Prognostic utility of ischemic response in functional imaging tests (SPECT or stress echocardiography) in low-risk unstable angina patients

Trivi, Marcelo; Ronderos, Ricardo; Meretta, Alejandro; Conde, Diego; Avegliano, Gustavo

doi:10.5603/cj.a2014.0052

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…Other predictors observed in small studies include a history of CAD, ischemia detected during stress testing, and ECG changes. 11,12 The differences in sample sizes and definitions of obstructive CAD between studies may explain why our results differ from previous findings. In previous studies, obstructive CAD was defined according to the degree of stenosis, without consideration for revascularization procedures.…”

Section: Discussioncontrasting

confidence: 79%

“…8,9 This outcome has been attributed to a higher rate of endothelial dysfunction caused by a relative estrogen deficiency and a higher rate of metabolic syndrome among postmenopausal women, which correlate with symptoms and findings of ischemia in the absence of obstructive CAD. 10 Although the combined use of TIMI and GRACE scores for risk stratification did not predict obstructive CAD in our study, Trivi and colleagues 11 found that the TIMI score was an independent predictor of CAD with ≥70% stenosis. Other predictors observed in small studies include a history of CAD, ischemia detected during stress testing, and ECG changes.…”

Section: Discussioncontrasting

confidence: 49%

“…Traditional cardiovascular risk factors correlated with MACE in the univariate analysis. Although a meaningful multivariate analysis was not possible because of our low event rate, Trivi and colleagues 11 found that TIMI score independently predicted MACE at 6 months. We found that the incidence of MACE was similar among patients regardless of whether they had obstructive CAD; however, it is possible that revascularization improved outcomes in patients with obstructive disease to the extent that their MACE incidence was comparable with that of patients without disease.…”

Section: Discussionmentioning

confidence: 85%

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Incidence and Predictors of Obstructive Coronary Artery Disease and the Role of Cardiac Troponin Assays in Patients with Unstable Angina

Yang¹,

Bhatia²,

Xu³

et al. 2019

Texas Heart Institute Journal

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In a time when cardiac troponin assays are widely used to detect myocardial injury, data remain scarce concerning the incidence and predictors of substantial obstructive coronary artery disease that causes unstable angina. This retrospective single-center study included consecutive patients hospitalized for unstable angina from January 2015 through January 2016. Patients with troponin I levels above the upper reference limit and those who did not undergo angiography were excluded. Multivariate logistic regression analysis was used to identify predictors of obstructive coronary artery disease that warranted revascularization and of major adverse cardiac events up to 6 months after discharge from the hospital. Of the 114 patients who met the inclusion criteria, 46 (40%) had obstructive coronary artery disease. In the univariate analysis, male sex, white race, history of coronary artery disease, prior revascularization, hyperlipidemia, chronic kidney disease, aspirin use, long-acting nitrate use, and Thrombolysis in Myocardial Infarction score ≥3 were associated with obstructive coronary artery disease. History of coronary artery disease, prior revascularization, hyperlipidemia, and long-acting nitrate use were associated with major adverse cardiac events. Male sex was an independent predictor of obstructive coronary artery disease (adjusted odds ratio=4.82; 95% CI, 1.79–13; P=0.002) in the multivariate analysis. Our results showed that coronary artery disease warranting revascularization is present in a considerable proportion of patients who have unstable angina. The association that we found between male sex and obstructive coronary artery disease suggests that the risk stratification of patients presenting with unstable angina may need to be refined to improve outcomes.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 85%

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Incidence and Predictors of Obstructive Coronary Artery Disease and the Role of Cardiac Troponin Assays in Patients with Unstable Angina

Yang¹,

Bhatia²,

Xu³

et al. 2019

Texas Heart Institute Journal

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“…Ukupno preživljavanje u grupi ljudi sa normalnim SEHO nalazom bolje nego u samoj populaciji ljudi odgovarajućih godina i pola 20 . U grupi pacijenata koji boluju od nestabilne angine sa niskim rizikom , ishemijski odgovor pri izvodjenju SEHO testa ili SPECT testa opterećenjem je povezan sa nepovoljnim događajima u budućnosti 21 , što se pokazalo i u našem radu.…”

Section: Rezultatiunclassified

Prognostic utility of a stress echocardiography in patients with incomplete revascularization after successful primary PCI

