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Bonnesen K, Poulsen CFB, Schmidt SAJ, Sørensen HT, Schmidt M. Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00486-9. [PMID: 38492858 DOI: 10.1016/j.jaad.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Autoimmune blistering disorders (ABDs) might elevate cardiovascular risk, but studies are lacking. OBJECTIVE The objective of this study was to examine if ABDs elevate the risk of atherosclerotic cardiovascular disease, heart failure, arrhythmia, venous thromboembolism, and cardiovascular death. METHODS A population-based cohort of Danish patients with ABD (≥18 years of age) diagnosed during 1996-2021 (n = 3322) was compared with an age- and sex-matched comparison cohort from the general population (n = 33,195). RESULTS Compared with the general population, patients with ABDs had higher 1-year risks of atherosclerotic cardiovascular disease (3.4% vs 1.6%), heart failure (1.9% vs 0.7%), arrhythmia (3.8% vs 1.3%), venous thromboembolism (1.9% vs 0.3%), and cardiovascular death (3.3% vs 0.9%). The elevated risk persisted after 10 years for all outcomes but arrhythmia. The hazard ratios associating ABDs with the outcomes during the entire follow-up were 1.24 (1.09-1.40) for atherosclerotic cardiovascular disease, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for venous thromboembolism, and 2.01 (1.76-2.29) for cardiovascular death. The elevated cardiovascular risk was observed for both pemphigus and pemphigoid. LIMITATIONS Our findings might only generalize to patients with ABDs without prevalent cardiovascular diseases. CONCLUSION Patients with ABDs had an elevated cardiovascular risk compared with age- and sex-matched controls.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Christian F B Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark; Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Sigrun A J Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark
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JIN X, WU B, WU H, XU D. Effectiveness of Shenshu Guanxin recipe granules for improving exercise tolerance in patients with stable angina pectoris: a randomized, double-blind, placebo-controlled trial. J TRADIT CHIN MED 2023; 43:1227-1233. [PMID: 37946485 PMCID: PMC10623256 DOI: 10.19852/j.cnki.jtcm.20231008.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To assess the effectivess of Shenshu Guanxin recipe granules (, SGR) in improving exercise tolerance and the quality of life in patients with Stable Angina Pectoris (SAP). METHODS A total of 189 patients were consecutively enrolled between December 2012 and December 2014. The included patients were randomly assigned to SGR and placebo groups. The primary endpoints included mainly the results of treadmill exercise test and Seattle Angina Questionnaire (SAQ) during 12 weeks of treatment. RESULTS After 12 weeks of treatment, SGR extended the time of exercise-induced ST-segment depression of 0.1 MV, lowered the maximum ST-segment depression, and shortened the duration of ST-segment depression in patients with SAP in southern China. Besides, the study also proved that SGR could improve the quality of life and functional status of patients with SAP. CONCLUSIONS SGR showed a positive effect on exercise tolerance compared with the placebo besides optimal medical therapy. Also, the study proved that SGR could improve the SAQ score of the patients.
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Affiliation(s)
- Xiao JIN
- 1 Department of Traditional Chinese Medicine, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Bingxin WU
- 2 Department of Cardiology, Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Huanlin WU
- 3 Department of Cardiology, Dongzhimen Hosipital, Beijing 100029, China
| | - Danping XU
- 4 Department of Traditional Chinese Medicine, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
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CAO W, LIAO S, ZHANG Y, ZHOU L, LI G, OUYANG W, WEN Z. Effectiveness and safety of Xuefu Zhuyu oral liquid on -stagnation and blood-stasis pattern in patients with stable angina, tension-type headache and primary dysmenorrhea: rationale and design of a master protocol. J TRADIT CHIN MED 2023; 43:815-823. [PMID: 37454268 PMCID: PMC10320441 DOI: 10.19852/j.cnki.jtcm.20230517.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/19/2022] [Indexed: 07/18/2023]
Abstract
We present the rationale and design of a master protocol study that clarifies the effectiveness and safety of Chinese herbal formulas on -stagnation and blood-stasis pattern (QBP). Three randomized controlled trials (RCTs) and real-world observational studies. Based on three registry cohorts of stable angina, tension-type headache and primary dysmenorrhea, patients with QBP will be enrolled in RCTs to receive either Xuefu Zhuyu (, XFZY) oral liquid or a placebo, while patients with non-QBP will be enrolled in the observational studies and experience follow-up. 1414 patients (RCTs: 574; observational studies: 840) will be recruited at seven centers in China over a 3-year period. The primary outcome is the visual analog scale of pain intensity. Adverse events will also be reported. The analysis will be undertaken separately in each sub-study, and then an overall analysis combining multiple subgroups will be performed to comprehensively investigate the effect of XFZY oral liquid. This study will provide high-quality evidence of XFZY oral liquid for QBP patients and show a paradigm of post-marketing evaluation of the effectiveness and safety for Chinese medicine following the notion of the pattern dominating different disease research models.
