scholarly journals Predictors of inducible ischemia with radionuclide stress testing: Choosing the right patients when the patients are changing

2021 ◽  
Author(s):  
Hayan Jouni ◽  
Raymond J. Gibbons
Keyword(s):  
Stress Testing ◽  
Inducible Ischemia ◽  
The Right

scholarly journals Exercise induced atrio-ventricular (AV) block during nuclear perfusion stress testing: a case report

2016 ◽  
Vol 70 (1) ◽  
Author(s):  
Filippo Maria Sarullo ◽  
Salvatore Accardo ◽  
Paola D’Antoni ◽  
Annamaria Martino ◽  
Antonio Micari ◽  
...  
Keyword(s):  
Perfusion Imaging ◽  
Stress Testing ◽  
Coronary Intervention ◽  
Exercise Stress ◽  
Drug Eluting Stent ◽  
Acute Ischemia ◽  
Advanced Degree ◽  
Av Block ◽  
Nuclear Myocardial Perfusion Imaging ◽  
The Right

Background. Exercise causes enhanced sympathetic discharge and results in physiologic tachycardia. However, in some patients with a diseased conduction system resulting from acute ischemia, exercise can precipitate heart block. Methods and results. In this report we describe a 51 years old male patient with transient advanced degree atrioventricular (AV) block developed during recovery from exercise stress testing, resolved after the administration of atropine. Nuclear perfusion imaging demostrated stress-induced ischemia of the inferior-apical segments, and recovery of perfusion in the images obtained at rest. Coronarography showed critical stenosis of the right coronary artery, which was treated by percutaneous coronary intervention (PCI) and drug eluting stent (DES) deployment. Conclusion. Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the infero- apical segment can result in advanced degree AV block in patient with critical severe right coronary disease.

scholarly journals Resistive or dynamic exercise stress testing of the pulmonary circulation and the right heart

2017 ◽  
Vol 50 (1) ◽  
pp. 1700151 ◽  
Author(s):  
Yoshiki Motoji ◽  
Kevin Forton ◽  
Beatrice Pezzuto ◽  
Vitalie Faoro ◽  
Robert Naeije
Keyword(s):  
Pulmonary Circulation ◽  
Stress Testing ◽  
Dynamic Exercise ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Right Heart ◽  
The Right

scholarly journals Prognostic interest of vasodilator stress perfusion cardiovascular magnetic resonance after a first inconclusive stress testing

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
T Unterseeh ◽  
P Garot ◽  
T Hovasse ◽  
M Kinnel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Value ◽  
Stress Testing ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
C Statistic ◽  
Traditional Risk Factors ◽  
Stress Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND While current guidelines recommend to perform a noninvasive test to detect coronary artery disease, stress tests are deemed inconclusive in almost a third of cases. The strategy for risk stratification after inconclusive stress testing is not well standardized. PURPOSE To assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based coronary revascularization in patients after inconclusive stress testing. METHODS Between 2008 and 2020, consecutive patients with a first inconclusive stress test referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. CMR-related coronary revascularization was defined as any revascularisation occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter. RESULTS Of 1,563 patients who completed the CMR protocol, 1,402 patients (66.7% male, mean age 69.5 ± 11.0 years) completed the follow-up (median[interquartile range], 6.5 [5.6-7.5] years); 197 experienced a MACE (14.1%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.88 [95%CI, 2.18-3.81]; and HR: 1.46 [95%CI, 1.16-1.89], both p < 0.001; respectively). In multivariable Cox regression, the presence and extent of inducible ischemia were independent predictors of a higher incidence of MACE (HR: 2.53 [95%CI, 1.89-3.40]; and HR: 1.58 [95%CI, 1.47-1.71]; both p < 0.001; respectively). After adjustment, the extent of inducible ischemia showed the best improvement in model discrimination above traditional risk factors (C-statistic 0.75 [95%CI: 0.69-0.81] with C-statistic improvement: 0.12). The study showed no benefit of CMR-related coronary revascularization in reducing MACE. CONCLUSION In patients with a first inconclusive stress test, stress CMR has good prognostic value to predict MACE offering an incremental prognostic value over traditional risk factors.

scholarly journals Study of efficacy of ischemia reversal program (IRP) in ischemic heart disease (IHD) patients with VO2max and Duke’s treadmill score

2018 ◽  
Vol 7 (8) ◽  
pp. 1642 ◽  
Author(s):  
Rohit Sane ◽  
Varada Sugwekar ◽  
Aarti Nadapude ◽  
Archana Hande ◽  
Gayatri Depe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Heart Disease ◽  
Observational Study ◽  
Ischemic Heart Disease ◽  
Conventional Therapy ◽  
Stress Testing ◽  
World Health ◽  
Inducible Ischemia ◽  
Health Organization