Bošković¹,

Petrović²,

Rakocevic³

et al. 2017

Srce i krvni sudovi

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Uvod: Stresna ehokardiografija (SEHO) predstavlja pouzdanu tehniku ne samo za dijagnozu koronarne bolesti, već i za stratifikaciju rizika pacijenata sa suspektnom ili dokazanom koronarnom bolešću. Međutim, njena uloga u stratifikaciji rizika kod pacijenata sa inkompletnom revaskularizacijom nakon primarne perkutane koronarne intervencije (pPKI) još nije dovoljno proučena. Cilj rada je bio da se utvrdi i ispita pojava neželjenih događaja u odnosu na rezultat SEHO testa kod pacijenata koji su imali akutni infarkt miokarda i koji su lečeni primanom perkuatnom koronarnom intervencijom, ali su imali takođe i promene na drugim koronarnim arterijama koje u tom aktu nisu tretirane. Metode: Naša studija je obuhvatila 62 pacijenata (prosečne starosti 61 ± 8 godina, muski pol 42; 67,7%). Svi pacijenti su podvrgnuti stres ehokardiografskom testu po Bruce protokolu da bi se procenilo postojanje ishemije u neinfarktnoj arteriji. Stres ehokardiografski test je smatran pozitivnim za ishemiju ukoliko je nakon testa došlo do pojave nove ili pogoršanja postojeće abnormalnosti kinetike zida leve komore u regionu koji vaskularizuje sužena koronarna arterija. Duke skor, funkcionalni kapacitet (MET) i oporavak srčane frekevence su računati kod svakog pacijenta. Značajnost lezije na neinfarktnoj arteriji je procenjena na osnovu koronarne angiografije. Prosečno vreme praćenja ispitivane populacije bio je 35 ± 7 meseci za pojavu neželjenih događaja odnosno srčane smrti, infarkta miokarda i klinički indikovane revaskularizacije (bypass operacija ili perkutana koronarna intervencija). Rezultati: Tokom perioda praćenja bilo je ukupno 18 (29%) neželjenih događa (3 infarkta miokarda, 4 bypass operacije i 11 PKI). Pacijenti sa nežljenim događajima su imali statistički značajno veću učestalost pozitivnog SEHO testa (10; 55.6% vs 5; 11.4%, p<0,001), dijabetesa (9; 50% vs 10 22,7%, p=0,034) i značajno manji Duke skor (4,6 ± 3 vs 6,9 ± 2,7, p=0,007) u odnosu na pacijente bez neželjenih događaja. Koristeći Kaplan-Meier-ovu krivu preživljavanja pokazalo se da su rezultat SEHO testa (pozitivan SEHO prosečno vreme bez događaja 17,9 ± 5,2 meseca u odnosu na negativan SEHO test 41,6 ± 1,8, Log Rank 20,378, p<0,001) i dijabetes (prosečno vreme bez događaja 26,6 ± 4,8 meseca u odnosu na pacijente bez dijabetesa 40 ± 2,2, Log Rank 5,949, p=0,015) bili prediktori pojave neželjenih događaja. Međutim u Cox-ovoj regresionoj analizi kao nezavisni prediktor pojave neželjenih događaja bio je samo pozitivan SEHO test (HR 5,516 [95% CI 2,096-14,514], p=0.01) ali ne i dijabetes. Pozitivna prediktivna vrednost SEHO testa za predikciju neželjenih događaja bila je 66.7% a negativna prediktivna vrednost 82.9%. Zaključak: Naše ispitivanje je pokazalo da SEHO test ima visoku negativnu i zadovoljavajuću pozitivnu prediktivnu vrednost za pojavu neželjenih kardiovaskularnih događaja kod pacijenata sa inkompletnom revaskularizacijom nakon pPKI i da je veoma korisna metoda za stratifikaciju rizika kod ovih pacijenata. Stress ehokardiografoka, nekompletna revaskularizacija, prim...

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Coenzyme Q10 and Utility in Heart Failure: Just Another Supplement?

Oleck

Ventura²

2016

Curr Heart Fail Rep

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Heart failure affects 5.1 million people in the USA annually. It accounts for a frequent cause of hospitalizations and disability. Patients with congestive heart failure have lower plasma levels of CoQ10, which is an independent predictor of mortality in this patient population. It has been hypothesized that a deficiency of CoQ10 can play a role in the development and worsening of heart failure, and that oral supplementation can possibly improve symptoms and survival in these patients. Based on previous small studies and meta-analyses, the use of CoQ10 in heart failure suggested an improvement ejection fraction, stroke volume, cardiac output, and cardiac index with CoQ10 supplementation, however most of these small studies appeared to be underpowered to result in any significant data. The results of the recent Q-SYMBIO trial demonstrated an improvement in heart failure symptoms with a significant reduction in major adverse cardiovascular events and mortality.

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Prognostic utility of ischemic response in functional imaging tests (SPECT or stress echocardiography) in low-risk unstable angina patients

Abstract: IMAGING+ (OR: 6.4, p < 0.0001 (SPECT or SE) was associated with adverse events and severe coronary artery disease. (Cardiol J 2015; 22, 2: 160-164)

Cited by 7 publications

References 19 publications

Incidence and Predictors of Obstructive Coronary Artery Disease and the Role of Cardiac Troponin Assays in Patients with Unstable Angina

Incidence and Predictors of Obstructive Coronary Artery Disease and the Role of Cardiac Troponin Assays in Patients with Unstable Angina

Prognostic utility of a stress echocardiography in patients with incomplete revascularization after successful primary PCI

Coenzyme Q10 and Utility in Heart Failure: Just Another Supplement?

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