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Kedhi E, Hermanides RS, Dambrink JHE, Singh SK, Ten Berg JM, van Ginkel D, Hudec M, Amoroso G, Amat-Santos IJ, Andreas M, Campante Teles R, Bonnet G, Van Belle E, Conradi L, van Garsse L, Wojakowski W, Voudris V, Sacha J, Cervinka P, Lipsic E, Somi S, Nombela-Franco L, Postma S, Piayda K, De Luca G, Kolkman E, Malinowski KP, Modine T. TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial. Lancet 2025; 404:2593-2602. [PMID: 39644913 DOI: 10.1016/s0140-6736(24)02100-7] [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: 06/24/2024] [Revised: 08/21/2024] [Accepted: 09/19/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING Isala Heart Centre and Medtronic.
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Affiliation(s)
- Elvin Kedhi
- Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada; Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland.
| | | | | | - Sandeep K Singh
- Department of Thoracic Surgery, Isala Heart Center, Zwolle, Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - DirkJan van Ginkel
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Martin Hudec
- Stredoslovenský Ústav Srdcových a Cievnych Chorôb, Banská, Bystrica, Slovakia
| | - Giovanni Amoroso
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Madrid, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Carnaxide, Portugal; Comprehensive Health Research Center, Nova Medical School, Lisbon, Portugal
| | - Guillaume Bonnet
- Hôpital haut Lévêque, Unite Médico Chirurgicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Eric Van Belle
- Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases and Institut Coeur Poumon, Centre Hospitalier Universitaire Lille, Lille, France; INSERM U1011, Lille, France; Université de Lille, Lille, France
| | - Lenard Conradi
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany
| | - Leen van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland
| | - Vassilis Voudris
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland; Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Pavel Cervinka
- 1st Department Medicine-Cardioangiology, Charles University Prague, Medical Faculty and University Hospital Hradec Kralove, Prague, Czech Republic; University of Jan Evangelista Purkyne, Usti nad Labem, Czech Republic
| | - Erik Lipsic
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Samer Somi
- Department of Cardiology, Haga Hospital, The Hague, Netherlands
| | | | | | - Kerstin Piayda
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, Giessen, Germany
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera Universitaria Policlinico Gaetano Martino, University of Messina, Messina, Italy; Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, Milan, Italy
| | | | - Krzysztof P Malinowski
- Center for Digital Medicine and Robotics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Thomas Modine
- Hôpital haut Lévêque, Unite Médico Chirurgicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Warisawa T. From gatekeeper to game-changer? Rethinking FFR CT in revascularization strategy. Int J Cardiol 2025; 434:133370. [PMID: 40368304 DOI: 10.1016/j.ijcard.2025.133370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2025] [Accepted: 05/09/2025] [Indexed: 05/16/2025]
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Osude N, Spall HV, Bosworth H, Krychtiuk K, Spertus J, Fatoba S, Fleisher L, Fry E, Green J, Greene S, Ho M, Jackman J, Leopold J, Magwire M, McGuire D, Mensah G, Tuttle KR, Willey V, Pagidipati N, Granger C. Advancement of the implementation of evidence-based therapies for cardiovascular-kidney-metabolic conditions: A multi-stakeholder perspective. Am Heart J 2025; 286:18-34. [PMID: 40107643 DOI: 10.1016/j.ahj.2025.03.005] [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: 03/06/2025] [Accepted: 03/07/2025] [Indexed: 03/22/2025]
Abstract
Cardiovascular disease remains the leading cause of mortality and healthcare expenditures in the United States. It is also a major contributor to premature mortality, years lived with disability, and rising healthcare costs around the world. Despite the availability of proven therapies and interventions that could vastly decrease the burden of cardiovascular disease and cardiometabolic conditions, their implementation is poor, with generally less than half of patients being treated with the most effective therapies. Implementation science offers promise in bridging this gap and mitigating disparities. However, even though small studies have shown that there are effective methods to improve the implementation of evidence-based therapies, these methods have not been scaled to make an impact at the level of health systems or nationally. A coordinated, multi-stakeholder approach is essential to identify barriers to implementation on a broad scale and, more critically, to develop and deploy practical solutions. The Duke Clinical Research Institute conducted an Implementation Summit entitled "Scalability, Spread, and Sustainability" to explore strategies for advancing the uptake of evidence-based interventions for cardiometabolic diseases in healthcare in the United States. This manuscript presents the participants' multi-stakeholder perspective on the steps necessary to improve the implementation of evidence-based therapies in cardiometabolic disease. Key recommendations include focused efforts on evidence generation around broad implementation strategies, dissemination of the evidence generated, uptake of evidence into usual care settings, and investment in training the current and next generations of leaders in implementation.
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Affiliation(s)
- Nkiru Osude
- Duke Clinical Research Institute, Durham, NC.
| | | | - Hayden Bosworth
- Department of Population Health Sciences, Duke University, Durham, NC
| | | | - John Spertus
- University of Missouri-Kansas City School of Medicine, Kansas, MO
| | | | - Lee Fleisher
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Jennifer Green
- Department of Medicine, Duke University, Davison Building, Durham, NC
| | - Stephen Greene
- Department of Medicine, Duke University, Davison Building, Durham, NC
| | - Michael Ho
- University of Colorado School of Medicine, Aurora, CO
| | | | | | | | - Darren McGuire
- University of Texas Southwestern Medical Center, Dallas, TX
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Székely AE, Akil Engblom S, Hedeer F, Kellman P, Carlsson M, Erlinge D, Mohammad MA, Arheden H, Engblom H. Invasive Coronary Angiography has Limited Diagnostic Accuracy for Detecting Reduction of Myocardial Perfusion Assessed by Cardiac Magnetic Resonance. Am J Cardiol 2025; 247:68-75. [PMID: 40164322 DOI: 10.1016/j.amjcard.2025.03.027] [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: 12/20/2024] [Revised: 03/20/2025] [Accepted: 03/24/2025] [Indexed: 04/02/2025]
Abstract
The relationship between degree of coronary artery stenosis and its effect on myocardial perfusion is complex and constitutes a clinical challenge. The aim of this study was to assess diagnostic accuracy of visual assessment of invasive coronary angiography (ICA) for detecting reduced myocardial perfusion determined by quantitative first-pass perfusion (qFPP) cardiac magnetic resonance (CMR) in patients with suspected or established chronic coronary syndrome (CCS). Forty-nine patients with suspected or established CCS were included from the elective ICA list in this prospective, observational study and underwent qFPP CMR prior to ICA. Myocardial perfusion at stress and myocardial perfusion reserve (MPR) were assessed for each vessel territory. Myocardial perfusion at stress <2.0 ml/min/g and MPR <2.4 were considered abnormal. Visually assessed coronary artery stenoses from ICA were considered significant if ≥70%. Sensitivity and specificity of visual assessment of ICA for detecting significant reduction of myocardial perfusion ranged between 32%-41% and 70%-76% on a per vessel level depending on myocardial perfusion measure used as reference. Accuracy ranged between 0.48-0.64. In 59%-68% of vessel territories with reduced stress perfusion or MPR, no significant stenosis was found. Thus, visual assessment of ICA has limited diagnostic accuracy for detecting significant reduction of myocardial perfusion assessed by qFPP CMR in patients with suspected or established CCS. Hence, quantitative myocardial perfusion is required when evaluating the cause of angina to distinguish between coronary stenosis, microvascular dysfunction and non-cardiac causes of chest pain.
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Affiliation(s)
- Anna E Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahnaz Akil Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Moman A Mohammad
- Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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McHugh S, Allaham H, Chahal D, Gupta A. Coronary Artery Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2025; 14:311-316. [PMID: 40414657 DOI: 10.1016/j.iccl.2024.09.009] [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: 05/27/2025]
Abstract
Patients with concomitant severe aortic stenosis and significant coronary artery disease present a diagnostic and therapeutic challenge in clinical practice. There are no clear-cut guidelines as to the timing of revascularization in these patients who are referred for transcatheter aortic valve replacement (TAVR). This article aims to show that in patients without high-grade proximal coronary artery disease, revascularization after TAVR is safe, feasible, and practical. Additionally, the use of preoperative TAVR computed tomographic angiography might be used in both intermediate and high-risk patients rather than invasive coronary angiography to assess for significant proximal coronary artery disease to help guide the timing of revascularization.
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Affiliation(s)
| | | | - Diljon Chahal
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Lee JM, Lee SH, Kwon W, Kim HB, Hong D, Kim HK, Cho SG, Shin D, Park KS, Kim J, Moon JB, Song HC, Lee S, Ha DH, Jang J, Ahn Y, Jeong MH, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Hong YJ. Experimental validation of coronary stenosis severity and development of ischemic myocardium. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:521-532. [PMID: 39490529 DOI: 10.1016/j.rec.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 10/14/2024] [Indexed: 11/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES The current study aimed to evaluate the causal association between hemodynamically significant stenosis and the occurrence of ischemic myocardium using an experimental animal model of coronary artery stenosis. METHODS In Yorkshire swine (n=10), coronary stenosis in the left anterior descending artery was induced using a customized vascular occluder to create varying degrees of occlusion severity (40%-99%). Serial changes in coronary pressure and flow velocity were measured in the left anterior descending artery before and after the implantation of the vascular occluder. At 1 month, 13N-ammonia positron emission tomography (PET) was performed, followed by the collection of isolated hearts for 2,3,5-Triphenyltetrazolium chloride (TTC) staining to quantify the percent area of necrotic myocardium. Three animals in the control group were evaluated using the same protocols, but without the implantation of a vascular occluder. RESULTS The median diameter stenosis after vascular occluder implantation was 61.3% (Q1-Q3: 55.9%-72.3%). Significant differences were observed in hyperemic stenosis resistance, fractional flow reserve (FFR), stress perfusion defect and reversibility in PET, as well as in necrotic myocardium in TTC staining based on stenosis severity (control group: <50%, 50%-70%, 70%-90%, and >90%) (all P<.010). Animals with FFR <0.75 at 1 month exhibited a significantly higher area of stress perfusion defect (30.7±3.1% vs 6.0±4.2%, P<.001), reversibility in PET (11.0±4.0% vs 0.0±0.0%, P=.006), and necrotic myocardium in TTC staining (15.8±6.4% vs 0.0±0.0%, P<.001) than those with FFR ≥ 0.75. CONCLUSIONS In a porcine model, the induction of hemodynamically significant stenosis with FFR <0.75 was associated with the development of stress perfusion defects and reversibility in PET, as well as necrotic myocardium identified by pathology.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Woochan Kwon
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Byul Kim
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Doosup Shin
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, United States
| | - Ki Seong Park
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | | | | | - Jinah Jang
- Department of Creative IT Engineering, Department of Mechanical Engineering, School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Joon Hong
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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Bjerking LH, Schmidt SE, Skak-Hansen KW, Winther S, Böttcher M, Galatius S, Prescott E. Pre-test probability estimation of coronary artery disease can be improved by adding an acoustic-based risk score. IJC HEART & VASCULATURE 2025; 58:101672. [PMID: 40235941 PMCID: PMC11999282 DOI: 10.1016/j.ijcha.2025.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 03/16/2025] [Accepted: 03/26/2025] [Indexed: 04/17/2025]
Abstract
Background The American Heart Association/American College of Cardiology (AHA/ACC) 2021 Chest Pain Guidelines introduced a new pre-test probability (PTP) model for obstructive coronary artery disease (CAD). The model recommends a 15 % risk cut-off for referral for further testing. Whether addition of a risk score measured from acoustic detection of coronary turbulence obtained by the noninvasive device CADScor®System (CAD-score) improves the AHA/ACC-PTP capability to assign the correct risk category has not been tested. Methods Patients with symptoms suggestive of CAD referred for coronary CT angiography and undergoing a same-day CAD-score were included. PTP was calculated based on sex, age, and symptoms. All patients with suspected stenosis on CT angiography were referred for invasive angiography. A CAD-score ≤ 20 was used as cut-off for low likelihood of CAD. Results The study population consisted of 2874 patients (47 % women, median age [IQR] 58 [52-65] years). PTP categorized 2044 (71 %) of patients as > 15 % amongst whom 387 (18.9 %) were re-classified to low likelihood by a CAD-score ≤ 20. In patients aged < 70 without hypertension, 37 % were re-classified to low probability. Of the 830 patients with low PTP ≤ 15 %, 68.7 % had a CAD-score ≤ 20 indicating a deferred testing strategy. Conclusion Adding an acoustic-based CAD-score to the PTP in patients with AHA/ACC defined-PTP > 15 % risk can reduce the number of diagnostic tests by overall 19 %, and 37 % in subgroups, and may support cost-effective clinical decision-making. Moreover, CAD-score may aid risk stratification in patients, particularly with AHA/ACC-PTP ≤ 15 %.
