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Nakayama M, Takahashi T, Horinaka R, Uchiyama T. A case report of myocardial ischemia improvement despite early bypass graft occlusion: Efficiency of physiological reassessment. J Cardiol Cases 2020; 21:119-122. [PMID: 32153688 PMCID: PMC7054663 DOI: 10.1016/j.jccase.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022] Open
Abstract
Patients with functional ischemia often do not complain of chest symptoms even in early occlusion after coronary artery bypass grafting (CABG). The clinical evidence indicating the necessity of revascularization for these patients is unclear. A 70-year-old man who underwent 3 stent implant procedures to treat repeated in-stent restenosis to the left anterior descending artery (LAD) felt effort-related chest pain. Coronary angiography revealed that the patient's jailed diagonal had severe stenosis with delay and the LAD had intermediate stenosis. The instantaneous wave-free ratio (iFR) value of the LAD equalled 0.75. The patient underwent sequential CABG, where the left internal mammary artery (LIMA) to the LAD and diagonal artery grafts were performed. Although his effort-related chest pain disappeared, coronary and bypass angiography did not show flow competition in the diagonal branch and early occlusion in the LIMA to LAD graft was confirmed. The physiological assessment of the LAD did not reveal myocardial ischemia (iFR = 0.89 and fractional flow reserve = 0.87). This case highlights the importance of physiological assessment to detect cases of early graft occlusion. Although the LAD was not perfused from the CABG, the iFR value improved dramatically and pharmacological therapy without revascularization was successful for this patient. .
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Affiliation(s)
- Masafumi Nakayama
- Cardiovascular Centre, Todachuo General Hospital, Toda, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda University, Tokyo, Japan
| | | | - Ryo Horinaka
- Cardiovascular Centre, Todachuo General Hospital, Toda, Japan
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Mayala HA, Bakari KH, Zhaohui W. The role of Cardiac Magnetic Resonance (CMR) in the diagnosis of cardiomyopathy: A systematic review. Malawi Med J 2019; 31:241-245. [PMID: 31839897 PMCID: PMC6895381 DOI: 10.4314/mmj.v31i3.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Myocardial pathologies are significant causes of morbidity and mortality in patients worldwide. Ischemic and non-ischemic cardiomyopathies have become a worldwide epidemic of the 21st century with an increasing impact on health care systems. The 2012 European Society of Cardiology and 2013 American College of Cardiology Foundation/American Heart Association guidelines provide current therapy guidance to reduce mortality and morbidity. Methods This was a systematic review involving cardiac magnetic resonance (CMR) studies for the diagnosis of cardiomyopathy from January 2013 to April 2017. Out of 62 reviewed studies, only 12 were included in our study. Results The average sensitivity and specificity of CMR in the diagnosis of cardiomyopathy was 86.75% (95% confidence interval [CI], 70.30% to 92.58%) and 81.75% (95% CI, 73.0% to 87.6%), respectively, and the positive predictive and negative predictive values were 80.17% and 86.75%, respectively. Conclusion Despite some limitations, our study shows that CMR has high sensitivity, specificity, and positive predictive value in diagnosing different types of cardiomyopathy. CMR may be used to differentiate types of cardiomyopathy, accurately quantify the chamber dimensions, volumes, and cardiac function, which make it useful for prognosis as well.
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Affiliation(s)
- Henry Anselmo Mayala
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
| | - Khamis Hassan Bakari
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
| | - Wang Zhaohui
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
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3
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Mayala HA, Bakari KH, Zhaohui W. The role of cardiac magnetic resonance (CMR) in the diagnosis of cardiomyopathy: A systematic review. Malawi Med J 2019; 30:291-295. [PMID: 31798809 PMCID: PMC6863424 DOI: 10.4314/mmj.v30i4.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Myocardial pathologies are significant causes of morbidity and mortality in patients worldwide. Ischemic and non-ischemic cardiomyopathies have become a worldwide epidemic of the 21st century with an increasing impact on health care systems. The 2012 European Society of Cardiology and 2013 American College of Cardiology Foundation/American Heart Association guidelines provide current therapy guidance to reduce mortality and morbidity. Methods This was a systematic review involving cardiac magnetic resonance (CMR) studies for the diagnosis of cardiomyopathy from January 2013 to April 2017. Out of 62 reviewed studies, only 12 were included in our study. Results The average sensitivity and specificity of CMR in the diagnosis of cardiomyopathy was 86.75% (95% confidence interval [CI], 70.30% to 92.58%) and 81.75% (95% CI, 73.0% to 87.6%), respectively, and the positive predictive and negative predictive values were 80.17% and 86.75%, respectively. Conclusion Despite some limitations, our study shows that CMR has high sensitivity, specificity, and positive predictive value in diagnosing different types of cardiomyopathy. CMR may be used to differentiate types of cardiomyopathy, accurately quantify the chamber dimensions, volumes, and cardiac function, which make it useful for prognosis as well.