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Affiliation(s)
- Wencong CAO
- 1 Second Clinical Medical College (Second Affiliated Hospital), Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Shaojun LIAO
- 1 Second Clinical Medical College (Second Affiliated Hospital), Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Yuanwen ZHANG
- 2 First Clinical Medical College (First Affiliated Hospital), Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Li ZHOU
- 3 Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
- 4 State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Geng LI
- 3 Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
- 4 State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Wenwei OUYANG
- 3 Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
- 4 State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Zehuai WEN
- 3 Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
- 4 State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
- 5 Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
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Abstract
As society ages, the number of older adults with stable ischemic heart disease continues to rise. Older adults exhibit the greatest morbidity and mortality from stable angina. Furthermore, they suffer a higher burden of comorbidity and adverse events from treatment than younger patients. Given that older adults were excluded or underrepresented in most randomized controlled trials of stable ischemic heart disease, evidence for management is limited and hinges on subgroup analyses of trials and observational studies. This review aims to elucidate the current definitions of aging, assess the overall burden and clinical presentations of stable ischemic heart disease in older patients, weigh the available evidence for guideline-recommended treatment options including medical therapy and revascularization, and propose a framework for synthesizing complex treatment decisions in older adults with stable angina. Due to evolving goals of care in older patients, it is paramount to readdress the patient's priorities and preferences when deciding on treatment. Ultimately, the management of stable angina in older adults will need to be informed by dedicated studies in representative populations emphasizing patient-centered end points and person-centered decision-making.
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Affiliation(s)
- Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Stephen Y. Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Falls Church, VA
- Johns Hopkins University School of Medicine, Baltimore, MD
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Kuneman JH, van Rosendael SE, van der Bijl P, van Rosendael AR, Kitslaar PH, Reiber JH, Jukema JW, Leon MB, Ajmone Marsan N, Knuuti J, Bax JJ. Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease. Circ Cardiovasc Imaging 2023; 16:e014672. [PMID: 36802444 PMCID: PMC9946175 DOI: 10.1161/circimaging.122.014672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) attenuation has been associated with coronary inflammation and can be evaluated with coronary computed tomography angiography. The aims of this study were to compare the PCAT attenuation across precursors of culprit and nonculprit lesions of patients with acute coronary syndrome versus stable coronary artery disease (CAD). METHODS In this case-control study, patients with suspected CAD who underwent coronary computed tomography angiography were included. Patients who developed an acute coronary syndrome within 2 years after the coronary computed tomography angiography scan were identified, and patients with stable CAD (defined as any coronary plaque ≥30% luminal diameter stenosis) were 1:2 propensity score matched for age, sex, and cardiac risk factors. The mean PCAT attenuation was analyzed at lesion level and compared between precursors of culprit lesions, nonculprit lesions, and stable coronary plaques. RESULTS In total, 198 patients (age 62±10 years, 65% male) were selected, including 66 patients who developed an acute coronary syndrome and 132 propensity matched patients with stable CAD. Overall, 765 coronary lesions were analyzed (culprit lesion precursors: n=66; nonculprit lesion precursors: n=207; and stable lesions: n=492). Culprit lesion precursors had larger total plaque volume, fibro-fatty plaque volume, and low-attenuation plaque volume compared to nonculprit and stable lesions. The mean PCAT attenuation was significantly higher across culprit lesion precursors compared to nonculprit and stable lesions (-63.8±9.7 Hounsfield units versus -68.8±10.6 Hounsfield units versus -69.6±10.6 Hounsfield units, respectively; P<0.001), whereas the mean PCAT attenuation around nonculprit and stable lesions was not significantly different (P=0.99). CONCLUSIONS The mean PCAT attenuation is significantly increased across culprit lesion precursors in patients with acute coronary syndrome, compared to nonculprit lesions of these patients and to lesions of patients with stable CAD, which may suggest a higher intensity of inflammation. PCAT attenuation on coronary computed tomography angiography may be a novel marker to identify high-risk plaques.