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Affiliation(s)
- Louise H Bjerking
- Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Samuel E Schmidt
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Denmark
| | - Kim W Skak-Hansen
- Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Morten Böttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
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Mosseri M, Glazer J, Briskin EM, Leshno M. Cost-effectiveness of stress echocardiography and exercise tolerance tests as screening in asymptomatic adults before starting physical activity. Comput Biol Med 2025; 191:110175. [PMID: 40233678 DOI: 10.1016/j.compbiomed.2025.110175] [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: 12/15/2024] [Revised: 04/05/2025] [Accepted: 04/07/2025] [Indexed: 04/17/2025]
Abstract
AIMS Previous studies on exercise tolerance screening in asymptomatic individuals before starting physical activity were not cost-effective due to low specificity. However, given progress in diagnosing and treating coronary artery disease (CAD), a reevaluation of this approach is justified. We aimed to examine whether stress echocardiography (SE) would be cost-effective. METHODS AND RESULTS The study was conducted on asymptomatic individuals with no known coronary disease. The decision tree had two arms: in one arm, the subjects underwent stress echocardiography (SE) as a screening test before starting physical activity, and in the other, they did not. The probabilities and utilities of variables in the decision tree were taken from medical literature, and the costs of treatments were obtained from the Israeli Ministry of Health Tarif (HealthCare in Israel is universal, participation in one of four official health insurance organizations is compulsory, and "supplementary insurance" is optional). A 5-year Markov model and Monte Carlo simulation with 1000 iterations were used to assess cost-effectiveness from the insurer's perspective. The variables that had the most significant impact on cost-effectiveness were the prior risk of coronary disease and the frequency of physical activity in the population under study. When cost-effectiveness assessment of SE was conducted in subjects receiving optimal medical therapy (OMT) and revascularization either transcutaneously or with bypass surgery, both groups had almost identical benefits, with a slight advantage for those who did not undergo SE. However, the cost was higher for subjects who underwent SE, and the Incremental Cost-Effectiveness Ratio (ICER) favored the No-SE group. On the other hand, when subjects only received OMT without therapeutic catheterization or bypass surgery, a cost-effectiveness assessment of SE demonstrated a lower cost and higher benefit in the group that underwent SE. In fact, SE was found to be absolutely dominant, with a negative ICER of $(-)27,644, which means that performing SE not only adds effectiveness but also saves expenses. Finally, a cost-effectiveness evaluation was conducted to compare the benefits of performing exercise tolerance testing (ETT) without stress echocardiography in subjects receiving OMT without therapeutic catheterization or bypass surgery. The results showed that the group that underwent ETT had a slightly higher benefit at a higher cost, with an ICER of $1804. This value is much lower than a WTP (willingness-to-pay) of $50,000 per year. CONCLUSIONS Performing SE as a screening test before starting physical activity in asymptomatic individuals is not cost-effective when the therapeutic options include revascularization. However, when the therapeutic policy is medical therapy without revascularization - as recommended in current guidelines - performing SE screening tests improves subjects' utility and results in financial savings. Carrying out ETT also results in improved utility that is inferior to SE as a screening test. At the same time, the ICER for ETT is still much smaller than the WTP, so performing ETT is worthwhile in cases where SE is unavailable.
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Affiliation(s)
| | - Jacob Glazer
- Tel-Aviv University, Faculty of Management, Israel; University of Warwick, Department of Economics, UK
| | | | - Moshe Leshno
- Tel-Aviv University, Faculty of Medicine, Israel; Tel-Aviv University, Faculty of Management, Israel
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Supples MW, Miller CD. Revisiting the Role of Noninvasive Testing Among Emergency Department Patients Suspected of Acute Coronary Syndrome. Ann Emerg Med 2025:S0196-0644(25)00223-9. [PMID: 40448984 DOI: 10.1016/j.annemergmed.2025.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2025] [Revised: 04/21/2025] [Accepted: 04/22/2025] [Indexed: 06/02/2025]
Affiliation(s)
- Michael W Supples
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Chadwick D Miller
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Ueyama C, Horibe H, Maekawa Y, Hiramatsu S, Yamase Y, Funabiki J, Takemoto Y, Shigeta T, Hibino T, Kondo T, Yatsuya H, Ishii H, Murohara T. Relationship between abdominal visceral adipose tissue and cardiovascular events in patients with acute coronary syndrome. Heart Vessels 2025:10.1007/s00380-025-02557-z. [PMID: 40418252 DOI: 10.1007/s00380-025-02557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 05/07/2025] [Indexed: 05/27/2025]
Abstract
Abdominal visceral adipose tissue (AVAT) is associated with the incidence of cardiovascular events (CVEs). We retrospectively evaluated the association between AVAT and the incidence of CVEs in 602 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Patients were divided into four groups according to the quartiles of AVAT areas using computed tomography. The incidence of CVEs (cardiovascular death, ACS recurrence and stroke) during the follow-up period (median 49.5 months) was evaluated. Cox analysis adjusting for cardiovascular risk factors revealed that the AVAT quartile classification exhibited a significant association with the incidence of CVEs. The risk in quartile 3 (moderate AVAT areas, ≥ 106.0 to < 142.6 cm2) was significantly lower than in quartiles 1 (low AVAT areas, < 71.0cm2; P < 0.01; hazard ratio [HR], 5.06), 2 (mild AVAT areas, ≥ 71.0 to < 106.0 cm2; P < 0.01; HR, 4.25) and 4 (severe AVAT areas, ≥ 142.6 cm2; P < 0.01; HR, 4.52). Polynomial analyses revealed that quadratic model was the most appropriate to illustrate the relationship between AVAT area and the hazard ratios for CVEs (corrected Akaike's information criterion, 49.2; R2, 0.47). The AVAT area and the incidence of CVEs exhibited a U-shaped relationship in patients with ACS undergoing PCI independent of conventional cardiovascular risk factors. The risk of CVEs was the lowest in patients with moderate AVAT areas. Evaluating AVAT may provide additional information for the assessment of long-term prognosis in patients with ACS.
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Affiliation(s)
- Chikara Ueyama
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Hideki Horibe
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan.
| | - Yasutaka Maekawa
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Shotaro Hiramatsu
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Yuichiro Yamase
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Junya Funabiki
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Yoshio Takemoto
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Toshimasa Shigeta
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Takeshi Hibino
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Taizo Kondo
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-Cho, Tajimi, 507-8522, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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11
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Cheng K, de Silva R. Managing angina across the spectrum of non-acute myocardial ischaemic syndromes. Trends Cardiovasc Med 2025:S1050-1738(25)00068-4. [PMID: 40419005 DOI: 10.1016/j.tcm.2025.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2025] [Revised: 05/22/2025] [Accepted: 05/22/2025] [Indexed: 05/28/2025]
Affiliation(s)
- Kevin Cheng
- National Heart and Lung Institute, Imperial College London, London, UK; Specialist Angina Service, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London, London, UK; Specialist Angina Service, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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12
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White HD, O'Brien SM, Boden WE, Fremes SE, Bangalore S, Reynolds HR, Stone GW, Ali ZA, Parakh N, Lopez-Sendon JL, Wang Y, Chen YQ, Mark DB, Chaitman BR, Spertus JA, Maron DJ, Hochman JS. Use of Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention and Associated Outcomes in the ISCHEMIA Trial. Am Heart J 2025:S0002-8703(25)00165-6. [PMID: 40404111 DOI: 10.1016/j.ahj.2025.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2025] [Accepted: 05/15/2025] [Indexed: 05/24/2025]
Abstract
BACKGROUND In the ISCHEMIA Trial, 5179 patients with stable coronary disease were randomized to initial invasive or conservative management. METHODS PCI was recommended with a SYNTAX score 0-22 (low) and CABG with a SYNTAX score ≥33 (high). Either could be recommended for intermediate scores. The composite primary outcome was cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. There were two cohorts in this analysis. The descriptive cohort included patients who underwent CABG or PCI within 180 days of randomization and had no primary outcome before revascularization. The comparative cohort excluded participants with prior CABG, single vessel disease, SYNTAX score ≥ 45, and without core laboratory assessment. We focused on the intermediate (23-32) SYNTAX comparative group for which either CABG or PCI could be recommended. RESULTS For 1935 patients in the descriptive cohort (485 CABG, 1450 PCI), the SYNTAX score was 27.3 ± 11.0 in the CABG group and 15.3 ± 8.6 in the PCI group, p<0.0001. Most patients with low SYNTAX scores underwent PCI (87.1%), while most with high SYNTAX scores underwent CABG (72.6%). For the 1203 patients (385 CABG, 818 PCI) in the entire comparative cohort, the adjusted 4-year primary event rate was 14.5% for CABG and 13.2% for PCI (difference 1.3%, 95% CI, -4.9% to 7.7%). For the 346 patients (163 CABG, 183 PCI) in the intermediate SYNTAX group, the adjusted 4-year primary event rate was 10.6% for CABG and 18.3% for PCI (difference -7.6%, 95% CI, -16.1% to 0.9%). CONCLUSIONS Selection of revascularization method resulted in more PCI in the low SYNTAX group and more CABG in the high SYNTAX group. There was no statistical evidence of a difference between PCI and CABG in the intermediate SYNTAX group but the CIs are broad, reflecting uncertainty. CLINICAL TRIALS GOV IDENTIFIER NCT01471522; https://clinicaltrials.gov/ct2/show/NCT01471522.
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Affiliation(s)
- Harvey D White
- Health New Zealand - Whatu Ora -, Te Toka Tumai, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland 1142, New Zealand.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA.
| | - Stephen E Fremes
- University of Toronto, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON Canada.
| | - Sripal Bangalore
- NYU Grossman School of Medicine, NYU Langone Health, Department of Medicine, New York, NY, USA.
| | - Harmony R Reynolds
- NYU Grossman School of Medicine, NYU Langone Health, Department of Medicine, New York, NY, USA.
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA; St Francis Hospital, Roslyn, NY, USA.
| | - Neeraj Parakh
- All India Institute of Medical Sciences, New Delhi, India.
| | | | - Yixin Wang
- Stanford Prevention Research Center, Stanford, CA.
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Duke University, Durham, NC, USA.
| | - Bernard R Chaitman
- Saint Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St. Louis, MO.
| | - John A Spertus
- University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint; Luke's Mid America Heart Institute, Kansas City, MO, USA.
| | - David J Maron
- Stanford Prevention Research Center, Stanford, CA; Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Judith S Hochman
- NYU Grossman School of Medicine, NYU Langone Health, Department of Medicine, New York, NY, USA.
