1
|
Sritharan HP, Bhatia KS, van Gaal W, Kritharides L, Chow CK, Bhindi R. Cardiovascular outcomes for people hospitalised with COVID-19 in Australia, and the effect of vaccination: an observational cohort study. Med J Aust 2024. [PMID: 38741458 DOI: 10.5694/mja2.52307] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/02/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To assess the frequency of clinical cardiovascular outcomes for people hospitalised with coronavirus disease 2019 (COVID-19), and the impact of vaccination. STUDY DESIGN Observational cohort study. SETTING, PARTICIPANTS All index admissions of adults with laboratory-confirmed COVID-19 to 21 hospitals participating in the Australian Cardiovascular COVID-19 Registry (AUS-COVID), 4 September 2020 - 11 July 2022. MAIN OUTCOME MEASURES Frequency of elevated troponin levels, new arrhythmia, new or deteriorating heart failure or cardiomyopathy, new pericarditis or myocarditis, new permanent pacemaker or implantable cardioverter-defibrillator, and pulmonary embolism. SECONDARY OUTCOMES impact of COVID-19 vaccination on likelihood of in-hospital death, intubation, troponin elevation, and clinical cardiovascular events. RESULTS The mean age of the 1714 people admitted to hospital with COVID-19 was 60.1 years (standard deviation, 20.6 years); 926 were men (54.0%), 181 patients died during their index admissions (10.6%), 299 required intensive care (17.4%). Thirty-eight patients (2.6%) developed new atrial fibrillation or flutter, 27 (2.6%) had pulmonary embolisms, new heart failure or cardiomyopathy was identified in 13 (0.9%), and pre-existing cardiomyopathy or heart failure was exacerbated in 21 of 110 patients (19%). Troponin was elevated in 369 of the 986 patients for whom it was assessed (37.4%); in-hospital mortality was higher for people with elevated troponin levels (86, 23% v 23, 3.7%; P < 0.001). The COVID-19 vaccination status of 580 patients was known (no doses, 232; at least one dose, 348). The likelihood of in-hospital death (adjusted odds ratio [aOR], 0.38; 95% confidence interval [CI], 0.18-0.79) and intubation (aOR, 0.30; 95% CI, 0.15-0.61) were lower for people who had received at least one vaccine dose, but not the likelihood of troponin elevation (aOR, 1.44; 95% CI, 0.80-2.58) or clinical cardiovascular events (aOR, 1.56; 95% CI, 0.59-4.16). CONCLUSIONS Although troponin levels were elevated in a considerable proportion of people hospitalised with COVID-19, clinical cardiovascular events were infrequent, and their likelihood was not influenced by vaccination. COVID-19 vaccination, however, was associated with reduced likelihood of in-hospital death and intubation. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12620000486921 (prospective).
Collapse
Affiliation(s)
- Hari P Sritharan
- Royal North Shore Hospital, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - William van Gaal
- Northern Hospital Epping, Melbourne, VIC
- The University of Melbourne, Melbourne, VIC
| | - Leonard Kritharides
- Sydney Medical School, University of Sydney, Sydney, NSW
- Concord Repatriation General Hospital, Sydney, NSW
| | - Clara K Chow
- Sydney Medical School, University of Sydney, Sydney, NSW
- Westmead Applied Research Centre, Westmead Hospital, Sydney, NSW
| | - Ravinay Bhindi
- Royal North Shore Hospital, Sydney, NSW
- The University of Sydney, Sydney, NSW
| |
Collapse
|
2
|
Rafiudeen R, Barlis P, Hau R, Vasanthakumar S, Ng R, Wu P, Tacey M, Banning A, van Gaal W. Ivabradine in the Prevention, and Reduction in Size, of Perioperative Myocardial Injury in Patients Undergoing Orthopedic Surgery for Acute Fracture. J Am Heart Assoc 2023; 12:e028760. [PMID: 37982213 PMCID: PMC10727297 DOI: 10.1161/jaha.122.028760] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 10/02/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Perioperative myocardial injury is common after major noncardiac surgery and is associated with adverse outcomes. This study investigated the use of ivabradine in patients undergoing urgent surgery for fracture. METHODS AND RESULTS This was a prospective, double-blind, placebo-controlled, randomized clinical trial. Participants were enrolled 1:1 into ivabradine or placebo arm, and study drug was commenced before operation and continued for 7 days or until discharge. High-sensitivity troponin I was measured daily using Abbott Alinity analyzer and assay, and heart rate data were obtained using continuous Holter monitoring. A total of 199 patients underwent acute orthopedic surgery, 98 in the ivabradine group and 101 in the placebo group. The mean age was 78.7 years (range, 77.5-79.9 years), with 68% women. The average heart rate was 5 to 11 beats per minute lower in the ivabradine group compared with the placebo group at