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Basile C, Villaschi A, Maggioni AP. When a meta-analysis can be really useful? Int J Cardiol 2025; 436:133423. [PMID: 40425075 DOI: 10.1016/j.ijcard.2025.133423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 04/28/2025] [Accepted: 05/23/2025] [Indexed: 05/29/2025]
Abstract
Meta-analyses represent a key milestone in evidence-based medicine, integrating data from multiple studies to generate more robust estimates of an intervention's effects. By pooling information from various trials or observational studies, meta-analyses enhance statistical power, elucidate subgroup effects, and guide hypothesis generation. They have proven particularly useful in scenarios where individual randomized controlled trials (RCTs) cannot feasibly enroll enough participants (e.g., rare diseases or complex subpopulations) or when subgroups within an RCT are too small to draw meaningful conclusions. Nonetheless, meta-analyses carry intrinsic limitations, such as publication bias when performed using published data. Moreover, combining heterogeneous studies, or those of low quality, can yield spurious or conflicting results, as seen in early examples that overestimated benefits later disproven by large, well-conducted RCTs. Consequently, meta-analyses should be updated only when new evidence emerges that can refine or overturn existing conclusions. Beyond traditional methodologies, advanced techniques, such as individual patient data meta-analysis, network meta-analysis, dose-response meta-analysis, and umbrella reviews, offer additional granularity, enabling comparisons across multiple interventions or exposing nonlinear relationships between exposure and outcomes. Meanwhile, trial sequential analysis helps determine whether the accumulated evidence is conclusive or whether further studies are needed. When performed rigorously and interpreted cautiously, meta-analyses yield comprehensive insights that inform clinical practice and guide future research. Aim of this review is to define when a meta-analysis may be helpful in answering a clinical question.
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Affiliation(s)
- Christian Basile
- ANMCO Research Center, Heart Care Foundation, Florence, Italy.; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Villaschi
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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2
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Alwan M, El Yaman A, Sayed A, Shaikh A, Al Rifai M, Al-Mallah MH. Cardiac Positron emission tomography/ computed tomography (PET/CT) in current cardiology guidelines. J Nucl Cardiol 2025:102231. [PMID: 40348075 DOI: 10.1016/j.nuclcard.2025.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 04/15/2025] [Accepted: 05/01/2025] [Indexed: 05/14/2025]
Abstract
Cardiac positron emission tomography (PET) is increasingly utilized in clinical practice. This review examines the latest clinical practice guidelines from the American College of Cardiology/American Heart Association (ACC/AHA), the European Society of Cardiology (ESC), the International Society for Heart and Lung Transplantation (ISHLT), and multi-societal consensus statements as of December 2024 to assess the extent to which cardiac PET is incorporated into their recommendations.
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Affiliation(s)
- Maria Alwan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Ahmad El Yaman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Ahmed Sayed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Asim Shaikh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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3
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Song S, Han X, Ma X, Wang X, Yan C, Wang L, Fang W. Impact of Myocardial Hibernation and Scar on Benefits From CABG in Ischemic Left Ventricular Dysfunction. Ann Thorac Surg 2025; 119:1001-1010. [PMID: 39894429 DOI: 10.1016/j.athoracsur.2025.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 01/08/2025] [Accepted: 01/20/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND The significance of evaluating myocardial viability in making decisions regarding coronary artery bypass grafting (CABG) for patients with ischemic left ventricular dysfunction (ILVD) remains controversial. This study aimed to examine the impact of integrated assessment of hibernating myocardium and scars on the survival benefit associated with CABG in patients with ILVD. METHODS Consecutive patients with ILVD who underwent fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging with late gadolinium enhancement viability testing from January 2015 and April 2018 were retrospectively enrolled. The primary end point was all-cause death. The secondary end point was a composite of cardiovascular death, cardiovascular hospitalization, heart transplantation, revascularization, insertion of an implantable cardioverter-defibrillator, or nonfatal stroke. Cox models calculated hazard ratios (HRs) and CIs for CABG vs medical therapy alone for subgroups with different levels of hibernation and scars. RESULTS During a median follow-up of 71.5 months in 507 patients, 98 patients reached the primary end point and 194 reached the secondary end point. After adjustment, CABG was associated with lower risks of all-cause mortality (HR, 0.249; 95% CI, 0.154-0.428; P<.001) and lower incidences of secondary outcomes (HR, 0.457; 95% CI, 0.318-0.658; P<.001) compared with medical treatment alone in the population. Across all 4 subgroups classified by the optimal cutoff value (10% hibernation and 26% scar), CABG was associated with favorable outcomes regardless of the hibernation and scar level. CONCLUSIONS The extent and severity of hibernating myocardium and scars appear not to influence the effects of CABG in patients with ILVD.
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Affiliation(s)
- Shuyang Song
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Han
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinghong Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaodi Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaowu Yan
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Prunea DM, Homorodean C, Olinic M, Achim A, Olinic DM. Optimizing Revascularization in Ischemic Cardiomyopathy: Comparative Evidence on the Benefits and Indications of CABG and PCI. Life (Basel) 2025; 15:575. [PMID: 40283129 PMCID: PMC12028861 DOI: 10.3390/life15040575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/23/2025] [Accepted: 03/29/2025] [Indexed: 04/29/2025] Open
Abstract
Ischemic cardiomyopathy remains a leading cause of heart failure, yet the optimal revascularization approach for patients with reduced left ventricular function remains uncertain. This review synthesizes current evidence on coronary revascularization strategies, emphasizing real-world applicability and individualized treatment. It critically evaluates the benefits and limitations of coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI], highlighting key knowledge gaps. Findings from the STICH trial demonstrate that CABG improves long-term survival despite an elevated early procedural risk, particularly in patients with extensive multivessel disease. In contrast, the REVIVED-BCIS2 trial suggests that PCI enhances quality of life but does not significantly reduce mortality compared to optimal medical therapy, making it a viable alternative for high-risk patients ineligible for surgery. This review underscores the role of advanced imaging techniques in myocardial viability assessment and emphasizes the importance of comprehensive risk stratification in guiding revascularization decisions. Special attention is given to managing high-risk patients unsuitable for CABG and the potential benefits of PCI in symptom relief despite uncertain survival benefits. A stepwise algorithm is proposed to assist clinicians in tailoring revascularization strategies, reinforcing the need for a multidisciplinary Heart Team approach to optimize outcomes.
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Affiliation(s)
- Dan M. Prunea
- Medical Clinic No. 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Calin Homorodean
- Medical Clinic No. 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Cluj County Emergency Clinical Hospital, 3-5, Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Maria Olinic
- Medical Clinic No. 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Cluj County Emergency Clinical Hospital, 3-5, Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Alexandru Achim
- “Niculae Stăncioiu” Heart Institute, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Medical Clinic No. 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Cluj County Emergency Clinical Hospital, 3-5, Clinicilor Street, 400006 Cluj-Napoca, Romania
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5
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Nedadur R, Medina M, Lehtinen M, Bryner B, Johnston DR. Surgical Revascularization Decisions in Ischemia and Heart Failure. Heart Fail Clin 2025; 21:287-294. [PMID: 40107805 DOI: 10.1016/j.hfc.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
Coronary artery bypass grafting is the major modality of coronary revascularization in patients with ischemic cardiomyopathy as it provides surgical collateralization of the coronary bed protecting the functional myocardium. Myocardial viability testing does not have an established role in the surgical evaluation. Concomitant surgical ventricular restoration does not improve symptoms or survival, though patients with large aneurysms and significant reduction in ventricular size could benefit. Correction of functional mitral regurgitation does not improve survival, and severe functional mitral regurgitation should be addressed via mitral valve replacement. Temporary mechanical circulatory support can be used as a bridge to recovery.
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Affiliation(s)
- Rashmi Nedadur
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL 60611, USA
| | - Melissa Medina
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL 60611, USA
| | - Miia Lehtinen
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL 60611, USA; McGaw Medical Center of Northwestern University
| | - Benjamin Bryner
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL 60611, USA
| | - Douglas R Johnston
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL 60611, USA.
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Onur Omaygenc M, Mielniczuk LM. Viability and Congestive Heart Failure. Heart Fail Clin 2025; 21:215-225. [PMID: 40107800 DOI: 10.1016/j.hfc.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
Management of ischemic cardiomyopathy is challenging, especially when treatment benefits do not clearly exceed the estimated risk of procedures. Myocardial viability assessment provides additional data in this setting to anticipate potential functional recovery and possibly prognostic improvement following revascularization. This evidence comes from the positive signals received from posthoc analyses of some clinical trials. There are multiple clinically available modalities to evaluate myocardial viability among which more sensitive ones such as cardiac magnetic resonance and PET are more preferrable. Yet, there are emerging tools that may further escalate the utility of these modalities.
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Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Lisa Marie Mielniczuk
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.
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7
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Singh A, Zhang RS, Bangalore S. Percutaneous Coronary Intervention for Heart Failure due to Coronary Artery Disease. Heart Fail Clin 2025; 21:273-285. [PMID: 40107804 DOI: 10.1016/j.hfc.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
The role of revascularization and percutaneous coronary intervention (PCI) in patients with acute coronary syndrome is well established. However, the incremental value of revascularization over guideline-directed medical therapy is controversial. Currently available data supports the use of PCI to improve angina and quality of life for chronic coronary disease and heart failure (HF). However, there is insufficient data to support revascularization with PCI to improve mortality, reduce cardiovascular events, or improve ejection fraction over medical therapy alone. Additional trials are necessary to identify HF patients who may benefit from revascularization, and the optimal revascularization strategy for this population.
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Affiliation(s)
- Arushi Singh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Robert S Zhang
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA.