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13
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Gitto M, Baber U, Sartori S, Vogel B, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Oliva A, Escaned J, Feng Y, Gibson CM, Han YL, Di Muro FM, Shlofmitz RA, Huber K, Steg PG, Sharma S, Sardella G, Kastrati A, Kaul U, Kornowski R, Kunadian V, Stefanini GG, Mehta SR, Dangas G, Mehran R. Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: a post hoc analysis of the TWILIGHT trial. EUROINTERVENTION 2025; 21:550-559. [PMID: 40375766 PMCID: PMC12063552 DOI: 10.4244/eij-d-24-00973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/04/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND Short dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy may be a valuable therapeutic option for patients with chronic coronary syndrome (CCS) and high ischaemic risk (HIR) undergoing percutaneous coronary intervention (PCI). AIMS We aimed to compare ticagrelor monotherapy with ticagrelor-based DAPT in CCS patients with and without HIR undergoing PCI. METHODS The present analysis included the CCS cohort of the TWILIGHT trial, which randomised PCI patients to ticagrelor alone or in combination with aspirin for 12 months after 3 months of ticagrelor-based DAPT. Patients were stratified into HIR and non-HIR based on the 2019 European Society of Cardiology (ESC) CCS guidelines definition. Outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction or stroke, and Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding at 1 year. RESULTS Of the 2,503 CCS patients who underwent randomisation, the ESC definition classified 1,264 (50.5%) as HIR and 1,239 (49.5%) as non-HIR. HIR patients displayed a higher risk of MACCE (3.9% vs 2.3%; p=0.015) and similar rates of BARC Type 2-5 bleeding (5.1% vs 5.7%; p=0.455) as compared to non-HIR patients. Ticagrelor monotherapy and ticagrelor-based DAPT were associated with similar risks of MACCE (HIR: 4.0% vs 3.8%, hazard ratio [HR] 1.06, 95% confidence interval [CI]: 0.60-1.85; non-HIR: 2.1% vs 2.6%, HR 0.80, 95% CI: 0.38-1.66, pinteraction=0.553) and bleeding (HIR: 4.7% vs 5.7%, HR 0.82, 95% CI: 0.50-1.33; non-HIR: 4.9% vs 6.7%, HR 0.71, 95% CI: 0.44-1.14; pinteraction=0.684) in both the HIR and non-HIR groups. CONCLUSIONS In a post hoc analysis of the TWILIGHT trial that included CCS patients undergoing PCI, ticagrelor monotherapy after 3 months of DAPT appeared to be safe and was not associated with increased risks of ischaemic or bleeding events, regardless of baseline HIR status, compared with standard ticagrelor-based DAPT. These findings suggest the potential to expand guideline recommendations for ticagrelor monotherapy in CCS.
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Affiliation(s)
- Mauro Gitto
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samantha Sartori
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Vogel
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Carlo Briguori
- Unit of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Angelo Oliva
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Yihan Feng
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ya-Ling Han
- General Hospital of Northern Theater Command, Shenyang, China
| | - Francesca Maria Di Muro
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kurt Huber
- Third Department Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Philippe Gabriel Steg
- Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, INSERM_U1148, Paris, France
| | - Samin Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - George Dangas
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Patel L, Segar MW, Usman MS, Dhruve R, Keshvani N, Postalian A, Mentias A, Rubin CD, Patel KV, Kumbhani DJ, Banerjee S, Pandey A. Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials. J Am Geriatr Soc 2025. [PMID: 40365856 DOI: 10.1111/jgs.19508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 04/03/2025] [Accepted: 04/10/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND Frailty is common among patients with chronic coronary disease and is associated with worse outcomes. METHODS A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]). RESULTS Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (Pinteractionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (Pinteractionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups. CONCLUSION Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.
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Affiliation(s)
- Lajjaben Patel
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew W Segar
- Division of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Muhammad S Usman
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ritika Dhruve
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Amgad Mentias
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Craig D Rubin
- Division of Geriatric Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
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15
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Ahmed-Jushuf F, Foley MJ, Rajkumar CA, Chotai S, Simader FA, Wang D, Macierzanka K, Sehmi J, Kanaganayagam G, Lloyd G, Keenan N, Bual N, Davies JR, Keeble TR, O'Kane PD, Haworth P, Routledge H, Kotecha T, Williams R, Din J, Nijjer SS, Curzen N, Sinha M, Ruparelia N, Gamma R, Spratt JC, Cole GD, Harrell FE, Howard JP, Francis DP, Shun-Shin MJ, Al-Lamee RK. Ischemia on Dobutamine Stress Echocardiography Predicts Efficacy of PCI: Results From the ORBITA-2 Trial. J Am Coll Cardiol 2025; 85:1740-1753. [PMID: 40335250 DOI: 10.1016/j.jacc.2025.02.034] [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: 01/12/2025] [Revised: 02/25/2025] [Accepted: 02/27/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND ORBITA-2 (The Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) found that percutaneous coronary intervention (PCI) relieved angina in patients with single-vessel and multivessel stable coronary artery disease (CAD) on little or no antianginal medication. Whereas symptom characteristics and invasive physiological assessments can predict PCI efficacy, the role of noninvasive imaging with dobutamine stress echocardiography (DSE) remains unclear. OBJECTIVES This DSE-stratified secondary analysis of ORBITA-2 investigates the relationship between ischemia, assessed by DSE, and the placebo-controlled efficacy of PCI. METHODS Participants with angina, single-vessel or multivessel CAD, and ischemia were enrolled. Following discontinuation of antianginal medications, patients were evaluated prerandomization using the ORBITA-app, questionnaires, DSE, and exercise treadmill testing. Stress echocardiography scores were calculated for each left ventricular segment at peak stress, with normal, hypokinetic, akinetic, dyskinetic, and aneurysmal segments scoring 0 to 4, respectively. Bayesian proportional odds modeling was used. RESULTS Prerandomization DSE data were available for 262 patients. The median age was 65.5 years (Q1-Q3: 59-71 years), and 208 (79.4%) were male. At baseline, the median stress echocardiography score was 1.42 in the PCI group (n = 133) and 1.00 in the placebo group (n = 129), with an overall median score of 1.25 (Q1-Q3: 0.33-2.92). Higher stress echocardiography scores were strongly associated with greater placebo-controlled improvements in angina symptom score following PCI (OR: 1.23; 95% credible interval [CrI]: 1.13-1.35; Pr(interaction) > 99.9%). Higher scores also predicted significant reduction in daily angina episodes (OR: 1.36; 95% CrI: 1.24-1.49; Pr(interaction) > 99.9%), as well as improvement in the Seattle Angina Questionnaire angina frequency score (8.22; 95% CrI: 0.96-15.50; Pr(interaction) = 98.7%), and Seattle Angina Questionnaire quality of life score (8.95; 95% CrI: 2.05-16.00; Pr(interaction) = 99.3%). The relationship between stress echocardiography score and reduction in daily angina episodes remained consistent, irrespective of symptom characteristics. CONCLUSIONS In patients with single- and multivessel stable CAD on little or no antianginal medication, the placebo-controlled efficacy of PCI was predicted by the degree of ischemia detected on DSE. The greater the burden of baseline ischemia, the greater the improvement in symptoms and quality of life with PCI.
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Affiliation(s)
- Fiyyaz Ahmed-Jushuf
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael J Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Shayna Chotai
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Florentina A Simader
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Danqi Wang
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Joban Sehmi
- West Herts Teaching Hospitals NHS Trust, Hertfordshire, United Kingdom
| | | | - Guy Lloyd
- St Bartholomew's Hospital, London, United Kingdom; William Harvey Institute, Queen Mary University of London, London, United Kingdom; Institute for Cardiovascular Health, University College London, London, United Kingdom
| | - Niall Keenan
- West Herts Teaching Hospitals NHS Trust, Hertfordshire, United Kingdom; Institute of Clinical Sciences, Imperial College London, London, United Kingdom
| | - Nina Bual
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - John R Davies
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Anglia Ruskin School of Medicine & MTRC, Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Anglia Ruskin School of Medicine & MTRC, Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Peter D O'Kane
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Peter Haworth
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Helen Routledge
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Tushar Kotecha
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Rupert Williams
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jehangir Din
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Sukhjinder S Nijjer
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nick Curzen
- University of Southampton School of Medicine & University Hospital Southampton NHS foundation Trust, Southampton, United Kingdom
| | - Manas Sinha
- Salisbury Hospital NHS Foundation Trust, Salisbury, United Kingdom
| | - Neil Ruparelia
- Royal Berkshire NHS Foundation Trust, Berkshire, United Kingdom
| | - Reto Gamma
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom
| | - James C Spratt
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Frank E Harrell
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
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16
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Mark DB, Nanna MG, Douglas PS. Connecting Anatomic Coronary Disease and Functional Ischemia With Treatment of Patient-Reported Angina: A Jigsaw Puzzle of Surprising Complexity. J Am Coll Cardiol 2025; 85:1754-1756. [PMID: 40335251 DOI: 10.1016/j.jacc.2025.03.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Accepted: 03/13/2025] [Indexed: 05/09/2025]
Affiliation(s)
- Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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17
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Rodriguez C, Pappas L, Le Hong Q, Baquero L, Nagel E. Cardiac imaging for the detection of ischemia: current status and future perspectives. Expert Rev Med Devices 2025:1-14. [PMID: 40317465 DOI: 10.1080/17434440.2025.2500631] [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: 09/23/2024] [Revised: 03/04/2025] [Accepted: 04/07/2025] [Indexed: 05/07/2025]
Abstract
INTRODUCTION Coronary artery disease is the main cause of mortality worldwide mandating early detection, appropriate treatment, and follow-up. Noninvasive cardiac imaging techniques allow detection of obstructive coronary heart disease by direct visualization of the arteries or myocardial blood flow reduction. These techniques have made remarkable progress since their introduction, achieving high diagnostic precision. This review aims at evaluating these noninvasive cardiac imaging techniques, rendering a thorough overview of diagnostic decision-making for detection of ischemia. AREAS COVERED We discuss the latest advances in the field such as computed tomography angiography, single-photon emission tomography, positron emission tomography, and cardiac magnetic resonance; their main advantages and disadvantages, their most appropriate use and prospects. For the review, we analyzed the literature from 2009 to 2024 on noninvasive cardiac imaging in the diagnosis of coronary artery disease. The review included the 78 publications considered most relevant, including landmark trials, review articles and guidelines. EXPERT OPINION The progress in cardiac imaging is anticipated to overcome various limitations such as high costs, radiation exposure, artifacts, and differences in interpretation among observers. It is expected to lead to more automated scanning processes, and with the assistance of artificial intelligence-driven post-processing software, higher accuracy and reproducibility may be attained.
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Affiliation(s)
- Carlos Rodriguez
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Laura Pappas
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Quang Le Hong
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Laura Baquero
- Department of Cardiology, Hospital San Juan de Dios, Universidad de Costa Rica, San Jose, Costa Rica
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
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Du T, Ma Y, Huang Z, Zhao X, Zhang Q, Ren N. Unlocking the potential of embryos: insight of systematic review and meta-analysis into laser-assisted hatching's role in conquering recurrent implantation failure. FRONTIERS IN REPRODUCTIVE HEALTH 2025; 7:1581529. [PMID: 40417057 PMCID: PMC12098289 DOI: 10.3389/frph.2025.1581529] [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: 02/22/2025] [Accepted: 04/21/2025] [Indexed: 05/27/2025] Open
Abstract
Introduction The journey of assisted reproductive technology (ART) for couples facing recurrent implantation failure (RIF) is fraught with emotional and physical challenges. RIF, often characterized by the failure of high-quality embryos to implant after multiple ART cycles, has directed attention towards interventions like laser-assisted hatching (LAH). However, discrepancies in the literature necessitate a comprehensive review of LAH's efficacy and safety. Materials and methods Following a thorough search of PubMed, Embase, Cochrane, and Web of Science databases up to November 2023, retrospective studies or RCT were considered for inclusion. Summary effect sizes [odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI)] were calculated for each outcome. Results and conclusion Eight studies comprising 2,634 patients were included. LAH significantly improved implantation rates (OR: 1.26, 95% CI: 1.05-1.51). Clinical pregnancy rates increased in patients who had fresh embryos transferred (OR: 1.29, 95% CI: 1.05-1.58). Notably, LAH was associated with higher miscarriage rates in frozen embryo transfers (OR: 1.45, 95% CI: 1.04-2.02). No significant increase in ectopic or multiple pregnancy rates was observed. For patients with RIF, especially older women, LAH presents a potential avenue to improve implantation. Its impact on clinical pregnancy rates is less substantial. However, its impact on final live birth rates and the increased miscarriage risk in frozen transfers necessitate a cautious and individualized approach. The technique's safety, while generally upheld, requires careful application and consideration of the specific challenges RIF patients face. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497329, PROSPERO (CRD42024497329).