all time points (P<0.001 for all). There was no statistically significant difference between the ivabradine and placebo groups in the number of patients who had perioperative myocardial injury: 28.6% versus 31.6% (P=0.71). In patients with perioperative myocardial injury, average peak troponin was 168.8 ng/L (±431.2 ng/L) in the ivabradine group and 2094.5 ng/L (±7201.9 ng/L) in the placebo group (P=0.16). There was no statistically significant difference between groups in 30-day mortality, blood pressure, stroke, or major adverse cardiovascular event. CONCLUSIONS Starting ivabradine preoperatively in elderly patients requiring acute surgery for fracture did not result in a statistically significant difference in the incidence of perioperative myocardial injury. There was no statistically significant difference in morbidity, mortality, or adverse events between treatment groups. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12616001634460p.
Collapse
Affiliation(s)
- Rifly Rafiudeen
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Peter Barlis
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Raphael Hau
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | | | - Reginald Ng
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | - Philip Wu
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | - Mark Tacey
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Adrian Banning
- Cardiology DepartmentJohn Radcliffe HospitalOxfordUnited Kingdom
| | - William van Gaal
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| |
Collapse
|
3
|
Bray JE, Nehme Z, Finn JC, Kasza J, Clark RA, Stub D, Cadilhac DA, Buttery AK, Woods J, Kim J, Smith BJ, Smith K, Cartledge S, Beauchamp A, Dodge N, Walker T, Flemming-Judge E, Chow C, Stewart M, Cox N, van Gaal W, Nadurata V, Cameron P. A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk. Resusc Plus 2023; 15:100431. [PMID: 37555197 PMCID: PMC10405322 DOI: 10.1016/j.resplu.2023.100431] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
AIM To describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. METHODS The trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). RESULTS The intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. CONCLUSION The results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.
Collapse
Affiliation(s)
- Janet E. Bray
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
- Alfred Health, Australia
| | - Ziad Nehme
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Ambulance Victoria, Australia
| | - Judith C. Finn
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
| | - Jessica Kasza
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Robyn A. Clark
- Caring Futures Institute, Flinders University, Australia
- Southern Adelaide Local Health Network, Australia
| | - Dion Stub
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
- Ambulance Victoria, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | | | - Janelle Woods
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- National Heart Foundation of Australia, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | - Ben J. Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Australia
| | - Karen Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Department of Research and Innovation, Silverchain, Australia
| | - Susie Cartledge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | | | - Natasha Dodge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Tony Walker
- Department of Paramedicine, Monash University, Australia
| | | | - Clara Chow
- Faculty of Medicine and Health, Westmead Applied Research Centre, University of Sydney, Australia
- Westmead Hospital, Australia
| | | | | | | | | | - Peter Cameron
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
| |
Collapse
|
4
|
Sritharan HP, Bhatia KS, van Gaal W, Kritharides L, Chow CK, Bhindi R. Association between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in hospitalised patients with COVID-19. Front Cardiovasc Med 2023; 10:1224886. [PMID: 37476577 PMCID: PMC10354424 DOI: 10.3389/fcvm.2023.1224886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