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8
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Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K. JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure. J Card Fail 2025:S1071-9164(25)00100-9. [PMID: 40155256 DOI: 10.1016/j.cardfail.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
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9
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Gonnah A, Darke N, Mullen L, Hung J, Sandhu K, Giblett JP. Complete Revascularisation Following Acute MI: A Contemporary Review. Interv Cardiol 2025; 20:e10. [PMID: 40171022 PMCID: PMC11959580 DOI: 10.15420/icr.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 12/22/2024] [Indexed: 04/03/2025] Open
Abstract
Acute MI (AMI) is a leading cause of mortality globally. Swift diagnosis is imperative, with timely reperfusion crucial to minimise adverse outcomes. Revascularisation strategies include culprit-vessel-only therapy, staged complete revascularisation or immediate complete revascularisation. Evidence from randomised trials strongly favours complete revascularisation in ST-elevation MI (STEMI). Data regarding immediate complete revascularisation compared to a staged approach are limited, with uncertainties regarding the advantages of physiology-guided treatment compared to angiographic assessment alone. Non-STEMI (NSTEMI) patients with multivessel disease are often complex and current guidelines offer limited recommendations for this patient group, emphasising the need for individualised treatment. Observational studies have sought to find the optimal approach, yet conflicting data prevails. Dedicated trials for this issue in NSTEMI patients are currently unavailable. To enhance the decision-making processes for patients with AMI, future trials should consider the inclusion of functional health status and health-related quality of life outcomes. The existing gaps in knowledge underscore the intricacies of managing AMI and the ongoing necessity for comprehensive research to refine treatment strategies.
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Affiliation(s)
- Ahmed Gonnah
- School of Medicine, University of Liverpool Liverpool, UK
| | - Nadhrah Darke
- School of Medicine, University of Liverpool Liverpool, UK
| | - Liam Mullen
- Liverpool Heart and Chest Hospital Liverpool, UK
| | - John Hung
- Liverpool Heart and Chest Hospital Liverpool, UK
| | - Kully Sandhu
- Liverpool Heart and Chest Hospital Liverpool, UK
| | - Joel P Giblett
- Liverpool Heart and Chest Hospital Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool UK
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10
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Nealy Z, Wang S, Patel AR. The complex role of cardiovascular imaging in viability testing. Prog Cardiovasc Dis 2025; 88:113-125. [PMID: 39788340 PMCID: PMC11835452 DOI: 10.1016/j.pcad.2024.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 12/28/2024] [Indexed: 01/12/2025]
Abstract
Myocardial viability assessment is used to determine if chronically dysfunctional myocardium may benefit from coronary revascularization. Cardiac magnetic resonance with late gadolinium enhancement is the current gold standard for visualizing myocardial scar and provides valuable insight into myocardial viability. Viability assessments can also be made with Cardiac Positron Emission Tomography, Echocardiography, Single Photon Emission Tomography, and Cardiac Computed Tomography with each having advantages and disadvantages. Despite the classical interpretation that viability predicts segmental functional improvement, more recent studies have found that revascularization of viable myocardium has conflicting roles in predicting benefits for patients, especially as it relates to major adverse cardiovascular events, development of heart failure symptoms, and all-cause mortality. This review covers these conflicts along with an in-depth review of the pathophysiologic processes that are fundamental to myocardial viability and the various methods used for determining viability.
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Affiliation(s)
- Zachariah Nealy
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Shuo Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Amit R Patel
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
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11
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Howick V JF, Gersh BJ. Revascularization in ischemic cardiomyopathy. Is viability testing still viable? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:78-81. [PMID: 39455018 DOI: 10.1016/j.rec.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024]
Affiliation(s)
- James F Howick V
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States.
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12
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Hyasat K, Su CS, Kirtane AJ, McEntegart M. The efficacy of revascularization in ischemic cardiomyopathy. Prog Cardiovasc Dis 2025; 88:105-112. [PMID: 39743125 DOI: 10.1016/j.pcad.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 12/28/2024] [Indexed: 01/04/2025]
Abstract
Ischemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the current evidence for coronary revascularization in ICM, including consideration of the different modalities of coronary artery bypass grafting and percutaneous coronary intervention. In addition to a contemporary assessment of the literature, we aim to provide real-world insights and perspectives to guide clinical decision-making in this heterogeneous and complex patient population.
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Affiliation(s)
- Kais Hyasat
- Department of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, 161 Fort Washington Avenue, New York, NY 10032, United States of America.
| | - Chieh-Shou Su
- Department of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, 161 Fort Washington Avenue, New York, NY 10032, United States of America; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ajay J Kirtane
- Department of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, 161 Fort Washington Avenue, New York, NY 10032, United States of America
| | - Margaret McEntegart
- Department of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, 161 Fort Washington Avenue, New York, NY 10032, United States of America
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Flynn S, Haenel A, Coughlan F, Crilly S, Leipsic JA, Dodd JD. Cardiac CT, MRI, and PET in 2023: Exploration of Key Articles across Imaging and Multidisciplinary Journals. Radiology 2024; 313:e240975. [PMID: 39688488 DOI: 10.1148/radiol.240975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2024]
Abstract
In this review, the authors examine recent advancements in noninvasive cardiac imaging, focusing on cardiac CT, MRI, and PET, reviewing key publications from imaging and multidisciplinary journals from 2023. The authors discuss the increasing adoption of photon-counting CT and its applications in coronary and structural imaging, and explore various aspects of plaque and functional assessment, emphasizing their clinical implications. Radiation exposure analysis from the SCOT-HEART (Scottish Computed Tomography of the Heart) trial is also discussed. The authors highlight the integration of artificial intelligence applications in cardiac imaging. Three-year follow-up data from the ADVANCE Registry are described, showcasing the potential of using artificial intelligence to improve diagnostic accuracy and patient outcomes in cardiovascular care. The authors explore the latest studies evaluating different cardiomyopathies using cardiac MRI. Radiologists' growing understanding of the brain-heart axis is presented through discussion of several studies. The authors also discuss the prognostic advantages of MRI over PET in patients with cardiac sarcoidosis. Finally, the authors outline society statements and guidelines from 2023 that are pertinent to cardiac imaging, offering a comprehensive review of current trends and applications in noninvasive imaging modalities.
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Affiliation(s)
- Sebastian Flynn
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
| | - Alexander Haenel
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
| | - Fionn Coughlan
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
| | - Shane Crilly
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
| | - Jonathon A Leipsic
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
| | - Jonathan D Dodd
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (S.F., S.C., J.D.D.); Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada (A.H., F.C., J.A.L.); and School of Medicine, University College Dublin, Dublin, Ireland (S.F., J.D.D.)
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Maestre-Luque LC, González-Manzanares R, Fernández-Cordón C, Díez-Delhoyo F. Controversias en la revascularización y el estudio de viabilidad miocárdica en el síndrome coronario crónico. REC: CARDIOCLINICS 2024; 59:12-23. [DOI: 10.1016/j.rccl.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Javorski MJ, Bauza K, Xiang F, Soltesz E, Chen L, Bakaeen FG, Svensson L, Thuita L, Blackstone EH, Tong MZ. Identifying and mitigating risk of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy. J Thorac Cardiovasc Surg 2024; 168:1489-1499.e6. [PMID: 38452888 DOI: 10.1016/j.jtcvs.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To identify preoperative predictors of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy and evaluate trajectory of postoperative ventricular function. METHODS From January 2017 to January 2020, 238 patients with ejection fraction <30% (206/238) or 30% to 34% with at least moderately severe mitral regurgitation (32/238) underwent conventional cardiac surgery at Cleveland Clinic, 125 with ischemic and 113 with nonischemic cardiomyopathy. Preoperative ejection fraction was 25 ± 4.5%. The primary outcome was postcardiotomy cardiogenic shock, defined as need for microaxial temporary left ventricular assist device, extracorporeal membrane oxygenation, or vasoactive-inotropic score >25. RandomForestSRC was used to identify its predictors. RESULTS Postcardiotomy cardiogenic shock occurred in 27% (65/238). Pulmonary artery pulsatility index <3.5 and pulmonary capillary wedge pressure >19 mm Hg were the most important factors predictive of postcardiotomy cardiogenic shock in ischemic cardiomyopathy. Cardiac index <2.2 L·min-1 m-2 and pulmonary capillary wedge pressure >21 mm Hg were the most important predictive factors in nonischemic cardiomyopathy. Operative mortality was 1.7%. Ejection fraction at 12 months after surgery increased to 39% (confidence interval, 35-40%) in the ischemic group and 37% (confidence interval, 35-38%) in the nonischemic cardiomyopathy group. CONCLUSIONS Predictors of postcardiotomy cardiogenic shock were different in ischemic and nonischemic cardiomyopathy. Right heart dysfunction, indicated by low pulmonary artery pulsatility index, was the most important predictor in ischemic cardiomyopathy, whereas greater degree of cardiac decompensation was the most important in nonischemic cardiomyopathy. Therefore, preoperative right heart catheterization will help identify patients with low ejection fraction who are at greater risk of postcardiotomy cardiogenic shock.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karolis Bauza
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fei Xiang
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lin Chen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lucy Thuita
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Michael Z Tong
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio.