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Affiliation(s)
- Jurrien H. Kuneman
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.)
| | - Sophie E. van Rosendael
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.)
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.)
| | - Alexander R. van Rosendael
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.)
| | - Pieter H. Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Centre, The Netherlands (P.H.K.).,Medis Medical Imaging, Leiden, The Netherlands (P.H.K.)
| | - Johan H.C. Reiber
- Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.).,Netherlands Heart Institute, Utrecht, The Netherlands (J.W.J.)
| | - Martin B. Leon
- Department of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital and Cardiovascular Research Foundation, NY (M.B.L.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.)
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.).,Turku PET Centre, Turku University Hospital and University of Turku, Finland (J.K.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.H.K., S.E.v.R., P.v.d.R., A.R.v.R., J.W.J., N.A.M., J.K., J.J.B.).,Heart Center, Turku University Hospital and University of Turku, Finland (J.J.B.)
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7
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Waters DD, Stone GW. Usefulness of Angina to Guide Revascularization Decisions. Circulation 2021; 144:524-527. [PMID: 34398689 DOI: 10.1161/circulationaha.121.055065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, CA (D.D.W.).,Department of Medicine, University of California, San Francisco (D.D.W.)
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.).,Cardiovascular Research Foundation, New York (G.W.S.)
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8
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Christiansen MK, Winther S, Nissen L, Vilhjálmsson BJ, Frost L, Johansen JK, Møller PL, Schmidt SE, Westra J, Holm NR, Jensen HK, Christiansen EH, Guðbjartsson DF, Hólm H, Stefánsson K, Bøtker HE, Bøttcher M, Nyegaard M. Polygenic Risk Score-Enhanced Risk Stratification of Coronary Artery Disease in Patients With Stable Chest Pain. Circ Genom Precis Med 2021; 14:e003298. [PMID: 34032468 DOI: 10.1161/circgen.120.003298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Polygenic risk scores (PRSs) are associated with coronary artery disease (CAD), but the clinical potential of using PRSs at the single-patient level for risk stratification has yet to be established. We investigated whether adding a PRS to clinical risk factors (CRFs) improves risk stratification in patients referred to coronary computed tomography angiography on a suspicion of obstructive CAD. METHODS In this prespecified diagnostic substudy of the Dan-NICAD trial (Danish study of Non-Invasive testing in Coronary Artery Disease), we included 1617 consecutive patients with stable chest symptoms and no history of CAD referred for coronary computed tomography angiography. CRFs used for risk stratification were age, sex, symptoms, prior or active smoking, antihypertensive treatment, lipid-lowering treatment, and diabetes. In addition, patients were genotyped, and their PRSs were calculated. All patients underwent coronary computed tomography angiography. Patients with a suspected ≥50% stenosis also underwent invasive coronary angiography with fractional flow reserve. A combined end point of obstructive CAD was defined as a visual invasive coronary angiography stenosis >90%, fractional flow reserve <0.80, or a quantitative coronary analysis stenosis >50% if fractional flow reserve measurements were not feasible. RESULTS The PRS was associated with obstructive CAD independent of CRFs (adjusted odds ratio, 1.8 [95% CI, 1.5-2.2] per SD). The PRS had an area under the curve of 0.63 (0.59-0.68), which was similar to that for age and sex. Combining the PRS with CRFs led to a CRF+PRS model with area under the curve of 0.75 (0.71-0.79), which was 0.04 more than the CRF model (P=0.0029). By using pretest probability (pretest probability) cutoffs at 5% and 15%, a net reclassification improvement of 15.8% (P=3.1×10-4) was obtained, with a down-classification of risk in 24% of patients (211 of 862) in whom the pretest probability was 5% to 15% based on CRFs alone. CONCLUSIONS Adding a PRS improved risk stratification of obstructive CAD beyond CRFs, suggesting a modest clinical potential of using PRSs to guide diagnostic testing in the contemporary clinical setting. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02264717.
