Abstract 15317: Risk of Future Adverse Events in Patients Receiving Class IC Antiarrhythmic Drugs Who Have Elevated Coronary Artery Calcium Scores But Low-risk Cardiac Stress Test

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael J Cutler ◽  
Heidi T May ◽  
T Jared Bunch ◽  
Raymond O McCubrey ◽  
Brian G Crandall ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Adverse Events ◽  
Antiarrhythmic Drugs ◽  
Stress Test ◽  
Qualitative Assessment ◽  
Cardiac Stress ◽  
Quantitative Score ◽  
Stable Cad ◽  
One Year

Background: Class IC antiarrhythmic drugs (AAD) are a standard treatment of cardiac arrhythmias but are associated with harm in patients with prior myocardial infarction (MI)). Consensus guidelines have advocated that these drugs not be used in patients with coronary artery disease (CAD). However, the risk of Class IC AAD in patients with stable CAD, as demonstrated by an elevated coronary artery calcium (CAC) , but a low-risk cardiac stress test (LRCST), remains unclear. We hypothesized that the risk of future adverse cardiovascular events would not differ according to CAC severity among patients with an LRCST on Class Ic AAD treatment. Methods: We identified 355 patients without CAD and an LRCST (<5% ischemia) on cardiac stress PET before initiation of Class IC AAD. CAC was assessed using quantitative scores when available or qualitative CAC assessment on low-dose attenuation correction CT. Patients were divided into no/low CAC (i.e., quantitative score <100 or qualitative assessment of none/mild) or mod/severe CAC (i.e., quantitative score ≥100 or qualitative assessment of moderate/severe) The composite primary endpoint for this analysis was ventricular tachycardia/fibrillation (VT/VF), cardiac arrest, and all-cause death at one-year follow-up. Results: The majority of patients had no/low CAC (n = 278 [78.3%]) compared to mod/severe CAC (n = 77 [21.7%]). Those with no/low CAC were younger (62 vs 70, p<0.0001) and were more likely to have a higher BMI (33.1 v 30.4, p=0.007) when compared to the mod/severe CAC group. Other cardiovascular risk factors were similar between groups. There was no difference in the one-year primary composite outcome of VT/VF, cardiac arrest, and death between no/low CAC compared to mod/severe CAC (3.6% vs 5.2%, p=0.51). Conclusion: In patients receiving Class IC AAD therapy with an LRCST, an elevated CAC did not increase the risk of future adverse events. These data suggest that using Class IC AAD may be safe in patients with stable CAD (no ischemia/elevated CAC). Future prospective trials are needed to evaluate the safety of Class IC AAD in patients with elevated CAC.

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

scholarly journals A Rare Cause of Supraventricular Ectopic Beats and Angina in a Young Patient

2018 ◽  
Vol 4 (2) ◽  
pp. 106-109
Author(s):  
Monica Jurcău ◽  
Mariana Floria ◽  
Bogdan Mazilu ◽  
Anca Ouatu ◽  
Daniela Maria Tanase
Keyword(s):  
Coronary Artery ◽  
Stress Test ◽  
Young Patients ◽  
Physical Exertion ◽  
Diagnostic Techniques ◽  
History Of ◽  
Ectopic Beats ◽  
Artery Disease ◽  
One Year ◽  
The Right

Abstract Introduction: We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats. Case presentation: A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly. Conclusions: Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.

scholarly journals Simple exercise test score versus cardiac stress test for the prediction of coronary artery disease in patients with type 2 diabetes

2014 ◽  
Vol 124 (4) ◽  
pp. 157-164
Author(s):  
Witold Pikto‑Pietkiewicz ◽  
Monika Przewłocka ◽  
Barbara Chybowska ◽  
Alona Cyciwa ◽  
Tomasz Pasierski
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Test ◽  
Test Score ◽  
Stress Test ◽  
Cardiac Stress ◽  
Artery Disease ◽  
Cardiac Stress Test

Abstract 15530: Omega-3 Fatty acids Supplementation Attenuates the Progression of Microalbuminuria in Diabetics With Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dharshan K Lakshminarayan ◽  
Tarec K Elajami ◽  
Michael Soliman ◽  
Abdulhamied Alfaddagh ◽  
Francine K Welty
Keyword(s):  
Coronary Artery Disease ◽  
Fatty Acids ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Artery Disease ◽  
Stable Cad ◽  
One Year

