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https://www.readbyqxmd.com/read/29744011/noninvasive-evaluation-of-symptomatic-women-with-suspected-coronary-artery-disease
#1
REVIEW
Mohammed A Chamsi-Pasha, Karla M Kurrelmeyer
Cardiovascular disease (CVD) is the leading cause of death in the United States, yet several factors make it challenging to diagnose in women. Although women have more frequent chest pain than men, atypical symptoms such as nausea, dyspnea, and fatigue make it difficult to determine their risk of coronary artery disease (CAD) before testing. Current guidelines recommend exercise electrocardiography (ex-ECG) as the initial test in symptomatic women with intermediate pretest probability who can exercise and have a normal resting ECG; however, treadmill ex-ECG testing has a significantly lower positive predictive value in women...
October 2017: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/29720503/clinical-characteristics-sex-differences-and-outcomes-in-patients-with-normal-or-near-normal-coronary-arteries-non-obstructive-or-obstructive-coronary-artery-disease
#2
Michelle L Ouellette, Adrián I Löffler, George A Beller, Virginia K Workman, Eric Holland, Jamieson M Bourque
BACKGROUND: Normal or near-normal coronary arteries (NNCAs) or nonobstructive coronary artery disease (CAD) are found on invasive coronary angiography in ≈55% of patients. Some attribute this to frequent referral of low-risk patients. We sought to identify the referral indications, pretest risk, key clinical characteristics, sex, and outcomes in patients with NNCAs and nonobstructive CAD versus obstructive CAD on nonemergent invasive coronary angiography. METHODS AND RESULTS: Over 24 months, 925 consecutive patients were classified as having NNCAs (≤20% stenosis), nonobstructive CAD (21-49% stenosis), or obstructive CAD (≥50% stenosis)...
May 2, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29648692/multimodality-imaging-for-evaluation-of-chest-pain-using-strain-analysis-at-rest-and-peak-exercise
#3
Mohamad Jihad Mansour, Wael AlJaroudi, Omar Hamoui, Sarah Chaaban, Elie Chammas
BACKGROUND: Exercise stress echocardiography (SE) is commonly used for diagnosing coronary artery disease (CAD). The use of quantitative echocardiographic measures such as strain imaging is expected to improve the sensitivity of conventional SE which relies on the visual diagnosis of wall-motion abnormalities (WMAs). This study is set to demonstrate the added value of resting and exercise strain analysis to detect underlying microangiopathy and inducible myocardial ischemia during a resting and SE in comparison with the results of coronary computed tomographic angiogram (CCTA)...
April 12, 2018: Echocardiography
https://www.readbyqxmd.com/read/29608443/myocardial-infarction-with-nonobstructive-coronary-arteries-a-single-center-retrospective-study
#4
Fernando Montenegro Sá, Catarina Ruivo, Luís G Santos, Alexandre Antunes, Fátima Saraiva, Francisco Soares, João Morais
BACKGROUND: Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. We aim to determine MINOCA differential characteristics, the main etiologies, and prognostic outcomes. PATIENTS AND METHODS: We carried out a retrospective longitudinal analysis including 1047 patients with MI, from 1 January 2011 to 1 January 2016, subjected to coronary angiography and classified according to the presence [MI and obstructive coronary artery disease (MICAD)] or absence (MINOCA) of any coronary stenosis of at least 50%...
March 31, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29571423/recent-developments-in-sex-related-differences-in-presentation-prognosis-and-management-of-coronary-artery-disease
#5
REVIEW
Mahraz Parvand, Erin Rayner-Hartley, Tara Sedlak
Coronary artery disease (CAD) is the most prevalent type of heart disease among women and men. Sex-related differences in the presentation, prognosis, and management of patients with CAD has been increasingly studied. Compared with men, women are more likely to present with multiple comorbidities, have a higher prevalence of psychological risk factors, and present with atypical symptoms. These factors, along with delays in seeking medical attention, might contribute to sex-related treatment differences in women with stable angina and acute coronary syndrome...
