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Adam NL, Kowalik G, Tyler A, Mooiweer R, Neofytou AP, McElroy S, Kunze K, Speier P, Stäb D, Neji R, Nazir MS, Razavi R, Chiribiri A, Roujol S. Fast reconstruction of SMS bSSFP myocardial perfusion images using noise map estimation network (NoiseMapNet): a head-to-head comparison with parallel imaging and iterative reconstruction. Front Cardiovasc Med 2024; 11:1350345. [PMID: 39055659 PMCID: PMC11269255 DOI: 10.3389/fcvm.2024.1350345] [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: 12/05/2023] [Accepted: 06/13/2024] [Indexed: 07/27/2024] Open
Abstract
Background Simultaneous multi-slice (SMS) bSSFP imaging enables stress myocardial perfusion imaging with high spatial resolution and increased spatial coverage. Standard parallel imaging techniques (e.g., TGRAPPA) can be used for image reconstruction but result in high noise level. Alternatively, iterative reconstruction techniques based on temporal regularization (ITER) improve image quality but are associated with reduced temporal signal fidelity and long computation time limiting their online use. The aim is to develop an image reconstruction technique for SMS-bSSFP myocardial perfusion imaging combining parallel imaging and image-based denoising using a novel noise map estimation network (NoiseMapNet), which preserves both sharpness and temporal signal profiles and that has low computational cost. Methods The proposed reconstruction of SMS images consists of a standard temporal parallel imaging reconstruction (TGRAPPA) with motion correction (MOCO) followed by image denoising using NoiseMapNet. NoiseMapNet is a deep learning network based on a 2D Unet architecture and aims to predict a noise map from an input noisy image, which is then subtracted from the noisy image to generate the denoised image. This approach was evaluated in 17 patients who underwent stress perfusion imaging using a SMS-bSSFP sequence. Images were reconstructed with (a) TGRAPPA with MOCO (thereafter referred to as TGRAPPA), (b) iterative reconstruction with integrated motion compensation (ITER), and (c) proposed NoiseMapNet-based reconstruction. Normalized mean squared error (NMSE) with respect to TGRAPPA, myocardial sharpness, image quality, perceived SNR (pSNR), and number of diagnostic segments were evaluated. Results NMSE of NoiseMapNet was lower than using ITER for both myocardium (0.045 ± 0.021 vs. 0.172 ± 0.041, p < 0.001) and left ventricular blood pool (0.025 ± 0.014 vs. 0.069 ± 0.020, p < 0.001). There were no significant differences between all methods for myocardial sharpness (p = 0.77) and number of diagnostic segments (p = 0.36). ITER led to higher image quality than NoiseMapNet/TGRAPPA (2.7 ± 0.4 vs. 1.8 ± 0.4/1.3 ± 0.6, p < 0.001) and higher pSNR than NoiseMapNet/TGRAPPA (3.0 ± 0.0 vs. 2.0 ± 0.0/1.3 ± 0.6, p < 0.001). Importantly, NoiseMapNet yielded higher pSNR (p < 0.001) and image quality (p < 0.008) than TGRAPPA. Computation time of NoiseMapNet was only 20s for one entire dataset. Conclusion NoiseMapNet-based reconstruction enables fast SMS image reconstruction for stress myocardial perfusion imaging while preserving sharpness and temporal signal profiles.
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Affiliation(s)
- Naledi Lenah Adam
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Grzegorz Kowalik
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Andrew Tyler
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Ronald Mooiweer
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Alexander Paul Neofytou
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Sarah McElroy
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Karl Kunze
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Peter Speier
- Cardiovascular Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Daniel Stäb
- MR Research Collaborations, Siemens Healthcare Limited, Melbourne, VIC, Australia
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Royal Brompton Hospital, Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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Jin Y, Shen L, Ye R, Zhou M, Guo X. Development and validation of a novel score for predicting perioperative major adverse cardiovascular events in patients with stable coronary artery disease undergoing noncardiac surgery. Int J Cardiol 2024; 405:131982. [PMID: 38521511 DOI: 10.1016/j.ijcard.2024.131982] [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: 12/01/2023] [Revised: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND A model developed specifically for stable coronary artery disease (SCAD) patients to predict perioperative major adverse cardiovascular events (MACE) has not been previously reported. METHODS The derivation cohort consisted of 5780 patients with SCAD undergoing noncardiac surgery at the First Affiliated Hospital of Zhejiang University School of Medicine, from January 1, 2013 until May 31, 2021. The validation cohort consisted of 2677 similar patients from June 1, 2021 to May 31, 2023. The primary outcome was a composite of MACEs (death, resuscitated cardiac arrest, myocardial infarction, heart failure, and stroke) intraoperatively or during hospitalization postoperatively. RESULTS Six predictors, including Creatinine >90 μmol/L, Hemoglobin <110 g/L, Albumin <40 g/L, Leukocyte >10 ×109/L, high-risk Surgery (general abdominal or vascular), and American Society of Anesthesiologists (ASA) class (III or IV), were selected in the final model (CHALSA score). Each patient was assigned a CHALSA score of 0, 1, 2, 3, or > 3 according to the number of predictors present. The incidence of perioperative MACEs increased steadily across the CHALSA score groups in both the derivation (0.5%, 1.4%, 2.9%, 6.8%, and 23.4%, respectively; p < 0.001) and validation (0.3%, 1.5%, 4.1%, 9.2%, and 29.2%, respectively; p < 0.001) cohorts. The CHALSA score had a higher discriminatory ability than the revised cardiac risk index (C statistic: 0.827 vs. 0.695 in the validation dataset; p < 0.001). CONCLUSIONS The CHALSA score showed good validity in an external dataset and will be a valuable bedside tool to guide the perioperative management of patients with SCAD undergoing noncardiac surgery.
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Affiliation(s)
- Yunpeng Jin
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Liang Shen
- Department of Information Technology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Runze Ye
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Min Zhou
- Department of Information Technology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Schaefer JK, Errickson J, Kong X, Ali MA, DeCamillo D, Edupuganti S, Haymart B, Kaatz S, Kline-Rogers E, Kozlowski JH, Krol GD, Sood SL, Froehlich JB, Barnes GD. Outcomes of direct oral anticoagulants with aspirin vs warfarin with aspirin: a registry-based cohort study. Res Pract Thromb Haemost 2024; 8:102449. [PMID: 38983902 PMCID: PMC11231707 DOI: 10.1016/j.rpth.2024.102449] [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: 12/30/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
Background For patients anticoagulated with direct oral anticoagulants (DOACs) or warfarin and on aspirin (ASA) for nonvalvular atrial fibrillation and/or venous thromboembolism, it is unclear if bleeding outcomes differ. Objectives To assess bleeding rates for ASA with DOACs vs warfarin and one another. Methods Registry-based cohort study of patients followed by a 6-center quality improvement collaborative in Michigan using data from 2009 to 2022. The study included adults on ASA with warfarin or DOACs for atrial fibrillation and/or venous thromboembolism without a recent myocardial infarction or heart valve replacement. Results After propensity matching by anticoagulant class, we compared 2 groups of 1467 patients followed for a median of 18.0 months. Any bleeding and nonmajor bleeding was increased with DOACs + ASA compared with warfarin + ASA (32.2 vs 27.8 and 27.1 vs 22.9 events/100 patient-years; relative risks [RRs], 1.1 and 1.2; 95% CIs, 1.1-1.2 and 1.1-1.3, respectively). After matching by drug, patients on apixaban + ASA vs warfarin + ASA had more bleeding (31.2 vs 27.8 events/100 patient-years; RR, 1.1; 95% CI, 1.0-1.2) and nonmajor bleeding but less major bleeding (3.8 vs 4.7 events/100 patient-years; RR, 0.8; 95% CI, 0.6-1.0) and emergency room visits for bleeding. Patients on rivaroxaban + ASA vs warfarin + ASA had more bleeding (39.3 vs 26.3 events/100 patient-years, RR, 1.5; 95% CI, 1.3-1.6), nonmajor bleeding, and thrombosis. Patients on apixaban + ASA vs rivaroxaban + ASA had significantly less bleeding (22.5 vs 39.3/100 patient-years; RR, 0.6; 95% CI, 0.5-0.7), nonmajor bleeding, major bleeding (2.1 vs 5.5 events/100 patient-years; RR, 0.4; 95% CI, 0.2-0.6), emergency room visits for bleeding, and thrombotic events. Conclusion Patients on DOAC + ASA without a recent myocardial infarction or heart valve replacement had more nonmajor bleeding but otherwise similar outcomes compared with warfarin + ASA. Patients treated with rivaroxaban + ASA experienced more adverse clinical events compared with warfarin + ASA or apixaban + ASA.
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Affiliation(s)
- Jordan K Schaefer
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Josh Errickson
- Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Xiaowen Kong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mona A Ali
- Department of Heart and Vascular Services, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Deborah DeCamillo
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Subhash Edupuganti
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Haymart
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Eva Kline-Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jay H Kozlowski
- Huron Valley Sinai Hospital, Commerce Township, Michigan, USA
| | - Gregory D Krol
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Suman L Sood
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - James B Froehlich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Cabanas-Sánchez V, Duarte Junior MA, Lavie CJ, Celis-Morales C, Rodríguez-Artalejo F, Martínez-Gómez D. Physical Activity and Cause-Specific Cardiovascular Mortality Among People With and Without Cardiovascular Disease: A Cohort Study of 0.6 Million US Adults. Mayo Clin Proc 2024; 99:564-577. [PMID: 37676199 DOI: 10.1016/j.mayocp.2023.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To assess the association of physical activity (PA) with cause-specific cardiovascular disease (CVD) mortality among people with preexisting CVD and to analyze the relationship of PA with CVD-related mortality in people without CVD as well as the association of PA with nonspecific CVD mortality in both populations. PARTICIPANTS AND METHODS Of the total participants in the 1997 through 2018 US National Health Interview Survey waves, 87,959 adults with CVD and 527,185 without CVD were included. Leisure-time PA was self-reported; based on frequency and duration, minutes per week in PA were calculated and subsequently classified into: (1) none: 0 min/wk, (2) insufficient: 1 to 149.9 min/wk, (3) recommended: 150 to 300 min/wk, and (4) additional: more than 300 min/wk. Mortality data were obtained through link to records from the National Death Index. Statistical analyses were performed with Cox regression adjusted for potential confounders. RESULTS During a mean follow-up of 8.5 years, 12,893 participants with CVD, 9943 with coronary heart disease (CHD), and 843 with stroke died of CVD mortality, diseases of heart mortality, and cerebrovascular mortality, respectively. In fully adjusted models, compared with no PA, insufficient, recommended, and additional PA were associated with 25.9%, 37.1%, and 42.0% lower risk of diseases of heart mortality among people with prior CHD, respectively. Among people with stroke, recommended and additional PA was related to 30.7% and 59.3% lower risk of cerebrovascular mortality, respectively. The protective effect of PA on cause-specific CVD mortality was greater in people with CVD than in those without prior CVD. Moreover, PA was more markedly inversely associated with cause-specific CVD mortality than with nonspecific CVD mortality in people with CVD. CONCLUSION Physical activity was strongly associated with lower risk of CVD-, CHD-, and stroke-related mortality among people with a history of these specific diseases. Health care professionals should emphasize the importance of a physically active lifestyle in patients with CVD.