Background: Number of people dying from IHD has increased from 0.61 million in 1990 to 1.13 million in 2010, which is a disturbing fact. According to report by World Health Organization, India would be spending a whopping 237 billion US dollars, owing to direct spending on health care and indirectly due to loss of productivity due to IHD. Ischemia Reversal Program (IRP) is a combination of Panchakarma and allied therapy. This study was conducted to evaluate the effect of IRP on VO2max, Duke’s treadmill score, systolic blood pressure (SBP), diastolic blood pressure (DBP), and dependency on conventional therapy in IHD patients.Methods: This observational study was conducted in January 2017, wherein the data of IHD patients (inducible ischemia on stress testing) who attended out-patient departments (OPDs) at Madhavbaug clinics in Maharashtra, India were identified. Data of patients who were administered IRP (60-75 minutes) with minimum 7 sittings over 90 days (±15 days) were considered. Variables were compared between day 1 and day 90 of the IRP.Results: Out of 38 enrolled patients, 25 were males while 13 females. There was significant improvement in Duke’s score with  subjects at moderate (50%) and high (31.6%) risk at baseline were significantly decreased to low (52.6%) and moderate (47.4%) after the 90th day of therapy.  IRP also showed significant improvement in VO2max by 9.11 (from 20.29±6.72 to 29.40±6.71; p<0.001), SBP by 5.78 (from 128.78±17.40 to 123±12.23, p<0.03), DBP by 4.76 (from 80.53±8.10 to 75.76±6.85, p<0.005). Dependency on concomitant medicines was reduced.Conclusions: IRP was effective in IHD; it had dual benefits, i.e. anti-ischemic effect, as well as reducing the dependency on allopathic medicines.

Abstract 12598: Stress Testing During Long-term Follow-up After Kawasaki Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Audrey Dionne ◽  
Meaghan Beattie ◽  
Thomas Giorgio ◽  
Annette L Baker ◽  
Ming Hui Chen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Myocardial Ischemia ◽  
Cardiac Mri ◽  
Stress Testing ◽  
Stress Test ◽  
Artery Aneurysm ◽  
Exercise Stress ◽  
Inducible Ischemia ◽  
History Of

Introduction: The American Heart Association (AHA) guidelines recommend testing for inducible myocardial ischemia in all patients with a history of coronary artery aneurysm (CAA) after Kawasaki disease (KD). Because the prevalence of clinical coronary complications is exceedingly low in patients whose worst-ever CAA dimension was <large/giant, we examined the yield of stress testing in KD over a 20-year period. Methods: Retrospective study including patients <18 yo with KD who underwent cardiac imaging to evaluate for inducible ischemia between 2000-2019. Patients with a prior coronary artery intervention were excluded. Inducible ischemia was defined as stress-induced reversible wall motion abnormalities on echocardiogram or cardiac MRI, or reversible defect on nuclear myocardial perfusion imaging. Results: A total of 588 stress tests were performed in 208 patients at median age of 12.4 [IQR 8.8, 16.8] years, 8.3 [IQR 5.0, 12.9] years after diagnosis (Table). Tests were performed using either exercise stress (545 [93%] tests) or pharmacologic stress with dobutamine (43 [7%] tests). Echocardiography was the most frequently used modality (n=481, 82%), followed by nuclear imaging (n=133, 23%) and cardiac MRI (n=53, 9%). Inducible ischemia was found on 11 (2%) tests in 6 (3%) patients. All patients with inducible ischemia had a history of giant CAA with persistent CAA at time of testing (moderate CAA in 2 (18%) tests, giant CAA in 9 (82%) tests). After finding inducible ischemia on stress test, coronary artery bypass grafting was performed in 3 cases, cardiac catheterization in 4, stress testing using a different imaging modality in 1, and careful clinical monitoring without intervention in 3. Conclusions: Inducible ischemia was found in 2% of test after KD, and only in patients with a history of giant CAA. Recommendations in the 2017 AHA guidelines for KD for testing for myocardial ischemia in patients with non-giant CAA should be reconsidered in light of these findings.

scholarly journals Prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance after inconclusive stress testing

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Théo Pezel ◽  
Thierry Unterseeh ◽  
Philippe Garot ◽  
Thomas Hovasse ◽  
Marine Kinnel ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Stress Testing ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
C Statistic ◽  
Traditional Risk Factors ◽  
Stress Cmr

Abstract Background While current guidelines recommend noninvasive testing to detect coronary artery disease, stress tests are deemed inconclusive in a quarter of cases. The strategy for risk stratification after inconclusive stress testing is not well standardized. To assess the prognostic value of vasodilator stress cardiovascular magnetic resonance (CMR) parameters and CMR-based coronary revascularization in patients after inconclusive stress testing. Methods Between 2008 and 2020, consecutive patients with a first non-CMR inconclusive stress test referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. CMR-related coronary revascularization was defined as any revascularisation occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter. Results Of 1563 patients who completed the CMR protocol, 1402 patients (66.7% male, 69.5 ± 11.0 years) completed the follow-up (median [interquartile range], 6.5 [5.6–7.5] years); 197 experienced a MACE (14.1%). Vasodilator stress CMR was well tolerated without severe adverse events. Using Kaplan–Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.88 [95% CI 2.18–3.81]; and HR: 1.46 [95% CI 1.16–1.89], both p < 0.001; respectively). In multivariable Cox regression, the presence and extent of inducible ischemia were independent predictors of a higher incidence of MACE (HR: 2.53 [95% CI 1.89–3.40]; and HR: 1.58 [95% CI 1.47–1.71]; both p < 0.001; respectively). After adjustment, the extent of inducible ischemia showed the best improvement in model discrimination above traditional risk factors (C-statistic 0.75 [95% CI 0.69–0.81] with C-statistic improvement: 0.12). The study suggested no benefit of CMR-related coronary revascularization in reducing MACE. Conclusions In patients with a first non-CMR inconclusive stress test, vasodilator stress CMR has good prognostic value to predict MACE offering an incremental prognostic value over traditional risk factors.