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Affiliation(s)
| | | | | | | | - Qin Zhang
- Department of Medical TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Ning Ren
- Department of Medical TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Thompson PD. Does Coronary Calcium Mean the Same in Active and Sedentary Individuals? Circulation 2025; 151:1309-1311. [PMID: 40324033 DOI: 10.1161/circulationaha.125.074396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Affiliation(s)
- Paul D Thompson
- Division of Cardiology, Hartford Hospital, CT. Heart and Vascular Institute, Hartford Healthcare, CT
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Hijazi W, Feng Y, Southern DA, Chew D, Filipchuk N, Mylonas I, Kazmi M, Banijamali H, Har B, James M, Wilton S, Slomka PJ, Berman D, Miller RJ. Association of medical therapies with survival according to SPECT MPI findings. J Nucl Cardiol 2025:102229. [PMID: 40324562 DOI: 10.1016/j.nuclcard.2025.102229] [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: 11/25/2024] [Revised: 04/12/2025] [Accepted: 04/20/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) results in downstream changes to medication prescription. While the benefits of medical therapy for coronary artery disease (CAD) are established, how this varies with MPI findings is unknown. Our goal was to evaluate the association of medical therapy with survival among patients undergoing MPI, including differential associations as a function of imaging findings. METHODS Consecutive patients who underwent single-photon emission computed tomography MPI for suspected CAD between January 2015 and December 2021 were identified. Multivariable Cox regression modeling was used to assess the associations between medical therapy and all-cause mortality. RESULTS In total, 7802 patients were included with a mean age of 66.1 ± 12.0 years and 3841 (49.2 %) male patients. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE inhibitors/ARBs) were associated with lower mortality (adjusted hazard ratio [HR] .66, 95 % confidence interval [CI]: .57-.77, P < .001). Beta-blockers were not associated with mortality overall (adjusted HR .95, 95 % CI: .83-1.10, P = .506) but were associated with lower mortality among patients with more ischemia (HR .94 per summed difference score point, 95 % CI: .90-.97, P-value <.001). Statins were associated with greater survival in patients with coronary calcium (adjusted HR .67, 95 % CI .56-.81, P = <0.001) but not in patients without assessment of coronary calcium (adjusted HR: 1.16, 95 % CI: .91-1.49 P = .236). CONCLUSION ACE/ARB prescription was significantly associated with improved survival. Beta-blocker prescription was associated with greater survival in patients with ischemia and statins were in patients with coronary calcification. Findings from MPI may identify patients more likely to benefit from specific therapies, suggesting a role for hybrid MPI in guiding medical therapy for CAD.
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Affiliation(s)
- Waseem Hijazi
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Yuanchao Feng
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Danielle A Southern
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Chew
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada; Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil Filipchuk
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Ilias Mylonas
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Mustapha Kazmi
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Hamid Banijamali
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Bryan Har
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Matthew James
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Wilton
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Robert Jh Miller
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada.
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de Vasconcelos NNB, Queiroz VNF, de Souza GM, Mangini S, Silva FMF, da Costa LGV, Campos PPZDA, Steffen SP, Takaoka F, Serpa A, Pereira AJ, Barbas CSV, Corrêa TD, Chaves RCDF. Perioperative management of adult patients undergoing coronary artery bypass grafting and valve surgery: a literature review. EINSTEIN-SAO PAULO 2025; 23:eRW1353. [PMID: 40332183 PMCID: PMC12061441 DOI: 10.31744/einstein_journal/2025rw1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/29/2024] [Indexed: 05/08/2025] Open
Abstract
PURPOSE OF REVIEW Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery. RECENT FINDINGS Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.
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Affiliation(s)
| | - Veronica Neves Fialho Queiroz
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Takaoka AnestesiaSão PauloSPBrazilTakaoka Anestesia, São Paulo, SP, Brazil.
| | - Guilherme Martins de Souza
- Hospital Israelita Albert EinsteinSalvadorBABrazilHospital Ortopédico do Estado da Bahia;Hospital Israelita Albert Einstein, Salvador, BA, Brazil.
| | - Sandrigo Mangini
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Luiz Guilherme Villares da Costa
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Takaoka AnestesiaSão PauloSPBrazilTakaoka Anestesia, São Paulo, SP, Brazil.
| | | | - Samuel Padovani Steffen
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flávio Takaoka
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Takaoka AnestesiaSão PauloSPBrazilTakaoka Anestesia, São Paulo, SP, Brazil.
| | - Ary Serpa
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- University of MelbourneAustin HospitalMelbourneAustralia University of Melbourne,Austin Hospital, Melbourne, Australia.
| | - Adriano José Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Thiago Domingos Corrêa
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Renato Carneiro de Freitas Chaves
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Massachusetts Institute of TechnologyCambridgeMAUnited States Massachusetts Institute of Technology, Cambridge, MA, United States.
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22
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You Y, Tian Y, Guo R, Shi J, Kwak KJ, Tong Y, Estania AP, Hsu WH, Liu Y, Hu S, Cao J, Yang L, Bai R, Huang P, Lee LJ, Jiang W, Kim BYS, Ma S, Liu X, Shen Z, Lan F, Phuong Nguyen PK, Lee AS. Extracellular vesicle-mediated VEGF-A mRNA delivery rescues ischaemic injury with low immunogenicity. Eur Heart J 2025; 46:1662-1676. [PMID: 39831819 DOI: 10.1093/eurheartj/ehae883] [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: 04/23/2024] [Revised: 09/09/2024] [Accepted: 12/05/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND AND AIMS Lackluster results from recently completed gene therapy clinical trials of VEGF-A delivered by viral vectors have heightened the need to develop alternative delivery strategies. This study aims to demonstrate the pre-clinical efficacy and safety of extracellular vesicles (EVs) loaded with VEGF-A mRNA for the treatment of ischaemic vascular disease. METHODS After encapsulation of full-length VEGF-A mRNA into fibroblast-derived EVs via cellular nanoporation (CNP), collected VEGF-A EVs were delivered into mouse models of ischaemic injury. Target tissue delivery was verified by in situ analysis of protein and gene expression. Functional rescue was confirmed by in vivo imaging and histology. The safety of single and serial delivery was demonstrated using immune-based assays. RESULTS VEGF-A EVs were generated with high mRNA content using a CNP methodology. VEGF-A EV administration demonstrated expression of exogenous VEGF-A mRNA by in situ RNA hybridization and elevated protein expression by western blot, microscopy, and enzyme-linked immunosorbent assay. Mice treated with human VEGF-A EVs after femoral or coronary artery ligation exhibited heightened neovascularization in ischaemic tissues with increased arterial perfusion and improvement in left ventricular function, respectively. Serial delivery of VEGF-EVs in injured skin showed improved wound healing with repeat administration. Importantly, as compared with adeno-associated viral and lipid nanoparticle VEGF-A gene therapy modalities, murine VEGF-A EV delivery did not trigger innate or adaptive immune responses at the injection site or systemically. CONCLUSIONS This study demonstrated that VEGF-A EV therapy offers efficient, dose-dependent VEGF-A protein formation with low immunogenicity, resulting in new vessel formation in murine models of ischaemic vascular disease.
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Affiliation(s)
- Yi You
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Yu Tian
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Rui Guo
- Department of Cardiac Surgery, Peking University Third Hospital, 49 Huayuan N Rd, Haidian District, Beijing 100191, China
| | - Junfeng Shi
- Department of Chemical and Biomolecular Engineering, 151 W Woodruff Ave, Columbus, The Ohio State University, Columbus, OH 43210, USA
| | - Kwang Joo Kwak
- Department of Chemical and Biomolecular Engineering, 151 W Woodruff Ave, Columbus, The Ohio State University, Columbus, OH 43210, USA
| | - Yuhao Tong
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Andreanne Poppy Estania
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Wei-Hsiang Hsu
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Yutong Liu
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Shijun Hu
- Department of Cardiovascular Surgery for the First Affiliated Hospital & Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, 899 Pinghai Road, Suzhou, Jiangsu 215000, China
| | - Jianhong Cao
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Liqun Yang
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
| | - Rui Bai
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen Key Laboratory of Cardiovascular Disease, No. 12 Langshan Road, Nanshan District, Shenzhen 518057, China
| | - Pufeng Huang
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen Key Laboratory of Cardiovascular Disease, No. 12 Langshan Road, Nanshan District, Shenzhen 518057, China
| | - Ly James Lee
- Spot Biosystems Ltd, 432 High Street, Apartment 201, Palo Alto, CA 94301, USA
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, Houston, TX 77030, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Shuhong Ma
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen Key Laboratory of Cardiovascular Disease, No. 12 Langshan Road, Nanshan District, Shenzhen 518057, China
- State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing 100037, China
| | - Xujie Liu
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen Key Laboratory of Cardiovascular Disease, No. 12 Langshan Road, Nanshan District, Shenzhen 518057, China
- State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing 100037, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery for the First Affiliated Hospital & Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, 899 Pinghai Road, Suzhou, Jiangsu 215000, China
| | - Feng Lan
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen Key Laboratory of Cardiovascular Disease, No. 12 Langshan Road, Nanshan District, Shenzhen 518057, China
- State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing 100037, China
- Beijing Laboratory for Cardiovascular Precision Medicine, The Key Laboratory of Biomedical Engineering for Cardiovascular Disease Research, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Research Institute Building, Room 323, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Patricia Kim Phuong Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, 870 Quarry Road, Rm 183, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, 265 Campus Drive, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Andrew S Lee
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 2199 Lishui Rd, Nanshan, Shenzhen, Guangdong Province 518055, China
- Institute for Cancer Research, Shenzhen Bay Laboratory, Guangqiao Road, Guangming District, Shenzhen 518055, China
- Greater Bay Area International Clinical Trials Center, Shenzhen Medical Academy of Research and Translation, Shenzhen 518055, China
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Kaczorowski DJ, Takeda K, Atluri P, Cevasco M, Cogswell R, D'Allesandro D, Daneshmand MA, Jeevanandam V, Kapur NK, Milano C, Ono M, Potapov E, Ramzy D, Silvestry SC, Soltesz E, Uriel N. 2025 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Surgical management of acute myocardial infarction and associated complications. J Thorac Cardiovasc Surg 2025:S0022-5223(25)00302-2. [PMID: 40320004 DOI: 10.1016/j.jtcvs.2025.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/08/2025] [Accepted: 04/08/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Complications of acute myocardial infarction (AMI) can result in significant morbidity and mortality. This document reports the findings and recommendations of a multidisciplinary group of experts on the management of patients with complications of AMI, with particular focus on the use of mechanical circulatory support in this context. METHODS Through the American Association of Thoracic Surgery Clinical Practice Standards Committee, a committee of multidisciplinary experts, including both cardiologists and cardiothoracic surgeons, was established. A list of topics was developed. Committee members were divided into subgroups that developed relevant questions. A systematic literature review was then performed, and the results were synthesized into clinical recommendations. Expert consensus was then established using the Delphi process. RESULTS Based on the results of the systematic literature review, as well as the clinical expertise of the committee, clinical recommendations were developed. Each of these recommendations, the strength of each recommendation, and the level or quality of evidence on which the recommendation was based are presented here. Topics addressed include general considerations, revascularization strategies, cardiogenic shock, papillary muscle rupture, postinfarction ventricular septal defect, free wall rupture, arrhythmias, and the use of durable therapies in this context. CONCLUSIONS AMI may result in cardiogenic shock, malignant arrhythmias, or mechanical complications, each of which is associated with high mortality. Prompt management of these complications, including consideration for mechanical circulatory support, is warranted.