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Affiliation(s)
- Henry Anselmo Mayala
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
| | - Khamis Hassan Bakari
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
| | - Wang Zhaohui
- Wuhan Union Hospital, Tongji Medical College of Huazhong, University of Science and Technology, China
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Rodriguez AE, Larribau M, Fernandez-Pereira C, Iravedra J, Santaera O, Haiek C, Lloberas J, Montoya M, Sisu E, Menendez M, Pavlovsky H, Rodriguez-Granillo AM, Mieres J, Romero G, Ming Z, Pan W, Antoniucci D. One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819854059. [PMID: 31285655 PMCID: PMC6600492 DOI: 10.1177/1179546819854059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate 1-year follow-up results in an all “comers”
population treated with a new cobalt chromium bare-metal stent (BMS) design.
Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive
patients undergoing coronary stent implantation in 11 centers in Argentina were
prospectively included in our registry. The inclusion criteria were
multiple-vessel disease and/or unprotected left main disease, acute coronary
syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major
epicardial vessel. In-stent restenosis, protected left main stenosis, or
impossibility to receive dual-antiplatelet therapy was an exclusion criterion.
Major adverse cardiac events (MACE) were the primary endpoint and included
cardiac death, myocardial infarction (MI), and target lesion revascularization
(TLR); also, all components of the primary endpoint were separately analyzed.
Completeness of revascularization was analyzed as post hoc data using residual
SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of
patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel
disease, 67% have ACS, and 32% have ST elevation MI. At a mean of
376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients:
death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac
death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with
98% of event-free survival (P < .04). In conclusion, this
prospective, multicenter, and observational all-comers registry with this novel
BMS design showed a low incidence of adverse events at 1 year mainly due to
coronary restenosis.
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Affiliation(s)
- Alfredo E Rodriguez
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina
| | - Miguel Larribau
- Department of Interventional Cardiology, Hospital Español de Mendoza, Mendoza, Argentina.,Department of Interventional Cardiology, Clinica de Cuyo, Mendoza, Argentina
| | - Carlos Fernandez-Pereira
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Jorge Iravedra
- Department of Interventional Cardiology, Clinica 25 de Mayo, Buenos Aires, Argentina
| | - Omar Santaera
- Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Carlos Haiek
- Department of Interventional Cardiology, Sanatorio de la Trinidad Quilmes, Buenos Aires, Argentina
| | - Juan Lloberas
- Department of Interventional Cardiology, Sanatorio San Miguel, Buenos Aires, Argentina
| | - Mario Montoya
- Department of Interventional Cardiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Elias Sisu
- Department of Interventional Cardiology, Clinica Ipensa, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Alfredo M Rodriguez-Granillo
- Department of Clinical Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Biostatistical Analysis, Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Juan Mieres
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Graciela Romero
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Zheng Ming
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - William Pan
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - David Antoniucci
- Division of Cardiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Moscona JC, Stencel JD, Milligan G, Salmon C, Maini R, Katigbak P, Saleh Q, Nelson R, Srivastav S, Mogabgab O, Samson R, Le Jemtel T. Physiologic assessment of moderate coronary lesions: a step towards complete revascularization in coronary artery bypass grafting. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:300. [PMID: 30211188 DOI: 10.21037/atm.2018.06.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background An accurate diagnostic assessment of coronary artery disease is crucial for patients undergoing coronary artery bypass grafting (CABG). Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) to guide complete revascularization have not been adequately studied in patients prior to CABG. We compared an anatomic to a physiologic assessment of moderate coronary lesions (40-70% stenosis) in patients referred for CABG. Methods We retrospectively reviewed 109 medical records of patients who underwent CABG at Tulane Medical Center from 2014 to 2016. Patients were divided into an FFR/iFR-guided and an angiography-guided group. Clinical characteristics, procedural outcomes, and clinical outcomes for the two groups were compared over an 18-month follow-up period. Results There were significantly higher rates of three-vessel anastomoses (85.7% vs. 74.7%, P<0.05) and venous grafting (85.7% vs. 76.8%, P<0.05) in the FFR/iFR group. The FFR/iFR group had a lower rate of grafts placed to the left anterior descending artery (LAD) distribution than the angiography group (7.1% vs. 29.5%, P<0.05). The FFR/iFR group had a higher rate of grafts placed to the left circumflex (LCx) artery distribution than the angiography group (28.6% vs. 9.5%, P<0.05). We observed a trend toward reduction in major adverse cardiac events (MACEs) (7.1% vs. 11.6%, P=0.369) and angina (0.0% vs. 6.3%, P=0.429) in the FFR/iFR group compared to the angiography group over 18 months. Conclusions Physiologic assessment of coronary lesions can effectively guide complete revascularization in patients undergoing CABG. Moreover, FFR/iFR-guided CABG was associated with significantly higher rates of three-vessel anastomoses, venous grafting, and graft distribution to the circumflex system.
