scholarly journals P327 Concordance between regadenoson stress echocardiography and spect-MIBI (99mTc) in patients with suspected myocardial ischemia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J C E M Echarte ◽  
P M S Menendez ◽  
I I G Iglesias ◽  
J V M Vara ◽  
J B R Borrego ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Coronary Revascularization ◽  
Kappa Index ◽  
A2a Adenosine Receptor ◽  
Adenosine Receptor Agonist ◽  
Risk Stratum ◽  
Artery Disease

Abstract Background Regadenoson is a selective A2A adenosine receptor agonist approved for the detection of myocardial with SPECT-MIBI. To date, few studies have appraised the utility of this drug using transthoracic echocardiography with the same purpose. We designed this prospective study to evaluate the diagnostic agreement between these two techniques used simultaneously to detect myocardial ischemia. We report our first results evaluating the concordance between both techniques. Methods Patients enrolled were referred to our clinic for the evaluation of chest pain. Myocardial perfusion imaging was performed with regadenoson (400 µg ) which was injected before 99mTc-MIBI. Stress and rest sets of images were evaluated for relative uptake of the radiotracer in order to detect and characterize perfusion defects. The echocardiogram was acquired 60-90 seconds after the administration of the drug using a standardized technique. Two independent observers (one cardiologist and one specialist in nuclear medicine) interpreted the images, both unaware of the result of the complementary technique. Results One hundred twenty five patients were included, 69 (55%) of them males. Median age was 73 years (IQR 65-79). One hundred seventeen patients had both studies interpretable. Thirty-nine (32.5%) patients had had a diagnosis of ischemic heart disease before the study (either a myocardial infarction or a coronary revascularization). The median pre-test probability of coronary artery disease in those without a true previous diagnosis was 30.5% (16.0-50.8), being 50% in the intermediate risk (15-85%) and 49% in the low risk stratum (less than 15%). Significant reductions is systolic and diastolic blood pressure were detected with regadenoson [systolic 134 (21) mmHg Vs 131 (23) mmHg, p < 0.001; diastolic: 78 (12) mmHg Vs 73 (13) mmHg, p < 0.001], with a striking increase in heart rate: 67 (13) bpm Vs 91 (17) bpm, p < 0.001. More patients had a SPECT test showing myocardial ischemia (28% Vs 16%; p < 0.001). Agreement between both tests were 84%. The kappa index obtained from this sample was 0.34 (CI95% 0.15-0.53). Segregating those patients without a history of coronary artery disease (n = 81), the positive test rate were 14% for echo and 20% for SPECT-MIBI (p = 0.019). Kappa index was even lower: 0.29 (CI95% 0.02-0.56). Conclusions. SPECT-MIBI provides more positive tests than stress echocardiography when regadenoson is used as the stressor agent. The concordance between tests is low.

Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

2001 ◽  
Vol 40 (06) ◽  
pp. 198-206 ◽  
Author(s):  
M. Jochims ◽  
P. Theissen ◽  
F. M. Baer ◽  
J. Crnac ◽  
E. Voth ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Dobutamine Stress ◽  
Resonance Imaging ◽  
Alternative Strategies ◽  
Artery Disease

SummaryAim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

scholarly journals Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Vladimir Ganyukov ◽  
Nikita Kochergin ◽  
Aleksandr Shilov ◽  
Roman Tarasov ◽  
Jan Skupien ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trial ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Sick Leave ◽  
Hospital Stay ◽  
Randomized Clinical Trial ◽  
Coronary Revascularization ◽  
Hybrid Coronary Revascularization ◽  
Artery Disease

Aim. Optimal revascularization strategy in multivessel (MV) coronary artery disease (CAD) eligible for percutaneous management (PCI) and surgery remains unresolved. We evaluated, in a randomized clinical trial, residual myocardial ischemia (RI) and clinical outcomes of MV-CAD revascularization using coronary artery bypass grafting (CABG), hybrid coronary revascularization (HCR), or MV-PCI. Methods. Consecutive MV-CAD patients (n = 155) were randomized (1 : 1 : 1) to conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart Team agreement on equal technical and clinical feasibility of each strategy. SPECT at 12 months (primary endpoint of RI that the trial was powered for; a measure of revascularization midterm efficacy and an independent predictor of long-term prognosis) preceded routine angiographic control. Results. Data are given, respectively, for the CABG, HCR, and MV-PCI arms. Incomplete revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.71). Hospital stay was 13.8 vs. 13.5 vs. 4.5 days (p<0.001), and sick-leave duration was 23 vs. 16 vs. 8 weeks (p<0.001). At 12 months, RI was 5 (2, 9)% vs. 5 (3, 7)% vs. 6 (3, 10)% (median; Q1, Q3) with noninferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs. CABG). Rates of angiographic graft stenosis/occlusion or in-segment restenosis were 20.4% vs. 8.2% vs. 5.9% (p=0.05). Clinical target vessel/graft failure occurred in 12.0% vs. 11.5% vs. 11.3% (p=0.62). Major adverse cardiac and cerebral event (MACCE) rate was similar (12% vs. 13.4% vs. 13.2%; p=0.83). Conclusion. In this first randomized controlled study comparing CABG, HCR, and MV-PCI, residual myocardial ischemia and MACCE were similar at 12 months. There was no midterm indication of any added value of HCR. Hospital stay and sick-leave duration were shortest with MV-PCI. While longer-term follow-up is warranted, these findings may impact patient and physician choices and healthcare resources utilization. This trial is registered with NCT01699048.