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Affiliation(s)
- Verónica Cabanas-Sánchez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain.
| | - Miguel Angelo Duarte Junior
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK G12 8TA; Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, 3466706, Chile
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain
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Ren C, Pan Q, Fu C, Wang P, Zheng Z, Hsu B, Huo L. Phase I, first-in-human study of XTR004, a novel 18F-labeled tracer for myocardial perfusion PET: Biodistribution, radiation dosimetry, pharmacokinetics, and safety after a single injection at rest. J Nucl Cardiol 2024; 34:101823. [PMID: 38360262 DOI: 10.1016/j.nuclcard.2024.101823] [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: 01/29/2024] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES This study assessed the imaging characteristics, pharmacokinetics and safety of XTR004, a novel 18F-labeled Positron Emission Tomography (PET) myocardial perfusion imaging tracer, after a single injection at rest in humans. METHODS Eleven healthy subjects (eight men and three women) received intravenous XTR004 (239-290 megabecquerel [MBq]). Safety profiles were monitored on the dosing day and three follow-up visits. Multiple whole-body PET scans were conducted over 4.7 h to evaluate biodistribution and radiation dosimetry. Blood and urine samples collected for 7.25 h were metabolically corrected to characterize pharmacokinetics. RESULTS In the first 0-12 min PET images of ten subjects, liver (26.81 ± 4.01), kidney (11.43 ± 2.49), lung (6.75 ± 1.76), myocardium (4.72 ± 0.67) and spleen (3.1 ± 0.84) exhibited the highest percentage of the injected dose (%ID). Myocardial uptake of XTR004 in the myocardium initially reached 4.72 %ID and 7.06 g/mL, and negligibly changed within an hour (Δ: 7.20%, 5.95%). The metabolically corrected plasma peaked at 2.5 min (0.0013896 %ID/g) and halved at 45.2 min. Whole-body effective dose was 0.0165 millisievert (mSv)/MBq. Cumulative urine excretion was 8.18%. Treatment-related adverse events occurred in seven out of eleven subjects (63.6%), but no severe adverse event was reported. CONCLUSIONS XTR004 demonstrated a favorable safety profile, rapid, high, and stable myocardial uptake and excellent potential for PET myocardial perfusion imaging (MPI). Further exploration of XTR004 PET MPI for detecting myocardial ischemia is warranted.
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Affiliation(s)
- Chao Ren
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qingqing Pan
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chao Fu
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Peipei Wang
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhiquan Zheng
- Medical Department, Sinotau Pharmaceutical Group, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
| | - Li Huo
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Li X, Wang C, Jin Y. Temporal trends and risk factors of perioperative cardiac events in patients over 80 years old with coronary artery disease undergoing noncardiac surgery: a high-volume single-center experience, 2014-2022. Postgrad Med J 2024; 100:252-261. [PMID: 38223919 DOI: 10.1093/postmj/qgad141] [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: 07/14/2023] [Revised: 11/11/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Temporal trends and risk factors of perioperative cardiac events (PCEs) in patients over 80 years old with coronary artery disease (CAD) undergoing noncardiac surgery are still unclear. METHODS We retrospectively reviewed 1478 patients over 80 years old, with known CAD undergoing selective noncardiac surgery in a single center (2014-2022). Patients were divided into three equal time groups based on the discharge date (2014-2016, 2017-2019, and 2020-2022), with 367, 473, and 638 patients in Groups 1-3, respectively. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCEs intraoperatively or during hospitalization postoperatively, defined as any of the following events: myocardial infarction, heart failure, nonfatal cardiac arrest, and death. RESULTS PCEs occurred in 180 (12.2%) patients. Eight independent risk factors were associated with PCEs, including four clinical factors (body mass index < 22 kg/m2, history of myocardial infarction, history of heart failure, and general anesthesia) and four preoperative laboratory results (hemoglobin < 110 g/L, albumin < 40 g/L, creatinine > 120 μmol/L, and potassium <3.6 mmol/L). Significant rising trends were seen over the 9-year study period in the incidence of PCEs and independent risk factors including history of myocardial infarction, history of heart failure, general anesthesia, preoperative hemoglobin < 110 g/L, preoperative albumin < 40 g/L, and preoperative creatinine > 120 μmol/L (P for trend <0.05). CONCLUSION The incidence and independent risk factors of PCEs in patients over 80 years old with CAD undergoing noncardiac surgery showed significant rising trends over the last 9-year period.
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Affiliation(s)
- Xiaolin Li
- Department of Nutrition, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322000 Zhejiang, People's Republic of China
| | - Congying Wang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322000 Zhejiang, People's Republic of China
| | - Yunpeng Jin
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322000 Zhejiang, People's Republic of China
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Jonik S, Kageyama S, Ninomiya K, Onuma Y, Kochman J, Grabowski M, Serruys PW, Mazurek T. Five-year outcomes in patients with multivessel coronary artery disease undergoing surgery or percutaneous intervention. Sci Rep 2024; 14:3218. [PMID: 38332036 PMCID: PMC10853195 DOI: 10.1038/s41598-024-53905-4] [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: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
The outcomes from real-life clinical studies regarding the optimal revascularization strategy in patients with multivessel coronary artery disease (MVD) are still poorly investigated. In this retrospective study we assessed 5-year outcomes: primary, secondary endpoints and quality of life of 1035 individuals with severe coronary artery disease (CAD) treated either with coronary artery bypass grafting (CABG)-356 patients or percutaneous coronary intervention (PCI)-679 patients according to the recommendation of a local Heart Team (HT). At 5 years no significant difference in overall mortality and rates of myocardial infarctions (MI) were observed between CABG and PCI cohorts (11.0% vs. 13.4% for PCI, P = 0.27 and 9.6% vs. 12.8% for PCI, P = 0.12, respectively). The incidence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by increased rates of repeat revascularization (RR) were higher in PCI-cohort than in CABG-group (56.1% vs. 40.4%, P < 0.01 and 26.8% vs. 12.6%, P < 0.01, respectively), while CABG-patients experienced stroke more often (7.3% vs. 3.1% for PCI, P < 0.01). In real-life practice with long-term follow-up, none of the two revascularization modalities implemented following HT decisions showed overwhelming superiority: occurrence of death and MI were similar, rates of RR favoured CABG, while incidence of strokes advocated PCI.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland.
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
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Palicherla A, Ismayl M, Thandra A, Budoff M, Shaikh K. Evaluation of stable angina by coronary computed tomographic angiography versus standard of care: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:67-75. [PMID: 37541837 DOI: 10.1016/j.carrev.2023.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION There is limited data comparing Coronary Computed Tomography Angiography (CCTA) versus the usual Standard of care (SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis to compare CCTA versus SOC in patients with stable CAD. METHODS We searched multiple databases for randomized controlled trials (RCTs) comparing CCTA with SOC, which included various functional testing approaches for evaluating stable CAD. We used a random-effects model to calculate risk ratios (RRs) with 95 % confidence intervals (CIs). Outcomes included all-cause mortality, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). RESULTS We identified 6 RCTs with 19,881 patients with stable CAD, of which 9995 underwent CCTA, and 9886 underwent SOC. There were no significant differences between CCTA and SOC in terms of all-cause mortality (RR: 0.91; 95 % CI: 0.70-1.19; p = 0.50), MI (RR: 0.78; 95 % CI: 0.58-1.05; p = 0.11), hospitalizations for UA (RR: 1.20; 95 % CI: 0.95-1.51;p = 0.12), invasive angiography (RR: 0.71; 95 % CI: 0.32-1.61; p = 0.42), revascularization (RR:1.25; 95 % CI: 0.83-1.89; p = 0.29), PCI (RR: 1.20; 95 % CI: 0.78-1.85; p = 0.40), and CABG rates (RR: 0.89; 95 % CI: 0.530-1.49; p = 0.65). CONCLUSION In patients with stable CAD, CCTA is associated with similar outcomes compared to the usual Standard of care. Given its potential to quickly rule out severe obstructive disease, its ability to provide non-invasive physiology and identify non-obstructive CAD with plaque information makes it an attractive addition to the available armamentarium to evaluate chest pain.
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Affiliation(s)
- Anirudh Palicherla
- Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States of America.
| | - Mahmoud Ismayl
- Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Abhishek Thandra
- Interventional Cardiology, Creighton University School of Medicine, Omaha, NE, United States of America.
| | - Matthew Budoff
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Kashif Shaikh
- University of Tennessee, Knoxville, United States of America
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Hajra A, Ujjawal A, Ghalib N, Chowdhury S, Biswas S, Balasubramanian P, Gupta R, Aronow WS. Expanding Indications of Nonvitamin K Oral Anticoagulants Beyond Nonvalvular Atrial Fibrillation and Venous Thromboembolism: A Review of Emerging Clinical Evidence. Curr Probl Cardiol 2024; 49:102017. [PMID: 37544618 DOI: 10.1016/j.cpcardiol.2023.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Direct oral anticoagulants (DOAC) have emerged as a new therapy for patients who need and can tolerate oral anticoagulation. DOACs were initially approved for nonvalvular atrial fibrillation (NVAF) and treatment for deep vein thrombosis (DVT) and pulmonary embolism (PE). Ease of administration, no requirement of bridging with other anticoagulants, and less frequent dosing have made DOACs preferable choice for anticoagulation. Studies are showing promising results regarding use of DOACs beyond the common indications. Studies have been done to show the potential benefit of DOACs in valvular atrial fibrillation, heart failure, acute coronary syndrome, stroke, and peripheral arterial disease. Data have shown safety as well as comparable bleeding incidences with DOACs compared to vitamin K antagonist anticoagulants. Naturally interest is growing to see the use of DOACs apart from the NVAF, DVT, or PE. Authors have highlighted various study results to show the potential beneficial role of DOACs in the above-mentioned situations.