Background Pre-existing cardiovascular disease and cardiovascular risk factors are common in patients with COVID-19 and there remain concerns for poorer in-hospital outcomes in this cohort. We aimed to analyse the relationship between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in patients hospitalised with COVID-19 in a prospective, multicentre observational study. Method This prospective, multicentre observational study included consecutive patients of age ≥18 in their index hospitalisation with laboratory-proven COVID-19 in Australia. Patients with suspected but not laboratory-proven COVID-19 and patients with no available past medical history were excluded. The primary exposure was pre-existing cardiovascular disease, defined as a composite of coronary artery disease, heart failure or cardiomyopathy, atrial fibrillation or flutter, severe valvular disease, peripheral arterial disease and stroke or transient ischaemic attack. The primary outcome was in-hospital mortality. Secondary outcomes were clinical cardiovascular complications (new onset atrial fibrillation or flutter, high-grade atrioventricular block, sustained ventricular tachycardia, new heart failure or cardiomyopathy, pericarditis, myocarditis or myopericarditis, pulmonary embolism and cardiac arrest) and myocardial injury. Results 1,567 patients (mean age 60.7 (±20.5) years and 837 (53.4%) male) were included. Overall, 398 (25.4%) patients had pre-existing cardiovascular disease, 176 patients (11.2%) died, 75 (5.7%) had clinical cardiovascular complications and 345 (37.8%) had myocardial injury. Patients with pre-existing cardiovascular disease had significantly increased in-hospital mortality (aOR: 1.76 95% CI: 1.21-2.55, p = 0.003) and myocardial injury (aOR: 3.27, 95% CI: 2.23-4.79, p < 0.001). There was no significant association between pre-existing cardiovascular disease and in-hospital clinical cardiovascular complications (aOR: 1.10, 95% CI: 0.58-2.09, p = 0.766). On mediation analysis, the indirect effect and Sobel test were significant (p < 0.001), indicating that the relationship between pre-existing cardiovascular disease and in-hospital mortality was partially mediated by myocardial injury. Apart from age, other cardiovascular risk factors such as diabetes, hypercholesterolemia and hypertension had no significant impact on mortality, clinical cardiovascular complications or myocardial injury. Conclusions Pre-existing cardiovascular disease is associated with significantly higher mortality in patients hospitalised with COVID-19. This relationship may be partly explained by increased risk of myocardial injury among patients with pre-existing cardiovascular disease which in turn is a marker associated with higher mortality.
Collapse
Affiliation(s)
- Hari P. Sritharan
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - William van Gaal
- Department of Cardiology, Northern Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Leonard Kritharides
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Clara K. Chow
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre and Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Hanson L, Vogrin S, Noaman S, Dinh D, Zheng W, Lefkovits J, Brennan A, Reid C, Stub D, Duffy SJ, Layland J, Freeman M, van Gaal W, Cox N, Chan W. Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery. Am J Cardiol 2022; 168:39-46. [PMID: 35115134 DOI: 10.1016/j.amjcard.2021.12.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/01/2022]
Abstract
Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.
Collapse
|
6
|
Sutherland N, Dayawansa N, Filipopoulos B, Vasanthakumar S, Narayan O, Ponnuthurai FA, van Gaal W. Letter to the Editor: Acute Coronary Syndrome Trends and COVID-19 Waves (Response to the Letter of Čulić et al.). Heart Lung Circ 2022; 31:e34-e35. [PMID: 35033431 PMCID: PMC8754509 DOI: 10.1016/j.hlc.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nigel Sutherland
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia.
| | - Nalin Dayawansa
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | | | - Om Narayan
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | - William van Gaal
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| |
Collapse
|
7
|
Rafiudeen R, Barlis P, White HD, van Gaal W. Type 2 MI and Myocardial Injury in the Era of High-sensitivity Troponin. Eur Cardiol 2022; 17:e03. [PMID: 35284006 PMCID: PMC8900132 DOI: 10.15420/ecr.2021.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022] Open
Abstract
Troponin has been the cornerstone of the definition of MI since its introduction to clinical practice. High-sensitivity troponin has allowed clinicians to detect degrees of myocardial damage at orders of magnitude smaller than previously and is challenging the definitions of MI, with implications for patient management and prognosis. Detection and diagnosis are no doubt enhanced by the greater sensitivity afforded by these markers, but perhaps at the expense of specificity and clarity. This review focuses on the definitions, pathophysiology, prognosis, prevention and management of type 2 MI and myocardial injury. The five types of MI were first defined in 2007 and were recently updated in 2018 in the fourth universal definition of MI. The authors explore how this pathophysiological classification is used in clinical practice, and discuss some of the unanswered questions in this era of availability of high-sensitivity troponin.
