Prognostic value of hybrid cardiac perfusion SPECT/CT for patients with coronary artery disease after coronary artery bypass grafting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Fukushima ◽  
Y Ishii ◽  
T Kiriyama ◽  
T Nitta ◽  
S Kumita
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Prognostic Value ◽  
Artery Bypass ◽  
Ct Imaging ◽  
Cardiac Spect ◽  
Cardiac Perfusion ◽  
Ct Analysis ◽  
Perfusion Spect ◽  
Artery Disease

Abstract Introduction Patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) occasionally experience recurrent myocardial ischemia. Because of their severe CAD and its complicated hemodynamics, conventional cardiac perfusion SPECT often cannot reveal the severity and prognosis solely. Hybrid cardiac SPECT/CT imaging simultaneously shows myocardial ischemia distribution, coronary artery lesion distribution, and their relationship, and this modality may enable detailed interpretation and risk stratification for such patients. Aim This study aimed to assess the prognostic value of hybrid cardiac SPECT/CT for patients with CAD and suspected myocardial ischemia after CABG. Methods A total of 201 consecutive patients, registered between April 2016 and September 2018, with suspected recurrent angina pectoris after CABG requiring examinations for myocardial ischemia were included in this study. Among these, 135 patients who underwent cardiac perfusion SPECT, cardiac CT, and hybrid cardiac SPECT/CT imaging were analyzed. In the SPECT-only analysis, SDS was calculated, and the patients were divided into none-to-mild (SDS <4) and moderate-to-severe ischemia (SDS ≥4) groups. In the SPECT/CT analysis, the patients were divided into a matched group (SPECT reversible accumulation defects [SDS ≥2] along coronary arteries with significant lesions) and an unmatched group (accumulation defects not coincided with coronary artery territories or no significant stenoses in the corresponding coronary arteries). All patients were observed from the time of these tests for the occurrence of major adverse cardiac events (MACE), and the prognostic performances of these analyses were compared. Results In the SPECT-only analysis, 62 were in the none-to-mild group and 73 were in the moderate-to-severe group. In the SPECT/CT analysis, 61 were in the matched group and 74 were in the unmatched group. Within the follow-up period of 29±8 months, 15 patients experienced MACE. The patients' prognoses were clearly stratified by hybrid SPECT/CT analysis (matched: 13/61, 21.3% vs. unmatched: 2/74, 2.7%) compared with SPECT-only analysis (moderate-to-severe: 11/73, 15.0% vs. none-to-mild: 4/62, 6.5%). The hybrid cardiac SPECT/CT analysis was more strongly associated with the occurrence of MACE compared with SPECT-only analysis (p=0.008 vs. p=0.04, respectively). Conclusions Hybrid cardiac SPECT/CT imaging can have higher prognostic value compared with stand-alone cardiac perfusion SPECT for patients with CAD after CABG. Funding Acknowledgement Type of funding source: None

Transesophageal Atrial Pacing in Anesthetized Patients with Coronary Artery Disease

1996 ◽  
Vol 85 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Charles W. Jr. Hogue ◽  
Victor G. Davila-Roman ◽  
Charles Pond ◽  
Edward Hauptmann ◽  
David Braby ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Anesthesia Induction ◽  
Atrial Pacing ◽  
Artery Disease ◽  
Hypotensive Response

Background Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery. Methods Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 micrograms/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 beats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP. Results Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively. Conclusions Control of heart rate with TEAP restores intraoperative hemodynamics to baseline in patients in whom bradycardia and a hypotensive response develop before coronary artery bypass surgery. When using TEAP for patients with severe coronary artery disease, these results support using the lowest TEAP rate titrated to achieve optimal hemodynamics, while closely monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm.

Factors Affecting Perioperative Transfusion Decisions in Patients with Coronary Artery Disease Undergoing Coronary Artery Bypass Surgery

2006 ◽  
Vol 105 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Nadine Shehata ◽  
Kumanan Wilson ◽  
C David Mazer ◽  
George Tomlinson ◽  
David Streiner ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Index ◽  
Myocardial Ischemia ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Hemoglobin Concentration ◽  
Patient Morbidity ◽  
Artery Disease