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Affiliation(s)
- Adrija Hajra
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
| | | | - Natasha Ghalib
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | | | - Suman Biswas
- Calcutta National Medical College, Kolkata, West Bengal, India
| | | | | | - Wilbert S Aronow
- New York Medical College at Westchester Medical Center, New York, NY
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Hanna JM, Wang SY, Kochar A, Park DY, Damluji AA, Henry GA, Ahmad Y, Curtis JP, Nanna MG. Complex Percutaneous Coronary Intervention Outcomes in Older Adults. J Am Heart Assoc 2023; 12:e029057. [PMID: 37776222 PMCID: PMC10727245 DOI: 10.1161/jaha.122.029057] [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: 12/01/2022] [Accepted: 07/17/2023] [Indexed: 10/02/2023]
Abstract
Background Complex percutaneous coronary intervention (PCI) is increasingly performed in older adults (age ≥75 years) with stable ischemic heart disease. However, little is known about clinical outcomes. Methods and Results We derived a cohort of older adults undergoing elective PCI for stable ischemic heart disease across a large health system. We compared 12-month event-free survival (freedom from all-cause death, nonfatal myocardial infarction, stroke, and major bleeding), all-cause death, target lesion revascularization, and bleeding events for patients receiving complex versus noncomplex PCI and derived risk estimates with Cox regression models. We included 513 patients (mean age, 81±5 years). Patients receiving complex PCI versus noncomplex PCI did not significantly differ across a host of clinical characteristics including cardiovascular disease features, noncardiac comorbidities, guideline-directed medical therapy use, and frailty. Patients receiving complex PCI versus noncomplex PCI experienced worse event-free survival (80.4% versus 86.8%), which was not significant in adjusted analyses (hazard ratio [HR], 1.38 [95% CI, 0.88-2.16]). All-cause death at 1 year for patients undergoing complex PCI was nearly double that seen for patients receiving noncomplex PCI (10.2% versus 5.9%), and the risk was significant in models adjusted for clinical characteristics (HR, 1.97 [95% CI, 1.02-3.79]). Target lesion revascularization risk was lower for patients receiving complex PCI (2.2% versus 3.5%, adjusted HR), but bleeding events were not statistically different between groups (25.3% versus 20.5%; P=0.19). Conclusions Complex PCI in older adults with stable ischemic heart disease was associated with lower risk of target lesion revascularization but higher all-cause death compared with noncomplex PCI.
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Affiliation(s)
- Jonathan M. Hanna
- Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Stephen Y. Wang
- Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Ajar Kochar
- Department of Cardiovascular MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonMAUSA
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | - Dae Yong Park
- Department of Medicine, Cook County HealthChicagoILUSA
| | - Abdulla A. Damluji
- Inova Center of Outcomes ResearchFalls ChurchVAUSA
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Glen A. Henry
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of MedicineNew HavenCTUSA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of MedicineNew HavenCTUSA
| | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of MedicineNew HavenCTUSA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of MedicineNew HavenCTUSA
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Pei G, Liu R, Wang L, He C, Fu C, Wei Q. Monocyte to high-density lipoprotein ratio is associated with mortality in patients with coronary artery diseases. BMC Cardiovasc Disord 2023; 23:451. [PMID: 37697241 PMCID: PMC10496218 DOI: 10.1186/s12872-023-03461-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Whether the monocyte to high-density lipoprotein ratio (MHR) is associated with the prognosis of coronary artery disease (CAD) is inconclusive. METHODS Patients with CAD were enrolled and their data were collected. Blood was sampled within 24 h after admission. Multivariate Cox regression analysis was performed to determine the relationship between the MHR and all-cause mortality as well as complications during hospitalization. RESULTS We included 5371 patients in our cohort study. Among them, 114 (2.12%) patients died in hospital. MHR was independently associated with all-cause mortality (hazard ratio [HR], 1.81; 95% confidence interval [CI] 1.35, 2.42), cardiovascular mortality (1.69; 1.17, 2.45) and non-cardiovascular mortality (2.04; 1.27, 3.28). This association was only observed in patients with hypertension (P for interaction = 0.003). Patients with higher MHR levels also have a higher risk of complications, including infection, pneumonia, electrolyte disturbance, gastrointestinal bleeding, multiple organ dysfunction syndrome, and disturbance of consciousness. The receiver operating characteristic (ROC) analysis showed that the MHR had higher prognostic values than monocytes and high-density lipoprotein. CONCLUSION MHR was an independent predictor of all-cause mortality and in-hospital complications in patients with CAD, especially in patients with hypertension.
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Affiliation(s)
- Gaiqin Pei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lu Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chengqi He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chenying Fu
- West China Hospital, National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, Sichuan, China.
- Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China.
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12
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Tserioti E, Chana H, Salmasi AM. Hypertensive Subjects are More Likely to Develop Coronary Artery Lesions: A Study by Computerised Tomography Coronary Angiography. Angiology 2023:33197231200774. [PMID: 37678558 DOI: 10.1177/00033197231200774] [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: 09/09/2023]
Abstract
Coronary Computed Tomography Angiography (CCTA) is commonly used to identify coronary artery disease. In this study, the indications for CCTA referrals are reviewed, to identify the strongest predictors of CAD, as seen on CCTA. A retrospective study, reviewing the electronic health records of consecutive patients who underwent CCTA between July and November 2020 at our Trust, was conducted. A total of 485 patient reports were reviewed. Of patients with moderate-to-severe CAD, 128 (73.6%) were hypertensive. Of those with severe CAD, 79 patients (76%) were hypertensive. Univariate analysis for comparison of patients with absent (n = 219), mild (n = 92), moderate (n = 70) and severe (n = 104) CAD revealed that hypertension (P < .001), diabetes mellitus (P < .001), gender (P < .001), dyslipidemia (P < .001) and smoking (P = .006), were each significantly associated with the presence of CAD on CCTA. However, multiple logistic regression analysis confirmed that hypertension has the strongest association with CAD (OR = 2.22, P < .001) Furthermore, the presence of typical chest pain in hypertensive patients was strongly associated with significant CAD, on CCTA. Among all risk factors, hypertension is the strongest independent predictor for the presence of CAD on CCTA. These results suggest that hypertension is a significant factor when considering referral for CCTA, particularly when associated with chest pain.
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Affiliation(s)
| | - Harmeet Chana
- London North West University Healthcare Hospital NHS Trust, London, UK
| | - Abdul-Majeed Salmasi
- London North West University Healthcare Hospital NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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13
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MacDonald BJ, Turgeon RD. Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022. JAMA Netw Open 2023; 6:e2332793. [PMID: 37676658 PMCID: PMC10485733 DOI: 10.1001/jamanetworkopen.2023.32793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
Importance Shared decision-making (SDM) is a key component of the provision of ethical care, but prior reviews have indicated that clinical practice guidelines seldom promote or facilitate SDM. It is currently unknown whether these findings extend to contemporary cardiovascular guidelines. Objective To identify and characterize integration of SDM in contemporary cardiovascular guideline recommendations using a systematic classification system. Design, Setting, and Participants This cross-sectional study assessed the latest guidelines or subsequent updates that included pharmacotherapy recommendations and were published between January 2012 and December 2022 by the American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC). Data were analyzed from February 21 to July 21, 2023. Main Outcomes and Measures All pharmacotherapy recommendations were identified within each guideline. Recommendations that incorporated SDM were rated according to a systematic rating framework to evaluate the quality of SDM incorporation based on directness (range, 1-3; assessing whether SDM was incorporated directly and impartially into the recommendation's text, with 1 indicating direct and impartial incorporation of SDM into the recommendation's text) and facilitation (range, A-D; assessing whether decision aids or quantified benefits and harms were provided, with A indicating that a decision aid quantifying benefits and harms was provided). The proportion of recommendations incorporating SDM was also analyzed according to guideline society and category (eg, general cardiology, heart failure). Results Analyses included 65 guideline documents, and 33 documents (51%) incorporated SDM either in a general statement or within specific recommendations. Of 7499 recommendations, 2655 (35%) recommendations addressed pharmacotherapy, and of these, 170 (6%) incorporated SDM. By category, general cardiology guidelines contained the highest proportion of pharmacotherapy recommendations incorporating SDM (86 of 865 recommendations [10%]), whereas heart failure and myocardial disease contained the least (9 of 315 recommendations [3%]). The proportion of pharmacotherapy recommendations incorporating SDM was comparable across societies (ACC: 75 of 978 recommendations [8%]; CCS: 29 of 333 recommendations [9%]; ESC: 67 of 1344 recommendations [5%]), with no trend for change over time. Only 5 of 170 SDM recommendations (3%) were classified as grade 1A (impartial recommendations for SDM supported by a decision aid), whereas 114 of 170 recommendations (67%) were grade 3D (SDM mentioned only in supporting text and without any tools or information to facilitate SDM). Conclusions and Relevance In this cross-sectional study across guidelines published by 3 major cardiovascular societies over the last decade, 51% of guidelines mentioned the importance of SDM, yet only 6% of recommendations incorporated SDM in any form, and fewer adequately facilitated SDM.
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Affiliation(s)
- Blair J. MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Zhang Y, Liao J, Le W, Wu G, Zhang W. Improving the Data Quality of Untargeted Metabolomics through a Targeted Data-Dependent Acquisition Based on an Inclusion List of Differential and Preidentified Ions. Anal Chem 2023; 95:12964-12973. [PMID: 37594469 DOI: 10.1021/acs.analchem.3c02888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Metabolomics based on high-resolution mass spectrometry has become a powerful technique in biomedical research. The development of various analytical tools and online libraries has promoted the identification of biomarkers. However, how to make mass spectrometry collect more data information is an important but underestimated research topic. Herein, we combined full-scan and data-dependent acquisition (DDA) modes to develop a new targeted DDA based on the inclusion list of differential and preidentified ions (dpDDA). In this workflow, the MS1 datasets for statistical analysis and metabolite preidentification were first obtained using full-scan, and then, the MS/MS datasets for metabolite identification were obtained using targeted DDA of quality control samples based on the inclusion list. Compared with the current methods (DDA, data-independent acquisition, targeted DDA with time-staggered precursor ion list, and iterative exclusion DDA), dpDDA showed better stability, higher characteristic ion coverage, higher differential metabolites' MS/MS coverage, and higher quality MS/MS spectra. Moreover, the same trend was verified in the analysis of large-scale clinical samples. More surprisingly, dpDDA can distinguish patients with different severities of coronary heart disease (CHD) based on the Canadian Cardiovascular Society angina classification, which we cannot distinguish through conventional metabolomics data collection. Finally, dpDDA was employed to differentiate CHD from healthy control, and targeted metabolomics confirmed that dpDDA could identify a more complete metabolic pathway network. At the same time, four unreported potential CHD biomarkers were identified, and the area under the receiver operating characteristic curve was greater than 0.85. These results showed that dpDDA would expand the discovery of biomarkers based on metabolomics, more comprehensively explore the key metabolites and their association with diseases, and promote the development of precision medicine.
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Affiliation(s)
- Yuhao Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Jingyu Liao
- School of Pharmacy, Guangdong Pharmaceutical University, Guangdong 510006, China
| | - Wanqi Le
- Institute of Interdisciplinary Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Gaosong Wu
- Institute of Interdisciplinary Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Weidong Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
- Institute of Interdisciplinary Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100193, China
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González-Juanatey C, Anguita-Sánchez M, Barrios V, Núñez-Gil I, Gómez-Doblas JJ, García-Moll X, Lafuente-Gormaz C, Rollán-Gómez MJ, Peral-Disdier V, Martínez-Dolz L, Rodríguez-Santamarta M, Viñolas-Prat X, Soriano-Colomé T, Muñoz-Aguilera R, Plaza I, Curcio-Ruigómez A, Orts-Soler E, Segovia-Cubero J, Fanjul V, Marín-Corral J, Cequier Á. Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain. J Clin Med 2023; 12:5218. [PMID: 37629262 PMCID: PMC10456002 DOI: 10.3390/jcm12165218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65-75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data.
