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.

scholarly journals How to prevent and manage radiation-induced coronary artery disease

Heart ◽  
2018 ◽  
Vol 104 (20) ◽  
pp. 1647-1653 ◽  
Author(s):  
Jason R Cuomo ◽  
Sean P Javaheri ◽  
Gyanendra K Sharma ◽  
Deepak Kapoor ◽  
Adam E Berman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Risk Factor Management ◽  
Triple Vessel Disease ◽  
Long Latency ◽  
Perfusion Defects ◽  
Radiation Induced ◽  
Artery Disease

Radiation-induced coronary heart disease (RICHD) is the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin’s lymphoma and other prevalent mediastinal malignancies. The risk of RICHD increases with radiation dose. Exposed patients may present decades after treatment with manifestations ranging from asymptomatic myocardial perfusion defects to ostial, triple-vessel disease and sudden cardiac death. RICHD is insidious, with a long latency and a tendency to remain silent late into the disease course. Vessel involvement is often diffuse and is preferentially proximal. The pathophysiology is similar to that of accelerated atherosclerosis, characterised by the formation of inflammatory plaque with high collagen and fibrin content. The presence of conventional risk factors potentiates RICHD, and aggressive risk factor management should ideally be initiated prior to radiation therapy. Stress echocardiography is more sensitive and specific than myocardial perfusion imaging in the detection of RICHD, and CT coronary angiography shows promise in risk stratification. Coronary artery bypass grafting is associated with higher risks of graft failure, perioperative complications and all-cause mortality in patients with RICHD. In most cases, the use of drug-eluting stents is preferable to surgical intervention, bare metal stenting or balloon-angioplasty alone.

scholarly journals AGE PECULIARITIES OF COMORBID PATHOLOGY IN PATIENTS UNDERGOING PLANNED CORONARY ARTERYBYPASS GRAFTING

2017 ◽  
Vol 8 (3) ◽  
pp. 54-60 ◽  
Author(s):  
O L Barbarash ◽  
I I Zhidkova ◽  
I A Shibanova ◽  
S V Ivanov ◽  
A N Sumin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Age Groups ◽  
Heart Rhythm ◽  
Bypass Grafting ◽  
Previous Myocardial Infarction ◽  
Cardiovascular Comorbidities ◽  
Number Of Patients ◽  
Age Factor ◽  
Artery Disease

Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing worldwide. Therefore, the assessment of comorbidities based on the age factor in patients with coronary artery disease (CAD) is highly relevant.Aim: To assess the associations between the age factor and comorbidities in patients undergoing CABG. Material and Methods: Data of 680 patients [538 (79.10%) men and 142 (20.90%) women], undergoing elective CABG in the period 2011-2012, included in the CABG Registry were used to detect comorbidities.All patients were enrolled into 4 age groups: below 50 years, 51-60 years, 61-70 years, over 70 years.Results: Aging was associated with an increase in the proportion of women suffering from arterial hypertension (AH), and multivessel disease. Similarly, the proportion of patients with higher func-tional class (FC) of angina, heart failure (CH), and heart rhythm disturbances increased. The number of patients referred to elective CABG with previous myocardial infarction (MI) was the highest among young adults (77%). Aging was associated with an increase in the number of patients with chronic pyelonephritis (44.30%) and thyroid pathology (3.40%).Conclusion: Patients’ aging is associated with an increase in cardiovascular comorbidities, but not MI. Importantly, there was no any increase in the rate of non-cardiovascular comorbidities.

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

scholarly journals MODERN SURGICAL APPROACHES TO THE TREATMENT OF COMBINED ATHEROSCLEROTIC DAMAGE OF THE CORONARY AND CAROTID ARTERIES

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
R RAKHIMOVA ◽  
D ALIMOV
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Randomized Clinical Trials ◽  
Carotid Artery Disease ◽  
Artery Bypass ◽  
Carotid Stenting ◽  
Risk Level ◽  
Surgical Approaches ◽  
Number Of Patients ◽  
Artery Disease

The number of patients with brachiocephalic artery disease and coronary artery disease (CHD) is steadily increasing. Despite the achieved results in the surgical treatment of patients with lesions of the brachiocephalic arteries and concomitant coronary artery disease, the world has not yet reached a consensus on the tactics of treating this group of patients. Most patients with concomitant coronary and carotid artery disease have a combination of two or more risk factors for neurological complications. In addition, for elderly patients, the time of artificial circulation and the duration of the operation are of decisive importance. An increase in this time is inevitable with a single-stage surgical operation. Carotid endarterectomy or carotid stenting is indicated before or simultaneously with coronary artery bypass grafting in symptomatic patients with 80% carotid stenosis (LE: C). However, until data from randomized clinical trials are available, the surgical approach to patients with severe coronary and carotid lesions will be individualized, based on the specific risk level of each patient and the experience of the institution.