Background A high proportion of patients having cardiac bypass surgery receive erythrocyte transfusions. Decisions about when to transfuse patients having surgery for coronary artery disease may impact on erythrocyte utilization and patient morbidity and mortality. There are no published data about the factors that influence physicians' decisions to transfuse erythrocytes to these patients. The objectives of this study were to determine the hemoglobin concentration for transfusion and the factors that influence physicians' perioperative transfusion decisions for coronary artery bypass patients. Methods The authors conducted a cross-sectional study using pretested, self-administered, mailed questionnaires sent in 2004 to all cardiac surgeons and anesthesiologists in Canada who participate in coronary artery bypass surgery. The questionnaire included four intraoperative and four postoperative vignettes. Factors assessed included patient age, sex, cardiac index, and myocardial ischemia. Results The response rates were 70% (345 of 489) for the intraoperative and 61% (297 of 489) for the postoperative case scenarios. The mean hemoglobin concentrations for transfusion were 7.0 g/dl for the intraoperative case scenarios and 7.2 g/dl for the postoperative case scenarios. Older age, the presence of myocardial ischemia, and a low cardiac index were factors that increased the hemoglobin concentration for transfusion (P < 0.0001). Physicians ranked myocardial ischemia as the most significant factor affecting their transfusion decisions. Conclusions Factors such as the presence of a low cardiac index, myocardial ischemia, and older age increase the hemoglobin concentrations at which physicians transfuse coronary bypass surgery patients. Future studies are required to elucidate whether transfusions based on these variables affect patient morbidity and mortality.

scholarly journals Incremental Prognostic Value of Stress/Rest Gated Perfusion SPECT in Patients With Coronary Artery Disease

2010 ◽  
Vol 74 (11) ◽  
pp. 2505
Author(s):  
Akiyoshi Hashimoto ◽  
Tomoaki Nakata ◽  
Takeru Wakabayashi ◽  
Hideo Kusuoka ◽  
Tsunehiko Nishimura
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Gated Perfusion Spect ◽  
Perfusion Spect ◽  
Artery Disease ◽  
Incremental Prognostic Value

scholarly journals Incremental Prognostic Value of Stress/Rest Gated Perfusion SPECT in Patients With Coronary Artery Disease

2009 ◽  
Vol 73 (12) ◽  
pp. 2288-2293 ◽  
Author(s):  
Akiyoshi Hashimoto ◽  
Tomoaki Nakata ◽  
Takeru Wakabayashi ◽  
Hideo Kusuoka ◽  
Tsunehiko Nishimura
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Gated Perfusion Spect ◽  
Perfusion Spect ◽  
Artery Disease ◽  
Incremental Prognostic Value

scholarly journals Análise da contribuição da cintilografia de perfusão miocárdica na decisão entre tratamento clínico vs. revascularização em pacientes com doença coronariana

2021 ◽  
Vol 3 (4) ◽  
pp. 2519-2527
Author(s):  
Artelho de Freitas Guimarães Júnior ◽  
Tathyanne Tremura Rezende ◽  
Nagib Yassin ◽  
Jair Pereira De Melo Júnior ◽  
Whemberton Martins De Araújo
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Clinical Treatment ◽  
Cardiac Perfusion ◽  
Invasive Treatment ◽  
Number Of Patients ◽  
Perfusion Defects ◽  
Artery Disease