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Affiliation(s)
- David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Koji Takeda
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Pavan Atluri
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Marisa Cevasco
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Rebecca Cogswell
- Cardiovascular Division, University of Minnesota, Minneapolis, Minn
| | | | | | | | - Navin K Kapur
- Division of Cardiology, Tufts Medicine, Boston, Mass
| | | | - Minoru Ono
- Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Evgenij Potapov
- Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany
| | - Danny Ramzy
- Department of Cardiothoracic and Vascular Surgery, UT Health Houston McGovern School of Medicine, Houston, Tex
| | - Scott C Silvestry
- Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nir Uriel
- New York Presbyterian-Columbia University Irving Medical Center, New York, NY
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24
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Lemesle G, Coisne A, Ninni S, Aghezzaf S, Verdier B, Schurtz G, Sudre A, Modine T, Tazibet A, Staels B, Montaigne D, Bauters C, VALVENOR investigators. Risk of Myocardial Infarction in Patients With Aortic Stenosis: Insights From the VALVENOR Registry. JACC. ADVANCES 2025; 4:101707. [PMID: 40286367 PMCID: PMC12102945 DOI: 10.1016/j.jacadv.2025.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 01/27/2025] [Accepted: 03/04/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND A close interaction between aortic stenosis (AS) and coronary artery disease has been suggested. However, the risk of myocardial infarction (MI) in patients with AS is poorly described outside the context of aortic valve replacement. OBJECTIVES The purpose of this study was to assess the incidence, correlates, and impact on outcomes of MI occurrence in patients with different degrees of AS severity. METHODS Between 2016 and 2017, the multicenter prospective VALVENOR registry enrolled 2,830 outpatients with native valvular AS (peak aortic jet velocity [Vmax] ≥2.5 m/s). AS was defined as mild (Vmax 2.5-2.9), moderate (Vmax 3-3.9), or severe (Vmax ≥4). MI was defined using the fourth universal definition (type 2 MI were not considered). RESULTS The mean age was 76.0 years, 54% of the patients were men, and 18.3% had experienced prior coronary event (PCE). At 5 years, the cumulative incidence of MI (death as competing event) was only 2.5% (n = 72, one-third of ST-segment elevation MI). PCE and angina symptoms were associated with an increased risk, whereas female gender was associated with a decreased risk. By contrast, AS severity was not associated with the risk of MI. Subsequent mortality was high and at 52.8% during follow-up (median 648 days after MI occurrence). Incident MI was a powerful predictor of mortality (HR: 2.00, P < 0.001 after adjustment). CONCLUSIONS In patients with AS, the risk of MI is relatively low especially in patients without PCE and without angina. No association between the risk of MI and AS severity was observed. Although rare, incident MI is strongly associated with subsequent mortality.
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Affiliation(s)
- Gilles Lemesle
- Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France; University of Lille, Lille, France; Institut Pasteur of Lille, Inserm U1011-EGID, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
| | - Augustin Coisne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Sandro Ninni
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Samy Aghezzaf
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Basile Verdier
- Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France
| | - Guillaume Schurtz
- Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France
| | - Arnaud Sudre
- Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France
| | - Thomas Modine
- Department of Cardiac Surgery, CHU Bordeaux, Hôpital Cardiologique Haut Leveque, Pessac, France
| | - Amine Tazibet
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Bart Staels
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - David Montaigne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Christophe Bauters
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
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25
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Sano A, Matoba S, Miyake K, Ono S, Tada T, Maruo T, Kadota K. Comparative Accuracy of Semiconductor Single-Photon Emission Computed Tomography (SPECT) Versus Cardiac Magnetic Resonance (CMR) for Myocardial Viability Assessment. Cureus 2025; 17:e83679. [PMID: 40342643 PMCID: PMC12058546 DOI: 10.7759/cureus.83679] [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] [Accepted: 05/06/2025] [Indexed: 05/11/2025] Open
Abstract
Background Evaluating myocardial viability is critical for developing optimal strategies for ischemic cardiomyopathy. While semiconductor single-photon emission computed tomography (D-SPECT) demonstrated higher image quality than conventional Anger cameras for assessing myocardial viability, its accuracy compared to cardiac magnetic resonance (CMR) in the same patient cohort is still unknown. Methods We conducted a retrospective study on patients with known or suspected coronary artery disease who underwent D-SPECT and CMR within 100 days. Rest deficit score on D-SPECT and depth of contrast enhancement on late gadolinium enhancement (LGE) in CMR were classified and compared using a 16-segment analysis. Follow-up echocardiography was performed about a year after the initial examinations, detecting whether the optimal medical therapy (OMT) was followed by invasive therapy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]). The five-year survival rates were also compared. Results The study comprised 336 segments from 21 consecutive patients collected between January 2015 and December 2017. Using LGE as a viability criterion, a D-SPECT score of three had the highest diagnostic accuracy (area under the curve: 0.97). Follow-up echocardiography showed significant improvements in left ventricular ejection fraction in patients receiving OMT + PCI/CABG compared to OMT alone (OMT vs. OMT + PCI/CABG; 1.5% ± 3.4% vs. 7.1% ± 5.0%, p = 0.008); five-year survival rate did not significantly differ between the groups. Conclusions Deficits observed at rest on D-SPECT and LGE extent on CMR showed a strong correlation in evaluating myocardial viability, implying that D-SPECT is a viable alternative to CMR for this purpose.
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Affiliation(s)
- Arata Sano
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Koshi Miyake
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Sachiyo Ono
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Takeshi Maruo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, JPN
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26
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Asmussen A, Hilgendorf I. [Conservative Management of Chronic Coronary Syndrome]. Dtsch Med Wochenschr 2025; 150:615-622. [PMID: 40328269 DOI: 10.1055/a-2442-7841] [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: 05/08/2025]
Abstract
CCS management, based on the 2024 ESC Guidelines, a cornerstone of contemporary cardiology, aims to prevent cardiovascular events, alleviate symptoms, and enhance quality of life through conservative and invasive strategies. Non-invasive approaches, encompassing patient education, lifestyle interventions, and optimized pharmacological treatments, have demonstrated significant benefits in prognosis and quality of life. The guidelines advocate for a patient-centered approach, tailoring therapies to pathophysiological mechanisms, comorbidities, and individual needs. Pharmacological strategies integrate antithrombotic, lipid-lowering, RAAS-blocking, anti-inflammatory, and antidiabetic agents for event prevention, alongside antianginal medications for symptom relief. Invasive interventions remain essential for high-risk patients with obstructive coronary artery disease (e.g., left main disease, three-vessel disease, or proximal LAD involvement) or refractory angina despite optimal medical therapy. However, the growing efficacy of medical management increasingly challenges the incremental benefits of early revascularization. The guidelines also highlight underdiagnosed conditions such as ANOCA (Angina with Non-Obstructive Coronary Arteries) and INOCA (Ischemia with Non-Obstructive Coronary Arteries). Recognizing diverse endotypes, including microvascular dysfunction and vasospastic angina, enables precise and individualized therapeutic approaches. Conservative therapy remains the foundation of CCS management, demanding a holistic, multidisciplinary, and patient-centered approach to optimize outcomes and improve quality of life.
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27
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Pérez-Solé N, de Dios E, Monmeneu JV, López-Lereu MP, Gavara J, Ríos-Navarro C, Marcos-Garces V, Merenciano H, Bonanad C, Cánoves J, Platero F, Ventura A, Moratal D, Bayés-Genís A, Sanz J, Jiménez-Navarro M, Martínez-Dolz L, Sanchis J, Núñez J, Bodí V. Prognostic role of persistent angina after percutaneous revascularization in chronic coronary syndrome with altered angiography and stress CMR. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:425-436. [PMID: 39370100 DOI: 10.1016/j.rec.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024]
Abstract
INTRODUCTION AND OBJECTIVES In patients with established chronic coronary syndrome (CCS), the significance of persistent angina is controversial. We aimed to evaluate the prognostic role of persistent angina in symptomatic CCS patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiographic findings undergoing percutaneous revascularization. METHODS We analyzed 334 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficits on stress CMR and severe lesions in angiography who underwent medical therapy optimization plus CMR-guided percutaneous revascularization. We investigated the association of persistent angina at 6 months postintervention with subsequent cardiac death, myocardial infarction, and hospital admission. RESULTS All patients had angina class ≥2 (mean: 2.8±0.7), abnormal stress CMR (mean ischemic burden: 5.8±2.7 segments), and severe angiographic lesions. The angina resolution rates were 81% at 6 months, and 81%, 81%, and 77% at 1, 2, and 5 years, respectively. During a median follow-up of 8.9 years, persistent angina was independently associated with higher rates of subsequent cardiac death (13% vs 4%; HR, 3.7; 95%CI, 1.5-9.2; P=.005), myocardial infarction (24% vs 6%; HR, 4.9; 95%CI, 2.4-9.9; P<.001), and hospital admission for heart failure (27% vs 13%; HR, 2.7; 95%CI, 1.5-5.2; P=.001). CONCLUSIONS In CCS patients with robust diagnostic evidence from symptoms, stress CMR, and angiography, persistent angina after percutaneous revascularization is a strong predictor of subsequent cardiac death, myocardial infarction, and hospital admission for heart failure.
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Affiliation(s)
| | - Elena de Dios
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José V Monmeneu
- Unidad de Resonancia Magnética Nuclear, Grupo Biomédico ASCIRES, Valencia, Spain
| | - María P López-Lereu
- Unidad de Resonancia Magnética Nuclear, Grupo Biomédico ASCIRES, Valencia, Spain
| | - José Gavara
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Víctor Marcos-Garces
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Héctor Merenciano
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Clara Bonanad
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Joaquim Cánoves
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Félix Platero
- Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Andrea Ventura
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - David Moratal
- Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sanz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Manuel Jiménez-Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain; Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Luis Martínez-Dolz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan Sanchis
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Julio Núñez
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Vicente Bodí
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain.
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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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29
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Riedl KA, Schnabel R. [Diagnostic of the chronic coronary syndrome]. Dtsch Med Wochenschr 2025; 150:607-614. [PMID: 40328268 DOI: 10.1055/a-2463-2902] [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: 05/08/2025]
Abstract
The chronic coronary syndrome can be attributed to different pathophysiological epicardial or microvascular mechanisms. In the current ESC guideline from 2024, a diagnostic algorithm was developed based on a risk-factor-weighted individual pre-test probability. The baseline diagnostic includes anamnesis, electrocardiogram, and a laboratory chemical analysis, especially to exclude an acute coronary syndrome. The early and direct assessments for risk-factor-weighted individual pre-test probability are calculated by taking into account clinical symptoms, individual cardiovascular risk factors, age, and gender. Resting ECG, echocardiography and the evaluation of the peripheral arteries and data on possible known vascular calcifications in previous imaging examinations can further adjust and modify the pre-test probability. Non-invasive imaging methods (computed tomography angiography, magnetic resonance imaging, stress echocardiography, SPECT, PET) or invasive coronary angiography can be used to confirm or exclude the diagnosis of chronic coronary syndrome.
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30
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Sampath-Kumar R, Mohammad M, von Koch S, Reeves R, Al Khiami B, Ang L, Melendez A, Mahmud E, Ben-Yehuda O, Erlinge D. Practice patterns and percutaneous coronary intervention outcomes: a comparison between Sweden and the US. EUROPEAN HEART JOURNAL OPEN 2025; 5:oeaf045. [PMID: 40329990 PMCID: PMC12053007 DOI: 10.1093/ehjopen/oeaf045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 03/26/2025] [Accepted: 04/15/2025] [Indexed: 05/08/2025]
Abstract
Aims Comparisons of international practice patterns and their impact on percutaneous coronary intervention (PCI) outcomes are lacking. We compared temporal PCI trends between Sweden and a large university hospital system in the US. Methods and results Data within the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and the University of California San Diego Health internal National Cardiovascular Data Registry (NCDR) CathPCI Registry were used to identify patients who underwent PCI from 2007 to 2021. Baseline characteristics and practice patterns were assessed using all patients (275 021 Swedish cohort, 9883 US cohort). Mortality was analysed using a random-effects Cox model, restricted to patients treated at university hospitals and excluding those with cardiac arrest or cardiogenic shock (108 136 Swedish cohort, 9592 US cohort). The Swedish cohort was older, had a greater proportion of men, and was more likely to smoke (all P < 0.001). The US cohort had a higher body mass index and was more likely to have diabetes, hyperlipidaemia, prior PCI, congestive heart failure, and peripheral arterial disease (all P < 0.001). Sweden had lower rates of PCI for stable angina and lower use of mechanical circulatory support (all P < 0.001). More STEMI patients were treated with only heparin as anticoagulation in Sweden, even in the contemporary era. There was earlier adoption and increased utilization of ticagrelor and radial access in Sweden, while there was earlier use of drug-eluting stents in the US. Fractional flow reserve was used more frequently in Sweden. There was no difference in adjusted all-cause mortality 1 year post-PCI for any indication between university hospitals in Sweden and the US (hazard ratio [HR] 1.09; 95% CI 0.86-1.37; P = 0.48), and this finding was consistent across subgroups. Conclusion Despite significant differences in patient populations and practice variations, we found no difference in post-PCI mortality between university hospitals in Sweden and the US.