Collapse
Affiliation(s)
- Rifly Rafiudeen
- Department of Cardiology, The Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Peter Barlis
- Department of Cardiology, The Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - William van Gaal
- Department of Cardiology, The Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
8
|
Sutherland N, Dayawansa NH, Filipopoulos B, Vasanthakumar S, Narayan O, Ponnuthurai FA, van Gaal W. Acute Coronary Syndrome in the COVID-19 Pandemic: Reduced Cases and Increased Ischaemic Time. Heart Lung Circ 2022; 31:69-76. [PMID: 34452843 PMCID: PMC8384488 DOI: 10.1016/j.hlc.2021.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to unprecedented stress on health care systems, and has affected acute coronary syndrome treatment at every step. This study aimed to examine the impact of COVID-19 on patient presentations with acute coronary syndromes during the first and second pandemic wave in Melbourne, Victoria. METHOD A retrospective cohort study of adults presenting with cute coronary syndrome during the first pandemic wave from 1 March 2020 to 31 April 2020 and the second pandemic wave from 1 July 2020 to 31 August 2020 was compared to a control period from 1 March to 31 April 2019 at a single sub-tertiary referral centre in Melbourne, Victoria servicing a catchment area with a relatively high incidence of COVID-19 cases. RESULTS Three-hundred-and-thirty-five (335) patients were hospitalised with acute coronary syndromes across all three time periods. The total number of patients presenting with an acute coronary syndrome was reduced during the pandemic, with a higher proportion of ST elevation myocardial infarctions. Ischaemic times increased with time from symptom onset to first medical contact rising from 191 minutes in the control period to 292 minutes in the first wave (p=0.06) and 271 minutes in the second wave (p=0.06). Coronary angiography with subsequent revascularisation significantly increased from 55% in the control period undergoing revascularisation to 69% in the first wave (p<0.001) and 74% in the second wave (p<0.001). CONCLUSION A concerning reduction in acute coronary presentations occurred during the COVID-19 pandemic, associated with longer ischaemic times and a higher proportion requiring revascularisation. It is crucial that public awareness campaigns are instituted to address the contributing patient factors in future waves.
Collapse
Affiliation(s)
- Nigel Sutherland
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia.
| | - Nalin H Dayawansa
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | | | - Om Narayan
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | - William van Gaal
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| |
Collapse
|
9
|
Tong DC, Bloom JE, Quinn S, Nasis A, Hiew C, Roberts-Thomson P, Adams H, Sriamareswaran R, Htun NM, Wilson W, Stub D, van Gaal W, Howes L, Yeap A, Yip B, Wu S, Perera P, Collins N, Yong A, Bhindi R, Whitbourn R, Lee A, Premaratne M, Asrress K, Freeman M, Amerena J, Layland J. Colchicine in Patients With Acute Coronary Syndrome: Two-Year Follow-Up of the Australian COPS Randomized Clinical Trial. Circulation 2021; 144:1584-1586. [PMID: 34748393 DOI: 10.1161/circulationaha.121.054610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David C Tong
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Jason E Bloom
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S.)
- The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (J.E.B.)
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia (S.Q.)
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, Victoria, Australia (A.N.)
| | - Chin Hiew
- Barwon Health - University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | | | - Heath Adams
- Royal Hobart Hospital, Hobart, Tasmania, Australia (P.R.-T., H.A.)
| | - Rumes Sriamareswaran
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Nay M Htun
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - William Wilson
- Royal Melbourne Hospital, Parkville, Victoria, Australia (W.W.)
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S.)
- Western Health, St Albans, Victoria, Australia (D.S.)
| | | | - Laurie Howes
- Gold Coast University Hospital, Southport, Queensland, Australia (L.H.)
| | - Allysha Yeap
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Brian Yip
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Sam Wu
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Padeepa Perera
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Nicholas Collins
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia (N.C.)
| | - Andy Yong
- Concord Repatriation General Hospital, New South Wales, Australia (A. Yong)
| | - Ravinay Bhindi
- Royal North Shore Hospital, St Leonards, New South Wales, Australia (R.B.)
| | - Robert Whitbourn
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
| | - Astin Lee
- Wollongong Hospital, New South Wales, Australia (A.L.)
| | - Manuja Premaratne
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Kaleab Asrress
- Bankstown-Lidcombe Hospital, New South Wales, Australia (K.A.)
| | | | - John Amerena
- Barwon Health - University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | - Jamie Layland
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia (J.L.)