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16
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Magalhães TA, Carneiro ACDC, Moreira VDM, Trad HS, Lopes MMU, Cerci RJ, Nacif MS, Schvartzman PR, Chagas ACP, Costa IBSDS, Schmidt A, Shiozaki AA, Montenegro ST, Piegas LS, Zapparoli M, Nicolau JC, Fernandes F, Hadlich MS, Ghorayeb N, Mesquita ET, Gonçalves LFG, Ramires FJA, Fernandes JDL, Schwartzmann PV, Rassi S, Torreão JA, Mateos JCP, Beck-da-Silva L, Silva MC, Liberato G, Oliveira GMMD, Feitosa Filho GS, Carvalho HDSMD, Markman Filho B, Rocha RPDS, Azevedo Filho CFD, Taratsoutchi F, Coelho-Filho OR, Kalil Filho R, Hajjar LA, Ishikawa WY, Melo CA, Jatene IB, Albuquerque ASD, Rimkus CDM, Silva PSDD, Vieira TDR, Jatene FB, Azevedo GSAAD, Santos RD, Monte GU, Ramires JAF, Bittencourt MS, Avezum A, Silva LSD, Abizaid A, Gottlieb I, Precoma DB, Szarf G, Sousa ACS, Pinto IMF, Medeiros FDM, Caramelli B, Parga Filho JR, Santos TSGD, Prazeres CEED, Lopes MACQ, Avila LFRD, Scanavacca MI, Gowdak LHW, Barberato SH, Nomura CH, Rochitte CE. Cardiovascular Computed Tomography and Magnetic Resonance Imaging Guideline of the Brazilian Society of Cardiology and the Brazilian College of Radiology - 2024. Arq Bras Cardiol 2024; 121:e20240608. [PMID: 39475988 DOI: 10.36660/abc.20240608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2025] Open
Affiliation(s)
- Tiago Augusto Magalhães
- Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, PR - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Sírio Libanês, SP, São Paulo, SP - Brasil
| | | | - Valéria de Melo Moreira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | - Marly Maria Uellendahl Lopes
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | | | - Marcelo Souto Nacif
- Universidade Federal Fluminense, Niterói, RJ - Brasil
- Hospital Universitário Antonio Pedro, Niterói, RJ - Brasil
| | | | - Antônio Carlos Palandrini Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
- Faculdade de Medicina do ABC, Santo André, SP - Brasil
| | | | - André Schmidt
- Universidade de São Paulo (USP), Ribeirão Preto, SP - Brasil
| | - Afonso Akio Shiozaki
- ND Núcleo Diagnóstico, Maringá, PR - Brasil
- Ômega Diagnóstico, Maringá, PR - Brasil
- Hospital Paraná, Maringá, PR - Brasil
| | | | | | - Marcelo Zapparoli
- Quanta Diagnóstico por Imagem, Curitiba, PR - Brasil
- DAPI, Curitiba, PR - Brasil
| | - José Carlos Nicolau
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Fabio Fernandes
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brasil
- Rede D'Or RJ, Rio de Janeiro, RJ - Brasil
- Unimed, Rio de Janeiro, RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Inspirali Educação, São Paulo, SP - Brasil
- Anhanguera Educacional, São Paulo, SP - Brasil
| | | | - Luiz Flávio Galvão Gonçalves
- Hospital São Lucas, Rede D'Or SE, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju, SE - Brasil
- Clínica Climedi, Aracaju, SE - Brasil
| | - Felix José Alvarez Ramires
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | - Pedro Vellosa Schwartzmann
- Hospital Unimed Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Centro Avançado de Pesquisa, Ensino e Diagnóstico (CAPED), Ribeirão Preto, SP - Brasil
| | | | | | - José Carlos Pachón Mateos
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Sírio Libanês, SP, São Paulo, SP - Brasil
| | - Luiz Beck-da-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Gabriela Liberato
- Hospital Sírio Libanês, SP, São Paulo, SP - Brasil
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | | | - Hilka Dos Santos Moraes de Carvalho
- PROCAPE - Universidade de Pernambuco, Recife, PE - Brasil
- Hospital das Clínicas de Pernambuco da Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Real Hospital Português de Pernambuco, Recife, PE - Brasil
| | - Brivaldo Markman Filho
- Hospital das Clínicas de Pernambuco da Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
| | | | | | - Flávio Taratsoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | - Walther Yoshiharu Ishikawa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Cíntia Acosta Melo
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
- Hospital Infantil Sabará, São Paulo, SP - Brasil
| | | | | | - Carolina de Medeiros Rimkus
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo SP - Brasil
| | - Paulo Savoia Dias da Silva
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brasil
- University of Iowa Hospitals and Clinics, Iowa City - EUA
| | - Thiago Dieb Ristum Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Guilherme Sant Anna Antunes de Azevedo
- ECOMAX, Blumenau, SC - Brasil
- Hospital Unimed Blumenau, Blumenau, SC - Brasil
- Hospital São José de Jaraguá do Sul, Blumenau, SC - Brasil
- Cliniimagem Criciúma, Blumenau, SC - Brasil
| | - Raul D Santos
- Hospital Sírio Libanês, SP, São Paulo, SP - Brasil
- Universidade de São Paulo (USP), Ribeirão Preto, SP - Brasil
| | | | - José Antonio Franchini Ramires
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz, São Paulo, SP - Brasil
| | | | | | - Ilan Gottlieb
- Fonte Imagem Medicina Diagnostica, Rio de Janeiro, RJ - Brasil
| | | | - Gilberto Szarf
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe, Aracaju, SE - Brasil
- Hospital São Lucas, Aracaju, SE - Brasil
- Rede D'Or de Aracaju, Aracaju, SE - Brasil
| | | | | | - Bruno Caramelli
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - José Rodrigues Parga Filho
- Hospital Sírio Libanês, SP, São Paulo, SP - Brasil
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | | | | | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
| | - Luis Henrique Wolff Gowdak
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
- Universidade de São Paulo (USP), Ribeirão Preto, SP - Brasil
| | - Silvio Henrique Barberato
- Quanta Diagnóstico por Imagem, Curitiba, PR - Brasil
- Cardioeco, Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
| | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
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Zhao F, Chen Y, Zhao J, Pang Z, Wang J, Cao B, Li J. Impact of CT attenuation correction on viable myocardium detection in combined SPECT and PET/CT: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e40175. [PMID: 39470532 PMCID: PMC11521058 DOI: 10.1097/md.0000000000040175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 09/11/2024] [Accepted: 09/16/2024] [Indexed: 10/30/2024] Open
Abstract
The influence of computed tomography attenuation correction (CTAC) on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with F-18-FDG Positron Emission Tomography/Computed Tomography (PET/CT) metabolic imaging, compared with conventional SPECT MPI, remains to be fully elucidated. To evaluate the impact of CTAC on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT, compared to conventional SPECT MPI. 193 patients underwent CZT SPECT and F-18-FDG PET/CT imaging, while 39 patients underwent conventional SPECT and F-18-FDG PET/CT imaging, with both groups utilizing CT for attenuation correction. The injured myocardium (hibernating and scarring) was quantified using the Q.PET software. After CTAC, both groups showed significant improvements in perfusion of the injured myocardial areas, particularly in the inferior wall (INF). The reduction in perfusion was more notable in the CZT SPECT group than that in the conventional group, particularly in the inferior and lateral walls. Among patients with large cardiac chambers, those undergoing MPI with CZT, with normal weights, or males, hibernating myocardium (HM) and scar post-CTAC reductions were particularly significant in the INF. If HM ≥ 10% is considered an indicator for recommended revascularization, among the 87 patients without prior cardiac bypass, 25 (28.7%) might not require revascularization treatment. Dedicated cardiac CZT SPECT and conventional SPECT MPI combined with F-18-FDG PET/CT significantly influenced the assessment of viable myocardium. The impact of CTAC was more profound in dedicated cardiac CZT SPECT, particularly in the INF region. CTAC significantly enhances the accuracy of viable myocardial assessment and may influence clinical decisions regarding revascularization therapy. Therefore, CTAC should be routinely used in dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT for myocardial viability diagnosis.
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Affiliation(s)
- Fukai Zhao
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China
| | - Yue Chen
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China
| | - Jiaming Zhao
- Department of Intelligence and Computing, Tianjin University, Tianjin, P.R. China
| | - Zekun Pang
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China
| | - Jiao Wang
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China
| | - Bing Cao
- Department of Intelligence and Computing, Tianjin University, Tianjin, P.R. China
| | - Jianming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China
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18
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Lancellotti P, Sugimoto T, Bäck M. Revisiting secondary mitral regurgitation threshold severity: insights and lessons from the RESHAPE-HF2 trial. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae084. [PMID: 39474117 PMCID: PMC11520926 DOI: 10.1093/ehjopen/oeae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 09/23/2024] [Accepted: 09/28/2024] [Indexed: 11/28/2024]
Abstract
Aims This article revisits the severity threshold for secondary mitral regurgitation (MR), focusing on insights and lessons from the RESHAPE-HF2 trial. It aims to challenge the traditional effective regurgitant orifice area (EROA) threshold of ≥0.40 cm2 used for intervention, suggesting that earlier intervention may benefit patients with lower EROA. It also explores how transcatheter edge-to-edge repair (TEER) improves outcomes in patients with secondary MR and assesses the impact of left ventricular (LV) remodeling on treatment success. Methods and Results The RESHAPE-HF2 trial evaluated the use of TEER in patients with moderate-to-severe secondary MR, comparing outcomes in those with an EROA ≥0.2 cm2 and no extensive LV remodeling. TEER significantly reduced heart failure hospitalizations and improved quality of life in these patients. This supports the notion that patients with less severe MR, who still show symptoms despite optimal medical therapy, may benefit from earlier intervention. Comparisons with COAPT and MITRA-FR trials underscored the importance of selecting patients based on MR severity relative to LV dilatation. Conclusions The RESHAPE-HF2 trial highlights the need to reconsider the current EROA threshold for secondary MR intervention. TEER has shown to be beneficial even in patients with lower MR severity, suggesting that earlier intervention could improve outcomes. A more dynamic and integrated approach, considering both MR severity and LV remodeling, is essential for optimizing patient selection and treatment success.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Institutes, CHU Sart Tilman, Avenue de l'Hôpital, 1, 4000 Liège, Belgium
| | - Tadafumi Sugimoto
- Department of Cardiology, Nagoya City University Mirai Kousei Hospital, 2 Chome-1501 Sekobo, Meito Ward, Nagoya, Aichi 465-0055, Japan
| | - Magnus Bäck
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital Solna, Anna Steckséns g 41, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Anna Steckséns g 41, 17176 Stockholm, Sweden
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19
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Saraste A, Ståhle M, Roivainen A, Knuuti J. Molecular Imaging of Heart Failure: An Update and Future Trends. Semin Nucl Med 2024; 54:674-685. [PMID: 38609753 DOI: 10.1053/j.semnuclmed.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Molecular imaging can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Targeted tracers have enabled assessment of various cellular and subcellular mechanisms of heart failure aiming for improved phenotyping, risk stratification, and personalized therapy. This review outlines the current status of molecular imaging in heart failure, accompanied with discussion on novel developments. The focus is on radionuclide methods with data from clinical studies. Imaging of myocardial metabolism can identify left ventricle dysfunction caused by myocardial ischemia that may be reversible after revascularization in the presence of viable myocardium. In vivo imaging of active inflammation and amyloid deposition have an established role in the detection of cardiac sarcoidosis and transthyretin amyloidosis. Innervation imaging has well documented prognostic value in predicting heart failure progression and arrhythmias. Tracers specific for inflammation, angiogenesis and myocardial fibrotic activity are in earlier stages of development, but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of cardiac function over time. Early detection of disease activity is a key for transition from medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive cardiac dysfunction.
