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Affiliation(s)
- Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Andrea Igoren Guaricci
- Cardiothoracic Department, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo, AOUP P. Giaccone, Palermo, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Reggio Emilia University, Modena, Italy
- Radiology Department, AOU of Modena, Modena, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare- A.S.LNa1-Centro, Naples, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia E Le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nazario Carrabba
- Cardiothoracovascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Qian L, Xie F, Xu D, Porter TR. Long-term prognostic value of stress myocardial perfusion echocardiography in patients with coronary artery disease: a meta-analysis. Eur Heart J Cardiovasc Imaging 2021; 22:553-562. [PMID: 32125367 DOI: 10.1093/ehjci/jeaa026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/17/2019] [Accepted: 02/06/2020] [Indexed: 01/18/2023] Open
Abstract
AIMS To evaluate the prognostic value of myocardial perfusion (MP) imaging during contrast stress echocardiography (cSE) in patients with known or suspected coronary artery disease (CAD). METHODS AND RESULTS A search in PubMed, Embase databases, and the Cochrane library was conducted through May 2019. The Cochran Q statistic and the I2 statistic were used to assess heterogeneity, and the results were analysed by RevMan V5.3 and Stata V15.1 software. Twelve studies (seven dipyridamole and five exercise/dobutamine) without evidence of patient overlap (same institution publishing results over a similar time period) enrolling 5953 subjects (47% female, 8-80 months of follow-up) were included in the analysis. In all studies, total adverse cardiovascular events were defined as either cardiac death, non-fatal myocardial infarction (NFMI), or need for urgent revascularization. Hazard ratios (HRs) revealed that a MP abnormality [pooled HR 4.75; 95% confidence interval (CI) 2.47-9.14] was a higher independent predictor of total events than abnormal wall motion (WM, pooled HR 2.39; 95% CI 1.58-3.61) and resting left ventricular ejection fraction (LVEF, pooled HR 1.92; 95% CI 1.44-2.55) with significant subgroup differences (P = 0.002 compared with abnormal WM and 0.01 compared with abnormal LVEF). Abnormal MP was associated with higher risks for death [Risk ratio (RR) 5.24; 95% CI 2.91-9.43], NFMI (RR 3.09; 95% CI 1.84-5.21), and need for coronary revascularization (RR 16.44; 95% CI 6.14-43.99). CONCLUSION MP analysis during stress echocardiography is an effective prognostic tool in patients with known or suspected CAD and provides incremental value over LVEF and WM in predicting clinical outcomes.
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Affiliation(s)
- Lijun Qian
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Xie
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, 69198-1165, USA
| | - Di Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - T R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, 69198-1165, USA
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Bodini A, Michelucci E, Di Giorgi N, Caselli C, Signore G, Neglia D, Smit JM, Scholte AJHA, Mincarone P, Leo CG, Pelosi G, Rocchiccioli S. Predictive Added Value of Selected Plasma Lipids to a Re-estimated Minimal Risk Tool. Front Cardiovasc Med 2021; 8:682785. [PMID: 34336947 PMCID: PMC8322727 DOI: 10.3389/fcvm.2021.682785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Lipidomics is emerging for biomarker discovery in cardiovascular disease, and circulating lipids are increasingly incorporated in risk models to predict cardiovascular events. Moreover, specific classes of lipids, such as sphingomyelins, ceramides, and triglycerides, have been related to coronary artery disease (CAD) severity and plaque characteristics. To avoid unnecessary testing, it is important to identify individuals at low CAD risk. The only pretest model available so far to rule out the presence of coronary atherosclerosis in patients with chest pain, but normal coronary arteries, is the minimal risk tool (MRT). Aim: Using state-of-the-art statistical methods, we aim to verify the additive predictive value of a set of lipids, derived from targeted plasma lipidomics of suspected CAD patients, to a re-estimated version of the MRT for ruling out the presence of coronary atherosclerosis assessed by coronary CT angiography (CCTA). Methods: Two hundred and fifty-six subjects with suspected stable CAD recruited from five European countries within H2020-SMARTool, undergoing CCTA and blood sampling for clinical biochemistry and lipidomics, were selected. The MRT was validated by regression methods and then re-estimated (reMRT). The reMRT was used as a baseline model in a likelihood ratio test approach to assess the added predictive value of each lipid from 13 among ceramides, triglycerides, and sphingomyelins. Except for one lipid, the analysis was carried out on more than 240 subjects for each lipid. A sensitivity analysis was carried out by considering two alternative models developed on the cohort as baseline models. Results: In 205 subjects, coronary atherosclerosis ranged from minimal lesions to overt obstructive CAD, while in 51 subjects (19.9%) the coronary arteries were intact. Four triglycerides and seven sphingomyelins were significantly (p < 0.05) and differentially expressed in the two groups and, at a lesser extent, one ceramide (p = 0.067). The probability of being at minimal risk was significantly better estimated by adding either Cer(d18:1/16:0) (p = 0.01), SM(40:2) (p = 0.04), or SM(41:1) at a lesser extent (p = 0.052) to reMRT than by applying the reMRT alone. The sensitivity analysis confirmed the relevance of these lipids. Furthermore, the addition of SM(34:1), SM(38:2), SM(41:2), and SM(42:4) improved the predictive performance of at least one of the other baseline models. None of the selected triglycerides was found to provide an added value. Conclusions: Plasma lipidomics can be a promising source of diagnostic and prognostic biomarkers in cardiovascular disease, exploitable not only to assess the risk of adverse events but also to identify subjects without coronary atherosclerosis, thus reducing unnecessary further testing in normal subjects.