| |
Collapse
|
10
|
Bhatia KS, van Gaal W, Kritharides L, Chow CK, Bhindi R. The incidence of cardiac complications in patients hospitalised with COVID-19 in Australia: the AUS-COVID study. Med J Aust 2021; 215:279. [PMID: 34405420 PMCID: PMC8446954 DOI: 10.5694/mja2.51225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Leonard Kritharides
- Concord Repatriation General Hospital, Sydney, NSW.,ANZAC Research Institute, Sydney, NSW
| | - Clara K Chow
- Westmead Clinical School, University of Sydney, Sydney, NSW.,Westmead Hospital, Sydney, NSW
| | - Ravinay Bhindi
- Royal North Shore Hospital, Sydney, NSW.,Northern Clinical School, University of Sydney, Sydney, NSW
| | | |
Collapse
|
11
|
Patel A, Vlachadis Castles A, Sharma N, van Gaal W. Optical coherence tomography in ablation-related coronary artery injury. Eur Heart J Case Rep 2021; 5:ytab264. [PMID: 34377912 PMCID: PMC8343469 DOI: 10.1093/ehjcr/ytab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 06/03/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Aayush Patel
- Division of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia
| | | | - Naveen Sharma
- Division of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia
| | - William van Gaal
- Division of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia.,Division of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| |
Collapse
|
12
|
Tong DC, Quinn S, Nasis A, Hiew C, Roberts-Thomson P, Adams H, Sriamareswaran R, Htun NM, Wilson W, Stub D, van Gaal W, Howes L, Collins N, Yong A, Bhindi R, Whitbourn R, Lee A, Hengel C, Asrress K, Freeman M, Amerena J, Wilson A, Layland J. Colchicine in Patients With Acute Coronary Syndrome. Circulation 2020; 142:1890-1900. [DOI: 10.1161/circulationaha.120.050771] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
Inflammation plays a crucial role in clinical manifestations and complications of acute coronary syndromes (ACS). Colchicine, a commonly used treatment for gout, has recently emerged as a novel therapeutic option in cardiovascular medicine owing to its anti-inflammatory properties. We sought to determine the potential usefulness of colchicine treatment in patients with ACS.
Methods:
This was a multicenter, randomized, double-blind, placebo-controlled trial involving 17 hospitals in Australia that provide acute cardiac care service. Eligible participants were adults (18–85 years) who presented with ACS and had evidence of coronary artery disease on coronary angiography managed with either percutaneous coronary intervention or medical therapy. Patients were assigned to receive either colchicine (0.5 mg twice daily for the first month, then 0.5 mg daily for 11 months) or placebo, in addition to standard secondary prevention pharmacotherapy, and were followed up for a minimum of 12 months. The primary outcome was a composite of all-cause mortality, ACS, ischemia-driven (unplanned) urgent revascularization, and noncardioembolic ischemic stroke in a time to event analysis.
Results:
A total of 795 patients were recruited between December 2015 and September 2018 (mean age, 59.8±10.3 years; 21% female), with 396 assigned to the colchicine group and 399 to the placebo group. Over the 12-month follow-up, there were 24 events in the colchicine group compared with 38 events in the placebo group (
P
=0.09, log-rank). There was a higher rate of total death (8 versus 1;
P
=0.017, log-rank) and, in particular, noncardiovascular death in the colchicine group (5 versus 0;
P
=0.024, log-rank). The rates of reported adverse effects were not different (colchicine 23.0% versus placebo 24.3%), and they were predominantly gastrointestinal symptoms (colchicine, 23.0% versus placebo, 20.8%).
Conclusions:
The addition of colchicine to standard medical therapy did not significantly affect cardiovascular outcomes at 12 months in patients with ACS and was associated with a higher rate of mortality.
Registration:
URL:
https://www.anzctr.org.au
; Unique identifier: ACTRN12615000861550.
Collapse
Affiliation(s)
- David C. Tong
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia (S.Q.)