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Affiliation(s)
- Revathy Sampath-Kumar
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Moman Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Sacharias von Koch
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Ryan Reeves
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Belal Al Khiami
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Lawrence Ang
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Anna Melendez
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Ori Ben-Yehuda
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden
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Hamilton GW, Koshy AN, Dinh D, Brennan A, Yeoh J, Yudi MB, Horrigan M, Reid CM, Stub D, Chan W, Oqueli E, Freeman M, Hiew C, Ajani A, Farouque O, Clark DJ. The impact of stress testing to guide PCI in patients with chronic coronary disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025; 74:45-51. [PMID: 39174434 DOI: 10.1016/j.carrev.2024.08.010] [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: 03/29/2024] [Revised: 07/20/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Guidelines and international appropriate use criteria increasingly endorse non-invasive stress testing to evaluate patients with suspected chronic coronary disease (CCD). We sought to review the real-world utilisation of non-invasive stress testing and investigate whether their use prior to PCI associates with outcomes in patients with CCD. METHODS Consecutive patients from a multicentre registry who underwent PCI for CCD between 2006 and 2018 were included. Clinical characteristics and outcomes were stratified according to whether stress testing was performed prior to PCI (stress vs no-stress groups). The primary outcome was 3-year all-cause mortality. RESULTS Among the 8251 patients included, 4970 (60.2 %) underwent pre-PCI stress testing and this proportion increased over time (p-for-trend<0.001). The stress group had a lower prevalence of prior revascularization, myocardial infarction, or heart failure, and a lower incidence of triple vessel disease, in stent re-stenosis, and ACC/AHA class B2/C lesions (all p < 0.001). When comparing post-procedural outcomes, the stress group had lower rates of arrhythmia (1.5 % vs 2.6 %, p = 0.001), new heart failure (0.2 % vs 0.8 %, p = 0.001), renal impairment, and a shorter length of stay (1.6 vs 2.1 days, p < 0.001). Mortality at 3-years was lower in those undergoing PCI following stress testing (5.8 % vs 8.8 %, p < 0.001). After adjusting for key clinical variables, stress guided revascularization was associated with a significantly lower risk of 3-year mortality (adjusted Hazard Ratio 0.77, 95 % CI 0.64-0.92). CONCLUSIONS In patients with CCD, PCI guided by non-invasive stress testing is increasingly utilized and associated with improved survival. Further studies are necessary to investigate whether this results from differences in patient characteristics, optimized patient selection, or refined choice of target vessel.
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia; School of Population Health, Curtin University, Perth, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - William Chan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health, Ballarat, Australia; School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia.
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Wang D, Lai S, Wang Z, Xuan C, Ren X, Peng W, Pan G. Impact of PCI strategies on outcomes of patients undergoing Transcatheter Aortic Valve Implantation with concomitant coronary artery disease: A systematic review and meta-analysis. PLoS One 2025; 20:e0321395. [PMID: 40305479 PMCID: PMC12043176 DOI: 10.1371/journal.pone.0321395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 03/05/2025] [Indexed: 05/02/2025] Open
Abstract
The aim of this study is to compare the clinical benefits associated with different percutaneous coronary intervention (PCI) timing strategies in patients undergoing transcatheter aortic valve implantation (TAVI) who have coexisting coronary artery disease (CAD). A systematic review and meta-analysis were conducted. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched for relevant articles up to April 10th, 2024. Studies that reported comparisons of clinical outcomes between PCI before/concomitant with TAVI (PCI-TAVI) vs. TAVI alone, or comparisons between PCI before/concomitant with TAVI vs. PCI after TAVI (TAVI-PCI) were selected. Primary outcomes were all-cause mortality in the short-term, mid-term and long-term follow-up. A total of 23 studies pooling 15812 patients were included. Compared to TAVI alone, PCI-TAVI showed no significant difference in all-cause mortality at short- and mid-term (RRshort-term = 1.10 95%CI 0.88-1.38; RRmid-term = 1.12 95%CI 0.97-1.30), but an increase during long-term follow-up (RRlong-term = 1.20 95%CI 1.06-1.36). Compared with PCI-TAVI, TAVI-PCI is associated with lower rate of all-cause mortality at both short- and long-term follow-ups. PCI before or concomitant with TAVI may not offer clinical benefits and could potentially lead to worse outcomes in the long term. Conversely, PCI after TAVI is associated with improved clinical outcomes in both the short and long term.
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Affiliation(s)
- Dayang Wang
- Institute of Cardiovascular Diseases, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Sijia Lai
- Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Zichen Wang
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Changbo Xuan
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Xiaoxia Ren
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Wenhua Peng
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Guozhong Pan
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Rasmussen LD, Schmidt SE, Knuuti J, Spiro J, Rajwani A, Lopes PM, Lima MR, Ferreira AM, Maaniitty T, Saraste A, Newby D, Douglas PS, Bøttcher M, Baskaran L, Winther S. Clinical likelihood models calibrated against observed obstructive coronary artery disease on computed tomography angiography. Eur Heart J Cardiovasc Imaging 2025; 26:802-813. [PMID: 39918232 PMCID: PMC12042743 DOI: 10.1093/ehjci/jeaf049] [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: 08/27/2024] [Revised: 12/10/2024] [Accepted: 02/01/2025] [Indexed: 02/20/2025] Open
Abstract
AIMS Models predicting the likelihood of obstructive coronary artery disease (CAD) on invasive coronary angiography exist. However, as stable patients with new-onset chest pain frequently have lower clinical likelihood and preferably undergo index testing by non-invasive tests such as coronary computed tomography angiography (CCTA), clinical likelihood models calibrated against observed obstructive CAD at CCTA are warranted. The aim was to develop CCTA-calibrated risk-factor- and coronary artery calcium score-weighted clinical likelihood models (i.e. RF-CLCCTA and CACS-CLCCTA models, respectively). METHODS AND RESULTS Based on age, sex, symptoms, and cardiovascular risk factors, an advanced machine learning algorithm utilized a training cohort (n = 38 269) of symptomatic outpatients with suspected obstructive CAD to develop both a RF-CLCCTA model and a CACS-CLCCTA model to predict observed obstructive CAD on CCTA. The models were validated in several cohorts (n = 28 340) and compared with a currently endorsed basic pre-test probability (Basic PTP) model. For both the training and pooled validation cohorts, observed obstructive CAD at CCTA was defined as >50% diameter stenosis. Observed obstructive CAD at CCTA was present in 6443 (22.7%) patients in the pooled validation cohort. While the Basic PTP underestimated the prevalence of observed obstructive CAD at CCTA, the RF-CLCCTA and CACS-CLCCTA models showed superior calibration. Compared with the Basic PTP model, the RF-CLCCTA and CACS-CLCCTA models showed superior discrimination (area under the receiver operating curves 0.71 [95% confidence interval (CI) 0.70-0.72] vs. 0.74 (95% CI 0.73-0.75) and 0.87 (95% CI 0.86-0.87), P < 0.001 for both comparisons). CONCLUSION CCTA-calibrated clinical likelihood models improve calibration and discrimination of observed obstructive CAD at CCTA.
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Affiliation(s)
- Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jon Spiro
- Royal Perth Hospital, University of Western Australia, Australia
| | - Adil Rajwani
- Royal Perth Hospital, Curtin University, Australia
| | - Pedro M Lopes
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Lisbon, Portugal
| | - Maria Rita Lima
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Lisbon, Portugal
| | - António M Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Lisbon, Portugal
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - David Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lohendran Baskaran
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Williams MS, Levine GN, Kalra D, Agarwala A, Baptiste D, Cigarroa JE, Diekemper RL, Foster MV, Gulati M, Henry TD, Itchhaporia D, Lawton JS, Newby LK, Rogers KC, Soni K, Tamis-Holland JE. 2025 AHA/ACC Clinical Performance and Quality Measures for Patients With Chronic Coronary Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2025:e000140. [PMID: 40305583 DOI: 10.1161/hcq.0000000000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.
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Affiliation(s)
| | | | | | | | - Diana Baptiste
- Preventive Cardiovascular Nurses Association representative
| | | | | | | | - Martha Gulati
- American Society for Preventive Cardiology representative
| | - Timothy D Henry
- Society for Cardiovascular Angiography and Interventions representative
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35
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Boden WE, Kaski JC, Bairey Merz CN, Marzilli M, Pepine CJ, Crea F, De Caterina R. Myocardial Ischaemic Syndromes: Shifting from a Coronary-centric to a Substrate-based Nomenclature is More Accurate and Inclusive. Eur Cardiol 2025; 20:e12. [PMID: 40343144 PMCID: PMC12060175 DOI: 10.15420/ecr.2025.01] [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: 01/15/2025] [Accepted: 01/30/2025] [Indexed: 05/11/2025] Open
Abstract
This article highlights the rationale for a more accurate and inclusive classification that does not focus solely on epicardial coronary lesions as the causa sine qua non for angina and myocardial ischaemia in all patients but rather represents a more comprehensive classification encompassing both obstructive and non-obstructive causes. Ischaemia may be 'silent' clinically or electrocardiographically and is observed in both acute and non-acute settings, as seen in patients with diabetes and other conditions associated with microvascular dysfunction. By pivoting away from the more restrictive and overly simplistic 'vessel-based' classification that disproportionately focuses on obstructed epicardial arteries to a 'substrate-based' nomenclature inclusive of both obstructive and non-obstructive causes, 'myocardial ischaemic syndromes' will better align and unify a patient-centric approach by harmonising the full spectrum of pathophysiologic causes.
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Affiliation(s)
- William E Boden
- VA Boston Healthcare SystemBoston, MA, US
- Department of Medicine, Boston University School of MedicineBoston, MA, US
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George’s University of LondonLondon, UK
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart InstituteLos Angeles, CA, US
| | - Mario Marzilli
- Cardiology Division, Pisa University Hospital, University of PisaPisa, Italy
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida School of MedicineGainesville, FL, US
| | - Filippo Crea
- Department of Cardiovascular Sciences, Università Cattolica del Sacro CuoreRome, Italy
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Jurado-Román A, Montero-Cabezas JM. Prognostic benefit of percutaneous revascularization for chronic total coronary occlusions. Paradoxes and contradictions in an endless debate. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025:S1885-5857(25)00122-7. [PMID: 40288636 DOI: 10.1016/j.rec.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 03/10/2025] [Indexed: 04/29/2025]
Affiliation(s)
- Alfonso Jurado-Román
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - José M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. https://x.com/@JMonteroMD
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37
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Fezzi S, Scheller B, Cortese B, Alfonso F, Jeger R, Colombo A, Joner M, Shin ES, Kleber FX, Latib A, Rissanen TT, Eccleshall S, Ribichini F, Tao L, Koo BK, Chieffo A, Ge J, Granada JF, Stoll HP, Spaulding C, Cavalcante R, Abizaid A, Muramatsu T, Boudoulas KD, Waksman R, Mehran R, Cutlip DE, Krucoff MW, Stone GW, Garg S, Onuma Y, Serruys PW. Definitions and standardized endpoints for the use of drug-coated balloon in coronary artery disease: consensus document of the Drug Coated Balloon Academic Research Consortium. Eur Heart J 2025:ehaf029. [PMID: 40270117 DOI: 10.1093/eurheartj/ehaf029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 10/20/2024] [Accepted: 01/15/2025] [Indexed: 04/25/2025] Open
Abstract
The Drug Coated Balloon Academic Research Consortium project originated from the lack of standardization and comparability between studies using drug-coated balloons in the treatment of obstructive coronary artery disease. This document is a collaborative effort between academic research organizations and percutaneous coronary intervention societies in Europe, the USA, and Asia. This consensus sought to standardize study designs and endpoints for clinical trials involving drug-coated balloons, including defining angiographic, intravascular, and non-invasive imaging methods for lesion assessment, alongside considerations for post-revascularization pharmaco-therapy. The concept of 'blended therapy', which advocates for combining device strategies, is also discussed. This paper delineates study types, endpoint definitions, follow-up protocols, and analytical approaches, aiming to provide consistency and guidance for interventional cardiologists and trialists.
