2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Fihn, Stephan D.; Blankenship, James C.; Alexander, Karen P.; Bittl, John A.; Byrne, John G.; Fletcher, Barbara J.; Fonarow, Gregg C.; Lange, Richard A.; Levine, Glenn N.; Maddox, Thomas M.; Naidu, Srihari S.; Ohman, E. Magnus; Smith, Peter K.

doi:10.1016/j.jacc.2014.07.017

Cited by 627 publications

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References 84 publications

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“…The average myocardial perfusion values in patients with coronary artery stenosis less than 70% during the diastolic phase images were significantly lower than the corresponding values obtained without cardiac motion correction: SSS 5(3-7) and 6,5(5-9), (p<0,01); Stress Extent 9,5% (5,5-17,5%) and 12% (9-21,5%), (p<0,01), respectively. The average myocardial perfusion values in patients with coronary artery stenosis more than 70% in the diastole phase images were significantly higher than the corresponding values obtained without cardiac motion correction: SSS 23 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)) and 21 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), (p<0,01); Stress Extent 44,5(35-63) and 39% (18-50%), (p=0,01), respectively. ROC analysis showed that the sensitivity and the specificity rates of MPS performed with cardiac motion correction were significantly (p < 0.05) higher compared with those obtained based on the assessment of summation images.…”

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confidence: 72%

“…-8]. Чувствительность и специфичность данной методики в диагностике ИБС составляют 90-91% и 75-84% соответственно [9]. Одним из факторов, определяющих возникновение лож-ноположительных и ложноотрицательных ре-зультатов ПСМ, является наличие артефактов, обусловленных естественным движением серд-ца.…”

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The Method for Correction of Motion Artefacts to Improve Myocardial Perfusion Imaging

Zavadovsky¹,

Мишкина²,

Мочула³

et al. 2017

Rejr

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ель исследования. Разработка и клиническая апробация методики устране-ния артефактов сокращения сердца при выполнении перфузионной сцинти-графии миокарда. Материалы и методы. В исследование были включены 42 пациента (39 мужчин и 3 женщины) с ишемической болезнью сердца (ИБС). По показаниям пациен-там была выполнена инвазивная (n=30) и МСКТ-коронарография (n=12). Всем пациен-там проводили перфузионную сцинтиграфию миокарда (ПСМ) в условии стресс-нагрузки с ЭКГ-синхронизацией и в состоянии покоя. При помощи специального про-граммного обеспечения из нативных данных реконструировали статические томосцин-тиграммы сердца без ЭКГ-синхронизации и 16 серий томографических изображений в различных фазах сердечного цикла. Для дальнейшего анализа использовали серию изображений, отражающую фазу диастолы сердечного цикла. По результатам инвазив-ной и МСКТ-коронарографии все пациенты были подразделены на две группы: в первую вошли больные ИБС с наличием стенозов коронарных артерий ≥70% (n=18), вторую составили пациенты с сужением коронарных артерий <70% (n=24). По данным ПСМ оценивали следующие показатели: SSS -нарушение перфузии миокарда в усло-виях нагрузочного стресс-теста, Stress Extent -площадь дефектов перфузии при нагрузке.Результаты. У пациентов со стенозом коронарных артерий менее 70% сцинти-графические величины, оцененные по изображениям сердца в фазу диастолы, были до-стоверно ниже в сравнении с их значениями, полученными без коррекции движения сердца: SSS 5 (3-7) и 6,5 (5-9), (p<0,01); Stress Extent 9,5% (5,5-17,5%) и 12% (9-21,5%), (p<0,01) соответственно. В группе пациентов со стенозом коронарных артерий ≥70% показатели ПСМ, оцененные по томосцинтиграммам с коррекцией движения сердца, были статистически значимо выше, чем при оценке изображений без коррекции: SSS 23(19-31) и 21 (8-22), (p<0,01); Stress Extent 44,5 (35-63) и 39% (18-50%), (p=0,01) соот-ветственно. При выполнении ROC-анализа было показано, что показатели чувствитель-ности и специфичности перфузионной сцинтиграфии миокарда, выполненной с кор-рекцией движения сердца, оказались статистически значимо выше (p<0,05), по сравне-нию с оценкой суммационных изображений.Выводы. Значения индексов нарушения миокардиальной перфузии, получен-ные при анализе конечно-диастолических перфузионных томосцинтиграмм, являются достоверно более информативными по сравнению с таковыми при классической мето-дике выполнения ОФЭКТ миокарда, в диагностике ангиографически-значимых стено-зов коронарных артерий (сужение просвета ≥70%). Применение данной методики поз-воляет сократить количество ложноположительных и ложноотрицательных результатов ПСМ и более четко диагностировать гемодинамически значимые стенозы коронарных артерий.Ключевые слова: перфузионная сцинтиграфия миокарда, артефакты движения, ишемическая болезнь сердца.Контактный автор: Завадовский К.В.,

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confidence: 72%

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The Method for Correction of Motion Artefacts to Improve Myocardial Perfusion Imaging

Zavadovsky¹,

Мишкина²,

Мочула³

et al. 2017

Rejr

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“…Current guidelines recommend the use of β‐blockers in patients with CHD 7, 8, 9, 10. Indeed, previous studies have shown the effectiveness of β‐blockers in patients with MI 22.…”