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, Victoria, Australia (A.N.)
| | - Chin Hiew
- Barwon Health, University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | | | - Heath Adams
- Royal Hobart Hospital, Tasmania, Australia (P.R.-T., H.A.)
| | - Rumes Sriamareswaran
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - Nay M. Htun
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - William Wilson
- Royal Melbourne Hospital, Parkville, Victoria, Australia (W.W.)
| | - Dion Stub
- Western Health, St Albans, Victoria, Australia (D.S.)
| | | | - Laurie Howes
- Gold Coast University Hospital, Southport, Queensland, Australia (L.H.)
| | - Nicholas Collins
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia (N.C.)
| | - Andy Yong
- Concord Repatriation General Hospital, New South Wales, Australia (A.Y.)
| | - Ravinay Bhindi
- Royal North Shore Hospital, St Leonards, New South Wales, Australia (R.B.)
| | - Robert Whitbourn
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
| | - Astin Lee
- Wollongong Hospital, New South Wales, Australia (A.L.)
| | - Chris Hengel
- Ballarat Health Services, Victoria, Australia (C.H.)
| | - Kaleab Asrress
- Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia (K.A.)
| | | | - John Amerena
- Barwon Health, University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | - Andrew Wilson
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
| | - Jamie Layland
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia (J.L.)
| |
Collapse
|
13
|
Nandal S, Castles A, Asrar Ul Haq M, van Gaal W. Takotsubo cardiomyopathy triggered by status epilepticus: case report and literature review. BMJ Case Rep 2019; 12:12/1/e225924. [PMID: 30700451 DOI: 10.1136/bcr-2018-225924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.
Collapse
Affiliation(s)
- Savvy Nandal
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
| | - Anastasia Castles
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
| | | | - William van Gaal
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
| |
Collapse
|
14
|
Chow CL, Ponnuthurai FA, Allman KC, van Gaal W. The Applicability of the American College of Cardiology Appropriate Use Criteria for Myocardial Perfusion Scintigraphy in Australia. Heart Lung Circ 2018; 27:469-476. [DOI: 10.1016/j.hlc.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
|
15
|
Abstract
CLINICAL INTRODUCTION A 66-year-old asymptomatic patient underwent a routine transthoracic echocardiogram prior to commencement of clozapine, and was found to have a mobile echogenic structure in the right atrium, which was later confirmed on transoesophageal echocardiogram to be adjacent to the insertion of inferior vena cava.Follow-up cardiovascular MRI (CMR) revealed a mobile, avascular 2.1×2.2 cm2 mass with regular and smooth borders, adjacent to the eustachian valve (Figure 1 panel A: coronal view; online supplementary movie 1). Late gadolinium enhancement (LGE; panel B) demonstrated heterogeneity, and T1-imaging demonstrated mild hyperintensity (panel C). There was no evidence of obstructive haemodynamic compromise.The mass was subsequently resected, and the histology (H&E staining, magnification ×100) is shown in panel D. QUESTION The diagnosis of this mass is: Aberrant liverAngiosarcomaAtrial myxomaRenal cell carcinomaThrombus.
Collapse
Affiliation(s)
- Chee Loong Chow
- Department of Cardiology, Northern Hospital, Epping, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Sylvia S M Chen
- Department of Cardiology, Northern Hospital, Epping, Victoria, Australia
| | - William van Gaal
- Department of Cardiology, Northern Hospital, Epping, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
16
|
Castles AV, Mutha V, Asrar ul Haq M, Rudd N, van Gaal W. PW316 Feasibility and safety of nuclear stress testing in patients referred for dobutamine stress echocardiography. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
17
|
Castles AV, van Gaal W. PW317 Use of echocardiography and nuclear medicine myocardial perfusion scintigraphy in assessing rest and stress cardiac function across different patient demographics in Australia. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
18
|
New G, Jangwal H, Parker H, Roberts L, Barger B, Smith K, Toogood G, Soon K, Cox N, Malaiapan Y, van Gaal W, Wilson J, Whitbourn R, Maclsaac A, Grigg L, Black A, Broughton A, Farouque HMO, Sanders K, Dick R, Briganti E, Lefkovits J, Harper R. PRE-HOSPITAL NOTIFICATION OF STEMI (PNS): COLLABORATION BETWEEN THE VICTORIAN CARDIAC CLINICAL NETWORK, AMBULANCE VICTORIA AND PARTICIPATING HOSPITALS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
van Gaal W, Arnold J, Testa L, Karamitsos T, Lim C, Ponnuthurai F, Petersen S, Francis J, Selvanayagam J, Sayeed R, West N, Westaby S, Neubauer S, Banning A. Myocardial Injury following Coronary Artery Surgery versus Angioplasty (MICASA): a randomised trial using biochemical markers and cardiac magnetic resonance imaging. EUROINTERVENTION 2011; 6:703-10. [DOI: 10.4244/eijv6i6a119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
20
|
Selvanayagam JB, Cheng ASH, Jerosch-Herold M, Rahimi K, Porto I, van Gaal W, Channon KM, Neubauer S, Banning AP. Effect of Distal Embolization on Myocardial Perfusion Reserve After Percutaneous Coronary Intervention. Circulation 2007; 116:1458-64. [PMID: 17785626 DOI: 10.1161/circulationaha.106.671909] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
Studies have shown that a subset of patients demonstrate persistent impairment in microcirculatory function after percutaneous coronary intervention (PCI). Distal embolization of plaque contents has been postulated as the main mechanism for this. We sought to investigate this further by evaluating PCI-induced changes in myocardial perfusion reserve index (MPRI) over time in segments with “distal-type” procedure-related myonecrosis using high-resolution quantitative cardiovascular magnetic resonance imaging.