April 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29495996/diagnosis-of-microvascular-angina-using-cardiac-magnetic-resonance
#6
Alexander Liu, Rohan S Wijesurendra, Joanna M Liu, John C Forfar, Keith M Channon, Michael Jerosch-Herold, Stefan K Piechnik, Stefan Neubauer, Rajesh K Kharbanda, Vanessa M Ferreira
BACKGROUND: In patients with angina and nonobstructive coronary artery disease (NOCAD), confirming symptoms due to coronary microvascular dysfunction (CMD) remains challenging. Cardiac magnetic resonance (CMR) assesses myocardial perfusion with high spatial resolution and is widely used for diagnosing obstructive coronary artery disease (CAD). OBJECTIVES: The goal of this study was to validate CMR for diagnosing microvascular angina in patients with NOCAD, compared with patients with obstructive CAD and correlated to the index of microcirculatory resistance (IMR) during invasive coronary angiography...
March 6, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29495995/gadolinium-free-cardiac-mr-stress-t1-mapping-to-distinguish-epicardial-from-microvascular-coronary-disease
#7
Alexander Liu, Rohan S Wijesurendra, Joanna M Liu, Andreas Greiser, Michael Jerosch-Herold, John C Forfar, Keith M Channon, Stefan K Piechnik, Stefan Neubauer, Rajesh K Kharbanda, Vanessa M Ferreira
BACKGROUND: Novel cardiac magnetic resonance (CMR) stress T1 mapping can detect ischemia and myocardial blood volume changes without contrast agents and may be a more comprehensive ischemia biomarker than myocardial blood flow. OBJECTIVES: This study describes the performance of the first prospective validation of stress T1 mapping against invasive coronary measurements for detecting obstructive epicardial coronary artery disease (CAD), defined by fractional flow reserve (FFR <0...
March 6, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29481375/etiology-of-acute-coronary-syndrome-after-noncardiac-surgery
#8
Mohammad A Helwani, Amit Amin, Paul Lavigne, Srikar Rao, Shari Oesterreich, Eslam Samaha, Jamie C Brown, Peter Nagele
BACKGROUND: The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia. METHODS: In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes...
June 2018: Anesthesiology
https://www.readbyqxmd.com/read/29477931/self-management-interventions-for-women-with-cardiac-pain-a-systematic-review-and-meta-analysis
#9
REVIEW
Monica Parry, Ann Kristin Bjørnnes, J Charles Victor, Ana Patricia Ayala, Erica Lenton, Hance Clarke, Paula Harvey, Chitra Lalloo, Judith McFetridge-Durdle, Michael H McGillion, Jennifer Price, Jennifer Stinson, Judy Watt-Watson
BACKGROUND: Cardiac pain is considered the primary indicator of coronary artery disease (CAD). Existing reviews lack appropriate numbers of women or sex-based subgroup analyses, or both; thus, the benefits of self-management (women with cardiac pain actively participating in their own care and treatment) remain uncertain. METHODS: Using methods described by the Evidence for Policy and Practice Information and Co-ordinating Centre at the Institute of Education, 7 databases were systematically searched to examine and synthesize the evidence on self-management interventions for women with cardiac pain and cardiac pain equivalents, such as fatigue, dyspnea, and exhaustion...
April 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29467150/high-sensitivity-troponin-i-levels-and-coronary-artery-disease-severity-progression-and-long-term-outcomes
#10
Ayman Samman Tahhan, Pratik Sandesara, Salim S Hayek, Muhammad Hammadah, Ayman Alkhoder, Heval M Kelli, Matthew Topel, Wesley T O'Neal, Nima Ghasemzadeh, Yi-An Ko, Mohamad Mazen Gafeer, Naser Abdelhadi, Fahad Choudhary, Keyur Patel, Agim Beshiri, Gillian Murtagh, Jonathan Kim, Peter Wilson, Leslee Shaw, Viola Vaccarino, Stephen E Epstein, Laurence Sperling, Arshed A Quyyumi
BACKGROUND: The associations between high-sensitivity troponin I (hsTnI) levels and coronary artery disease (CAD) severity and progression remain unclear. We investigated whether there is an association between hsTnI and angiographic severity and progression of CAD and whether the predictive value of hsTnI level for incident cardiovascular outcomes is independent of CAD severity. METHODS AND RESULTS: In 3087 patients (aged 63±12 years, 64% men) undergoing cardiac catheterization without evidence of acute myocardial infarction, the severity of CAD was calculated by the number of major coronary arteries with ≥50% stenosis and the Gensini score...