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Affiliation(s)
- Antonella Bodini
- Institute for Applied Mathematics and Information Technologies "E. Magenes," National Research Council, Milan, Italy
| | - Elena Michelucci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Chiara Caselli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.,Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Signore
- NEST, Scuola Normale Superiore, Pisa, Italy.,Fondazione Pisana per la Scienza, San Giuliano Terme, Italy
| | - Danilo Neglia
- Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Pierpaolo Mincarone
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
| | - Carlo G Leo
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Pradella S, Zantonelli G, Grazzini G, Cozzi D, Danti G, Acquafresca M, Miele V. The Radiologist as a Gatekeeper in Chest Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6677. [PMID: 34205792 PMCID: PMC8296491 DOI: 10.3390/ijerph18126677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.
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Affiliation(s)
- Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Giulia Zantonelli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Manlio Acquafresca
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
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Woodward W, Dockerill C, McCourt A, Upton R, O'Driscoll J, Balkhausen K, Chandrasekaran B, Firoozan S, Kardos A, Wong K, Woodward G, Sarwar R, Sabharwal N, Benedetto E, Spagou N, Sharma R, Augustine D, Tsiachristas A, Senior R, Leeson P, Boardman H, d'Arcy J, Abraheem A, Banypersad S, Boos C, Bulugahapitiya S, Butts J, Coles D, Easaw J, Hamdan H, Jamil-Copley S, Kanaganayagam G, Mwambingu T, Pantazis A, Papachristidis A, Rajani R, Rasheed MA, Razvi NA, Rekhraj S, Ripley DP, Rose K, Scheuermann-Freestone M, Schofield R, Sultan A. Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study. Eur Heart J Cardiovasc Imaging 2021; 23:689-698. [PMID: 34148078 PMCID: PMC9016358 DOI: 10.1093/ehjci/jeab092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography. Methods and results Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57–74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals. Conclusion Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.
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Affiliation(s)
- William Woodward
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Cameron Dockerill
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Annabelle McCourt
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Ross Upton
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK.,Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Jamie O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.,School of Human and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK
| | - Katrin Balkhausen
- Department of Cardiology, Royal Berkshire Hospitals NHS Foundation Trust, Reading RG1 5AN, UK
| | | | - Soroosh Firoozan
- Department of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe HP11 2TT, UK
| | - Attila Kardos
- Department of Cardiology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK
| | - Kenneth Wong
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool FY3 8NP, UK
| | - Gary Woodward
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Rizwan Sarwar
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Nikant Sabharwal
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Elena Benedetto
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Nancy Spagou
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Daniel Augustine
- Department of Cardiology, Royal United Hospitals NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Apostolos Tsiachristas
- Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK.,Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NJ, UK.,Department of Cardiology, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Henry Boardman
- Department of Cardiology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Joanna d'Arcy
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Abraheem Abraheem
- Department of Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Sanjay Banypersad
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - Christopher Boos
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | | | - Jeremy Butts
- Department of Cardiology, Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Duncan Coles
- Department of Cardiology, Mid Essex NHS Hospital Services NHS Trust, Broomfield, UK
| | - Jacob Easaw
- Department of Cardiology, Royal United Hospitals NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Haytham Hamdan
- Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shahnaz Jamil-Copley
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gajen Kanaganayagam
- Department of Cardiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tom Mwambingu
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Pinderfields, UK
| | - Antonis Pantazis
- Department of Cardiology, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Naveed A Razvi
- Department of Cardiology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Sushma Rekhraj
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David P Ripley
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Kathleen Rose
- Department of Cardiology, Northampton General Hospital NHS Trust, Northampton, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Ayyaz Sultan
- Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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49
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Ru L, Lan P, Xu C, Lu L, Chen T. The value of coronary CTA in the diagnosis of coronary artery disease. Am J Transl Res 2021; 13:5287-5293. [PMID: 34150120 PMCID: PMC8205783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of coronary computed tomography angiography (CTA) in the detection of coronary artery disease. METHODS From January 2017 to December 2019, 150 patients with suspected coronary artery disease admitted to the Affiliated People's Hospital of Ningbo University were recruited as the research cohort for this study. All the patients underwent a coronary CTA and a coronary angiography. The results of the patients' coronary CTAs and coronary angiographies were compared. Analyses were performed on the practical implications of coronary CTA in the detection of coronary artery disease and the detection and coincidence rates of coronary CTA for determining the severity of coronary stenosis. RESULTS There were no statistical differences in the detection of positive results of coronary artery diseases or the identification of coronary stenosis between the coronary CTAs and the coronary angiographies. The sensitivity of coronary CTA in the examination of coronary artery diseases was 81.8%. The specificity was 87.5%, the negative predictive value was 63.6%, and the positive predictive value was 94.7%. In contrast to the coronary angiography, the coincidence rates of coronary CTA for determining the location of coronary lesions were 89.1% for LAD lesions, 80.0% for LCX lesions, and 100% for RCA lesions. CONCLUSIONS Coronary CTA has a significant value in the detection of coronary artery diseases, as it can accurately examine the severity of coronary stenoses and locate the sites of the stenotic lesions. It is worthy of clinical use.
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Affiliation(s)
- Li Ru
- Department of Radiology, Affiliated People’s Hospital of Ningbo UniversityNingbo, Zhejiang Province, China
| | - Pengxun Lan
- Department of Radiology, Affiliated People’s Hospital of Ningbo UniversityNingbo, Zhejiang Province, China
| | - Chengcheng Xu
- Department of Radiology, Ningbo First HospitalNingbo, Zhejiang Province, China
| | - Lingling Lu
- Department of Radiology, Affiliated People’s Hospital of Ningbo UniversityNingbo, Zhejiang Province, China
| | - Ting Chen
- Department of Radiology, Affiliated People’s Hospital of Ningbo UniversityNingbo, Zhejiang Province, China
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