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Affiliation(s)
- Simone Fezzi
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- DCB Academy, Milan, Italy
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBERCV, Madrid, Spain
| | - Raban Jeger
- Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland
- Department of Cardiology, University of Basel, Basel, Switzerland
| | - Antonio Colombo
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Michael Joner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Franz X Kleber
- Mitteldeutsches Herzzentrum, University Halle-Wittenberg, Halle, Germany
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Tuomas T Rissanen
- Heart Center, Central Hospital of North Karelia, Siunsote, Joensuu, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, China
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College of Medicine, Seoul, South Korea
| | - Alaide Chieffo
- Department of Medicine, Vita Salute San Raffaele University, Milan, Italy
- Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
| | | | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris and INSERM, Paris, France
| | | | - Alexandre Abizaid
- Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | | | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donald E Cutlip
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Mitchell W Krucoff
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
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Lim P, Eris T, Shaw LJ, Gelfman L, Gelijns A, Moskowitz A, Bagiella E, Lin FA, Bhatt DL, Stone G, Morrison RS, Cohen D, Nanna M, Alexander K, Patel KK. Representation of Older Adults and Women in Randomized Trials of Non-Invasive Imaging for Chest Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.04.23.25326261. [PMID: 40313274 PMCID: PMC12045410 DOI: 10.1101/2025.04.23.25326261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2025]
Abstract
Background Non-invasive imaging is widely used both for initial diagnosis and to guide management of ischemic heart disease (IHD). Older adults and women with IHD may have different responses to imaging as well as to treatments and outcomes that follow compared with younger adults and men. We aimed to study the representation of older adults and women in randomized controlled trials (RCT) of non-invasive imaging among patients with acute and stable chest pain. Methods We conducted a systematic search to identify RCTs evaluating non-invasive, imaging-guided diagnosis and management for IHD that were published before September 1, 2023. Participation-to-Prevalence Ratio (PPR) was estimated for women and age subgroups of <65, 65-74, ≥75 years. PPR of <0.8, 0.8-1.2, and >1.2 indicated underrepresentation, appropriate representation, and overrepresentation, respectively. Results Among 53 RCTs, sex and age breakdown were available in 53 (n=55,893) and 21 trials (n=35,503), respectively. The median age across all trials was 57.4 years [IQR: 55.0- 60.2]. Participants aged <65 years were overrepresented with a median PPR 2.13 [IQR: 1.73- 2.43], while those aged 65-74 years and ≥75 years were underrepresented with median PPRs of 0.74 [IQR: 0.56-0.83] and 0.21 [IQR: 0.11-0.33], respectively. Women were adequately represented with a median PPR of 1.2 [1.06-1.32]. Conclusion While women were appropriately represented, adults 65 years or older, especially those ≥75 years, were under-represented in these trials. Future RCTs on non-invasive imaging should target enrollment of older adults to ensure generalizability of results to this growing population. CLINICAL PERSPECTIVE In a systematic review of 53 randomized controlled trials of non-invasive imaging for chest pain published before September 1, 2023 (n=55,893 participants), adults aged 65 years and older, especially those aged 75 years and above, were significantly underrepresented, whereas women had representation proportional to prevalence estimates. These findings highlight an urgent need to increase enrollment of older adults in future imaging trials to ensure broader applicability and relevance of study results. Abstract Figure
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Williams MS, Levine GN, Kalra D, Agarwala A, Baptiste D, Cigarroa JE, Diekemper RL, Foster MV, Gulati M, Henry TD, Itchhaporia D, Lawton JS, Newby LK, Rogers KC, Soni K, Tamis-Holland JE. 2025 AHA/ACC Clinical Performance and Quality Measures for Patients With Chronic Coronary Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2025:S0735-1097(25)00282-7. [PMID: 40310322 DOI: 10.1016/j.jacc.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.
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40
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Oshima A, Ninomiya K, Sekiguchi M, Yoshiura D, Gonda Y, Horiuchi Y, Taniwaki M, Yuzawa H, Komiyama K, Tanaka J, Onuma Y, Serruys PW, Tanabe K, Asami M. Diagnostic Performance of Angiography-Based Vessel-Fractional Flow Reserve Compared with Various Wire-Based Physiological Assessments. Catheter Cardiovasc Interv 2025. [PMID: 40230047 DOI: 10.1002/ccd.31534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2025] [Revised: 03/25/2025] [Accepted: 03/28/2025] [Indexed: 04/16/2025]
Abstract
BACKGROUND Although considered the gold standard, pressure wire-derived fractional flow reserve (PW-FFR) and instantaneous wave-free ratio (PW-iFR) are not sufficiently adopted. Vessel fractional flow reserve (vFFR) is a potentially less invasive surrogate. AIMS To validate the diagnostic performance of vFFR against the wire-based physiological assessments in real-world clinical settings. METHODS In this single-center retrospective study, we analyzed 479 patients (586 vessels) who underwent PW-FFR and vFFR in the same vessel, and evaluated the correlation between vFFR and PW-FFR using PW-FFR ≦ 0.80 as the reference. Additionally, we analyzed 378 patients (455 vessels) with vFFR, PW-FFR, and PW-iFR, and 93 patients (119 vessels) with vFFR, PW-FFR, and resting full-cycle ratio (RFR). RESULTS The indications for coronary angiography were stable angina (92%), unstable angina (6.3%), and non-ST-elevation myocardial infarction (1.5%). The target vessels were the left anterior descending artery (61%), left circumflex artery (20%), and right coronary artery (19%). A good correlation was found between vFFR and PW-FFR (R = 0.67; p < 0.001) with a mean bias of 0.0068 ± 0.0786. vFFR demonstrated good accuracy at predicting PW-FFR ≦0.80 (area under the curve [AUC] = 0.86; 95% confidence interval [CI]: 0.83-0.89). At a vFFR cut-off value of ≦0.80, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for predicting PW-FFR ≦0.80 were 78.8%, 82.5%, 77.6%, 83.5%, and 80.9%, respectively, with a Cohen's Kappa coefficient of 0.612. Similar results were observed for vFFR with PW-iFR and RFR. CONCLUSION vFFR demonstrated good correlation and diagnostic performance compared with wire-based physiological assessments.
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Affiliation(s)
- Asahi Oshima
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- CORRIB Research Center for Advanced Imaging and Core lab, School of Medicine, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | | | - Daiki Yoshiura
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuki Gonda
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshinobu Onuma
- CORRIB Research Center for Advanced Imaging and Core lab, School of Medicine, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- CORRIB Research Center for Advanced Imaging and Core lab, School of Medicine, University of Galway, Galway, Ireland
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Gaudino M, Stone GW, Heise RS, Caldonazo T, Kim J, Harik L, Sandner S, Biondi-Zoccai G, Masterson-Creber R, Alexander JH, Bhatt DL, Puskas J, Devereaux PJ, Spertus J, Redfors B. Association Between Myocardial Infarction and Quality Of Life in the ISCHEMIA Trial. JACC Cardiovasc Interv 2025:S1936-8798(25)00805-2. [PMID: 40272347 DOI: 10.1016/j.jcin.2025.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/29/2025] [Accepted: 02/11/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND The association between myocardial infarction (MI) subtypes (procedural MI [PMI] and spontaneous MI [SMI]) and subsequent quality of life (QoL) is incompletely understood. OBJECTIVES The authors analyzed the association between PMI and SMI and generic and disease-specific QoL in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS QoL was assessed before randomization and at 1.5, 3, and 6 months, and every 6 months thereafter. European Quality of Life-5 dimensions visual analog scale (EQ-5D VAS) (generic) and Seattle Angina Questionnaire (SAQ-7) summary score (disease-specific) were used. The primary analysis was a linear, repeated-measures, multivariable-adjusted, mixed-effects model, with a random intercept for patient. QoL assessments occurring <3 months after MI were defined as early QoL and those occurring >3 months after MI were defined as late QoL. RESULTS 4,375 randomized patients were included in the primary analysis population. The median duration of follow-up was 36.2 months (Q1-Q3: 23.8-49.5 months). In the primary analysis population, a total of 84 PMIs and 352 SMIs occurred. SMI was associated with significant decreases in both early (adjusted difference -5.7; 95% CI: -7.3 to -4.1 points) and late EQ-5D VAS (-3.1 points; 95% CI: -4.3 to -1.9 points) and in early (-7.7 points; 95% CI: -9.4 to -6.1 points) and late SAQ-7 (-1.9 points; 95% CI: -3.2 to -0.7 points). PMI was not associated with early (adjusted difference -0.8 points; 95% CI: -3.3 to 1.8 points) or late (-0.7 points; 95% CI: -2.7 to 1.2 points) changes in EQ-5D VAS, and was associated with a reduction in early (-3.0 points; 95% CI: -5.7 to -0.4) but not late SAQ-7 (-0.2 points; 95% CI -2.2 to 1.8 points). CONCLUSIONS In ISCHEMIA, SMI was associated with reductions in both early and late generic and disease-specific QoL, whereas PMI was only associated with a transient reduction in disease-specific QoL.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel S Heise
- Division of Biostatisticcs, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Jessica Kim
- Division of Biostatisticcs, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | | | - John H Alexander
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Puskas
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Cardiovascular Institute, New York, New York, USA; Department of Cardiovascular Surgery, Mount Sinai Heart at Mount Sinai Beth Israel, New York, New York, USA
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - John Spertus
- University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Bjorn Redfors
- Division of Biostatisticcs, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zaman S, Wasfy JH, Kapil V, Ziaeian B, Parsonage WA, Sriswasdi S, Chico TJA, Capodanno D, Colleran R, Sutton NR, Song L, Karam N, Sofat R, Fraccaro C, Chamié D, Alasnag M, Warisawa T, Gonzalo N, Jomaa W, Mehta SR, Cook EES, Sundström J, Nicholls SJ, Shaw LJ, Patel MR, Al-Lamee RK. The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma. Lancet 2025; 405:1264-1312. [PMID: 40179933 DOI: 10.1016/s0140-6736(25)00055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 01/01/2025] [Accepted: 01/09/2025] [Indexed: 04/05/2025]
Affiliation(s)
- Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Jason H Wasfy
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - William A Parsonage
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sira Sriswasdi
- Center of Excellence in Computational Molecular Biology, Chulalongkorn University, Pathum Wan, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
| | - Timothy J A Chico
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico, University of Catania, Catania, Italy
| | - Róisín Colleran
- Department of Cardiology and Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Nadia R Sutton
- Department of Internal Medicine, and Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Lei Song
- Department of Cardiology, National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, Beijing, China; Peking Union Medical College (Chinese Academy of Medical Sciences), Beijing, China
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Paris City University, Paris, France
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Chiara Fraccaro
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Daniel Chamié
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Nieves Gonzalo
- Cardiology Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Walid Jomaa
- Cardiology B Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton Health Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Elizabeth E S Cook
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Johan Sundström
- Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK.