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Affiliation(s)
- Morten Krogh Christiansen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Internal Medicine, Horsens Regional Hospital, Denmark (M.K.C.)
| | - Simon Winther
- Department of Cardiology (S.W., M.B.), Hospital Unit West, Herning, Denmark
| | - Louise Nissen
- Department of Radiology (L.N.), Hospital Unit West, Herning, Denmark
| | | | - Lars Frost
- Department of Cardiology, Silkeborg Regional Hospital, Denmark (L.F., J.K.J.)
| | - Jane Kirk Johansen
- Department of Cardiology, Silkeborg Regional Hospital, Denmark (L.F., J.K.J.)
| | - Peter Loof Møller
- Department of Biomedicine (P.L.M., M.N.), Aarhus University, Denmark
| | - Samuel Emil Schmidt
- Department of Health Science and Technology, Aalborg University, Denmark (S.E.S., M.N.)
| | - Jelmer Westra
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | - Niels Ramsing Holm
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health (H.K.J., H.E.B.), Aarhus University, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | | | - Hilma Hólm
- deCODE Genetics/Amgen, Inc, Reykjavik, Iceland (D.F.G., H.H., K.S.)
| | - Kári Stefánsson
- deCODE Genetics/Amgen, Inc, Reykjavik, Iceland (D.F.G., H.H., K.S.)
| | - Hans Erik Bøtker
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health (H.K.J., H.E.B.), Aarhus University, Denmark
| | - Morten Bøttcher
- Department of Cardiology (S.W., M.B.), Hospital Unit West, Herning, Denmark
| | - Mette Nyegaard
- Department of Clinical Genetics (M.N.), Aarhus University Hospital, Denmark.,Department of Biomedicine (P.L.M., M.N.), Aarhus University, Denmark.,Department of Health Science and Technology, Aalborg University, Denmark (S.E.S., M.N.)
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9
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Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (R.A.-L.).,Imperial College Healthcare NHS Trust, London, UK (R.A.-L.)
| | - Alice K Jacobs
- Boston University School of Medicine, Boston Medical Center, MA (A.K.J.)
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10
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Cook CM, Howard JP, Ahmad Y, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, de Waard GA, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. How Do Fractional Flow Reserve, Whole-Cycle PdPa, and Instantaneous Wave-Free Ratio Correlate With Exercise Coronary Flow Velocity During Exercise-Induced Angina? Circ Cardiovasc Interv 2020; 13:e008460. [PMID: 32200646 DOI: 10.1161/circinterventions.119.008460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Christopher M Cook
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Amarjit Sethi
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Gerald J Clesham
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Kare H Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - Sukhjinder S Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Paul A Kelly
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - John R Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Iqbal S Malik
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Raffi Kaprielian
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Ghada Mikhail
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Grigoris V Karamasis
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - Guus A de Waard
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Justin E Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
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Al-Lamee RK, Shun-Shin MJ, Howard JP, Nowbar AN, Rajkumar C, Thompson D, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik I, Bual N, Cook C, Ahmad Y, Seligman H, Sharp AS, Gerber R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom S, Davies JE, Francis DP. Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease: The Stress Echocardiography-Stratified Analysis of ORBITA. Circulation 2019; 140:1971-1980. [PMID: 31707827 PMCID: PMC6903430 DOI: 10.1161/circulationaha.119.042918] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina). METHODS One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling. RESULTS At prerandomization, the stress echocardiography score was 1.56±1.77 in the PCI arm (n=98) and 1.61±1.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (Pinteraction=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (Pinteraction=0.116), physical limitation (Pinteraction=0.461), quality of life (Pinteraction=0.689), EuroQOL 5 quality-of-life score (Pinteraction=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (Pinteraction=0.693), and treadmill exercise time (Pinteraction=0.426). CONCLUSIONS The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha K. Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J. Shun-Shin
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Alexandra N. Nowbar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.)