Introduction: Microalbuminuria is a marker of generalized endothelial dysfunction, a key step in the pathogenesis of coronary artery disease (CAD). It is also an independent predictor of cardiovascular morbidity and mortality. Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy is considered a standard of care to attenuate progression of albuminuria in diabetic patients. Hypothesis: Omega-3 fatty acids (FAs) supplementation will attenuate progression of microalbuminuria in diabetic subjects with stable CAD. Method: In our study, 262 subjects with stable CAD were randomized to 3.6 g of omega-3 FAs (1.86 g of eicosapentaenoic acid + 1.5 g of docosahexaenoic acid) per day or no omega-3 FA (control) for one year. Urine microalbumin to creatinine ratio (urine MCR mg/g) was calculated as a measure of microalbuminuria at baseline and one year follow-up. Results: Mean age was 63.3 ± 7.6 yrs, 17% were women, 30% had diabetes, and 74% were on ACEI or ARB therapy. At one year follow-up in non-diabetics, there was no significant difference in the % change in urine MCR between the omega-3 FAs and control groups (see table). In contrast in diabetics, those not receiving omega-3 FAs had a significant 72.3% increase in urine MCR whereas those receiving omega-3 FAs had no change (table). In subgroup analysis, diabetics on an ACEI or ARB receiving omega-3 FAs had no change in urine MCR whereas those not receiving omega-3 FAs had a 64.2% increase at one year follow-up. Conclusions: Omega-3 FAs attenuated worsening of urine MCR in diabetics with CAD compared to diabetics not receiving omega-3 FAs over a one year period. Our results suggest that a combination of omega-3 FAs and ACEI or ARB is better in attenuating the progression of microalbuminuria than ACEI or ARB alone in diabetics with CAD. This suggests that omega-3 FAs may provide additional benefit when added to ACEI/ARB in diabetics with CAD.

Abstract 323: Assessment of Coronary Artery Calcium on Routine Non-gated Chest Computed Tomography to Risk Stratify Patients Presenting With Chest Pain

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Richard Vautier ◽  
Dae Hyun Lee ◽  
Yasmin Ayoubi ◽  
Paula Hernandez Burgos ◽  
Fahad Hawk ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Predictive Value ◽  
Coronary Artery Stenosis ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Chest Ct ◽  
Cardiac Stress ◽  
Risk Patients

Background: Coronary artery calcium (CAC) scoring is an important tool for cardiovascular risk stratification. CAC scoring in both asymptomatic and symptomatic, low-intermediate risk patients has also shown prognostic utility and has a high negative predictive value for obstructive coronary artery disease (CAD). Patients who present with chest pain frequently undergo non-gated chest computed tomography (CT) to evaluate for non-cardiac etiologies. In fact, several studies have demonstrated that a CAC score from a non-gated chest CT correlates well with a dedicated calcium-scoring CT. However, the predictive value on CAD through assessing the presence (CAC>0) or the absence of calcium (CAC=0) detected on non-gated chest CT in patients presenting with chest pain is unknown. Methods: Low-intermediate risk patients (n=92) presenting to the emergency department with chest pain who underwent non-gated chest CT and were subsequently evaluated with either a cardiac stress test or invasive coronary angiography were included. Dichotomous CAC was assessed in a blinded fashion and classified as CAC=0 or CAC>0. Obstructive CAD was defined as either: ischemia on stress testing or any coronary artery stenosis greater than 70% (left main coronary artery stenosis greater than 50%) on invasive coronary angiography. Results: CAC=0 on non-gated chest CT was found in 59.2% (n=42). Patients with CAC=0 had a significantly lower age and TIMI score compared to patients with a CAC>0. (p<0.01 ) Patients with a CAC>0 were found to more likely have obstructive CAD on subsequent testing: cardiac stress test (Likelihood ratio[LR]:6.42, p=0.022); and invasive angiography (LR:12.46, p=0.002). There were no patients with a CAC=0 that were found to have obstructive CAD on invasive coronary angiography, resulting in a 100% sensitivity and 100% negative predictive value. Conclusion: Patient who presents with chest pain frequently undergo evaluation with a non-gated chest CT to assess non-cardiac etiologies. Exclusion of CAC on non-gated chest CT may be useful as an adjunct for further risk stratification to avoid potential adverse events and cost associated with further testing.

scholarly journals Left Atrial Myxoma Causing Coronary Steal: An Atypical Cause of Angina

2015 ◽  
Vol 42 (3) ◽  
pp. 270-272 ◽  
Author(s):  
Kevin Stiver ◽  
Peter Bittenbender ◽  
Bryan A. Whitson ◽  
Charles A. Bush
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Left Atrial ◽  
Stress Test ◽  
Atrial Myxoma ◽  
Cardiac Stress ◽  
Coronary Steal ◽  
Anomalous Coronary ◽  
Anomalous Coronary Arteries ◽  
Cardiac Stress Test

Cardiac myxomas are rare primary cardiac tumors that usually present with dyspnea or manifestations of systemic embolization. Coronary steal is a rare phenomenon of unbalanced blood flow that is seen primarily in patients who have undergone coronary artery bypass grafting and have subclavian artery stenosis. We report the case of a 72-year-old woman who presented with fatigue, weakness, and exertional chest heaviness and had abnormal results on a cardiac stress test. The results of coronary angiography showed no obstructive coronary artery disease but revealed a large intracardiac left atrial mass that was supplied by 2 anomalous coronary arteries. The patient underwent successful ligation of the anomalous coronary arteries and resection of the mass, which was histologically an atrial myxoma. The patient's symptoms resolved, and results of a repeat cardiac stress test were normal. To our knowledge, this is the first report of a highly vascularized atrial myxoma that caused coronary steal with objective evidence of ischemia, and with subsequent resolution after resection of the mass and ligation of the anomalous coronary arteries.

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