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Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
| | - Mia Ståhle
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
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20
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Schindler TH, Valenta I, Dilsizian V. Viability assessment in an evolving field of heart failure treatment: still needed? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1823-1825. [PMID: 39340722 DOI: 10.1007/s10554-024-03252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Affiliation(s)
- Thomas Hellmut Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine - Cardiovascular, Washington University in St. Louis School of Medicine, 510 S. Kingshighway Boulevard, Campus Box 8223, St. Louis, MO, 63110, USA.
| | - Ines Valenta
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine - Cardiovascular, Washington University in St. Louis School of Medicine, 510 S. Kingshighway Boulevard, Campus Box 8223, St. Louis, MO, 63110, USA
| | - Vasken Dilsizian
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MA, USA
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Pastore MC, Campora A, Mandoli GE, Lisi M, Benfari G, Ilardi F, Malagoli A, Sperlongano S, Henein MY, Cameli M, D'Andrea A. Stress echocardiography in heart failure patients: additive value and caveats. Heart Fail Rev 2024; 29:1117-1133. [PMID: 39060836 PMCID: PMC11306652 DOI: 10.1007/s10741-024-10423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 07/28/2024]
Abstract
Heart failure (HF) is a clinical syndrome characterized by well-defined signs and symptoms due to structural and/or myocardial functional impairment, resulting in raised intracardiac pressures and/or inadequate cardiac stroke volume at rest or during exercise. This could derive from direct ischemic myocardial injury or other chronic pathological conditions, including valvular heart disease (VHD) and primary myocardial disease. Early identification of HF etiology is essential for accurate diagnosis and initiation of early and appropriate treatment. Thus, the presence of accurate means for early diagnosis of HF symptoms or subclinical phases is fundamental, among which echocardiography being the first line diagnostic investigation. Echocardiography could be performed at rest, to identify overt structural and functional abnormalities or during physical or pharmacological stress, in order to elicit subclinical myocardial function impairment e.g. wall motion abnormalities and raised ventricular filling pressures. Beyond diagnosis of ischemic heart disease, stress echocardiography (SE) has recently shown its unique value for the evaluation of diastolic heart failure, VHD, non-ischemic cardiomyopathies and pulmonary hypertension, with recommendations from international societies in several clinical settings. All these features make SE an important additional tool, not only for diagnostic assessment, but also for prognostic stratification and therapeutic management of patients with HF. In this review, the unique value of SE in the evaluation of HF patients will be described, with the objective to provide an overview of the validated methods for each setting, particularly for HF management.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci1 , Siena, Italy.
| | - Alessandro Campora
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci1 , Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci1 , Siena, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Modena, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci1 , Siena, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, SA, Italy
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22
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Khangembam BC, Jaleel J, Roy A, Gupta P, Patel C. A Novel Approach to Identifying Hibernating Myocardium Using Radiomics-Based Machine Learning. Cureus 2024; 16:e69532. [PMID: 39416566 PMCID: PMC11482292 DOI: 10.7759/cureus.69532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2024] [Indexed: 10/19/2024] Open
Abstract
Background To assess the feasibility of a machine learning (ML) approach using radiomics features of perfusion defects on rest myocardial perfusion imaging (MPI) to detect the presence of hibernating myocardium. Methodology Data of patients who underwent 99mTc-sestamibi MPI and 18F-FDG PET/CT for myocardial viability assessment were retrieved. Rest MPI data were processed on ECToolbox, and polar maps were saved using the NFile PMap tool. The reference standard for defining hibernating myocardium was the presence of mismatched perfusion-metabolism defect with impaired myocardial contractility at rest. Perfusion defects on the polar maps were delineated with regions of interest (ROIs) after spatial resampling and intensity discretization. Replicable random sampling allocated 80% (257) of the perfusion defects of the patients from January 2017 to September 2022 to the training set and the remaining 20% (64) to the validation set. An independent dataset of perfusion defects from 29 consecutive patients from October 2022 to January 2023 was used as the testing set for model evaluation. One hundred ten first and second-order texture features were extracted for each ROI. After feature normalization and imputation, 14 best-ranked features were selected using a multistep feature selection process including the Logistic Regression and Fast Correlation-Based Filter. Thirteen supervised ML algorithms were trained with stratified five-fold cross-validation on the training set and validated on the validation set. The ML algorithms with a Log Loss of <0.688 and <0.672 in the cross-validation and validation steps were evaluated on the testing set. Performance matrices of the algorithms assessed included area under the curve (AUC), classification accuracy (CA), F1 score, precision, recall, and specificity. To provide transparency and interpretability, SHapley Additive exPlanations (SHAP) values were assessed and depicted as beeswarm plots. Results Two hundred thirty-nine patients (214 males; mean age 56 ± 11 years) were enrolled in the study. There were 371 perfusion defects (321 in the training and validation sets; 50 in the testing set). Based on the reference standard, 168 perfusion defects had hibernating myocardium (139 in the training and validation sets; 29 in the testing set). On cross-validation, six ML algorithms with Log Loss <0.688 had AUC >0.800. On validation, 10 ML algorithms had a Log Loss value <0.672, among which six had AUC >0.800. On model evaluation of the selected models on the unseen testing set, nine ML models had AUC >0.800 with Gradient Boosting Random Forest (xgboost) [GB RF (xgboost)] achieving the highest AUC of 0.860 and could detect the presence of hibernating myocardium in 21/29 (72.4%) perfusion defects with a precision of 87.5% (21/24), specificity 85.7% (18/21), CA 78.0% (39/50) and F1 Score 0.792. Four models depicted a clear pattern of model interpretability based on the beeswarm SHAP plots. These were GB RF (xgboost), GB (scikit-learn), GB (xgboost), and Random Forest. Conclusion Our study demonstrates the potential of ML in detecting hibernating myocardium using radiomics features extracted from perfusion defects on rest MPI images. This proof-of-concept underscores the notion that radiomics features capture nuanced information beyond what is perceptible to the human eye, offering promising avenues for improved myocardial viability assessment.
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Affiliation(s)
| | - Jasim Jaleel
- Nuclear Medicine, Institute of Liver and Biliary Sciences, New Delhi, IND
| | - Arup Roy
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Priyanka Gupta
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Chetan Patel
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Betemariam TA, Morgan H, Perera D. REVIVED BCIS-2: update and key learnings. Curr Opin Cardiol 2024; 39:431-436. [PMID: 39110078 DOI: 10.1097/hco.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2024]
Abstract
PURPOSE OF REVIEW This review summarises the shifting paradigms in the treatment of ischemic left ventricular dysfunction, spotlighting the revascularization for ischemic ventricular dysfunction-British cardiovascular intervention society-2 (REVIVED-BCIS2) trial results and its impact on key therapeutic goals: survival, left ventricular function, arrhythmia prevention, quality of life and viability testing. RECENT FINDINGS The REVIVED-BCIS2 trial, and its subsequent sub studies highlighted that (PCI) does not provide additional benefits to optimal medical therapy in terms of improving survival, left ventricular (LV) function, arrhythmic risk or quality of life. Additionally, viability testing did not differentiate patients who could benefit from PCI, although scar burden was found to be a significant predictor of outcome in these patients. SUMMARY The outcomes of REVIVED have challenged multiple existing beliefs in the field of ischaemic left ventricular dysfunction management, emphasising the importance of investigating evidence free areas in our practice. Future work, including the STICH3 international consortium of trials, aims to answer some of the remaining unanswered questions.
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Affiliation(s)
- Tesfamariam Aklilu Betemariam
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London
| | - Holly Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Omaygenc MO, Morgan H, Mielniczuk L, Perera D, Panza JA. In search of the answers to the viability questions. J Nucl Cardiol 2024; 39:101912. [PMID: 39370172 DOI: 10.1016/j.nuclcard.2024.101912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Holly Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, United Kingdom.
| | - Lisa Mielniczuk
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, United Kingdom
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and the Department of Medicine, New York Medical College, Valhalla, NY, USA.
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25
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Sohn SH, Kang Y, Kim JS, Park EA, Lee W, Hwang HY. Impact of Myocardial Viability on Long-term Outcomes after Surgical Revascularization. Thorac Cardiovasc Surg 2024; 72:441-448. [PMID: 38092064 DOI: 10.1055/a-2228-7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). METHODS Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades-0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5-95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure. RESULTS Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10-1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II. CONCLUSION The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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26
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Al-Sadawi M, Tao M, Dhaliwal S, Radakrishnan A, Liu Y, Gier C, Masson R, Rahman T, Tam E, Mann N. Utility of coronary revascularization in patients with ischemic left ventricular dysfunction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:88-97. [PMID: 38503643 DOI: 10.1016/j.carrev.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). OBJECTIVES The purpose of this meta-analysis is to evaluate the association of coronary revascularization with outcomes in patients with ischemic LV dysfunction. METHODS A literature search was conducted for studies reporting on cardiovascular outcomes after revascularization compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. RESULTS A total of 23 studies with 10,110 participants met inclusion criteria. Revascularization was significantly associated with lower all-cause mortality and CV mortality compared to OMT. The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Subgroup analysis demonstrated that revascularization was significantly associated with lower all-cause and CV mortality compared to OMT for patients with viable myocardium and mixed cohorts with variable viability, but not patients without viable myocardium. Revascularization was not associated with a significant difference in risk of heart failure (HF) hospitalization or acute myocardial infarction (AMI) compared to OMT. CONCLUSIONS Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization.