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Affiliation(s)
| | - Manuel Anguita-Sánchez
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, 14014 Cordoba, Spain;
| | | | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Juan José Gómez-Doblas
- IBIMA (Instituto de Investigación Biomédica de Málaga), Hospital Universitario Virgen de la Victoria, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 29010 Malaga, Spain;
| | - Xavier García-Moll
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | | | | | | | - Luis Martínez-Dolz
- Hospital Universitario y Politécnico La Fe, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), IIS La Fe, 46026 Valencia, Spain;
| | | | - Xavier Viñolas-Prat
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | - Toni Soriano-Colomé
- Hospital Vall d’Hebron, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 08035 Barcelona, Spain;
| | | | | | | | - Ernesto Orts-Soler
- Hospital General Universitario de Castellón, 12004 Castellon de la Plana, Spain;
| | | | - Víctor Fanjul
- Savana Research SL, 28013 Madrid, Spain; (V.F.); (J.M.-C.)
| | | | - Ángel Cequier
- Hospital Universitario de Bellvitge, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), Universidad de Barcelona, 08007 Barcelona, Spain;
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Ono M, Serruys PW, Kawashima H, Lunardi M, Wang R, Hara H, Gao C, Garg S, O'Leary N, Wykrzykowska JJ, Piek JJ, Holmes DR, Morice MC, Kappetein AP, Noack T, Davierwala PM, Spertus JA, Cohen DJ, Onuma Y. Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:490-501. [PMID: 36001991 PMCID: PMC10405129 DOI: 10.1093/ehjqcco/qcac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
AIMS The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD). METHODS AND RESULTS In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups. A sensitivity analysis was performed using a 6-month SAQ-AF.At 1 year, 373 (26.1%) out of 1428 patients reported RA. Whilst RA at 1 year was an independent correlate of repeat revascularization at 5 years [18.3 vs. 11.5%; adjusted hazard ratio (HR): 1.54; 95% confidence interval (CI): 1.10-2.15], it was not associated with all-cause death at 10 years (22.1 vs. 21.6%; adjusted HR: 1.11; 95% CI: 0.83-1.47). These results were consistent when stratified by the modality of revascularization (PCI or CABG) or by anginal frequency. The sensitivity analysis replicating the analyses based on 6-month angina status resulted in similar findings. CONCLUSION Among patients with LMCAD and/or 3VD, patient-reported RA at 1 year post-revascularization was independently associated with repeat revascularization at 5 years; however, it did not significantly increase 10-year mortality, irrespective of the primary modality of revascularization or severity of RA.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Hideyuki Kawashima
- Department of Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Mattia Lunardi
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Hironori Hara
- Department of Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Joanna J Wykrzykowska
- Department of Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Ramsay Générale de Santé Massy, France
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
- Department of Surgery, University of Toronto, TorontoCanada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, 15 University Health Network, Toronto, Ontario, Canada
| | - John A Spertus
- Department of Cardiology, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, Missouri, 22 USA
| | - David J Cohen
- Clinical and Outcomes Research, Cardiovascular Research Foundation, New York NY and St. Francis Hospital, Roslyn NY, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
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Goli R, Ya’Qoub L, Blusztein D, Mahadevan VS. Treatment of left main coronary artery compression in the setting of unpalliated congenital heart disease: a case series. Eur Heart J Case Rep 2023; 7:ytad262. [PMID: 37601230 PMCID: PMC10438211 DOI: 10.1093/ehjcr/ytad262] [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: 12/17/2022] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 08/22/2023]
Abstract
Background Left main coronary artery compression syndrome (LMCS) is a well-characterized phenomenon resulting from compression of the left main coronary artery (LMCA) between the aorta and an enlarged pulmonary arterial trunk. The development of LMCS is usually described in the context of severe pulmonary arterial hypertension. Cases of LMCS, in the context of unpalliated congenital heart disease (CHD), are complex clinical scenarios that challenge traditional treatment paradigms. Case summary Here, we discuss two thought-provoking patients with unpalliated CHD complicated by severe pulmonary hypertension (PH). Both patients developed LMCS, one with severe non-ST elevation myocardial infarction and the other with refractory angina. Their pulmonary vascular resistance was severely elevated despite pulmonary vasodilator therapy, and concomitant surgical correction of their CHD in addition to bypass grafting was deemed high risk. They underwent successful percutaneous coronary intervention (PCI) of the LMCA with drug-eluting stents. Discussion Pulmonary hypertension can develop in the setting of long-standing unpalliated CHD. Surgical correction of congenital heart defects may be performed in select patients with systemic-to-pulmonary shunts, contingent on the status of PH severity. Pulmonary vasodilator therapy modulates haemodynamics to ensure surgical correction without risk of cardiopulmonary demise-termed the 'treat and repair' strategy. LMCS, an increasingly recognized phenomenon in patients with long-standing PH, is a notable complicating factor in the 'treat and repair' strategy. We introduce the concept that PCI of the LMCA may bridge patients to corrective surgery for CHD by allowing time for optimization of their pulmonary vasodilator therapy.
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Affiliation(s)
- Rahul Goli
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
| | - Lina Ya’Qoub
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
| | - David Blusztein
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Vaikom S Mahadevan
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
- University of Massachusetts, Chan School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
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18
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Marsh JF, VanMeter PD, Rajendran K, Leng S, McCollough CH. Ex vivo coronary calcium volume quantification using a high-spatial-resolution clinical photon-counting-detector computed tomography. J Med Imaging (Bellingham) 2023; 10:043501. [PMID: 37408984 PMCID: PMC10319293 DOI: 10.1117/1.jmi.10.4.043501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Coronary artery calcification (CAC) is an important indicator of coronary disease. Accurate volume quantification of CAC is challenging using computed tomography (CT) due to calcium blooming, which is a consequence of limited spatial resolution. Ex vivo coronary specimens were scanned on an ultra-high-resolution (UHR) clinical photon-counting detector (PCD) CT scanner, and the accuracy of CAC volume estimation was compared with a state-of-the-art conventional energy-integrating detector (EID) CT, a previous-generation investigational PCD-CT, and micro-CT. Approach CAC specimens (n = 13 ) were scanned on EID-CT and PCD-CT using matched parameters (120 kV, 9.3 mGy CTDI vol ). EID-CT images were reconstructed using our institutional routine clinical protocol for CAC quantification. UHR PCD-CT data were reconstructed using a sharper kernel. An image-based denoising algorithm was applied to the PCD-CT images to achieve similar noise levels as EID-CT. Micro-CT images served as the volume reference standard. Calcification images were segmented, and their volume estimates were compared. The CT data were further compared with previous work using an investigational PCD-CT. Results Compared with micro-CT, CT volume estimates had a mean absolute percent error of 24.1 % ± 25.6 % for clinical PCD-CT, 60.1 % ± 48.2 % for EID-CT, and 51.1 % ± 41.7 % for previous-generation PCD-CT. Clinical PCD-CT absolute percent error was significantly (p < 0.01 ) lower than both EID-CT and previous generation PCD-CT. The mean calcification CT number and contrast-to-noise ratio were both significantly (p < 0.01 ) higher in clinical PCD-CT relative to EID-CT. Conclusions UHR clinical PCD-CT showed reduced calcium blooming artifacts and further enabled improved accuracy of CAC quantification beyond that of conventional EID-CT and previous generation PCD-CT systems.
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Affiliation(s)
- Jeffrey F. Marsh
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | | - Kishore Rajendran
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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Waksman R, Bhogal S. In-Stent Restenosis and Stent Thrombosis: An Elusive Target. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100972. [PMID: 39131648 PMCID: PMC11307575 DOI: 10.1016/j.jscai.2023.100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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20
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Restan Perez M, da Silva VA, Cortez PE, Joddar B, Willerth SM. 3D-bioprinted cardiac tissues and their potential for disease modeling. JOURNAL OF 3D PRINTING IN MEDICINE 2023; 7:10.2217/3dp-2022-0023. [PMID: 38250545 PMCID: PMC10798787 DOI: 10.2217/3dp-2022-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Heart diseases cause over 17.9 million total deaths globally, making them the leading source of mortality. The aim of this review is to describe the characteristic mechanical, chemical and cellular properties of human cardiac tissue and how these properties can be mimicked in 3D bioprinted tissues. Furthermore, the authors review how current healthy cardiac models are being 3D bioprinted using extrusion-, laser- and inkjet-based printers. The review then discusses the pathologies of cardiac diseases and how bioprinting could be used to fabricate models to study these diseases and potentially find new drug targets for such diseases. Finally, the challenges and future directions of cardiac disease modeling using 3D bioprinting techniques are explored.
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Affiliation(s)
| | - Victor Alisson da Silva
- Department of Mechanical Engineering, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada
| | - Polette Esmeralda Cortez
- Department of Metallurgical, Materials & Biomedical Engineering, The University of Texas at El Paso, 500 West University Avenue, El Paso, TX 79968, USA
| | - Binata Joddar
- Department of Metallurgical, Materials & Biomedical Engineering, The University of Texas at El Paso, 500 West University Avenue, El Paso, TX 79968, USA
| | - Stephanie Michelle Willerth
- Axolotl Biosciences, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada
- Department of Mechanical Engineering, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada
- Division of Medical Sciences, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada
- Centre for Advanced Materials & Technology, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada
- School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
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21
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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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22
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Dahrab M, Gaddipati SP, Patel KB, Patel T, Gaddam AR, Jain M, Gudi TR, Meenashi Sundaram D, Mahfooz K, Vasavada AM. The Effect of Percutaneous Coronary Intervention on QT Dispersion and the Association Between Them: A Systematic Review. Cureus 2023; 15:e36226. [PMID: 37065409 PMCID: PMC10103800 DOI: 10.7759/cureus.36226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Electrocardiography (ECG) parameters are significant in the prognosis of ischemia and other cardiovascular conditions. Reperfusion or revascularization techniques are essential in reestablishing blood flow to ischemic tissues. This study aims to demonstrate the association between percutaneous coronary intervention (PCI), a revascularization technique, and the electrocardiography (ECG) parameter, QT dispersion (QTd). We conducted a systematic review of the association between PCI and QTd through a literature search in three electronic databases, ScienceDirect, PubMed, and Google Scholar, for empirical studies published in English. Review Manager (RevMan) 5.4 (Cochrane Collaboration, Oxford, England) was used for statistical analysis. Of 3,626 studies, 12 articles met the inclusion criteria, enrolling a total of 1,239 patients. After a successful PCI procedure, QTd and corrected QT (QTc) tremendously reduced at various time intervals with statistical significance in most of the studies. There was a clear association between ECG parameters QTd, QTc, and corrected QT dispersion (QTcd), and PCI, in that there is a considerable reduction in these ECG parameters after PCI treatment.