February 21, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29415142/a-hidden-culprit-illuminated-with-advanced-cardiac-imaging
#11
Hampton A Crimm, Benjamin W Little, Eugene K Soh, Edward A Hulten
This case demonstrates the complementary benefit of utilizing multimodality cardiac imaging in the assessment of myocardial infarction with nonobstructive coronary artery disease especially when a culprit lesion is not discovered upon initial coronary catheterization. Use of cardiac magnetic resonance imaging, optical coherence tomography, and invasive coronary angiography together solidified the diagnosis of unstable, complex coronary artery disease in this case.
February 5, 2018: Military Medicine
https://www.readbyqxmd.com/read/29322167/use-of-high-risk-coronary-atherosclerotic-plaque-detection-for-risk-stratification-of-patients-with-stable-chest-pain-a-secondary-analysis-of-the-promise-randomized-clinical-trial
#12
Maros Ferencik, Thomas Mayrhofer, Daniel O Bittner, Hamed Emami, Stefan B Puchner, Michael T Lu, Nandini M Meyersohn, Alexander V Ivanov, Elizabeth C Adami, Manesh R Patel, Daniel B Mark, James E Udelson, Kerry L Lee, Pamela S Douglas, Udo Hoffmann
Importance: Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. Objective: To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors...
February 1, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29246884/mortality-of-myocardial-infarction-by-sex-age-and-obstructive-coronary-artery-disease-status-in-the-action-registry-gwtg-acute-coronary-treatment-and-intervention-outcomes-network-registry-get-with-the-guidelines
#13
Nathaniel R Smilowitz, Asha M Mahajan, Matthew T Roe, Anne S Hellkamp, Karen Chiswell, Martha Gulati, Harmony R Reynolds
BACKGROUND: Sex differences in early mortality after myocardial infarction (MI) vary by age. MI with nonobstructive coronary arteries (MINOCA [<50% stenosis]) is more common among younger patients and women, and MINOCA has a better prognosis than MI with obstructive coronary artery disease (MI-CAD). The relationship between age, sex, and obstructive CAD status and outcomes post-MI has not been established. METHODS AND RESULTS: Adults who underwent coronary angiography for acute ST-segment-elevation and non-ST-segment-elevation MI in the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines) from 2007 to 2014 were identified...
December 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29240566/a-practical-clinical-approach-to-utilize-cardiopulmonary-exercise-testing-in-the-evaluation-and-management-of-coronary-artery-disease-a-primer-for-cardiologists
#14
Sundeep Chaudhry, Ross Arena, Deepak L Bhatt, Subodh Verma, Naresh Kumar
PURPOSE OF REVIEW: There is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care. RECENT FINDINGS: CPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD)...
March 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29222132/invasive-assessment-of-the-coronary-microvasculature-the-index-of-microcirculatory-resistance
#15
REVIEW
William F Fearon, Yuhei Kobayashi
Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown. Several invasive modalities for interrogating microvascular function have been proposed. Angiographic techniques have been limited by their qualitative and subjective nature. Doppler wire-derived coronary flow reserve has been applied in research studies, but its clinical role has been limited by its lack of reproducibility, its lack of a clear normal value, and the fact that it is not specific for the microvasculature but interrogates the entire coronary circulation...