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Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, University of Michigan Hospital, Ann Arbor, MI, USA.
| | - Michael Tao
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Simrat Dhaliwal
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Archanna Radakrishnan
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Yang Liu
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Chad Gier
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ravi Masson
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Tahmid Rahman
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Edlira Tam
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Noelle Mann
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
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Canton L, Suma N, Amicone S, Impellizzeri A, Bodega F, Marinelli V, Ciarlantini M, Casuso M, Bavuso L, Belà R, Salerno J, Armillotta M, Angeli F, Sansonetti A, Attinà D, Russo V, Lovato L, Tuttolomondo D, Gaibazzi N, Bergamaschi L, Pizzi C. Clinical impact of multimodality assessment of myocardial viability. Echocardiography 2024; 41:e15854. [PMID: 38940225 DOI: 10.1111/echo.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
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Affiliation(s)
- Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jessica Salerno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Russo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Masroor M, Wang Y, Zhang C, Dong N. Surgical Management of Ischemic Cardiomyopathy Patients with Severe Left Ventricular Dysfunction: Is It Time to Reconsider Revascularization Surgery? J Cardiovasc Dev Dis 2024; 11:184. [PMID: 39057607 PMCID: PMC11276879 DOI: 10.3390/jcdd11070184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, etc. Despite multiple treatment options, there are no explicit clinical guidelines available to guide surgeons in choosing the most appropriate option and ensuring that the specific patient can benefit from the selected surgical treatment. Heart transplantation is the gold standard treatment for ischemic cardiomyopathy patients with severe left ventricular dysfunction, but it is limited to very few highly equipped centers around the world due to donor shortages, complex perioperative and surgical management, and limited technological and human resources. It is evident from some studies that heart transplant-eligible candidates can benefit from alternative surgical options such as coronary artery bypass surgery alone or combined with surgical ventricular restoration. Therefore, alternative surgical options that are used for most of the population, especially in developing and underdeveloped countries, need to be discussed to improve their outcomes. A challenge in the recent era which has yet to find a solution is to determine which heart transplant candidate can benefit from simple revascularization compared to a complex heart transplantation procedure. Myocardial viability testing was one of the most important determinants in deciding whether a patient should undergo revascularization, but its role in guiding appropriate surgical options has been challenged. This review aims to discuss the available surgical management options and their long-term outcomes for patients with ischemic cardiomyopathy, which will eventually help surgeons when choosing a surgical procedure.
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Affiliation(s)
- Matiullah Masroor
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd, Kabul 1010, Afghanistan
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
| | - Chao Zhang
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.M.); (Y.W.)
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Karur GR, Aneja A, Stojanovska J, Hanneman K, Latchamsetty R, Kersting D, Rajiah PS. Imaging of Cardiac Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329870. [PMID: 37753860 DOI: 10.2214/ajr.23.29870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Myocardial fibrosis (MF) is defined as excessive production and deposition of extra-cellular matrix proteins that result in pathologic myocardial remodeling. Three types of MF have been identified: replacement fibrosis from tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative interstitial fibrosis from progressive deposition of nondegradable material such as amyloid. Although echocardiography, nuclear medicine, and CT play important roles in the assessment of MF, MRI is pivotal in the evaluation of MF, with the late gadolinium enhancement (LGE) technique used as a primary end point. The LGE technique focuses on the pattern and distribution of gadolinium accumulation in the myocardium and assists in the diagnosis and establishment of the cause of both ischemic and nonischemic cardiomyopathy. LGE MRI also aids prognostication and risk stratification. In addition, LGE MRI is used to guide the management of patients considered for ablation for arrhythmias. Parametric mapping techniques, including T1 mapping and extracellular volume measurement, allow detection and quantification of diffuse fibrosis, which may not be detected by LGE MRI. These techniques also allow monitoring of disease progression and therapy response. This review provides an update on the imaging of MF, including prognostication and risk stratification tools, electrophysiologic considerations, and disease monitoring.
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Affiliation(s)
- Gauri R Karur
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Ashish Aneja
- Department of Cardiology, MetroHealth System, Cleveland, OH
| | | | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | | | - David Kersting
- Department of Nuclear Medicine and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
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Lorusso R, Matteucci M, Lerakis S, Ronco D, Menicanti L, Sharma SK, Moreno PR. Postmyocardial Infarction Ventricular Aneurysm: JACC Focus Seminar 5/5. J Am Coll Cardiol 2024; 83:1917-1935. [PMID: 38719371 DOI: 10.1016/j.jacc.2024.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 07/16/2024]
Abstract
Ventricular aneurysm represents a rare complication of transmural acute myocardial infarction, although other cardiac, congenital, or metabolic diseases may also predispose to such condition. Ventricular expansion includes all the cardiac layers, usually with a large segment involved. Adverse events include recurrent angina, reduced ventricular stroke volume with congestive heart failure, mitral regurgitation, thromboembolism, and ventricular arrhythmias. Multimodality imaging is paramount to provide comprehensive assessment, allowing for appropriate therapeutic decision-making. When indicated, surgical intervention remains the gold standard, although additional therapy (heart failure, anticoagulation, and advanced antiarrhythmic treatment) might be required. However, the STICH (Surgical Treatment for Ischemic Heart Failure) trial did not show any advantage from adding surgical ventricular reconstruction to coronary artery bypass surgery in terms of survival, rehospitalization or symptoms, compared with revascularization alone. Finally, implantable cardiac defibrillator may reduce the risk of fatal arrhythmias.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASSTSette Laghi, Varese, Italy
| | - Stamatios Lerakis
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniele Ronco
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Samin K Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pedro R Moreno
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Igor Palacios Fellows Foundation, Boston Massachusetts, USA.
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Bista R, Zghouzi M, Jasti M, Lichaa H, Kerrigan J, Haddad E, Alraies MC, Paul TK. Outcomes of Percutaneous Revascularization in Severe Ischemic Left Ventricular Dysfunction. Curr Cardiol Rep 2024; 26:435-442. [PMID: 38642298 PMCID: PMC11136825 DOI: 10.1007/s11886-024-02045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF REVIEW This article presents a comprehensive review of coronary revascularization versus optimal medical therapy (OMT) in patients with severe ischemic left ventricular dysfunction. RECENT FINDINGS The REVIVED-BCIS2 trial randomized 700 patients with extensive coronary artery disease and left ventricular (LV) ejection fraction (LVEF) ≤ 35% and viability in more than four dysfunctional myocardial segments to percutaneous coronary intervention (PCI) plus OMT versus OMT alone. Over a median duration of 41 months, there was no difference in the composite of all-cause mortality, heart failure hospitalization, or improvement in LVEF with PCI plus OMT versus OMT alone at 6 and 12 months, quality of life scores at 24 months, or fatal ventricular arrhythmia. The STICH randomized trial was conducted between 2002 and 2007, involving patients with LV dysfunction and coronary artery disease. The patients were assigned to either CABG plus medical therapy or medical therapy alone. At the 5-year follow-up, the trial showed that CABG plus medical therapy reduced cardiovascular disease-related deaths and hospitalizations but no reduction in all-cause mortality. However, a 10-year follow-up showed a significant decrease in all-cause mortality with CABG. The currently available evidence showed no apparent benefit of PCI in severe ischemic cardiomyopathy as compared to OMT, but that CABG improves outcomes in this patient population. The paucity of data on the advantages of PCI in this patient population underscores the critical need for optimization of medical therapy for better survival and quality of life until further evidence from RCTs is available.
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Affiliation(s)
- Roshan Bista
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Mohamed Zghouzi
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Manasa Jasti
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Hady Lichaa
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Jimmy Kerrigan
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Elias Haddad
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - M Chadi Alraies
- Detroit Medical Center, Cardiovascular Institute, Heart Hospital, Detroit, MI, USA
| | - Timir K Paul
- University of Tennessee Health Science Center, Nashville, TN, USA.
- Ascension St., Thomas Hospital, Nashville, TN, USA.
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Chang AJ, Liang Y, Hamilton SA, Ambrosy AP. Medical Decision-Making and Revascularization in Ischemic Cardiomyopathy. Med Clin North Am 2024; 108:553-566. [PMID: 38548463 DOI: 10.1016/j.mcna.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Ischemic cardiomyopathy (ICM) is the most common underlying etiology of heart failure in the United States and is a significant contributor to deaths due to cardiovascular disease worldwide. The diagnosis and management of ICM has advanced significantly over the past few decades, and the evidence for medical therapy in ICM is both compelling and robust. This contrasts with evidence for coronary revascularization, which is more controversial and favors surgical approaches. This review will examine landmark clinical trial results in detail as well as provide a comprehensive overview of the current epidemiology, diagnostic approaches, and management strategies of ICM.
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Affiliation(s)
- Alex J Chang
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Yilin Liang
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Steven A Hamilton
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA 94115, USA; Clinical Trials Program, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
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Varma PK, Radhakrishnan RM, Gopal K, Krishna N, Jose R. Selecting the appropriate patients for coronary artery bypass grafting in ischemic cardiomyopathy-importance of myocardial viability. Indian J Thorac Cardiovasc Surg 2024; 40:341-352. [PMID: 38681722 PMCID: PMC11045715 DOI: 10.1007/s12055-023-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 05/01/2024] Open
Abstract
Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy.