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Chandrashekhar Y, Mensah G, Narula J. From coronary artery disease to atherosclerotic coronary artery disease: what is in a name? Lancet 2025; 405:1209-1211. [PMID: 40179928 DOI: 10.1016/s0140-6736(25)00563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Accepted: 03/19/2025] [Indexed: 04/05/2025]
Affiliation(s)
- Y Chandrashekhar
- VA Medical Centre, Minneapolis, and University of Minnesota, MN, USA
| | - George Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jagat Narula
- University of Texas Health-McGovern Medical School, Houston, TX 77030, USA.
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Muller M, Liu R, Shah F, Hu J, Held C, Kullo IJ, McManus B, Wallentin L, Newby LK, Sidhu MS, Bangalore S, Reynolds HR, Hochman JS, Maron DJ, Ruggles KV, Berger JS, Newman JD. Clonal Hematopoiesis of Indeterminate Potential in Chronic Coronary Disease: A Report From the ISCHEMIA Trials Biorepository. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2025:e004921. [PMID: 40207358 DOI: 10.1161/circgen.124.004921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Affiliation(s)
- Matthew Muller
- Department of Biomedical Engineering, New York University Tandon School of Engineering (M.M.)
- NYU Grossman School of Medicine (M.M., J.H.)
| | - Richard Liu
- Department of Population Health, Division of Biostatistics (R.L.)
| | - Farheen Shah
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - Jiyuan Hu
- NYU Grossman School of Medicine (M.M., J.H.)
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden (C.H., L.W.)
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (I.J.K.)
| | - Bruce McManus
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (B.M.M.)
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden (C.H., L.W.)
| | - L Kristin Newby
- Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, NC (L.K.N.)
| | | | - Sripal Bangalore
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - Harmony R Reynolds
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - Judith S Hochman
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, CA (D.J.M.)
| | - Kelly V Ruggles
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - Jeffrey S Berger
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
| | - Jonathan D Newman
- Department of Medicine (F.S., S.B., H.R.R., J.S.H., K.V.R., J.S.B., J.D.N.)
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Yamamoto A, Nagao M, Fukushima K, Yamaguchi J. Non-invasive and quantitative evaluation of myocardial PET imaging: Next step for advanced therapy. J Cardiol 2025:S0914-5087(25)00100-5. [PMID: 40209935 DOI: 10.1016/j.jjcc.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2025] [Revised: 03/28/2025] [Accepted: 04/01/2025] [Indexed: 04/12/2025]
Abstract
Myocardial positron emission tomography (PET) is superior in detecting ischemia in patients with left main or multivessel disease, conditions that are challenging to assess using single-photon emission computed tomography (SPECT). Additionally, quantitative measurements of myocardial blood flow and myocardial flow reserve (MFR) have been established as significant prognostic indicators for patients with ischemic heart disease. Moreover, 13N-ammonia PET offers high temporal and spatial resolution, enabling the assessment of both left and right ventricular strain, a quantitative marker of regional myocardial wall motion. Ongoing research aims to translate these advanced PET-based methodologies into SPECT imaging. Furthermore, MFR has proven valuable for diagnosing and predicting cardiac allograft vasculopathy in heart transplant recipients. More recently, it has also been utilized to evaluate the efficacy of cardiac regeneration therapy in individuals with severe heart failure and reduced cardiac function. This review presents existing evidence and highlights recent advancements in myocardial PET.
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Affiliation(s)
- Atsushi Yamamoto
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
| | - Michinobu Nagao
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Chiew K, Chotai S, Al-Lamee R. Mode of revascularization for ischaemic cardiomyopathy: comparing apples with oranges? Eur Heart J 2025:ehaf201. [PMID: 40197821 DOI: 10.1093/eurheartj/ehaf201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2025] Open
Affiliation(s)
- Kayla Chiew
- National Heart and Lung Institute, Imperial College London, Du Cane Rd, London W12 0HS, UK
| | - Shayna Chotai
- National Heart and Lung Institute, Imperial College London, Du Cane Rd, London W12 0HS, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, Du Cane Rd, London W12 0HS, UK
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47
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Pesarini G, Hellig F, Seth A, Shlofmitz RA, Ribichini FL. Percutaneous coronary intervention for calcified and resistant lesions. EUROINTERVENTION 2025; 21:e339-e355. [PMID: 40191879 PMCID: PMC11956026 DOI: 10.4244/eij-d-24-00195] [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: 03/01/2024] [Accepted: 09/19/2024] [Indexed: 04/09/2025]
Abstract
Relevant calcified coronary artery disease (CCAD) may be present in around 20% of patients undergoing percutaneous coronary interventions, and it is known to add procedural challenges and risks. Careful patient selection and specific expertise in multimodality imaging and plaque modification techniques are required to plan and adopt the most appropriate therapeutic strategy. This review aims to present the contemporary clinical approach and procedural planning for CCAD patients, describing the available tools and strategies in view of the most recent scientific evidence.
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Affiliation(s)
- Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Farrel Hellig
- Netcare Sunninghill Hospital, Sandton, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
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48
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Qi Z, Qiu M, Xu Y, Xu K, Liu H, Wang X, Li J, Liu B, Chen S, Chen J, Han Y, Li Y. Comparative outcomes of invasive versus conservative strategy in stable coronary artery disease patients: a risk-stratification-based hypothesis-generative study. BMC Med 2025; 23:199. [PMID: 40189505 PMCID: PMC11974019 DOI: 10.1186/s12916-025-04020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 03/18/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores. METHODS This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding. RESULTS The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13-2.26; P = 0.009). Similar results were observed in the low-risk patient subset (N = 2030). While in the moderate-to-high-risk subset (N = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48-0.95; P = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51-1.03; P = 0.07), and with no excessive risk of bleeding. CONCLUSIONS Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. The OPT-CAD risk score may be valuable to the guidance of optimal treatment strategy in SCAD patients.
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Affiliation(s)
- Zizhao Qi
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Miaohan Qiu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ying Xu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Kai Xu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Haiwei Liu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Yaling Han
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
| | - Yi Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
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Zivkovic S, Mandic A, Krupnikovic K, Obradovic A, Misevic V, Farkic M, Ilic I, Tesic M, Aleksandric S, Juricic S, Beleslin B, Dobric M. Myocardial Revascularization in Patients with Diabetes and Heart Failure-A Narrative Review. Int J Mol Sci 2025; 26:3398. [PMID: 40244271 PMCID: PMC11989545 DOI: 10.3390/ijms26073398] [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: 02/08/2025] [Revised: 03/13/2025] [Accepted: 03/20/2025] [Indexed: 04/18/2025] Open
Abstract
Heart failure and diabetes mellitus are major contributors to global morbidity and mortality, with their prevalence continuously rising, primarily due to aging populations and improvements in healthcare. These conditions often coexist or develop sequentially, leading to complex interactions that significantly influence the progression and management of both diseases. Furthermore, heart failure and diabetes are commonly associated with coronary artery disease, which presents a unique challenge in clinical management, particularly in the context of myocardial revascularization. The presence of diabetes exacerbates atherosclerotic progression and impairs endothelial function, while heart failure complicates the perfusion and recovery of myocardial tissue post-intervention. This narrative review delves into the underlying mechanisms contributing to revascularization failure in patients with heart failure and diabetes, emphasizing the importance of understanding these interactions for optimal treatment. The review also summarizes key findings from randomized controlled trials, examining evidence both in the general population and in specific subgroups, including the elderly and patients with left main coronary artery disease, chronic kidney disease, peripheral artery disease, and chronic obstructive pulmonary disease. Understanding these complexities is critical for improving patient outcomes.
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Affiliation(s)
- Stefan Zivkovic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Aleksandar Mandic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Kosta Krupnikovic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Aleksa Obradovic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Vojko Misevic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Mihajlo Farkic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
| | - Ivan Ilic
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.T.); (S.A.); (B.B.)
| | - Milorad Tesic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.T.); (S.A.); (B.B.)
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Srdjan Aleksandric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.T.); (S.A.); (B.B.)
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Stefan Juricic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branko Beleslin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.T.); (S.A.); (B.B.)
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Milan Dobric
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia; (A.M.); (K.K.); (A.O.); (V.M.); (M.F.); (I.I.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.T.); (S.A.); (B.B.)
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50
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Fairbairn TA, Mullen L, Nicol E, Lip GYH, Schmitt M, Shaw M, Tidbury L, Kemp I, Crooks J, Burnside G, Sharma S, Chauhan A, Liew C, Waidyanatha S, Iyenger S, Beale A, Sunderji I, Greenwood JP, Motwani M, Reid A, Beattie A, Carter J, Haworth P, Bellenger N, Hudson B, Rodrigues J, Watson O, Venugopal V, Bull R, O'Kane P, Deshpande A, McCann GP, Duckett S, Mansoubi H, Parish V, Sehmi J, Rogers C, Mullen S, Weir-McCalL J. Implementation of a national AI technology program on cardiovascular outcomes and the health system. Nat Med 2025:10.1038/s41591-025-03620-y. [PMID: 40186078 DOI: 10.1038/s41591-025-03620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 02/28/2025] [Indexed: 04/07/2025]
Abstract
Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system. The National Health Service funded use of an artificial intelligence (AI) diagnostic tool, computed tomography (CT)-derived fractional flow reserve (FFR-CT), in patients with chest pain to improve physician decision-making and reduce downstream tests. This observational cohort study assessed the impact of FFR-CT on cardiovascular outcomes by including all patients investigated with CCTA during the national AI implementation program at 27 hospitals (CCTA n = 90,553 and FFR-CT n = 7,863). FFR-CT was safe, with no difference in all-cause (n = 1,134 (3.2%) versus 1,612 (2.9%), adjusted-hazard ratio (aHR) 1.00 (0.93-1.08), P = 0.97) or cardiovascular mortality (n = 465 (1.3%) versus 617 (1.1%), aHR 0.96 (0.85-1.08), P = 0.48), while reducing invasive coronary angiograms (n = 5,720 (16%) versus 8,183 (14.9%), aHR 0.93 (0.90-0.97), P < 0.001) and noninvasive cardiac tests (189/1,000 patients versus 167/1,000), P < 0.001). Implementation of an AI-diagnostic tool as part of a health intervention program was safe and beneficial to the patient pathway and health system with fewer cardiac tests at 2 years.
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Affiliation(s)
- Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK.
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Liam Mullen
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Edward Nicol
- Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Trust, London, UK
- Department of Cardiovascular Imaging, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Matthew Shaw
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Laurence Tidbury
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ian Kemp
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jennifer Crooks
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Girvan Burnside
- Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sumeet Sharma
- Ashford and St Peters Hospital NHS Foundation Trust, London, UK
| | - Anoop Chauhan
- Blackpool Teaching Hospitals NHS Foundation Trusts, Blackpool, UK
| | - Chee Liew
- Blackpool Teaching Hospitals NHS Foundation Trusts, Blackpool, UK
| | | | - Sri Iyenger
- Frimley Health NHS Foundation Trust, Guildford, UK
| | - Andrew Beale
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manish Motwani
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Reid
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Beattie
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Justin Carter
- North Tees and Hartlepool NHS Foundation Trust, Middlesbrough, UK
| | | | | | | | | | - Oliver Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Russell Bull
- University Hospital Dorset NHS Trust, Bournemouth, UK
| | - Peter O'Kane
- University Hospital Dorset NHS Trust, Bournemouth, UK
| | | | - Gerald P McCann
- University Hospitals of Leicester NHS Trust, Leicester, UK
- University of Leicester, Leicester, UK
| | - Simon Duckett
- University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, UK
| | - Hatef Mansoubi
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Victoria Parish
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Joban Sehmi
- West Hertfordshire Hospital NHS Trust, Watford, UK
| | | | | | - Jonathan Weir-McCalL
- Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Trust, London, UK
- Department of Cardiovascular Imaging, Faculty of Life Sciences and Medicine, Kings College London, London, UK
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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