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23
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Swat SA, Hebbe A, Plomondon ME, Park KE, Bricker RS, Waldo SW, Valle JA. Contemporary Management Before Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Circ Cardiovasc Qual Outcomes 2023; 16:e008949. [PMID: 36722336 PMCID: PMC10033351 DOI: 10.1161/circoutcomes.122.008949] [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: 01/20/2022] [Accepted: 12/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Guidelines recommend maximal antianginal medical therapy before attempted coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The degree to which this occurs in contemporary practice is unknown. We aimed to characterize the frequency and variability of preprocedural use of antianginal therapy and stress testing within 3 months before PCI of CTO (CTO PCI) across a nationally integrated health care system. METHODS We identified patients who underwent attempted CTO PCI from January 2012 to September 2018 within the Veterans Affairs Healthcare System. Patients were categorized by management before CTO PCI: presence of ≥2 antianginals, stress testing, and ≥2 antianginals and stress testing within 3 months of PCI attempt. Multivariable logistic regression and inverse propensity weighting were used for adjustment before trimming, with median odds ratios calculated for variability estimates. RESULTS Among 4250 patients undergoing attempted CTO PCI, 40% received ≥2 antianginal medications and 24% underwent preprocedural stress testing. The odds of antianginal therapy with more than one medication before CTO PCI did not change over the years of the study (odds ratio [OR], 1.0 [95% CI, 0.97-1.04]), whereas the odds of undergoing preprocedural stress testing decreased (OR, 0.97 [95% CI, 0.93-0.99]), and the odds of antianginal therapy with ≥2 antianginals and stress testing did not change (OR, 0.98 [95% CI, 0.93-1.04]). Median odds ratios (MOR) showed substantial variability in antianginal therapy across hospital sites (MOR, 1.3 [95% CI, 1.26-1.42]) and operators (MOR, 1.35 [95% CI, 1.26-1.63]). Similarly, preprocedural stress testing varied significantly by site (MOR, 1.68 [95% CI, 1.58-1.81]) and operator (MOR, 1.80 [95% CI, 1.56-2.38]). CONCLUSIONS Just under half of patients received guideline-recommended management before CTO PCI, with significant site and operator variability. These findings suggest an opportunity to reduce variability in management before CTO PCI.
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Affiliation(s)
- Stanley A. Swat
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
| | - Annika Hebbe
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Mary E. Plomondon
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Ki E. Park
- Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Rory S. Bricker
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
| | - Stephen W. Waldo
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Javier A. Valle
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
- Michigan Heart and Vascular Institute, Ann Arbor, MI
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24
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De Cecco CN, van Assen M. Can Radiomics Help in the Identification of Vulnerable Coronary Plaque? Radiology 2023; 307:e223342. [PMID: 36786708 DOI: 10.1148/radiol.223342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Carlo N De Cecco
- From the Division of Cardiothoracic Imaging and Medical Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, 1365 Clifton Rd NE, Suite AT503, Atlanta, GA 30322 (C.N.D.C.); and Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University, Atlanta, Ga (M.v.A.)
| | - Marly van Assen
- From the Division of Cardiothoracic Imaging and Medical Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, 1365 Clifton Rd NE, Suite AT503, Atlanta, GA 30322 (C.N.D.C.); and Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University, Atlanta, Ga (M.v.A.)
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25
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Mokadam NA, Lawton J, Sabik JF, Sellke FW, Girardi LN. Roundtable Discussion on ACC/AHA/SCAI Guidelines on Coronary Revascularization. Semin Thorac Cardiovasc Surg 2023; 35:1-6. [PMID: 36535855 DOI: 10.1053/j.semtcvs.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Frank W Sellke
- Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
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26
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Vervaat FE, van der Gaag A, Teeuwen K, van Suijlekom H, Wijnbergen I. Neuromodulation in patients with refractory angina pectoris: a review. EUROPEAN HEART JOURNAL OPEN 2022; 3:oeac083. [PMID: 36632476 PMCID: PMC9825802 DOI: 10.1093/ehjopen/oeac083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
The number of patients with coronary artery disease (CAD) who have persisting angina pectoris despite optimal medical treatment known as refractory angina pectoris (RAP) is growing. Current estimates indicate that 5-10% of patients with stable CAD have RAP. In absolute numbers, there are 50 000-100 000 new cases of RAP each year in the USA and 30 000-50 000 new cases each year in Europe. The term RAP was formulated in 2002. RAP is defined as a chronic disease (more than 3 months) characterized by diffuse CAD in the presence of proven ischaemia which is not amendable to a combination of medical therapy, angioplasty, or coronary bypass surgery. There are currently few treatment options for patients with RAP. One such last-resort treatment option is spinal cord stimulation (SCS) with a Class of recommendation IIB, level of evidence B in the 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes. The aim of this review is to give an overview of neuromodulation as treatment modality for patients with RAP. A comprehensive overview is given on the history, proposed mechanism of action, safety, efficacy, and current use of SCS.
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Affiliation(s)
| | - Antal van der Gaag
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Hans van Suijlekom
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands
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27
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Pardo Y, Garin O, Oriol C, Zamora V, Ribera A, Ferrer M. Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures. Qual Life Res 2022; 32:1405-1425. [PMID: 36350473 PMCID: PMC10123044 DOI: 10.1007/s11136-022-03260-6] [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] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose.
Methods
A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed.
Results
After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care.
Conclusions
There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.
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Affiliation(s)
- Yolanda Pardo
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Olatz Garin
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain.
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - Cristina Oriol
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Víctor Zamora
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Aida Ribera
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Cardiovascular Epidemiology and Research Unit, University Hospital and Research Institute Vall d'Hebron (VHIR), Barcelona, Spain
| | - Montserrat Ferrer
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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28
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Falasa M, Holmes HR, Neal D, Choi CY, Park K, Bavry AA, Freeman KA, Manning EW, Stinson WW, Jeng EI. Outcome and Cost Comparisons Between Surgical and Transcatheter Aortic Valve Replacements. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:482-490. [PMID: 36317252 DOI: 10.1177/15569845221125474] [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: 11/06/2022]
Abstract
OBJECTIVE Surgical aortic valve replacement (SAVR) has been the standard of care for severe aortic stenosis. In 2019, annual transcatheter aortic valve replacement (TAVR) implantations surpassed SAVR. We compared in-hospital costs and outcomes between these two procedures. METHODS A single-center retrospective review was performed of patients who underwent isolated SAVR or TAVR from October 2013 to December 2019. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS), total LOS, cumulative cost, and complication rates were collected. Propensity matching was performed to identify differences in costs and outcomes between comparable groups. RESULTS There were 515 patients who met inclusion criteria. TAVR was performed in 402 patients, while SAVR was performed in 113. Propensity matching resulted in 82 matched pairs. The SAVR cohort more frequently spent >1 day in the ICU, had longer total hospital LOS, longer OR time, and higher hospitalization cost. However, TAVR was associated with higher mean OR cost and higher valve cost. The cumulative index admission costs were not significantly different between groups. TAVR patients had less postoperative atrial fibrillation but more frequent pacemaker placement. One-year mortality was similar between SAVR (2.4%) and TAVR (3.8%), but 3-year (5.8% vs 19.2%) and 5-year (5.8% vs 37.2%) mortality favored SAVR. CONCLUSIONS In propensity-matched groups, TAVR was associated with shorter ICU and hospital LOS and OR times but increased permanent pacemaker rates. In addition, while 1-year survival was similar between groups, SAVR had significantly improved 3-year and 5-year survival.
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Affiliation(s)
- Matheus Falasa
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA
| | - Henry R Holmes
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA
| | - Daniel Neal
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA
| | - Calvin Y Choi
- Division of Cardiology, University of Florida Health, Gainesville, FL, USA.,Division of Cardiology, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Ki Park
- Division of Cardiology, University of Florida Health, Gainesville, FL, USA.,Division of Cardiology, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kirsten A Freeman
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA.,Division of Cardiovascular Surgery, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Eddie W Manning
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA.,Division of Cardiovascular Surgery, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Wade W Stinson
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA.,Division of Cardiovascular Surgery, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Eric I Jeng
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL, USA
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Montenegro CGDSP, Dourado LOC, Jordão CP, Vieira MLC, Assumpção CRA, Gowdak LHW, Pereira ADC, Negrão CE, de Matos LDNJ. Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina? Arq Bras Cardiol 2022; 119:747-753. [PMID: 36453766 PMCID: PMC9750210 DOI: 10.36660/abc.20210564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/17/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA). OBJECTIVE We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA. METHODS This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant. RESULTS Thirty-two patients with RA were included (61 ± 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L). The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657). CONCLUSIONS A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.
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Affiliation(s)
| | - Luciana Oliveira Cascaes Dourado
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Camila Paixão Jordão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Camila Regina Alves Assumpção
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Luis Henrique Wolff Gowdak
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Alexandre da Costa Pereira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Carlos Eduardo Negrão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Universidade de São PauloEscola de Educação Física e EsporteSão PauloSPBrasilEscola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, SP – Brasil
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30
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Ansheles AA. Anatomical and Functional Approaches in the Assessment of Ischemia in Ischemic Heart Disease: Analysis of Major World Research. KARDIOLOGIIA 2022; 62:66-73. [DOI: 10.18087/cardio.2022.10.n1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/28/2020] [Accepted: 01/29/2021] [Indexed: 11/18/2022]
Abstract
This review provides a chronology of major international studies of the effect of evaluating transient myocardial ischemia, including with radionuclide methods, and coronary stenosis on the choice of therapeutic strategy and prognosis for patients with ischemic and coronary disease. The authors discussed the rationales for using anatomic, functional, and perfusion visualization methods of noninvasive diagnostics in evaluation of patients with suspected or established ischemic heart disease.
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Affiliation(s)
- A. A. Ansheles
- Chazov National Medical Research Center of Cardiology, Moscow
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31
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Lee C, Columbo JA, Stone DH, Creager MA, Henkin S. Preoperative evaluation and perioperative management of patients undergoing major vascular surgery. Vasc Med 2022; 27:496-512. [PMID: 36214163 PMCID: PMC9551317 DOI: 10.1177/1358863x221122552] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients undergoing major vascular surgery have an increased risk of perioperative major adverse cardiovascular events (MACE). Accordingly, in this population, it is of particular importance to appropriately risk stratify patients' risk for these complications and optimize risk factors prior to surgical intervention. Comorbidities that portend a higher risk of perioperative MACE include coronary artery disease, heart failure, left-sided valvular heart disease, and significant arrhythmic burden. In this review, we provide a current approach to risk stratification prior to major vascular surgery and describe the strengths and weaknesses of different cardiac risk indices; discuss the role of noninvasive and invasive cardiac testing; and review perioperative pharmacotherapies.
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Affiliation(s)
| | | | | | | | - Stanislav Henkin
- Stanislav Henkin, Heart and Vascular
Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at
Dartmouth, Lebanon, NH 03756, USA.