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Affiliation(s)
- Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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Belyayev L, Stock EM, Hattler B, Bakaeen FG, Kinlay S, Quin JA, Haime M, Biswas K, Zenati MA. Complete Coronary Revascularization and Outcomes in Patients Who Underwent Coronary Artery Bypass Grafting: Insights from The REGROUP Trial. Am J Cardiol 2024; 217:127-135. [PMID: 38266796 DOI: 10.1016/j.amjcard.2024.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
There is growing evidence in support of coronary complete revascularization (CR). Nonetheless, there is no universally accepted definition of CR in patients who undergo coronary bypass grafting surgery (CABG). We sought to investigate the outcomes of CR, defined as surgical revascularization of any territory supplied by a suitable coronary artery with ≥50% stenosis. We performed a preplanned subanalysis in the Randomized Trial of Endoscopic or Open Saphenous Vein Graft Harvesting (REGROUP) clinical trial cohort. Of 1,147 patients who underwent CABG, 810 (70.6%) received CR. The primary outcome was a composite of major adverse cardiac events (MACEs), including death from any cause, nonfatal myocardial infarction, or repeat revascularization over a median 4.7 years of follow-up. MACE occurred in 175 patients (21.6%) in the CR group and 86 patients (25.5%) in the incomplete revascularization (IR) group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.67 to 1.13, p = 0.29). A total of 97 patients (12.0%) in the CR group and 48 patients (14.2%) in the IR group died (HR 0.93, 95% CI 0.65 to 1.32, p = 0.67); nonfatal myocardial infarction occurred in 49 patients (6.0%) in the CR group and 30 patients (8.9%) in the IR group (HR 0.76, 95% CI 0.48 to 1.2, p = 0.24), and repeat revascularization occurred in 62 patients (7.7%) in the CR group and 39 patients (11.6%) in the IR group (HR 0.64; 95% CI 0.42 to 0.95, p = 0.027). In conclusion, in patients with a great burden of co-morbidities who underwent CABG in the REGROUP trial over a median follow-up period of a median 4.7 years, CR was associated with similar MACE rates but a reduced risk of repeat revascularization. Longer-term follow-up is warranted.
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Affiliation(s)
- Leonid Belyayev
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, Office of Research and Development, US Department of Veterans Affairs, Perry Point, Maryland
| | - Brack Hattler
- Division of Cardiology, Eastern Colorado Veterans Affairs Healthcare System and University of Colorado, Aurora, Colorado
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott Kinlay
- Divisions of Cardiology, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Jacqueline A Quin
- Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Miguel Haime
- Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, Office of Research and Development, US Department of Veterans Affairs, Perry Point, Maryland
| | - Marco A Zenati
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
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Bolognese L, Reccia MR. Myocardial viability on trial. Eur Heart J Suppl 2024; 26:i15-i18. [PMID: 38867871 PMCID: PMC11167980 DOI: 10.1093/eurheartjsupp/suae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
The concept of myocardial viability is usually referred to areas of the myocardium, which show contractile dysfunction at rest and in which contractility is expected to improve after revascularization. The traditional paradigm states that an improvement in function after revascularization leads to improved health outcomes and that assessment of myocardial viability in patients with ischaemic left ventricular dysfunction (ILVD) is a prerequisite for clinical decisions regarding treatment. A range of retrospective observational studies supported this 'viability hypothesis'. However, data from prospective trials have diverged from earlier retrospective studies and challenge this hypothesis. Traditional binary viability assessment may oversimplify ILVD's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centred on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ILVD's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
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Xu D, Zhang J, Liu B, Fu D, Li J, Fan L. Determination of viable myocardium through delayed enhancement cardiac magnetic resonance imaging combined with 18F-FDG PET myocardial perfusion/metabolic imaging before CABG. Int J Cardiovasc Imaging 2024; 40:887-895. [PMID: 38265540 PMCID: PMC11052819 DOI: 10.1007/s10554-024-03057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Study aims to investigate the consistency of delayed enhancement cardiac magnetic resonance imaging (DE-CMR) and 18F-FDG PET myocardial imaging in evaluating myocardial viability before CABG. METHODS The study analyzed data from 100 patients who were examined with DE-CMR, PET imaging, and echocardiography before and after CABG. All subjects were followed up for 6-12 month post- CABG. RESULTS DE-CMR and PET imaging have high consistency (90.1%; Kappa value = 0.71, p < 0.01) in determining myocardial viability. The degree of delayed enhancement was negatively correlated with the improvement in myocardial contractile function in this segment after revascularization (P < 0.001). The ratio of scarred myocardial segments and total DE score was significantly lower in the improvement group than non-improvement group. Multivariate regression identified that hibernating myocardium (OR = 1.229, 95%CI: 1.053-1.433, p = 0.009) was influencing factor of LVEF improvement after CABG. CONCLUSION Both imaging techniques are consistent in evaluating myocardial viability. Detecting the number of hibernating myocardium by PET is also important to predict the left heart function improvement after CABG.
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Affiliation(s)
- Dongsheng Xu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jiwang Zhang
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Bing Liu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Donghai Fu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jianming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China.
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De Caterina R, Liga R. A treatment algorithm for ischemic cardiomyopathy. Vascul Pharmacol 2024; 154:107274. [PMID: 38182081 DOI: 10.1016/j.vph.2023.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
Treatment of ischemic cardiomyopathy has been the focus of increased attention by cardiologists due to recent evidence of an important outcome study comparing percutaneous coronary intervention (PCI) plus optimal medical treatment vs optimal medical treatment alone, concluding for the futility of myocardial revascularization by PCI. A relatively older trial of coronary artery bypass grafting (CABG) in the same condition, on the other hand, had concluded for some prognostic improvement at a long-term follow-up. This short manuscript addresses how to triage such patients, frequently encountered in medical practice and considering clinical presentation, imaging results, and surgical risk, to provide practical guidance to treatment.
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Affiliation(s)
- Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of Cardiology, University of Pisa, Pisa, Italy.
| | - Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of Cardiology, University of Pisa, Pisa, Italy
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Kirov H, Caldonazo T, Doenst T. Invasive Treatment of Left Main Coronary Artery Disease: From Anatomical Features to Mechanistic Differences. Curr Cardiol Rev 2024; 20:e150724231978. [PMID: 39021193 PMCID: PMC11440332 DOI: 10.2174/011573403x321064240715061250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024] Open
Abstract
There is debate on the best treatment for significant stenoses of the left main (LM) coronary artery. The available evidence is based on four randomized trials, which were either performed specifically to assess patients with LM disease (EXCEL, NOBLE, PRECOMBAT) or had a significant fraction of patients with this disease pattern (SYNTAX). A meta-analysis revealed no difference in periprocedural and 5-year mortality but demonstrated a significant reduction of spontaneous myocardial infarction (MI) with CABG. Furthermore, the recently published SWEDEHEART registry data have shown survival advantage and fewer MACCE with CABG for LM disease after adjustment. In general, patients with more severe coronary artery disease (CAD) appear to have a survival advantage with CABG both over PCI and medical therapy (independent of the presence or absence of LM stenosis), which is always associated with a reduction of spontaneous MI in the CABG arm. Since the nomenclature of LM disease does not automatically reflect the complexity of CAD, we review the nature of LM disease in this article. We mechanistically assess the treatment effects of PCI and CABG for patients with LM disease, which is rarely isolated, often distal, and mostly associated with varying degrees of single and multi-vessel disease. We conclude that in patients with isolated LM shaft lesions and associated diseases of low complexity, the risk of spontaneous MI is lower, and PCI may achieve similar long-term outcomes compared to CABG. Thus, heart teams are essential for selecting the best treatment option and should focus on assessing infarction risk in chronic CAD.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
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Girotra S, Kumbhani DJ. Percutaneous Coronary Intervention for Heart Failure: Worth the Cost? Circ Cardiovasc Qual Outcomes 2024; 17:e010572. [PMID: 37929590 PMCID: PMC10872480 DOI: 10.1161/circoutcomes.123.010572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Saket Girotra
- University of Texas-Southwestern Medical Center, Dallas, TX
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40
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Zhang T, Masroor M, Jiang C, Xu L, Wang Y, Deng C, Dong N. Long-term survival of ischemic cardiomyopathy patients with severe left ventricular dysfunction after CABG vs heart transplantation: A single center retrospective analysis. Clin Transplant 2024; 38:e15243. [PMID: 38289883 DOI: 10.1111/ctr.15243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND There are no guidelines on the surgical management for ischemic cardiomyopathy (ICM) patients with severe left ventricular dysfunction. The present study aims to assess the long-term survival of these patients treated with two different surgical techniques, coronary artery bypass grafting (CABG) and heart transplantation (HTx). METHODS This retrospective study included 218 ICM patients with left ventricular ejection fraction (LVEF) ≤35% who underwent CABG (n = 106) and HTx (n = 112) from 2011 to 2021 in a single center. After propensity adjustment analysis each group consisted of 51 patients. Clinical characteristics were evaluated for all-cause follow-up mortality by the Cox proportional hazards regression model. A risk prediction model was generated from multivariable-adjusted Cox regression analysis and applied to stratify patients with different clinical risks. The long-term survival was estimated by Kaplan-Meier analysis for different surgery groups. RESULTS Long-term survival was comparable between CABG and HTx groups. After being stratified into different risk subgroups according to risk predictors, the HTx group exhibited superior survival outcomes compared to the CABG group among the high-risk patients (67.8% vs 44.4%, 64.1% vs 38.9%, and 64.1% vs 33.3%, p = 0.047) at 12, 36, and 60 months respectively, while the survival was comparable between HTx and CABG groups among low-risk patients (87.0% vs 97.0%, 82.4% vs 97.0%, and 70.2% vs 91.6%, p = 0.11) at 12, 36, and 60 months respectively in the PSM cohort. CONCLUSION Long-term survival in ICM patients with severe left ventricular dysfunction who received CABG or HTx was comparable in general. Nonetheless, a favorable outcome of HTx surgery compared to CABG was observed among high-risk patients.