scholarly journals P328 Relation between CHA2DS2-VASc and impaired heart rate recovery in patients without inducible myocardial ischemia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Boskovic ◽  
A Popovic ◽  
M T Petrovic ◽  
S Dedic ◽  
S Aleksandric ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Systolic Blood Pressure ◽  
Stress Echocardiography ◽  
Heart Rate Recovery ◽  
Inducible Ischemia ◽  
Artery Disease

Abstract Background Heart rate recovery (HRR) has been shown to predict cardiovascular and all-cause morbidity and mortality in different populations. Recent studies have indicated the CHA2DS2-VASc score can be used as predictor of mortality in patients with coronary artery disease, without atrial fibrillation. However, the relation between these two parameters has not yet been documented. The Aim: The aim of this study was to determine the relation between CHA2DS2-VASc score and impaired heart rate recovery in patients without inducible myocardial ischemia. Methods Our study comprised of 2699 consecutive patients (1319 male, 42.8%, average age 60 ± 11 years) who underwent treadmill exercise testing (stress echocardiography or stress echocardiography) according to Bruce protocol for the assessment of myocardial ischemia. We excluded patients with the systolic heart failure (left ventricle ejection fraction &lt;45%) and those with inducible ischemia. CHA2DS2-VASc score was calculated according to the guidelines. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), chronotropic competence (CC), body mass index (BMI) were calculated in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min. Results Out of 2699 patients, 378 (12.3%) had a positive test and they were excluded from further analysis. Of the remaining 2321 patients, 251 (10.8%) had an impaired HRR, whereas 2070 (89.2%) had normal HRR. Previously known coronary artery disease (previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery) had 78 (3.4%) patients. Patients with impaired HRR had significantly higher CHA2DS2-VASc score (3.1 ± 1.3 vs 2.3 ± 1.2, p &lt; 0.001), higher resting heart rate (76.9 ± 16.1 vs 73.3 ± 12.3bpm, p &lt; 0.001), higher systolic blood pressure at rest (122.1 ± 13.9 vs 117.2 ± 13.4mmHg, p &lt; 0.001), higher diastolic blood pressure at rest (73.7 ± 7.5 vs 72.3 ± 7.2mmHg, p &lt; 0.001), higher rate of hyperlipproteinemia (176/251, 70.1% vs 1294/2070, 62.5%, p &lt; 0.001), higher BMI (27.3 ± 3.6 vs 26.4± 3.6kg/m2, p &lt; 0.001), shorter duration of the test (5.2 ± 1.8 vs 6.4 ± 1.9 minutes, p &lt; 0.001). lower Duke score (4.6 ± 2.4 vs 6.1 ± 2.4 minutes, p &lt; 0.001). lower MET (6.3 ± 1.8 vs 7.5 ± 1.9, p &lt; 0.001) and higher rate of chronotropic incompetence (173/251, 68.9% vs 1036/2070, 50%, p &lt; 0.001) compares to the patients with normal HRR. Multivariate predictors of impaired HRR were higher CHA2DS2-VASc score (p &lt; 0.001), not achieved THR (p &lt; 0.001), higher heart rate at rest (p = 0.001), higher systolic blood pressure at rest (p = 0.001) and shorter duration of test (p = 0.046). Conclusion CHA2DS2-VASc score is an independent predictor of impaired HRR in patients without inducible ischemia.

scholarly journals Randomized clinical trial of surgical vs. percutaneous vs. hybrid revasculatization in multivessel coronary artery disease: 3 years follow-up (the HREVS Trial)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Ganyukov ◽  
N Kochergin ◽  
A Shilov ◽  
R Tarasov ◽  
J Skupien ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trial ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Randomized Clinical Trial ◽  
Primary Endpoint ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Heart Team ◽  
Artery Disease

Abstract Aim Optimal revascularization strategy in multi-vessel (MV) coronary artery disease (CAD) eligible for percutaneous intervention (PCI) and surgery remains unresolved. We evaluated, in a randomized clinical trial, residual myocardial ischemia (RI) and clinical outcomes of MV-CAD revascularization using coronary artery bypass grafting (CABG), hybrid coronary revascularization (HCR) or MV-PCI. Materials and methods Consecutive MV-CAD patients (n=155) were randomized (1:1:1) to conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart Team agreement on equal technical and clinical feasibility of each strategy. The primary endpoint was SPECT at 12 months (primary endpoint of RI that the trial was powered for; a measure of revascularization mid-term efficacy and an independent predictor of long-term prognosis). The secondary endpoint was 3-year MACCE. Results Baseline characteristics were similar between the study arms. 5 (9.8%) patients in the HCR group required conversion to CABG. Data are given respectively for the CABG, HCR and MV-PCI arm. Incomplete revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.86). At 12 months, RI was 5 (2,9)% vs. 5 (3,7)% vs. 6 (3,10)% (median; Q1,Q3) with non-inferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs. CABG). 3-year MACCE rate was similar (34.7% vs. 27.1% vs. 38%; p=0.18). Conclusion In patients with MV-CAD amenable to CABG, HCR, and MV-PCI, endpoints of residual myocardial ischemia at 12 months and 3-year MACCE were similar. ClinicalTrials: gov identifier: NCT01699048 Funding Acknowledgement Type of funding source: None

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