Twitter: @stanhenkin
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32
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Schaefer JK, Errickson J, Gu X, Alexandris-Souphis T, Ali MA, Haymart B, Kaatz S, Kline-Rogers E, Kozlowski JH, Krol GD, Shah V, Sood SL, Froehlich JB, Barnes GD. Assessment of an Intervention to Reduce Aspirin Prescribing for Patients Receiving Warfarin for Anticoagulation. JAMA Netw Open 2022; 5:e2231973. [PMID: 36121653 PMCID: PMC9486454 DOI: 10.1001/jamanetworkopen.2022.31973] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE For some patients receiving warfarin, adding aspirin (acetylsalicylic acid) increases bleeding risk with unclear treatment benefit. Reducing excess aspirin use could be associated with improved clinical outcomes. OBJECTIVE To assess changes in aspirin use, bleeding, and thrombosis event rates among patients treated with warfarin. DESIGN, SETTING, AND PARTICIPANTS This pre-post observational quality improvement study was conducted from January 1, 2010, to December 31, 2019, at a 6-center quality improvement collaborative in Michigan among 6738 adults taking warfarin for atrial fibrillation and/or venous thromboembolism without an apparent indication for concomitant aspirin. Statistical analysis was conducted from November 26, 2020, to June 14, 2021. INTERVENTION Primary care professionals for patients taking aspirin were asked whether an ongoing combination aspirin and warfarin treatment was indicated. If not, then aspirin was discontinued with the approval of the managing clinician. MAIN OUTCOMES AND MEASURES Outcomes were assessed before and after intervention for the primary analysis and before and after 24 months before the intervention (when rates of aspirin use first began to decrease) for the secondary analysis. Outcomes included the rate of aspirin use, bleeding, and thrombotic outcomes. An interrupted time series analysis assessed cumulative monthly event rates over time. RESULTS A total of 6738 patients treated with warfarin (3160 men [46.9%]; mean [SD] age, 62.8 [16.2] years) were followed up for a median of 6.7 months (IQR, 3.2-19.3 months). Aspirin use decreased slightly from a baseline mean use of 29.4% (95% CI, 28.9%-29.9%) to 27.1% (95% CI, 26.1%-28.0%) during the 24 months before the intervention (P < .001 for slope before and after 24 months before the intervention) with an accelerated decrease after the intervention (mean aspirin use, 15.7%; 95% CI, 14.8%-16.8%; P = .001 for slope before and after intervention). In the primary analysis, the intervention was associated with a significant decrease in major bleeding events per month (preintervention, 0.31%; 95% CI, 0.27%-0.34%; postintervention, 0.21%; 95% CI, 0.14%-0.28%; P = .03 for difference in slope before and after intervention). No change was observed in mean percentage of patients having a thrombotic event from before to after the intervention (0.21% vs 0.24%; P = .34 for difference in slope). In the secondary analysis, reducing aspirin use (starting 24 months before the intervention) was associated with decreases in mean percentage of patients having any bleeding event (2.3% vs 1.5%; P = .02 for change in slope before and after 24 months before the intervention), mean percentage of patients having a major bleeding event (0.31% vs 0.25%; P = .001 for change in slope before and after 24 months before the intervention), and mean percentage of patients with an emergency department visit for bleeding (0.99% vs 0.67%; P = .04 for change in slope before and after 24 months before the intervention), with no change in mean percentage of patients with a thrombotic event (0.20% vs 0.23%; P = .36 for change in slope before and after 24 months before the intervention). CONCLUSIONS AND RELEVANCE This quality improvement intervention was associated with an acceleration of a preexisting decrease in aspirin use among patients taking warfarin for atrial fibrillation and/or venous thromboembolism without a clear indication for aspirin therapy. Reductions in aspirin use were associated with reduced bleeding. This study suggests that an anticoagulation clinic-based aspirin deimplementation intervention can improve guideline-concordant aspirin use.
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Affiliation(s)
- Jordan K. Schaefer
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Josh Errickson
- Consulting for Statistics, Computing, & Analytics Research, University of Michigan, Ann Arbor
| | - Xiaokui Gu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Tina Alexandris-Souphis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Mona A. Ali
- Department of Heart and Vascular Services, Beaumont Hospital, Royal Oak, Michigan
| | - Brian Haymart
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Eva Kline-Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Gregory D. Krol
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Vinay Shah
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Suman L. Sood
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - James B. Froehlich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Geoffrey D. Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
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Liu Z, Xu G, Zhang Y, Duan H, Zhu Y, Xu L. Preoperative Transthoracic Echocardiography Predicts Cardiac Complications in Elderly Patients with Coronary Artery Disease Undergoing Noncardiac Surgery. Clin Interv Aging 2022; 17:1151-1161. [PMID: 35942335 PMCID: PMC9356610 DOI: 10.2147/cia.s369657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zijia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Guangyan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanyu Duan
- Department of Anesthesiology, Tibet Autonomous Region People’s Hospital, Lhasa, People’s Republic of China
| | - Yuanyuan Zhu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Li Xu, Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, People’s Republic of China, Tel +86 10 6915 2020, Fax +86 10 6915 5580, Email
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34
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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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35
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Aubiniere-Robb L, Gosling R, Taylor DJ, Newman T, Hose DR, Halliday I, Lawford PV, Narracott AJ, Gunn JP, Morris PD. The Complementary Value of Absolute Coronary Flow in the Assessment of Patients with Ischaemic Heart Disease. NATURE CARDIOVASCULAR RESEARCH 2022; 1:611-616. [PMID: 35865080 PMCID: PMC7613105 DOI: 10.1038/s44161-022-00091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fractional flow reserve (FFR) is the current gold-standard invasive assessment of coronary artery disease (CAD). FFR reports coronary blood flow (CBF) as a fraction of a hypothetical and unknown normal value. Although used routinely to diagnose CAD and guide treatment, how accurately FFR predicts actual CBF changes remains unknown. Here we compared fractional CBF with the absolute CBF (aCBF in mL/min), measured with a computational method during standard angiography and pressure-wire assessment, on 203 diseased arteries (143 patients). We found a substantial correlation between the two measurements (r 0.89, Cohen’s Kappa 0.71). Concordance between fractional and absolute CBF reduction was high when FFR was >0.80 (91%), but reduced when FFR was ≤0.80 (81%), 0.70-0.80 (68%) and, particularly 0.75-0.80 (62%). Discordance was associated with coronary microvascular resistance, vessel diameter and mass of myocardium subtended, all factors to which FFR is agnostic. Assessment of aCBF complements FFR, and may be valuable to assess CBF, particularly in cases within the FFR ‘grey-zone’.
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36
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Jonik S, Marchel M, Huczek Z, Kochman J, Wilimski R, Kuśmierczyk M, Grabowski M, Opolski G, Mazurek T. An Individualized Approach of Multidisciplinary Heart Team for Myocardial Revascularization and Valvular Heart Disease—State of Art. J Pers Med 2022; 12:jpm12050705. [PMID: 35629130 PMCID: PMC9144508 DOI: 10.3390/jpm12050705] [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: 03/26/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
The multidisciplinary Heart Team (HT) remains the standard of care for highly-burdened patients with coronary artery disease (CAD) and valvular heart disease (VHD) and is widely adopted in the medical community and supported by European and American guidelines. An approach of highly-experienced specialists, taking into account numerous clinical factors, risk assessment, long-term prognosis and patients preferences seems to be the most rational option for individuals with. Some studies suggest that HT management may positively impact adherence to current recommendations and encourage the incorporation of patient preferences through the use of shared-decision making. Evidence from randomized-controlled trials are scarce and we still have to satisfy with observational studies. Furthermore, we still do not know how HT should cooperate, what goals are desired and most importantly, how HT decisions affect long-term outcomes and patient’s satisfaction. This review aimed to comprehensively discuss the available evidence establishing the role of HT for providing optimal care for patients with CAD and VHD. We believe that the need for research to recognize the HT definition and range of its functioning is an important issue for further exploration. Improved techniques of interventional cardiology, minimally-invasive surgeries and new drugs determine future perspectives of HT conceptualization, but also add new issues to the complexity of HT cooperation. Regardless of which direction HT has evolved, its concept should be continued and refined to improve healthcare standards.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
- Correspondence: ; Tel.: +48-22-599-19-58; Fax: +48-22-599-19-57
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
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Gao F, Rahman F. DOACs and Atherosclerotic Cardiovascular Disease Management: Can We Find the Right Balance Between Efficacy and Harm. Curr Atheroscler Rep 2022; 24:457-469. [PMID: 35386093 DOI: 10.1007/s11883-022-01022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The balance between efficacy and harm remains a challenge in the adoption of non-vitamin K antagonist direct oral anticoagulants (DOACs) for secondary atherosclerotic disease prevention. We provide a comprehensive review of the evidence for and against the addition of DOACs to the current management of atherosclerotic cardiovascular disease, including stable coronary artery disease (CAD), acute coronary syndrome (ACS), peripheral artery disease (PAD), and percutaneous coronary interventions (PCI). RECENT FINDINGS The DOAC class exerts pleiotropic effects on atherosclerotic progression through coagulation and inflammatory pathways. In ACS, low-dose DOAC provides no added efficacy in the setting of dual antiplatelet therapy; however, full-dose DOAC increases bleeding. Efficacy-safety profile favor use of low-dose rivaroxaban in select stable CAD or PAD patients. Atrial fibrillation patients undergoing PCI resort to dual therapy with DOAC due to prohibitory bleeding with triple anti-thrombotic therapy. Evidence favors DOAC use in CAD and PAD; however, careful individual considerations must be undertaken.
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Affiliation(s)
- Feng Gao
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Faisal Rahman
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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38
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Hinton J, Bashar H, Curzen N. Atheroma or ischemia: which is more important for managing patients with stable chest pain? Future Cardiol 2022; 18:417-429. [PMID: 35360934 DOI: 10.2217/fca-2021-0053] [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: 11/21/2022] Open
Abstract
In the evaluation and management of patients with stable chest pain/chronic coronary syndrome, cardiologists need to be able to weigh up the relative merits of managing these patients using either optimal therapy alone or optimal therapy plus revascularization. These decisions rely on an understanding of both the presence and the degree of coronary atheroma and myocardial ischemia, and the impact that these have on patients' symptoms and their prognosis. In this review the authors examine the relative impact of the anatomical and physiological assessment of patients with chronic coronary syndrome and how it can be used to achieve optimal and tailored therapy.