Abstract 13293: Acyl-coa Binding Protein is Marker of Myocardial Ischemia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Xu Shi ◽  
Gregory Lewis ◽  
Michelle Keyes ◽  
Laurie Farrell ◽  
Steven Carr ◽  
...  
Keyword(s):  
Stress Testing ◽  
Binding Protein ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Alcohol Ablation ◽  
Inducible Ischemia ◽  
Liquid Chromatography Tandem Mass ◽  
Male Sex ◽  
Cardiac Stress Testing ◽  
Turn Over

Background: We recently applied a liquid chromatography tandem mass spectrometry (LC-MS/MS) based proteomics platform to plasma samples from individuals undergoing a “planned” myocardial infarction (PMI; alcohol ablation for hypertrophic cardiomyopathy) and identified acyl-CoA binding protein (ACBP) as a potential circulating biomarker of myocardial injury. ACBP is a 10 kDa intracellular protein that is highly expressed in cells with a high turn-over of fatty acids such as cardiomyocytes. We sought to determine the site of ACBP release and whether ischemia alone is sufficient to trigger an increment in plasma levels in humans. Methods: Coronary sinus (CS) and peripheral venous samples were obtained simultaneously from PMI patients; peripheral venous samples were obtained from derivation/validation cohorts of subjects undergoing cardiac stress testing. Plasma ACBP levels were measured by immunoassay. Results: In PMI patients (n=11), pre-injury levels of ACBP were comparable in the CS and peripheral samples. As early as 10 min after PMI, ACBP levels were 27% higher in the CS than in the periphery (P = 0.01), and remained 30% higher at 60 minutes (P = 0.02). Next, we studied 105 patients undergoing cardiac stress testing, 52 of whom demonstrated inducible ischemia (cases) and 53 of whom did not (controls). Baseline ACBP levels were comparable in cases and controls. Changes in median ACBP levels after the exercise stress challenge were significantly greater in the ischemic patients (cases) than in the controls (22% increase in cases; 1% decrease in controls; P = 0.0001), findings which were validated in a second cohort of 101 patients subjects (P = 0.002). These findings remained significant in a multivariable model adjusting for age, male sex, diabetes, BMI, smoking, creatinine, hypercholesterolemia, and total minutes of exercise. By contrast, the effects of exercise on established biomarkers (cTnI, NT-proBNP and FABP) did not differ betwen cases and controls. Conclusions: We provide initial verification that ACBP is rapidly released from the injured heart and increases in response not only to infarction but also ischemia. These findings motivate additional clinical studies of this novel biomarker in heterogeneous patient cohorts.

Investor-State Dispute Settlement under NAFTA Chapter 11: The Shape of Things to Come?

1998 ◽  
Vol 35 ◽  
pp. 263-290
Author(s):  
J. Anthony VanDuzer
Keyword(s):  
Free Trade Agreement ◽  
Dispute Settlement ◽  
Trade Agreement ◽  
Minimum Standards ◽  
The North ◽  
State Behaviour ◽  
Nafta Chapter 11 ◽  
To Come ◽  
The Right

SummaryRecently, there has been a proliferation of international agreements imposing minimum standards on states in respect of their treatment of foreign investors and allowing investors to initiate dispute settlement proceedings where a state violates these standards. Of greatest significance to Canada is Chapter 11 of the North American Free Trade Agreement, which provides both standards for state behaviour and the right to initiate binding arbitration. Since 1996, four cases have been brought under Chapter 11. This note describes the Chapter 11 process and suggests some of the issues that may arise as it is increasingly resorted to by investors.

What face familiarity feelings say about the lateralization of specific entities within the core system

2019 ◽  
Vol 42 ◽  
Author(s):  
Guido Gainotti
Keyword(s):  
Temporal Lobe ◽  
Memory System ◽  
Core System ◽  
The Core ◽  
Memory Traces ◽  
Specific Memory ◽  
Target Article ◽  
Temporal Structures ◽  
The Right

Abstract The target article carefully describes the memory system, centered on the temporal lobe that builds specific memory traces. It does not, however, mention the laterality effects that exist within this system. This commentary briefly surveys evidence showing that clear asymmetries exist within the temporal lobe structures subserving the core system and that the right temporal structures mainly underpin face familiarity feelings.

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