Section: Discussionmentioning

confidence: 99%

“…Current guidelines recommend the use of β‐blockers in patients with coronary heart disease (CHD);7, 8, 9, 10 however, there is no evidence supporting improved survival in patients with stable CHD without a history of myocardial infarction (MI) or heart failure with reduced left ventricular ejection fraction (HFrEF). In addition, based on the potential risk of hypoglycaemia and weight gain attributable to β‐blockers,11, 12 the disadvantages of β‐blockers may outweigh the benefits in patients with diabetes and CHD.…”

Section: Introductionmentioning

confidence: 99%

Effects of β‐blockers on all‐cause mortality in patients with type 2 diabetes and coronary heart disease

Tsujimoto

Sugiyama

Kajio

2017

Diabetes Obesity Metabolism

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AimsTo assess whether the use of beta‐blockers influences mortality and the incidence of major cardiovascular events in patients with diabetes and coronary heart disease (CHD).Materials and methodsUsing data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, we performed Cox proportional hazards analysis to assess the effects of β‐blockers on all‐cause mortality in 2244 patients with type 2 diabetes who had stable CHD with and without a history of myocardial infarction (MI)/heart failure with reduced left ventricular ejection fraction (HFrEF).ResultsAll‐cause mortality in patients with MI/HFrEF was significantly lower in those receiving β‐blockers than in those not receiving β‐blockers (adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.37‐0.98; P = .04), whereas that in patients without MI/HFrEF did not significantly differ (adjusted HR 0.91, 95% CI 0.76‐1.32; P = .64). Among patients with MI/HFrEF, all‐cause mortality in those who received intensive medical therapy alone for CHD was significantly lower in those on β‐blockers than in those not on β‐blockers (adjusted HR 0.45, 95% CI 0.23‐0.88; P = .02); however, mortality in patients who received early revascularization for CHD was not significantly lower in those on β‐blockers (adjusted HR 0.81, 95% CI 0.40‐1.65; P = .57). The risk of major cardiovascular events in patients without MI/HFrEF was not significantly different between those on and those not on β‐blocker treatment.ConclusionsIn patients with diabetes and CHD, the use of β‐blockers was effective in reducing all‐cause mortality in those with MI/HFrEF but not in those without MI/HFrEF.

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“…Outside of acute presentations of CAD or the diagnosis of 3‐vessel, left main, or proximal LAD coronary disease that confers a mortality benefit with revascularization, current guidelines suggest reservation of revascularization for medicallyre fractory, stable, ischemic heart disease 21. Accordingly, the complex decision to pursue revascularization by PCI for nonsurgical CAD is dependent on the physician, patient preferences, patient symptoms, and angiographic findings 22, 23, 24.…”

Section: Discussionmentioning

confidence: 99%

Variation in Management of Patients With Obstructive Coronary Artery Disease: Insights From the Veterans Affairs Clinical Assessment and Reporting Tool (VA CART) Program

Sandhu

Stanislawski

Grunwald

et al. 2017

JAHA

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BackgroundLittle is known about facility‐level variation in the use of revascularization procedures for the management of stable obstructive coronary artery disease. Furthermore, it is unknown if variation in the use of coronary revascularization is associated with use of other cardiovascular procedures.Methods and ResultsWe evaluated all elective coronary angiograms performed in the Veterans Affairs system between September 1, 2007, and December 31, 2011, using the Clinical Assessment and Reporting Tool and identified patients with obstructive coronary artery disease. Patients were considered managed with revascularization if they received percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 30 days of diagnosis. We calculated risk‐adjusted facility‐level rates of overall revascularization, PCI, and coronary artery bypass grafting. In addition, we determined the association between facility‐level rates of revascularization and post‐PCI stress testing. Among 15 650 patients at 51 Veterans Affairs sites who met inclusion criteria, the median rate of revascularization was 59.6% (interquartile range, 55.7%–66.7%). Across all facilities, risk‐adjusted rates of overall revascularization varied from 41.5% to 88.1%, rate of PCI varied from 23.2% to 80.6%, and rate of coronary artery bypass graftingvariedfrom 7.5% to 36.5%. Of 6179 patients who underwent elective PCI, the median rate of stress testing in the 2 years after PCI was 33.7% (interquartile range, 30.7%–47.1%). There was no evidence of correlation between facility‐level rate of revascularization and follow‐up stress testing.ConclusionsWithin the Veterans Affairs system, we observed large facility‐level variation in rates of revascularization for obstructive coronary artery disease, with variation driven primarily by PCI. There was no association between facility‐level use of revascularization and follow‐up stress testing, suggesting use rates are specific to a particular procedure and not a marker of overall facility‐level use.

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2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Cited by 627 publications

References 84 publications

The Method for Correction of Motion Artefacts to Improve Myocardial Perfusion Imaging

The Method for Correction of Motion Artefacts to Improve Myocardial Perfusion Imaging

Effects of β‐blockers on all‐cause mortality in patients with type 2 diabetes and coronary heart disease

Variation in Management of Patients With Obstructive Coronary Artery Disease: Insights From the Veterans Affairs Clinical Assessment and Reporting Tool (VA CART) Program

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