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Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hussein Bashar
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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39
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Zhang Q, Wang YF, Hu X, Tan YJ, Gao C, Chen J, Han F, Chen J, Yang Y. Association of serum cardiac troponin I and severity of coronary stenosis in patients with varied renal functions: a retrospective cohort study. BMJ Open 2022; 12:e054722. [PMID: 35351712 PMCID: PMC8961110 DOI: 10.1136/bmjopen-2021-054722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Recent studies showed cardiac troponin I (cTnI) might be a non-invasive biomarker to estimate the severity of coronary stenosis. However, serum cTnI is also found associated with renal function. The study objective is to analyse the association of serum cTnI and severity of coronary stenosis in patients with varied renal functions. DESIGN A retrospective cohort study. SETTING The First Affiliated Hospital, College of Medicine, Zhejiang University in Hangzhou, China. POPULATION A total of 6487 subjects who underwent elective coronary angiography between January 2017 to June 2020 were involved in this study. PRIMARY OUTCOMES Severity of coronary stenosis was divided into three degrees based on Gensini score, mild coronary stenosis, moderate coronary stenosis and severe coronary stenosis. RESULTS By using ordinal logistic regression, serum cTnI was associated with severity of coronary stenosis (OR=1.14, p<0.05). By construction and comparison of two models for predicting severity of coronary stenosis, the addition of cTnI significantly improved the predictive ability of the model. Differences between areas under the curves were 0.03, 0.03, 0.03, 0.12 (all p<0.05). Net reclassification improvements were 0.08, 0.05, 0.05, 0.35, respectively, in varied renal functions. Compared with the participants with normal renal function and without hypertroponinaemia, groups of participants with hypertroponinaemia showed higher ORs. ORs were 3.52, 4.20, 4.45, 6.00, respectively, as renal function decreased (all p<0.05). CONCLUSIONS In this cohort of patients with stable coronary artery disease and varied renal functions, cTnI was intensely associated with severity of coronary stenosis which based on Gensini score. The presentation of hypertroponinaemia in patients with impaired renal function always indicates a higher risk of severe coronary stenosis.
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Affiliation(s)
- Qian Zhang
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yong-Fei Wang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiao Hu
- Department of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya-Jun Tan
- Department of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cui Gao
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianxiao Chen
- Department of Nephrology, the Forth Affiliated Hospital, College of Medicine,Zhejiang University, Yiwu, Zhejiang, China
| | - Fei Han
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Department of Nephrology, the Forth Affiliated Hospital, College of Medicine,Zhejiang University, Yiwu, Zhejiang, China
| | - Yi Yang
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Yager N, Konduru S, Torosoff M. Nitrates as a Marker of Multiple Co-morbidities and Increased Mortality in Patients Undergoing Percutaneous Coronary Intervention (PCI). Cureus 2022; 14:e23520. [PMID: 35494964 PMCID: PMC9038167 DOI: 10.7759/cureus.23520] [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] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background Notwithstanding the guideline endorsement of various anti-anginal medications, there is a paucity of data on whether one anti-anginal regimen or medication is superior to another. It is also unknown how anti-anginal medications affect outcomes of elective percutaneous coronary intervention (PCI). To fill this knowledge gap, we investigated an association between commonly used anti-anginal medications and elective PCI outcomes in stable ischemic heart disease (SIHD) patients. Methods Using the New York State's (NYS) PCI Reporting System, we reviewed data on 33,568 consecutive patients who underwent non-emergent PCI in 2015. The primary endpoint of this study was all-cause in-hospital mortality. Results Regardless of the combination therapy of nitrates with any other non-nitrate anti-anginal therapy, including beta-adrenergic blockers (BB) and/or calcium channel blockers (CCB), nitrate treatment continued to be associated with significantly increased post-elective PCI mortality. Conclusions In this large, all-inclusive state-wide contemporary cohort study of SIHD patients, treatment with nitrates, but not beta-blockers, calcium channel blockers, or ranolazine, was associated with increased post-PCI mortality. Utilization of nitrate therapy is likely reflective of advanced disease burden rather than directly related to the specific medication intolerance. Additional studies investigating optimal anti-anginal medical therapy on PCI outcomes are warranted.
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Jonik S, Marchel M, Pędzich-Placha E, Pietrasik A, Rdzanek A, Huczek Z, Kochman J, Budnik M, Piątkowski R, Scisło P, Czub P, Wilimski R, Maksym J, Grabowski M, Opolski G, Mazurek T. Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach-Insights from Tertiary Cardiovascular Care Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073933. [PMID: 35409613 PMCID: PMC8997622 DOI: 10.3390/ijerph19073933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) follow-up of 37 (14) months of patients with severe CAD (three-vessel [3-VD] or/and left main [LM] disease) qualified after MHT discussion to optimal medical treatment (OMT) alone, OMT and coronary artery bypass grafting (CABG), or OMT and percutaneous coronary intervention (PCI) were evaluated. As the primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) (i.e., death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) were considered. Result: From 2016 to 2019, 176 MHT meetings were held, and a total of 1286 participants with severe CAD and completely implemented MHT decisions (OMT, CABG, or PCI for 251, 356, and 679 patients, respectively) were included. The occurrence of the primary endpoint was significantly increased in OMT-group (154 (61.4%) vs. CABG and PCI groups—110 (30.9%) and 302 (44.5%) patients, respectively (p < 0.05). For interventional strategies only—CABG was associated with reduced rates of MACCE and repeat revascularization, while the superiority of PCI for stroke and disabling stroke was observed (p < 0.05). The general health status assessed at the end of the follow-up was significantly better for patients who underwent CABG or PCI than in the OMT group (p < 0.05). Conclusions: In this real-life study, we presented a single-center experience of providing optimal medical care for patients with severe CAD following MHT discussion.
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Affiliation(s)
- Szymon Jonik
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Michał Marchel
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Ewa Pędzich-Placha
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Arkadiusz Pietrasik
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Adam Rdzanek
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Janusz Kochman
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Radosław Piątkowski
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Piotr Scisło
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Paweł Czub
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (P.C.); (R.W.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (P.C.); (R.W.)
| | - Jakub Maksym
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Marcin Grabowski
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
| | - Tomasz Mazurek
- Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (M.M.); (E.P.-P.); (A.P.); (A.R.); (Z.H.); (J.K.); (M.B.); (R.P.); (P.S.); (J.M.); (M.G.); (G.O.)
- Correspondence:
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Roifman I, Han L, Fang J, Chu A, Austin P, Ko DT, Douglas P, Wijeysundera H. Patient, physician and geographic predictors of cardiac stress testing strategy in Ontario, Canada: a population-based study. BMJ Open 2022; 12:e059199. [PMID: 35273065 PMCID: PMC8915339 DOI: 10.1136/bmjopen-2021-059199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify patient, physician and geographic level factors that are associated with variation in initial stress testing strategy in patients evaluated for chest pain. DESIGN Retrospective cohort study. SETTING Population-based study of patients undergoing evaluation for chest pain in Ontario, Canada between 1 January 2011 and 31 March 2018. PARTICIPANTS 103 368 patients who underwent stress testing (graded exercise stress testing (GXT), stress echocardiography (stress echo) or myocardial perfusion imaging (MPI)) following evaluation for chest pain. PRIMARY AND SECONDARY OUTCOME MEASURES To identify the patient, physician and geographic level factors associated with variation in initial test selection, we fit two separate 2-level hierarchical multinomial logistic regression models for which the outcome was initial stress testing strategy (GXT, MPI or stress echo). RESULTS There was significant variability in the initial type of stress test performed, with approximately 50% receiving a GXT compared with approximately 36% who received MPI and 14% who received a stress echo. Physician-level factors were key drivers of this variation, accounting for up to 59.0% of the variation in initial testing. Physicians who graduated medical school >30 years ago were approximately 45% more likely to order an initial stress echo (OR 1.45, 95% CI 1.17 to 1.80) than a GXT. Cardiovascular disease specialists were approximately sevenfold more likely to order an initial MPI (OR 7.35, 95% CI 5.38 to 10.03) than a GXT. Patients aged >70 years were approximately fivefold more likely to receive an MPI (OR 4.74, 95% CI 4.42 to 5.08) and approximately 26% more likely to receive a stress echo (OR 1.26, 95% CI 1.15 to 1.38) than a GXT. CONCLUSIONS We report significant variability in initial stress testing strategy in Ontario. Much of that variability was driven by physician-level factors that could potentially be addressed through educational campaigns geared at reducing this variability and improving guideline adherence.
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Affiliation(s)
- Idan Roifman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Lu Han
- ICES, Toronto, Ontario, Canada
| | | | | | - Peter Austin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Dennis T Ko
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Pamela Douglas
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Harindra Wijeysundera
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Wen XS, Luo R, Liu J, Liu ZQ, Zhang HW, Hu WW, Duan Q, Qin S, Xiao J, Zhang DY. The duration of beta-blocker therapy and outcomes in patients without heart failure or left ventricular systolic dysfunction after acute myocardial infarction: A multicenter prospective cohort study. Clin Cardiol 2022; 45:509-518. [PMID: 35246866 PMCID: PMC9045069 DOI: 10.1002/clc.23807] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 01/03/2023] Open
Abstract
Background The duration of beta‐blocker therapy in patients without heart failure (HF) or left ventricular systolic dysfunction after acute myocardial infarction (AMI) is unclear. Hypothesis Continuous beta‐blocker therapy is associated with an improved prognosis. Methods This is a prospective, multicenter, cohort study. One thousand four hundred and eighty‐three patients eventually met the inclusion criteria. The study groups included the continuous beta‐blocker therapy group (lasted ≥6 months) and the discontinuous beta‐blocker therapy group (consisting of the no‐beta‐blocker therapy group and the beta‐blocker therapy <6 months group). The inverse probability treatment weighting was used to control confounding factors. The study tried to learn the role of continuous beta‐blocker therapy on outcomes. The median duration of follow‐up was 13.0 months. The primary outcomes were cardiac death and major adverse cardiovascular events (MACE). The secondary outcomes were all‐cause death, stroke, unstable angina, rehospitalization for HF, and recurrent myocardial infarction (MI). Results Compared with discontinuous beta‐blocker therapy, continuous beta‐blocker therapy was associated with a reduced risk of unstable angina, recurrent MI, and MACE (hazard ratio [HR]: 0.51; 95% CI: 0.32–0.82; p = 0.006); but this association was not available for cardiac death (HR: 0.57; 95% CI: 0.24–1.36; p = 0.206). When compared to the subgroups of no‐beta‐blocker therapy and beta‐blocker therapy <6 months, respectively, continuous beta‐blocker therapy was still observed to be associated with a reduced risk of unstable angina, recurrent MI, and MACE. Conclusions Continuous beta‐blocker therapy was associated with a reduced risk of unstable angina or recurrent MI or MACE in patients without HF or left ventricular systolic dysfunction after AMI.
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Affiliation(s)
- Xue-Song Wen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Qiang Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han-Wen Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei-Wei Hu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Duan
- Department of Cardiovascular Medicine, The First Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shu Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Xiao
- Department of Cardiovascular Medicine, Chongqing University Center Hospital, Chongqing, China
| | - Dong-Ying Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Reynolds HR, Merz CNB, Berry C, Samuel R, Saw J, Smilowitz NR, de Souza ACDA, Sykes R, Taqueti VR, Wei J. Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries. Circ Res 2022; 130:529-551. [PMID: 35175840 PMCID: PMC8911308 DOI: 10.1161/circresaha.121.319892] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD.