| | - Iqbal Malik
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, UK (R.G.)
| | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, UK (S. Talwar)
| | - Ravi Assomull
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Graham Cole
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G. Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Joban Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Frank E. Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon Thom
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Justin E. Davies
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
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Al-Lamee R, Howard JP, Shun-Shin MJ, Thompson D, Dehbi HM, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik IS, Cook C, Ahmad Y, Sharp ASP, Gerber R, Baker C, Kaprielian R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom SA, Davies JE, Francis DP. Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease. Circulation 2019; 138:1780-1792. [PMID: 29789302 DOI: 10.1161/circulationaha.118.033801] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR ( Pinteraction=0.318) or iFR ( Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P<0.00001). The placebo-controlled effect of PCI on stress echocardiography score increased progressively with decreasing FFR ( Pinteraction<0.00001) and decreasing iFR ( Pinteraction<0.00001). PCI did not improve angina frequency score significantly more than placebo (odds ratio, 1.64; 95% CI, 0.96-2.80; P=0.072) with no detectable evidence of interaction with FFR ( Pinteraction=0.849) or iFR ( Pinteraction=0.783). However, PCI resulted in more patient-reported freedom from angina than placebo (49.5% versus 31.5%; odds ratio, 2.47; 95% CI, 1.30-4.72; P=0.006) but neither FFR ( Pinteraction=0.693) nor iFR ( Pinteraction=0.761) modified this effect. CONCLUSIONS In patients with stable angina and severe single-vessel disease, the blinded effect of PCI was more clearly seen by stress echocardiography score and freedom from angina than change in treadmill exercise time. Moreover, the lower the FFR or iFR, the greater the magnitude of stress echocardiographic improvement caused by PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Hakim-Moulay Dehbi
- Cancer Research UK and UCL Cancer Trials Centre, University College London (H.-M.D.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.)
| | - Iqbal S Malik
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, United Kingdom (R.G.)
| | - Christopher Baker
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, United Kingdom (S.T.)
| | | | - Graham Cole
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (N.G.K.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Frank E Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Justin E Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
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Campos CM, Lemos PA. To Defer or Not Defer? The Challenges of Physiology in Acute Coronary Syndromes. Arq Bras Cardiol 2018; 111:551-552. [PMID: 30365678 PMCID: PMC6199514 DOI: 10.5935/abc.20180206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Carlos M. Campos
- Hospital Israelita Albert Einstein, São Paulo, SP -
Brazil
- Instituto do Coração (InCor), Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Pedro A. Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP -
Brazil
- Instituto do Coração (InCor), Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
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14
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Adamson PD, Hunter A, Madsen DM, Shah ASV, McAllister DA, Pawade TA, Williams MC, Berry C, Boon NA, Flather M, Forbes J, McLean S, Roditi G, Timmis AD, van Beek EJR, Dweck MR, Mickley H, Mills NL, Newby DE. High-Sensitivity Cardiac Troponin I and the Diagnosis of Coronary Artery Disease in Patients With Suspected Angina Pectoris. Circ Cardiovasc Qual Outcomes 2018; 11:e004227. [PMID: 29444926 PMCID: PMC5837016 DOI: 10.1161/circoutcomes.117.004227] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/22/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND We determined whether high-sensitivity cardiac troponin I can improve the estimation of the pretest probability for obstructive coronary artery disease (CAD) in patients with suspected stable angina. METHODS AND RESULTS In a prespecified substudy of the SCOT-HEART trial (Scottish Computed Tomography of the Heart), plasma cardiac troponin was measured using a high-sensitivity single-molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomographic angiography. Rates of obstructive CAD were compared with the pretest probability determined by the CAD Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive CAD with a 5-fold increase across quintiles (9%-48%; P<0.001) independent of known cardiovascular risk factors (odds ratio, 1.35; 95% confidence interval, 1.25-1.46 per doubling of troponin). Cardiac troponin concentrations improved the discrimination and calibration of the CAD Consortium model for identifying obstructive CAD (C statistic, 0.788-0.800; P=0.004; χ2=16.8 [P=0.032] to 14.3 [P=0.074]). The updated model also improved classification of the American College of Cardiology/American Heart Association pretest probability risk categories (net reclassification improvement, 0.062; 95% confidence interval, 0.035-0.089). The revised model achieved similar improvements in discrimination and calibration when applied in the external validation cohort. CONCLUSIONS High-sensitivity cardiac troponin I concentration is an independent predictor of obstructive CAD in patients with suspected stable angina. Use of this test may improve the selection of patients for further investigation and treatment. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01149590.