Um método diagnóstico comumente utilizado por especialistas na detecção da Doença Arterial Coronariana (DAC) é a Cintilografia de Perfusão Miocárdica (CPM). Segundo Lindner et al. (2007), esse método oferece a possibilidade de estabelecimento de indicadores quantitativos que permitem a instituição de estratificações de risco cardíaco. O presente trabalho visou estabelecer um ponto de corte (“cut off”) baseado em um desses índices de estratificação - “SSS%” - capaz de influenciar na decisão terapêutica entre dois tipos de tratamento para DAC disponíveis – clínico (farmacológico) ou invasivo (angioplastia ou revascularização miocárdica). Além disso, este estudo também objetivou fornecer informações clínicas pertinentes que possam auxiliar os profissionais da área na propedêutica para DAC. Foram avaliados, indiretamente, sem acesso a prontuário, a partir de dados registrados em equipamento específico, via código de identificação, 2.529 pacientes. Desse total, foram analisados 129, dentre os  quais 39,53% se submeteram ao tratamento clínico e 60,47% se submeteram ao tratamento invasivo para DAC após o resultado do primeiro exame. Houve quantidade importante de pacientes submetidos ao tratamento invasivo que apresentou piora do estado de perfusão cardíaca após a terapêutica e, no geral, os pacientes submetidos ao tratamento clínico apresentaram maior redução dos defeitos perfusionais em relação àqueles submetidos ao tratamento invasivo. Não foi possível determinar o valor “cut off”; entretanto, através das análises com comprovação estatística, concluiu-se que pacientes com grandes defeitos perfusionais cardíacos apresentam resposta positiva ao tratamento invasivo. Pacientes com pequenos defeitos perfusionais apresentam piora quando submetidos ao tratamento invasivo.   A diagnostic method commonly used by specialists in the detection of Coronary Artery Disease (CAD) is the Myocardial Perfusion Scintigraphy (MPC). According to Lindner et al. (2007), this method offers the possibility of establishing quantitative indicators that allow the establishment of cardiac risk stratifications. The present study aimed to establish a cut-off point based on one of these stratification indexes - "SSS%" - capable of influencing the therapeutic decision between two types of available treatment for CAD - clinical (pharmacological) or invasive (angioplasty or coronary artery bypass grafting). In addition, this study also aimed to provide pertinent clinical information that may assist practitioners in the propedeutics for CAD. We indirectly evaluated 2,529 patients, without access to medical records, from data recorded in specific equipment via identification code. Of this total, 129 were analyzed, among which 39.53% underwent clinical treatment and 60.47% underwent invasive treatment for CAD after the result of the first exam. There was a significant number of patients undergoing invasive treatment that presented worsening of cardiac perfusion status after therapy and, in general, patients undergoing clinical treatment showed greater reduction of perfusion defects compared to those undergoing invasive treatment. It was not possible to determine the "cut off" value; however, through statistically proven analyses, it was concluded that patients with large cardiac perfusion defects have a positive response to invasive treatment. Patients with small perfusion defects show worsening when undergoing invasive treatment.

Abstract 13660: Initial Revascularization in Chronic Coronary Syndromes With Myocardial Ischemia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrea Soares ◽  
William E Boden ◽  
Whady Hueb ◽  
Maria M Brooks ◽  
Helen A Vlachos ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Artery Bypass ◽  
Obstructive Coronary Artery Disease ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Coronary Syndromes ◽  
Artery Disease

Introduction: Ischemic heart disease is the leading cause of death worldwide. It is unknown whether initial revascularization using percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) plus optimal medical therapy (OMT) in patients with chronic coronary syndromes (CCS), obstructive coronary artery disease (CAD) and myocardial ischemia improves hard clinical outcomes compared to OMT alone. Hypothesis: In CCS patients with obstructive CAD and documented myocardial ischemia, initial revascularization plus OMT does not reduce death or nonfatal myocardial infarction (MI) compared to OMT alone. Methods: We searched Ovid Medline, Embase, Scopus, and Cochrane Library databases from inception to March 2020 for randomized controlled trials (RCTs) of PCI or CABG and OMT vs OMT alone for CCS patients in whom stents and statins were used in more than 50% of patients. Random-effects models were used to estimate average treatment effects across trials. The co-primary outcomes were all-cause death and nonfatal MI at 5 years. Results: Six RCTs were identified that randomized 10,020 CCS patients. At 5 years, among 5,025 CCS patients assigned to revascularization plus OMT, there were 492 deaths (9.8%) compared to 482 deaths among 4,995 patients (9.6%) assigned to OMT (OR, 1.01, 95% CI: 0.88-1.16; P=0.87). There were 521 nonfatal MIs (10.3%) in those assigned to revascularization plus OMT compared with 593 MIs (11.9%) in those assigned to OMT arms (OR, 0.78, 95% CI: 0.58-1.05; P=0.10). In subgroup analysis, nonfatal MI was not reduced by PCI plus OMT (OR, 0.95, 95% CI: 0.74-1.23, P=0.71) but was significantly reduced in studies of CABG plus OMT compared to OMT alone (OR, 0.38, 95% CI: 0.23-0.64, P<0.001). The overall effect of CABG on reducing nonfatal MI was significantly greater than that of PCI (P=0.002). Conclusions: In patients with CCS and myocardial ischemia, initial revascularization with PCI or CABG plus OMT was not associated with a reduction in death at 5 years compared to OMT alone. CABG plus OMT reduced nonfatal MI compared to OMT alone whereas PCI did not. These findings suggest important differences in MI outcomes between those who undergo CABG vs. PCI, but no overall difference in mortality compared with OMT alone.

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