December 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29151028/variations-in-use-of-optimal-medical-therapy-in-patients-with-nonobstructive-coronary-artery-disease-a-population-based-study
#16
Adam Oxner, Gabby Elbaz-Greener, Feng Qui, Shannon Masih, Nevena Zivkovic, Sami Alnasser, Asim N Cheema, Harindra C Wijeysundera
BACKGROUND: There is a paucity of data on the need for optimal medical therapy (OMT) in nonobstructive coronary artery disease . We sought to understand if there was variation in the use of OMT between hospitals for patients with nonobstructive coronary artery disease, the factors associated with such variation, and its clinical consequences. METHODS AND RESULTS: Using a population-level clinical registry in Ontario, Canada, we identified all patients >66 years undergoing coronary angiography for the indication of stable angina, who had nonobstructive coronary artery disease between November 1, 2010, and October 31, 2013...
November 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29059651/-the-features-of-a-functional-state-of-the-coronary-circulation-in-women-smokers-with-non-st-elevation-acute-coronary-syndrome
#17
Тетяна М Соломенчук, Артем О Бедзай, Василь В Процько
INTRODUCTION: Acute coronary syndrome is one of the most adverse prognostic clinical forms of ischemic heart disease. In recent years, attention of researchers and cardiologists practical attract female patients due to a substantial increase in the prevalence including acute coronary syndrome, differences in the causes and features of its course. Women often diagnosed myocardial infarction without ST elevation and nonobstructive coronary heart disease associated with coronary spasm or stratification of coronary artery...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29021662/embolized-prostatic-brachytherapy-seeds-mimicking-acute-chest-pain-syndromes
#18
Nirmal Guragai, Upamanyu Rampal, Rahul Vasudev
A 59-year-old male with a history of nonobstructive coronary artery disease, diabetes mellitus, hypertension, and prostate cancer presented to the hospital with 1-day history of pleuritic chest pain. Initial workup for acute coronary event was unremarkable. Chest X-ray revealed multiple small radial densities which were linear and hyperdense, consistent with embolization of metallic seeds to the pulmonary circulation. The patient was noted to have had radioactive metallic seeds implanted for prostate cancer 6 months ago...
October 2017: Indian Journal of Urology: IJU: Journal of the Urological Society of India
https://www.readbyqxmd.com/read/28888269/depression-is-associated-with-recurrent-chest-pain-with-or-without-coronary-artery-disease-a-prospective-cohort-study-in-the-emergency-department
#19
Yeunjung Kim, Morgan Soffler, Summer Paradise, Qurat-Ul-Ain Jelani, James Dziura, Rajita Sinha, Basmah Safdar
BACKGROUND: Only a small fraction of acute chest pain in the emergency department (ED) is due to obstructive coronary artery disease (CAD). ED chest pain remains associated with high rates of recidivism, often in the presence of nonobstructive CAD. Psychological states such as depression, anxiety, and elevation of perceived stress may account for this finding. The objective of the study was to determine whether psychological states predict recurrent chest pain (RCP). METHODS: We conducted a prospective cohort study of low- to moderate-cardiac risk ED patients admitted to the Yale Chest Pain Center with acute chest pain...
September 2017: American Heart Journal
https://www.readbyqxmd.com/read/28817458/noninvasive-derivation-of-fractional-flow-reserve-from-coronary-computed-tomographic-angiography-a-review
#20
Stewart M Benton, Christian Tesche, Carlo N De Cecco, Taylor M Duguay, U Joseph Schoepf, Richard R Bayer
Coronary computed tomographic angiography (CCTA) has evolved as a rapid and highly sensitive method for the exclusion of obstructive coronary artery disease. Unfortunately, as it pertains to moderate and severe lesions, the ability to discriminate between those that are hemodynamically significant and those that are nonobstructive is lacking. Consequently, this deficiency can result in a significant number of unnecessary referrals for invasive angiography that yields nonobstructive results. Fractional flow reserve (FFR), which assesses the hemodynamic significance of a specific lesion, when performed during invasive angiography, results in improved patient outcomes compared with visual stenosis assessment alone...
March 2018: Journal of Thoracic Imaging
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