Methods and Results—
Forty patients undergoing PCI were studied with pre-PCI and 24-hour post-PCI delayed-enhancement magnetic resonance imaging and first-pass perfusion magnetic resonance imaging at rest and stress. Twenty patients underwent a third magnetic resonance imaging scan at 6 months. For perfusion imaging, 3 short-axis images were acquired during every heartbeat with a T1-weighted turboFLASH sequence. MPRI was calculated as the ratio of hyperemic to resting myocardial blood flow and subdivided according to the presence and location of new delayed hyperenhancement. Twenty-one patients demonstrated new distal hyperenhancement after PCI. Mean MPRI in revascularized myocardial segments not demonstrating new HE was significantly increased after the procedure (2.06 [95% CI, 1.99 to 2.13] before PCI and 2.52 [95% CI, 2.42 to 2.62] after PCI;
P
<0.001). In contrast, MPRI in segments with distal hyperenhancement was reduced after PCI (2.16 [95% CI, 1.95 to 2.37] before PCI; 2.00 [95% CI, 1.82 to 2.19] after PCI; mixed-model
z
=−4.82;
P
<0.001). Changes in mean MPRI 24 hours after PCI in segments upstream to new injury were not significantly different compared with perfusion changes in remote myocardium (
z
=−0.68;
P
=0.50). At 6 months after the procedure, mean MPRI in segments with new injury improved significantly compared with MPRI measured in these segments at 24 hours after PCI.
Conclusions—
MPRI is reduced in myocardial segments that demonstrate new distal irreversible injury at 24 hours after PCI. These reductions are confined to the segments with injury and do not affect the entire supply territory of the culprit vessel.
Collapse
Affiliation(s)
- Joseph B Selvanayagam
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Testa L, van Gaal W, Biondi-Zoccai GG, Abbate A, Bhindi R, Agostoni P. Letters to the Editor. J Thorac Cardiovasc Surg 2007; 134:816-7. [PMID: 17723848 DOI: 10.1016/j.jtcvs.2007.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 03/29/2007] [Indexed: 02/08/2023]
|
22
|
Abstract
BACKGROUND Scintigraphy is an established imaging technique for injuries of the ankle and foot that are not apparent on plain radiographs. The scintigraphic technique has varied, with planar and pinhole images being used. MATERIALS AND METHODS The incremental value of pinhole scintigraphy over planar imaging was studied in 16 patients with established diagnoses. Inter-reporter reproducibility was also measured. RESULTS Pinhole scintigraphy improved the diagnostic specificity in nearly one half of the patients (48%). It did not contribute substantial information in 46% and led to confusion in the diagnosis of one patient. Inter-reporter agreement was good, with a kappa value of 0.78. Diagnoses varied from fractures of the talar dome to avulsion fractures of the malleoli and impingement syndromes. CONCLUSIONS Pinhole images add a significant incremental value to planar scintigraphy of the foot and ankle. Although this had been perceived intuitively in the past, it has not been critically evaluated. The technique has good inter-reporter agreement.
Collapse
Affiliation(s)
- Clayton Frater
- School of Clinical Sciences, Faculty of Health Studies, Charles Sturt University, Wagga Wagga, Australia
| | | | | | | | | | | |
Collapse
|