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Affiliation(s)
- Philip D Adamson
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.).
| | - Amanda Hunter
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Debbie M Madsen
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Anoop S V Shah
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - David A McAllister
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Tania A Pawade
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Michelle C Williams
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Colin Berry
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Nicholas A Boon
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Marcus Flather
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - John Forbes
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Scott McLean
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Giles Roditi
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Adam D Timmis
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Edwin J R van Beek
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Marc R Dweck
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Hans Mickley
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - Nicholas L Mills
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
| | - David E Newby
- From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.)
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15
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Rossi A, Wragg A, Klotz E, Pirro F, Moon JC, Nieman K, Pugliese F. Dynamic Computed Tomography Myocardial Perfusion Imaging: Comparison of Clinical Analysis Methods for the Detection of Vessel-Specific Ischemia. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005505. [PMID: 28389506 DOI: 10.1161/circimaging.116.005505] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical analysis of myocardial dynamic computed tomography myocardial perfusion imaging lacks standardization. The objective of this prospective study was to compare different analysis approaches to diagnose ischemia in patients with stable angina referred for invasive coronary angiography. METHODS AND RESULTS Patients referred for evaluation of stable angina symptoms underwent adenosine-stress dynamic computed tomography myocardial perfusion imaging with a second-generation dual-source scanner. Quantitative perfusion parameters, such as blood flow, were calculated by parametric deconvolution for each myocardial voxel. Initially, perfusion parameters were extracted according to standard 17-segment model of the left ventricle (fully automatic analysis). These were then manually sampled by an operator (semiautomatic analysis). Areas under the receiver-operating characteristic curves of the 2 different approaches were compared. Invasive fractional flow reserve ≤0.80 or diameter stenosis ≥80% on quantitative coronary angiography was used as reference standard to define ischemia. We enrolled 115 patients (88 men; age 57±9 years). There were 72 of 286 (25%) vessels causing ischemia in 52 of 115 (45%) patients. The semiautomatic analysis method was better than the fully automatic method at predicting ischemia (areas under the receiver-operating characteristic curves, 0.87 versus 0.69; P<0.001) with readings obtained in the endocardial myocardium performing better than those in the epicardial myocardium (areas under the receiver-operating characteristic curves, 0.87 versus 0.72; P<0.001). The difference in performance between blood flow, expressed as relative to remote myocardium, and absolute blood flow was not statistically significant (areas under the receiver-operating characteristic curves, 0.90 versus 0.87; P=ns). CONCLUSIONS Endocardial perfusion parameters obtained by semiautomatic analysis of dynamic computed tomography myocardial perfusion imaging may permit robust discrimination between coronary vessels causing ischemia versus not causing ischemia.
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Affiliation(s)
- Alexia Rossi
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Andrew Wragg
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Ernst Klotz
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Federica Pirro
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - James C Moon
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Koen Nieman
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Francesca Pugliese
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.).
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16
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Bittencourt MS, Hulten EA, Murthy VL, Cheezum M, Rochitte CE, Di Carli MF, Blankstein R. Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis. Circ Cardiovasc Imaging 2016; 9:e004419. [PMID: 27072303 DOI: 10.1161/circimaging.115.004419] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care. METHODS AND RESULTS We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49-0.98; P=0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95-1.84; P=0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14-2.75). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95-1.54). CONCLUSIONS In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.