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Affiliation(s)
- John C Moscona
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jason D Stencel
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory Milligan
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christopher Salmon
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Rohit Maini
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Paul Katigbak
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Qusai Saleh
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ryan Nelson
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sudesh Srivastav
- Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Owen Mogabgab
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Rohan Samson
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Thierry Le Jemtel
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
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Should functional assessment of lesion severity be used to guide coronary bypass? Curr Opin Cardiol 2018; 33:565-570. [PMID: 29994809 DOI: 10.1097/hco.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to investigate the potential role of fractional flow reserve (FFR) to guide surgical revascularization. RECENT FINDINGS Coronary artery bypass is planned and executed primarily based on angiographic coronary anatomy. FFR is the most well-established tool for functional assessment of coronary lesions. Randomized trials have demonstrated the benefit of FFR-guided percutaneous coronary intervention (PCI) to determine the ischemic burden of intermediate lesions. Surgically, FFR is predominantly used to determine the functional severity of intermediate lesions of the left anterior descending (LAD) coronary artery to establish candidacy for multivessel coronary bypass. The broader use of FFR will likely downgrade a proportion of coronary lesions, which may alter the overall management plan. Whether this will improve clinical outcomes remains to be seen. Importantly, bypass of functionally nonsignificant lesions predicts graft failure. However, graft failure in the context of sufficient native coronary flow may not impact negatively on clinical outcome. Thus, at this time, there are insufficient data to support the wider use of FFR to guide surgical grafting of non-LAD targets. It remains to be seen whether FFR can be used to optimize the use of arterial grafts or to guide complex revascularization strategies such as hybrid coronary revascularization. SUMMARY FFR has become an invaluable tool for decision making for PCI in patients with stable ischemic heart disease. Beyond its use to assess an intermediate LAD lesion to establish candidacy for coronary bypass, at present there are insufficient data to support its wider use to guide surgical revascularization.
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Lotfi A, Davies JE, Fearon WF, Grines CL, Kern MJ, Klein LW. Focused update of expert consensus statement: Use of invasive assessments of coronary physiology and structure: A position statement of the society of cardiac angiography and interventions. Catheter Cardiovasc Interv 2018; 92:336-347. [DOI: 10.1002/ccd.27672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Amir Lotfi
- Baystate Medical Center; Tufts University School of Medicine; Springfield Massachusetts
| | | | | | - Cindy L. Grines
- Northwell Health, North Shore University Hospital; Manhasset New York
| | - Morton J. Kern
- Long Beach Veterans Administration Hospital; University of California, Irvine; Irvine California
| | - Lloyd W. Klein
- Advocate Illinois Masonic Medical Center, Rush Medical College; Chicago Illinois
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Hessian R, Jabagi H, Ngu JMC, Rubens FD. Coronary Surgery in Women and the Challenges We Face. Can J Cardiol 2018; 34:413-421. [PMID: 29571425 DOI: 10.1016/j.cjca.2018.01.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/27/2018] [Accepted: 01/28/2018] [Indexed: 02/07/2023] Open
Abstract
This review was undertaken to understand the dynamics that have shaped our current treatment of women who undergo coronary artery bypass grafting (CABG) and summarize the current literature on surgical revascularization in women. There has been improved access to CABG over the past several decades. Despite this, compared with men, CABG in women involves fewer grafts and less frequent use of arterial grafts, the latter having improved long-term patency compared with saphenous vein grafts. We attempt to determine whether the adverse clinical profile of women, when referred for CABG is responsible for this finding. Female coronary anatomy and pathophysiology are reviewed and an attempt is made to understand how this might affect decisions of selection and outcome measures post CABG. We review the short-term, long-term, and quality of life outcomes in women. These data are taken from large databases, as well as from more recent publications. Randomized controlled trial data and meta-analytic data are used when available. Differential use of and outcomes of surgical strategies, including off-pump CABG and total arterial revascularization, are contrasted with those in men. This review shows that there continues to be widespread differences in surgical approach to coronary artery disease in female vs male patients. We provide evidence suggestive of the existence of issues specific to women that affect selection for surgical procedures and outcomes in women. More work is required to understand the reason for these differences and how to optimize sex-specific outcomes.
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Affiliation(s)
- Renée Hessian
- Divisions of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Habib Jabagi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Janet M C Ngu
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fraser D Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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