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Affiliation(s)
- Tailong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Matiullah Masroor
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Kabul, Afghanistan
| | - Chen Jiang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cheng Deng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Perera D, Ryan M, Morgan HP, Greenwood JP, Petrie MC, Dodd M, Weerackody R, O’Kane PD, Masci PG, Nazir MS, Papachristidis A, Chahal N, Khattar R, Ezad SM, Kapetanakis S, Dixon LJ, De Silva K, McDiarmid AK, Marber MS, McDonagh T, McCann GP, Clayton TC, Senior R, Chiribiri A. Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction: A Prespecified Secondary Analysis of the REVIVED-BCIS2 Trial. JAMA Cardiol 2023; 8:1154-1161. [PMID: 37878295 PMCID: PMC10600721 DOI: 10.1001/jamacardio.2023.3803] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023]
Abstract
Importance In the Revascularization for Ischemic Ventricular Dysfunction (REVIVED-BCIS2) trial, percutaneous coronary intervention (PCI) did not improve outcomes for patients with ischemic left ventricular dysfunction. Whether myocardial viability testing had prognostic utility for these patients or identified a subpopulation who may benefit from PCI remained unclear. Objective To determine the effect of the extent of viable and nonviable myocardium on the effectiveness of PCI, prognosis, and improvement in left ventricular function. Design, Setting, and Participants Prospective open-label randomized clinical trial recruiting between August 28, 2013, and March 19, 2020, with a median follow-up of 3.4 years (IQR, 2.3-5.0 years). A total of 40 secondary and tertiary care centers in the United Kingdom were included. Of 700 randomly assigned patients, 610 with left ventricular ejection fraction less than or equal to 35%, extensive coronary artery disease, and evidence of viability in at least 4 myocardial segments that were dysfunctional at rest and who underwent blinded core laboratory viability characterization were included. Data analysis was conducted from March 31, 2022, to May 1, 2023. Intervention Percutaneous coronary intervention in addition to optimal medical therapy. Main Outcomes and Measures Blinded core laboratory analysis was performed of cardiac magnetic resonance imaging scans and dobutamine stress echocardiograms to quantify the extent of viable and nonviable myocardium, expressed as an absolute percentage of left ventricular mass. The primary outcome of this subgroup analysis was the composite of all-cause death or hospitalization for heart failure. Secondary outcomes were all-cause death, cardiovascular death, hospitalization for heart failure, and improved left ventricular function at 6 months. Results The mean (SD) age of the participants was 69.3 (9.0) years. In the PCI group, 258 (87%) were male, and in the optimal medical therapy group, 277 (88%) were male. The primary outcome occurred in 107 of 295 participants assigned to PCI and 114 of 315 participants assigned to optimal medical therapy alone. There was no interaction between the extent of viable or nonviable myocardium and the effect of PCI on the primary or any secondary outcome. Across the study population, the extent of viable myocardium was not associated with the primary outcome (hazard ratio per 10% increase, 0.98; 95% CI, 0.93-1.04) or any secondary outcome. The extent of nonviable myocardium was associated with the primary outcome (hazard ratio, 1.07; 95% CI, 1.00-1.15), all-cause death, cardiovascular death, and improvement in left ventricular function. Conclusions and Relevance This study found that viability testing does not identify patients with ischemic cardiomyopathy who benefit from PCI. The extent of nonviable myocardium, but not the extent of viable myocardium, is associated with event-free survival and likelihood of improvement of left ventricular function. Trial Registration ClinicalTrials.gov Identifier: NCT01920048.
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Affiliation(s)
- Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Holly P. Morgan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - John P. Greenwood
- Leeds Institute for Cardiometabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Peter D. O’Kane
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Alexandros Papachristidis
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Navtej Chahal
- London Northwest Health NHS Trust, London, United Kingdom
| | | | - Saad M. Ezad
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Stam Kapetanakis
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lana J. Dixon
- Belfast Health and Social Care NHS Trust, Belfast, United Kingdom
| | - Kalpa De Silva
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Michael S. Marber
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
| | - Theresa McDonagh
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerry P. McCann
- University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Tim C. Clayton
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roxy Senior
- Royal Brompton Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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Fagu A, Berger T, Pingpoh C, Kondov S, Kreibich M, Minners J, Czerny M, Siepe M. In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1967. [PMID: 38004016 PMCID: PMC10673513 DOI: 10.3390/medicina59111967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Patients with chronic total occlusions of the coronary arteries are either treated with PCI or referred for surgical revascularization. We analyzed the patients with chronic occluded coronary arteries that were surgically treated and aimed to describe the anatomical characteristics, revascularization rates, and in-hospital outcomes achieved with coronary artery bypass grafting. Methods: Angiographic data of 2005 patients with coronary artery disease treated in our institution between January 2005 and December 2014 were retrospectively analyzed. A total of 1111 patients with at least one coronary total occlusion were identified. We reviewed the preoperative coronary angiograms and surgical protocols to determine the presence, localization, and revascularization of coronary occlusions. We also evaluated the perioperative data and in-hospital outcomes. Results: The median age of the study population was 68 years (25th-75th percentiles, 61.0-74.0). Three-vessel disease was present in 94.8% of patients and the rest (5.8%) had a two-vessel disease. The localizations of the occlusions were as follows: 68.4% in the RCA system, 26.4% in the LAD, and 28.5% in the LCX system. Multiple occlusions were present in 22.6% of the patients. Complete coronary total occlusion revascularization was achieved in 86.1% of the patients. The overall in-hospital mortality was 2.3%. The median in-hospital stay was 14.0 days. After logistic regression analysis, age (odds ratio 3.44 [95% confidence interval, 1.81-6.53], p < 0.001, for a 10-year increase) and the presence of peripheral artery disease (odds ratio 3.32 [1.39-7.93], p = 0.007) were the only statistically significant independent predictors of in-hospital mortality. Conclusions: A high revascularization rate and favorable in-hospital outcomes are achieved with coronary artery bypass surgery in patients with multi-vessel diseases and coronary total occlusions. Older age and the presence of peripheral artery disease are independent predictors of in-hospital mortality. A long-term follow-up and the type of graft (arterial vs. venous) used would bring more useful data for this type of revascularization.
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Affiliation(s)
- Albi Fagu
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
- Division of Cardiac Surgery, University Hospital “Shefqet Ndroqi”, University of Medicine, 1005 Tirana, Albania
| | - Tim Berger
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Clarence Pingpoh
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, 79189 Bad Krozingen, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
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Thamrin AMH, Soetisna TW, Ramadhani ANE, Hendarto H. Cell sheet transplantation for ischemic heart disease: a systematic review. Indian J Thorac Cardiovasc Surg 2023; 39:577-587. [PMID: 37885940 PMCID: PMC10597942 DOI: 10.1007/s12055-023-01554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE Cell sheet transplantation is emerging as an appealing alternative for ischemic heart disease patients as it potentially can increase stem cell viability and retention. But the outcomes and safety of this treatment are still limited in literature and the result varies widely. We conduct a systematic review to look at the efficacy and safety of this promising transplantation method. METHODS A systematic review was performed according to PRISMA guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Embase databases. Articles were thoroughly evaluated and analyzed. RESULTS Seven publications about cell sheet transplantation for ischemic heart disease patients were included. The primary outcomes measured were left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) class. Safety measurement was depicted by cardiac-related readmission and deaths. The follow-up time ranged from 3 to 36 months for clinical outcomes and 8.5 years for safety outcomes. Cell sheet transplantation showed improvement in LVEF and NYHA class in most studies. Cardiac-related readmission and adverse events of cell sheet transplantation range from 0 to 30.4%, all were nonfatal as no cardiac-related death was reported. Patient preoperative status seems can affect the patient's response to cell sheet therapy. CONCLUSION Cell sheet transplantation can safely improve LVEF and NYHA class in ischemic heart disease patients, even in very low ejection fraction patients with unsuccessful standard therapy before. Further studies with better patient inclusion, larger population, and long-term follow-up required to confirm these results.
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Affiliation(s)
- Ahmad Muslim Hidayat Thamrin
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, S. Parman Street Cavling 87, Jakarta, Indonesia
- Faculty of Medicine Syarif Hidayatullah State Islamic University – Haji Hospital, Jakarta, Indonesia
| | - Tri Wisesa Soetisna
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, S. Parman Street Cavling 87, Jakarta, Indonesia
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Andi Nurul Erisya Ramadhani
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, S. Parman Street Cavling 87, Jakarta, Indonesia
| | - Hari Hendarto
- Faculty of Medicine Syarif Hidayatullah State Islamic University – Haji Hospital, Jakarta, Indonesia
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Isath A, Panza JA. The Evolving Paradigm of Revascularization in Ischemic Cardiomyopathy: from Recovery of Systolic Function to Protection Against Future Ischemic Events. Curr Cardiol Rep 2023; 25:1513-1521. [PMID: 37874470 DOI: 10.1007/s11886-023-01977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW We aim to reevaluate how the assessment of myocardial viability can guide optimal treatment strategies for patients with ischemic cardiomyopathy (ICM) based on a more contemporary understanding of the mechanism of benefit of revascularization. RECENT FINDINGS The assessment of viability in left ventricular (LV) segments with diminished contraction has been proposed as key to predict the benefit of revascularization and, therefore, as a requisite for the selection of patients to undergo this form of treatment. However, data from prospective trials have diverged from earlier retrospective studies. Traditional binary viability assessment may oversimplify ICM's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centered on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ICM's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA.
- Department of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, USA.
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Saraste A, Knuuti J, Bengel F. Phenotyping heart failure by nuclear imaging of myocardial perfusion, metabolism, and molecular targets. Eur Heart J Cardiovasc Imaging 2023; 24:1318-1328. [PMID: 37294318 PMCID: PMC10531130 DOI: 10.1093/ehjci/jead128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
Nuclear imaging techniques can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Combined imaging of myocardial perfusion and metabolism can identify left ventricle dysfunction caused by myocardial ischaemia that may be reversible after revascularization in the presence of viable myocardium. High sensitivity of nuclear imaging to detect targeted tracers has enabled assessment of various cellular and subcellular mechanisms of heart failure. Nuclear imaging of active inflammation and amyloid deposition is incorporated into clinical management algorithms of cardiac sarcoidosis and amyloidosis. Innervation imaging has well-documented prognostic value with respect to heart failure progression and arrhythmias. Emerging tracers specific for inflammation and myocardial fibrotic activity are in earlier stages of development but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of adverse left ventricular remodelling. Early detection of disease activity is a key for transition from broad medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive failure. This review outlines the current status of nuclear imaging in phenotyping heart failure and combines it with discussion on novel developments.