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Affiliation(s)
- Harmony R Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK, Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rohit Samuel
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel R Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Ana Carolina do A.H. de Souza
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Viviany R. Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol 2022; 348:1-8. [PMID: 34902504 PMCID: PMC8779638 DOI: 10.1016/j.ijcard.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
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Zhou T, Liu P, Dhruva SS, Shah ND, Ramachandran R, Berg KM, Ross JS. Assessment of Hypothetical Out-of-Pocket Costs of Guideline-Recommended Medications for the Treatment of Older Adults With Multiple Chronic Conditions, 2009 and 2019. JAMA Intern Med 2022; 182:185-195. [PMID: 34982097 PMCID: PMC8728660 DOI: 10.1001/jamainternmed.2021.7457] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/14/2021] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Most adults 65 years or older have multiple chronic conditions. Managing these conditions with prescription drugs can be costly, particularly for older adults with limited incomes. OBJECTIVE To estimate hypothetical out-of-pocket costs associated with guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases among older adults with Medicare prescription drug plans (PDPs). DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study used 2009 and 2019 Medicare prescription drug plan formulary files to estimate annual out-of-pocket costs among hypothetical patients enrolled in Medicare Advantage or stand-alone Medicare Part D plans. A total of 3599 PDPs in 2009 and 3618 PDPs in 2019 were included after inclusion and exclusion criteria were applied. Costs associated with guideline-recommended medications for 8 of the most common chronic diseases (atrial fibrillation, chronic obstructive pulmonary disease [COPD], heart failure with reduced ejection fraction, hypercholesterolemia, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes), alone and in 2 clusters of commonly comorbid conditions, were examined. MAIN OUTCOMES AND MEASURES Annual out-of-pocket costs for each chronic condition, inflation adjusted to 2019 dollars. RESULTS Among 3599 Medicare PDPs in 2009, 1998 were Medicare Advantage plans and 1601 were stand-alone plans; among 3618 Medicare PDPs in 2019, 2719 were Medicare Advantage plans and 899 were stand-alone plans. For an older adult enrolled in any Medicare PDP in 2019, the median annual out-of-pocket costs for individual conditions varied, from a minimum of $32 (IQR, $6-$48) for guideline-recommended management of osteoporosis (a decrease from $128 [IQR, $102-$183] in 2009) to a maximum of $1579 (IQR, $1524-$2229) for guideline-recommended management of atrial fibrillation (an increase from $91 [IQR, $73-$124] in 2009). For an older adult with a cluster of 5 commonly comorbid conditions (COPD, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) enrolled in any PDP, the median out-of-pocket cost in 2019 was $1999 (IQR, $1630-$2564), a 12% decrease from $2284 (IQR, $1920-$3107) in 2009. For an older adult with all 8 chronic conditions (atrial fibrillation, COPD, diabetes, hypercholesterolemia, heart failure, hypertension, osteoarthritis, and osteoporosis) enrolled in any PDP, the median out-of-pocket cost in 2019 was $3630 (IQR, $3234-$5197), a 41% increase from $2571 (IQR, $2185-$3719) in 2009. CONCLUSIONS AND RELEVANCE In this cross-sectional study, out-of-pocket costs for guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases varied by condition. Although costs generally decreased between 2009 and 2019, particularly with regard to conditions for which generic drugs were available, out-of-pocket costs remained high and may have presented a substantial financial burden for Medicare beneficiaries, especially older adults with conditions for which brand-name drugs were guideline recommended.
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Affiliation(s)
- Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut
| | - Patrick Liu
- Yale School of Medicine, New Haven, Connecticut
| | - Sanket S. Dhruva
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco
- Division of Cardiology, San Francisco VA Medical Center, San Francisco, California
| | - Nilay D. Shah
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Reshma Ramachandran
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Yale National Clinicians Scholar Program, Yale School of Medicine, New Haven, Connecticut
| | - Karina M. Berg
- Center on Aging, University of Connecticut School of Medicine, Farmington
| | - Joseph S. Ross
- Yale National Clinicians Scholar Program, Yale School of Medicine, New Haven, Connecticut
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
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McElroy S, Kunze KP, Milidonis X, Huang L, Nazir MS, Evans C, Bosio F, Mughal N, Masci PG, Neji R, Razavi R, Chiribiri A, Roujol S. Quantification of balanced SSFP myocardial perfusion imaging at 1.5 T: Impact of the reference image. Magn Reson Med 2022; 87:702-717. [PMID: 34554603 DOI: 10.1002/mrm.29019] [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: 04/22/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate the use of a high flip-angle (HFA) balanced SSFP (bSSFP) reference image (in comparison to conventional proton density [PD]-weighted reference images) for conversion of bSSFP myocardial perfusion images into dynamic T1 maps for improved myocardial blood flow (MBF) quantification at 1.5 T. METHODS The HFA-bSSFP (flip angle [FA] = 50°), PD gradient-echo (PD-GRE; FA = 5°), and PD-bSSFP (FA = 8°) reference images were acquired before a dual-sequence bSSFP perfusion acquisition. Simulations were used to study accuracy and precision of T1 and MBF quantification using the three techniques. The accuracy and precision of T1 , and the precision and intersegment variability of MBF were compared among the three techniques in 8 patients under rest conditions. RESULTS In simulations, HFA-bSSFP demonstrated improved T1 /MBF precision (higher T1 /MBF SD of 30%-80%/50%-100% and 30%-90%/60%-115% for PD-GRE and PD-bSSFP, respectively). Proton density-GRE and PD-bSSFP were more sensitive to effective FA than HFA-bSSFP (maximum T1 /MBF errors of 13%/43%, 20%/43%, and 1%/3%, respectively). Sensitivity of all techniques (defined as T1 /MBF errors) to native T1 , native T2 , and effective saturation efficiency were negligible (<1%/<1%), moderate (<14%/<19%), and high (<63%/<94%), respectively. In vivo, no difference in T1 accuracy was observed among HFA-bSSFP, PD-GRE, and PD-bSSFP (-9 ± 44 ms vs -28 ± 55 ms vs -22 ± 71 ms, respectively; p > .08). The HFA-bSSFP led to improved T1 /MBF precision (T1 /MBF SD: 41 ± 19 ms/0.24 ± 0.08 mL/g/min vs PD-GRE: 48 ± 20 ms/0.29 ± 0.09 mL/g/min and PD-bSSFP: 59 ± 23 ms/0.33 ± 0.11 mL/g/min; p ≤ .02) and lower MBF intersegment variability (0.14 ± 0.09 mL/g/min vs PD-GRE: 0.21 ± 0.09 mL/g/min and PD-bSSFP: 0.20 ± 0.10 mL/g/min; p ≤ .046). CONCLUSION We have demonstrated the feasibility of using a HFA-bSSFP reference image for MBF quantification of bSSFP perfusion imaging at 1.5 T. Results from simulations demonstrate that the HFA-bSSFP reference image results in improved precision and reduced sensitivity to effective FA compared with conventional techniques using a PD reference image. Preliminary in vivo data acquired at rest also demonstrate improved precision and intersegment variability using the HFA-bSSFP technique compared with PD techniques; however, a clinical study in patients with coronary artery disease under stress conditions is required to determine the clinical significance of this finding.
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Affiliation(s)
- Sarah McElroy
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Xenios Milidonis
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Li Huang
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Carl Evans
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Filippo Bosio
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Nabila Mughal
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Ananthasubramaniam G, Ananthasubramaniam K. Stress Electrocardiography Testing in Coronary Artery Disease: Is It Time for Its Swan Song or To Redefine Its Role in the Modern Era ? Indian Heart J 2022; 74:81-85. [PMID: 35167825 PMCID: PMC9039687 DOI: 10.1016/j.ihj.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
Stress electrocardiography (sECG) or treadmill stress testing is a well validated noninvasive diagnostic modality available to clinicians at low cost yet providing valuable functional data for coronary artery disease (CAD) diagnostic and prognostic evaluation. With the advances in cardiac imaging in both functional and anatomic fronts and the existing limitations of sECG testing, this modality appears less favored worldwide as reflected in some recent guideline updates. We review the past present and future of sECG to provide a viewpoint on where it stands in CAD evaluation and if it will remain relevant as a diagnostic modality or be retired going forward. We also provide our perspectives on how sECG can co-exist with other modalities such as calcium scoring and discuss the role of such testing in the Indian population.
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Lee PH, Hong SJ, Kim HS, Yoon YW, Lee JY, Oh SJ, Kang SJ, Kim YH, Park SW, Lee SW, Lee CW. Quantitative coronary angiography versus intravascular ultrasound guidance for drug-eluting stent implantation (GUIDE-DES): study protocol for a randomised controlled non-inferiority trial. BMJ Open 2022; 12:e052215. [PMID: 35027418 PMCID: PMC8762144 DOI: 10.1136/bmjopen-2021-052215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Angiography remains the gold standard for guiding percutaneous coronary intervention (PCI). However, it is prone to suboptimal stent results due to the visual estimation of coronary measurements. Although the benefit of intravascular ultrasound (IVUS)-guided PCI is becoming increasingly recognised, IVUS is not affordable for many catheterisation laboratories. Thus, a more practical and standardised angiography-based approach is necessary to support stent implantation. METHODS AND ANALYSIS The Quantitative Coronary Angiography versus Intravascular Ultrasound Guidance for Drug-Eluting Stent Implantation trial is a randomised, investigator-initiated, multicentre, open-label, non-inferiority trial comparing the quantitative coronary angiography (QCA)-guided PCI strategy with IVUS-guided PCI in all-comer patients with significant coronary artery disease. A novel, standardised, QCA-based PCI protocol for the QCA-guided group will be provided to all participating operators, while the PCI optimisation criteria will be predefined for both strategies. A total of 1528 patients will be randomised to either group at a 1:1 ratio. The primary endpoint is the 12-month cumulative incidence of target-lesion failure defined as a composite of cardiac death, target-vessel myocardial infarction or ischaemia-driven target-lesion revascularisation. Clinical follow-up assessments are scheduled at 1, 6 and 12 months for all patients enrolled in the study. ETHICS AND DISSEMINATION Ethics approval for this study was granted by the Institutional Review Board of Asan Medical Center (no. 2017-0060). Informed consent will be obtained from every participant. The study findings will be published in peer-reviewed journal articles and disseminated through public forums and academic conference presentations. Cost-effectiveness and secondary imaging analyses will be shared in secondary papers. TRIAL REGISTRATION NUMBER NCT02978456.
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Affiliation(s)
- Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Hyun-Sook Kim
- Department of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea (the Republic of)
| | - Young Won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Jin Oh
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
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50
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Arai AE, Kwong RY, Salerno M, Greenwood JP, Bucciarelli-Ducci C. Society for Cardiovascular Magnetic Resonance perspective on the 2021 AHA/ACC Chest Pain Guidelines. J Cardiovasc Magn Reson 2022; 24:8. [PMID: 34980173 PMCID: PMC8722020 DOI: 10.1186/s12968-021-00835-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Hospitals and School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
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