AB0 Blood Groups and Coronary Heart Disease (CHD)

1980 ◽  
Vol 43 (02) ◽  
pp. 137-140 ◽  
Author(s):  
Jan Erikssen ◽  
Erik Thaulow ◽  
Helge Stormorken ◽  
Ole Brendemoen ◽  
Arvid Hellem
Keyword(s):  
Coronary Artery ◽  
Blood Group ◽  
Artery Bypass ◽  
Laboratory Data ◽  
Epidemiological Data ◽  
Consecutive Series ◽  
Related Factors ◽  
Ab0 Blood Groups ◽  
Clinically Significant ◽  
Artery Disease

SummaryThe view based on epidemiological and laboratory data that blood group A subjects (=A) have clinically significant higher thrombotic potential than blood group 0 subjects (= O), is supported by the present finding of a significantly higher platelet retention in A than 0.The completely normal ABO distribution found among 71 cases of proven latent CHD, and the disproportionate excess of 0 vs. A in a consecutive series of 191 coronary artery bypass candidates apparently conflict with epidemiological data indicating a higher risk of achieving CHD in A than 0. The conflict may be solved by suggestinga) that the »thrombotic proneness« in A compared with 0 causes a poorer prognosis in CHD among the former, leaving a disproportionate excess of 0 among longterm CHD survivors, and b) that AB0-related factors have had an insignificant, independent impact on the evolution of preclinical coronary artery disease in our 71 men with latent CHD.

Coronary Artery Disease Screening Using CT Coronary Angiography

2020 ◽  
Vol 91 (10) ◽  
pp. 812-817
Author(s):  
Randy Wang Long Cheong ◽  
Brian See ◽  
Benjamin Boon Chuan Tan ◽  
Choong Hou Koh
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Risk ◽  
Disease Screening ◽  
Ct Coronary Angiography ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Artery Disease

BACKGROUND: The increased utility of CT coronary angiography (CTCA) in cardiovascular screenings of aircrew has led to the increased detection of asymptomatic coronary artery disease (CAD). A systematic review of studies relevant to the interpretation of CTCA for the occupational fitness assessment of high-risk vocations was performed, with findings used to describe the development of a pathway for the aeromedical disposition of military aviators with asymptomatic CAD.METHODS: Medline was searched using the terms CT coronary angiogram and screening and prognosis. The inclusion criteria were restricted to study populations ages > 18 yr, were asymptomatic, were not known to have CAD, had undergone CTCA, and with their associations with major adverse cardiovascular events (MACE) and other relevant cardiac outcomes reported.RESULTS: Included in this systematic review were 10 studies. When compared to subjects with no or nonobstructive CAD, those with obstructive CAD on CTCA had hazard ratios (HR) for cardiac events ranging from 1.42 to 105.48. Comparing subjects with nonobstructive CAD and those without CAD on CTCA, a lower HR of 1.19 for cardiac events was found. The annual event rates of subjects with no CAD on CTCA were extremely low, ranging from 0 to 0.5%.CONCLUSIONS: Based on the findings, we suggest that CTCA should only be performed in aircrew with higher cardiac risk profiles. Those found to have no CAD or minimal CAD (i.e., 25% stenosis) in a non-left main coronary artery on CTCA can be returned to flying duties. All other results should be further evaluated with an invasive angiogram.Cheong RWL, See B, Tan BBC, Koh CH. Coronary artery disease screening using CT coronary angiography. Aerosp Med Hum Perform. 2020; 91(10):812817.

Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

2010 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Dimitrios Bliagos ◽  
Ajay J Kirtane ◽  
Jeffrey W Moses ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Ageing Population ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Asymptomatic Diabetic Patient ◽  
Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

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