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Affiliation(s)
- Márcio Sommer Bittencourt
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.).
| | - Edward A Hulten
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Venkatesh L Murthy
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Michael Cheezum
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Carlos E Rochitte
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Marcelo F Di Carli
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Ron Blankstein
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
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17
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Affiliation(s)
- Antonios Karanasos
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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18
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Shah AD, Bartlett JW, Carpenter J, Nicholas O, Hemingway H. Comparison of random forest and parametric imputation models for imputing missing data using MICE: a CALIBER study. Am J Epidemiol 2014; 179:764-74. [PMID: 24589914 PMCID: PMC3939843 DOI: 10.1093/aje/kwt312] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Multivariate imputation by chained equations (MICE) is commonly used for imputing missing data in epidemiologic research. The “true” imputation model may contain nonlinearities which are not included in default imputation models. Random forest imputation is a machine learning technique which can accommodate nonlinearities and interactions and does not require a particular regression model to be specified. We compared parametric MICE with a random forest-based MICE algorithm in 2 simulation studies. The first study used 1,000 random samples of 2,000 persons drawn from the 10,128 stable angina patients in the CALIBER database (Cardiovascular Disease Research using Linked Bespoke Studies and Electronic Records; 2001–2010) with complete data on all covariates. Variables were artificially made “missing at random,” and the bias and efficiency of parameter estimates obtained using different imputation methods were compared. Both MICE methods produced unbiased estimates of (log) hazard ratios, but random forest was more efficient and produced narrower confidence intervals. The second study used simulated data in which the partially observed variable depended on the fully observed variables in a nonlinear way. Parameter estimates were less biased using random forest MICE, and confidence interval coverage was better. This suggests that random forest imputation may be useful for imputing complex epidemiologic data sets in which some patients have missing data.
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Affiliation(s)
- Anoop D. Shah
- Correspondence to Dr. Anoop D. Shah, Clinical Epidemiology Group, Department of Epidemiology and Public Health, School of Life and Medical Sciences, University College London, Wolfson House, 2-10 Stephenson Way, London NW1 2HE, United Kingdom (e-mail: )
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19
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Pettersen AÅR, Seljeflot I, Abdelnoor M, Arnesen H. High On-Aspirin Platelet Reactivity and Clinical Outcome in Patients With Stable Coronary Artery Disease: Results From ASCET (Aspirin Nonresponsiveness and Clopidogrel Endpoint Trial). J Am Heart Assoc 2012; 1:e000703. [PMID: 23130135 PMCID: PMC3487336 DOI: 10.1161/jaha.112.000703] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/09/2012] [Indexed: 12/12/2022]
Abstract
Background Patients with stable coronary artery disease on single-antiplatelet therapy with aspirin are still at risk for atherothrombotic events, and high on-aspirin residual platelet reactivity (RPR) has been suggested as a risk factor. Methods and Results In this randomized trial, the association between platelet function determined by the PFA100 platelet function analyzer system (Siemens Healthcare Diagnostics, Germany) and clinical outcome in 1001 patients, all on single-antiplatelet therapy with aspirin (160 mg/d) was studied. Patients were randomized to continue with aspirin 160 mg/d or change to clopidogrel 75 mg/d. A composite end point of death, myocardial infarction, ischemic stroke, and unstable angina was used. At 2-year follow-up, 106 primary end points were registered. The prevalence of high RPR was 25.9%. High on-aspirin RPR did not significantly influence the primary end point in the aspirin group (13.3% versus 9.9%, P=0.31). However, in post hoc analysis, patients with von Willebrand factor levels or platelet count below median values and high on-aspirin RPR had a statistically significant higher end point rate than that of patients with low RPR (20% versus 7.5%, P=0.014, and 18.2% versus 10.8%, P=0.039, respectively). The composite end point rate in patients with high on-aspirin RPR treated with clopidogrel was not different from that of patients treated with aspirin (7.6% versus 13.3%, P=0.16). Conclusions In stable, aspirin-treated patients with coronary artery disease, high on-aspirin RPR did not relate to clinical outcome and did not identify a group responsive to clopidogrel. Post hoc subgroup analysis raised the possibility that high on-aspirin RPR might be predictive in patients with low von Willebrand factor or platelet count, but these findings will require confirmation in future studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT00222261. (J Am Heart Assoc. 2012;1:e000703 doi: 10.1161/JAHA.112.000703.)
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Affiliation(s)
- Alf-Åge R Pettersen
- Center for Clinical Heart Research, Oslo University Hospital, Ullevaal, Norway (A.-Å.R.P., I.S., H.A.) ; Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (A.-Å.R.P., I.S., H.A.)
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