Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging

Gaibazzi, Nicola; Porter, Thomas R.; Lorenzoni, Valentina; Santis, Delia De; Rosa, Andrea D. De; Guaricci, Andrea Igoren

doi:10.1161/jaha.117.006202

Cited by 32 publications

(27 citation statements)

References 31 publications

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“…6 Studies using other stress modalities reported similar findings of an association of more ischemia and higher risk of death or MI. 11,[13][14][15][16][17][18] However, even in propensity-matched cohorts there is residual confounding, and a clinical trial was needed to verify this finding. Moreover, these patients did not receive OMT by contemporary standards, while in ISCHEMIA, the median baseline lowdensity lipoprotein cholesterol level was 83 mg/dL, with high rates of use of aspirin and potent statins, and this was prior to intensification of medical therapy when needed to achieve risk factor goals.…”

Section: Discussionmentioning

confidence: 99%

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

et al. 2019

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It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. OBJECTIVE To describe baseline characteristics of participants enrolled and randomized in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate whether qualification by stress imaging or nonimaging exercise tolerance test (ETT) influenced risk profiles. DESIGN, SETTING, AND PARTICIPANTS The ISCHEMIA trial recruited patients with SIHD with moderate or severe ischemia on stress testing. Blinded coronary computed tomography angiography was performed in most participants and reviewed by a core laboratory to exclude left main stenosis of at least 50% or no obstructive coronary artery disease (CAD) (<50% for imaging stress test and <70% for ETT). The study included 341 enrolling sites (320 randomizing) in 38 countries and patients with SIHD and moderate or severe ischemia on stress testing. Data presented were extracted on December 17, 2018. MAIN OUTCOMES AND MEASURES Enrolled, excluded, and randomized participants' baseline characteristics. No clinical outcomes are reported. RESULTS A total of 8518 patients were enrolled, and 5179 were randomized. Common reasons for exclusion were core laboratory determination of insufficient ischemia, unprotected left main stenosis of at least 50%, or no stenosis that met study obstructive CAD criteria on study coronary computed tomography angiography. Randomized participants had a median age of 64 years, with 1168 women (22.6%), 1726 nonwhite participants (33.7%), 748 Hispanic participants (15.5%), 2122 with diabetes (41.0%), and 4643 with a history of angina (89.7%). Among the 3909 participants randomized after stress imaging, core laboratory assessment of ischemia severity (in 3901 participants) was severe in 1748 (44.8%), moderate in 1600 (41.0%), mild in 317 (8.1%) and none or uninterpretable in 236 (6.0%), Among the 1270 participants who were randomized after nonimaging ETT, core laboratory determination of ischemia severity (in 1266 participants) was severe (an eligibility criterion) in 1051 (83.0%), moderate in 101 (8.0%), mild in 34 (2.7%) and none or uninterpretable in 80 (6.3%). Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79.0% had multivessel CAD (n = 2679 of 3390) and 86.8% had left anterior descending (LAD) stenosis (n = 3190 of 3677) (proximal in 46.8% [n = 1749 of 3739]). Participants undergoing ETT had greater frequency of 3-vessel CAD, LAD, and proximal LAD stenosis than participants undergoing stress imaging. CONCLUSIONS AND RELEVANCE The ISCHEMIA trial randomized an SIHD population with moderate or severe ischemia on stress testing, of whom most had multivessel CAD.

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Section: Discussionmentioning

confidence: 99%

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

et al. 2019

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“…Functional evidence of ischemia remains the major criterion for prognostically relevant CAD [ 48 – 50 ]. In 2011, a study by Krittayaphong et al assessed the prognostic value of combined myocardial perfusion CMR and LGE, thus identifying myocardial ischemia as the strongest predictor for hard cardiac events and major adverse cardiac events (MACE) among patients with known or suspected CAD [ 51 ].…”

Section: Prognostic Role Of Stress Cmrmentioning

confidence: 99%

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Baessato

Guglielmo

Muscogiuri

et al. 2021

BioMed Research International

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The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.

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“…Несмотря на наличие исследований, подтверждающих прогностическую роль изолированного нарушения перфузии миокарда [15,16], остается открытым вопрос о необходимости реваскуляризации таких больных. Существует нерандомизированное ретроспективное исследование, показавшее, что проведение чрескожного коронарного вмешательства (ЧКВ) у таких пациентов ассоциировано с более высоким риском смерти и тяжелых кардиальных событий, чем у пациентов, находившихся на медикаментозной терапии [17]. Вопрос этот не решен.…”

Section: миокардиальная контрастная стресс-эхокардиографияunclassified

Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses

Atabaeva

Saidova

Шитов

et al. 2020

Terapevticheskii arkhiv

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Aim. To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses. Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed. Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.

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Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging

Cited by 32 publications

References 31 publications

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses

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