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Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4–8, 20520 Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4–8, 20520 Turku, Finland
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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Kazakauskaite E, Vajauskas D, Bardauskiene L, Ordiene R, Zabiela V, Zaliaduonyte D, Gustiene O, Lapinskas T, Jurkevicius R. The incremental value of myocardial viability, evaluated by 18F-fluorodeoxyglucose positron emission tomography, and cardiovascular magnetic resonance for mortality prediction in patients with previous myocardial infarction and symptomatic heart failure. Perfusion 2023; 38:1288-1297. [PMID: 35503304 PMCID: PMC10466976 DOI: 10.1177/02676591221100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To find the imaging mortality predictors in patients with previous myocardial infarction (MI), symptomatic heart failure (HF), and reduced left ventricle (LV) ejection fraction (EF). METHODS for the study 39 patients were selected prospectively with prior MI, symptomatic HF, and LVEF ≤40%. All patients underwent transthoracic echocardiography (TTE), single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), 18F-FDG positron emission tomography (FDG PET). 31 patients underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Patients were divided into two groups: 1 group - cardiac death; 2 group - no cardiac death. Myocardial scars were assessed on a 5-point-scale. Follow-up data was obtained. RESULTS Imaging features disclosed significant difference (p < 0.05) of defect score (CMR and SPECT-PET), LV end-diastolic diameter (EDD) (TTE), LVEDD index (CMR), LV global longitudinal strain (CMR) and LV global circumferential strain (CMR) between the groups. Predictors of cardiac death were: LVEDD index (TTE) and LV global longitudinal strain. The cut-off values to predict cardiac death were: defect score (CMR) 25 (AUC, 79.5%; OR 1.8, 95% CI 1.2-2.7), SPECT-PET defect score 22 (AUC, 73.9%; OR 0.5, 95% CI 0.3-0.7), LVEDD (TTE) 58 mm (AUC, 88.4%; OR 23.6, 95% CI 2.6-217.7), LVEDDi 30 mm/m2 (TTE) (AUC, 73.6%; OR 22.0, 95% CI 1.9-251.5), LVEDDi 33.6 mm/m2 (CMR) (AUC, 73.6%; OR 22.0, 95% CI 1.9-251.5), LV global longitudinal strain -13.4 (AUC, 87.8%; OR 2.1, 95% CI 1.2-3.7) and LV global circumferential strain -16.3 (AUC, 76.1%; OR 1.9, 95% CI 1.2-3.0). CONCLUSIONS Imaging features, such as defect score (CMR) >25, SPECT-PET defect score >22, LVEDD (TTE) >58 mm, LVEDDi (TTE) >30 mm/m2, LVEDDi (CMR) >33.6 mm/m2, LV global longitudinal strain -13.4 and LV global circumferential strain -16.3, may increase sensitivity and specificity of FDG PET and LGE CMR predicting of late mortality.
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Affiliation(s)
- Egle Kazakauskaite
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Donatas Vajauskas
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Lina Bardauskiene
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Rasa Ordiene
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Diana Zaliaduonyte
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Olivija Gustiene
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
| | - Renaldas Jurkevicius
- Department of Cardiology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Lithuania
- Lithuanian University of Health Sciences, Lithuania
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Chellasamy RT, Sai Chandran BV, Halanaik D, Rath DP. Myocardial Perfusion Scan Study before and after On-Pump Coronary Artery Bypass Grafting Surgery - A Single-Center Study. Indian J Nucl Med 2023; 38:239-244. [PMID: 38046969 PMCID: PMC10693366 DOI: 10.4103/ijnm.ijnm_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/30/2023] [Indexed: 12/05/2023] Open
Abstract
Aim Ischemic cardiac disease is the most common adult heart disease. The primary aim of the study was to analyze the myocardial perfusion status of the patients undergoing coronary artery bypass graft using sestamibi scan and assess the improvement in perfusion status of the myocardium after the surgery. Materials and Methods This study was a descriptive study consisting of a single group of patients undergoing elective surgery for coronary artery disease. The patients underwent myocardial perfusion scan before surgery. Another myocardial perfusion scan was performed 3 months after the surgery. The change in myocardial perfusion status was analyzed. Results Totally, 49 patients were initially included in this study. Seven patients lost their follow-up. Among the 17 patients who had severely reduced tracer uptake preoperatively, 3 (7.1%) had a good outcome, while 14 (33.3%) had a poor outcome, which was statistically significant (P < 0.001). Eighteen cases who belonged to the category of moderately reduced tracer uptake while analyzed, it was found that 16 (38.1%) had a good outcome while only 2 (4.8%) had a poor outcome; the difference in proportion among these two groups was statistically significant (P < 0.001). The patients who had mildly reduced tracer uptake preoperatively, all 3 (7.1%) had a good outcome, but it was not statistically significant (P = 0.23). Four patients had adequate tracer uptake preoperatively, out of which 3 (7.1%) had a good outcome, while the other 1 (2.4%) had a poor outcome and was not statistically significant (P = 0.63). Conclusion Surgical revascularization improves perfusion in a selective group of patients.
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Affiliation(s)
- Rajeev Thilak Chellasamy
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - B V Sai Chandran
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Durga Prasad Rath
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Sperry BW, Bateman TM, Akin EA, Bravo PE, Chen W, Dilsizian V, Hyafil F, Khor YM, Miller RJH, Slart RHJA, Slomka P, Verberne H, Miller EJ, Liu C. Hot spot imaging in cardiovascular diseases: an information statement from SNMMI, ASNC, and EANM. J Nucl Cardiol 2023; 30:626-652. [PMID: 35864433 DOI: 10.1007/s12350-022-02985-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.
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Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA.
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA
| | - Esma A Akin
- George Washington University Hospital, Washington, DC, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Européen Georges-Pompidou, DMU IMAGINA, Assistance Publique -Hôpitaux de Paris, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hein Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA.
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Schenone AL, Hutt E, Cremer P, Jaber WA. Utility of nuclear cardiovascular imaging in the cardiac intensive care unit. J Nucl Cardiol 2023; 30:553-569. [PMID: 34109502 DOI: 10.1007/s12350-021-02665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The contemporary Cardiac Intensive Care Unit (CICU) has evolved into a complex unit that admits a heterogeneous mix of patients with a wide range of acute cardiovascular diseases often complicated by multi-organ failure. Although electrocardiography (ECG) and echocardiography are well-established as first-line diagnostic modalities for assessing patients in the CICU, nuclear cardiology imaging has emerged as a useful adjunctive diagnostic modality. The versatility, safety and accuracy of nuclear imaging (e.g., perfusion, metabolism, inflammation) for the assessment of patient with coronary artery disease, ventricular arrhythmias, infiltrative cardiomyopathies, infective endocarditis and inflammatory aortopathies has been proven useful and now often incorporated into the best practices for the management of critically ill cardiac patients. Thus, clinicians must familiarize themselves with the value and current and future applications of nuclear imaging in the management of the cardiac patient in the CICU.
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Affiliation(s)
- Aldo L Schenone
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Erika Hutt
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Paul Cremer
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Wael A Jaber
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA.
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Liga R, Colli A, Taggart DP, Boden WE, De Caterina R. Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How. J Am Heart Assoc 2023; 12:e026943. [PMID: 36892041 PMCID: PMC10111551 DOI: 10.1161/jaha.122.026943] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 03/10/2023]
Abstract
Background Myocardial revascularization has been advocated to improve myocardial function and prognosis in ischemic cardiomyopathy (ICM). We discuss the evidence for revascularization in patients with ICM and the role of ischemia and viability detection in guiding treatment. Methods and Results We searched for randomized controlled trials evaluating the prognostic impact of revascularization in ICM and the value of viability imaging for patient management. Out of 1397 publications, 4 randomized controlled trials were included, enrolling 2480 patients. Three trials (HEART [Heart Failure Revascularisation Trial], STICH [Surgical Treatment for Ischemic Heart Failure], and REVIVED [REVascularization for Ischemic VEntricular Dysfunction]-BCIS2) randomized patients to revascularization or optimal medical therapy. HEART was stopped prematurely without showing any significant difference between treatment strategies. STICH showed a 16% lower mortality with bypass surgery compared with optimal medical therapy at a median follow-up of 9.8 years. However, neither the presence/extent of left ventricle viability nor ischemia interacted with treatment outcomes. REVIVED-BCIS2 showed no difference in the primary end point between percutaneous revascularization or optimal medical therapy. PARR-2 (Positron Emission Tomography and Recovery Following Revascularization) randomized patients to imaging-guided revascularization versus standard care, with neutral results overall. Information regarding the consistency of patient management with viability testing results was available in ≈65% of patients (n=1623). No difference in survival was revealed according to adherence or no adherence to viability imaging. Conclusions In ICM, the largest randomized controlled trial, STICH, suggests that surgical revascularization improves patients' prognosis at long-term follow-up, whereas evidence supports no benefit of percutaneous coronary intervention. Data from randomized controlled trials do not support myocardial ischemia or viability testing for treatment guidance. We propose an algorithm for the workup of patients with ICM considering clinical presentation, imaging results, and surgical risk.
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Affiliation(s)
- Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - Andrea Colli
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - David P. Taggart
- Nuffield Department of Surgical SciencesOxford University John Radcliffe HospitalOxfordUnited Kingdom
| | - William E. Boden
- VA Boston Healthcare SystemBoston University School of MedicineBostonMA
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
- Fondazione VillaSerena per la Ricerca, Città Sant'AngeloItaly
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