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Nonobstructive coronary artery disease

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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
#1
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
#2
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...
August 16, 2017: Journal of Thoracic Imaging
https://www.readbyqxmd.com/read/28794138/quantitative-assessment-of-coronary-microvascular-function-dynamic-single-photon-emission-computed-tomography-positron-emission-tomography-ultrasound-computed-tomography-and-magnetic-resonance-imaging
#3
REVIEW
Attila Feher, Albert J Sinusas
A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance...
August 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28790123/prognostic-significance-of-nonobstructive-left-main-coronary-artery-disease-in-women-versus-men-long-term-outcomes-from-the-confirm-coronary-ct-angiography-evaluation-for-clinical-outcomes-an-international-multicenter-registry
#4
MULTICENTER STUDY
Joe X Xie, Parham Eshtehardi, Tina Varghese, Abhinav Goyal, Puja K Mehta, William Kang, Jonathon Leipsic, Bríain Ó Hartaigh, C Noel Bairey Merz, Daniel S Berman, Heidi Gransar, Matthew J Budoff, Stephan Achenbach, Tracy Q Callister, Hugo Marques, Ronen Rubinshtein, Mouaz H Al-Mallah, Daniele Andreini, Gianluca Pontone, Filippo Cademartiri, Erica Maffei, Kavitha Chinnaiyan, Gilbert Raff, Martin Hadamitzky, Joerg Hausleiter, Gudrun Feuchtner, Philipp A Kaufmann, Todd C Villines, Benjamin J W Chow, James K Min, Leslee J Shaw
BACKGROUND: Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%-49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. METHODS AND RESULTS: In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years...
August 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28782082/utility-of-imaging-in-risk-stratification-of-chest-pain-in-women
#5
REVIEW
Emily S Lau, Amy Sarma
Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease (CVD) is vital to optimal diagnosis and management, particularly of women (Mosca et al. Circulation 124:2145-54, 2011). There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men (Patel et al...
September 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28764841/non-st-elevation-acute-coronary-syndromes-a-comprehensive-review
#6
Tamunoinemi Bob-Manuel, Ikechuckwu Ifedili, Guy Reed, Uzoma N Ibebuogu, Rami N Khouzam
Non-ST elevation-acute coronary syndrome (NSTE-ACS) includes NSTE myocardial infarction and unstable angina. This patient population forms approximately two-thirds of all hospital admissions for ACS in the United States each year and is associated with an in-hospital mortality of 5%. NSTE-ACS is primarily due to an acute change in the supply and demand balance of coronary perfusion and myocardial oxygen consumption, because of the significant coronary artery obstruction presenting as plaque rupture or erosion...
September 2017: Current Problems in Cardiology
https://www.readbyqxmd.com/read/28714810/advances-in-cardiovascular-health-in-women-over-the-past-decade-guideline-recommendations-for-practice
#7
Pejman Raeisi-Giglou, Annabelle Santos Volgman, Hena Patel, Susan Campbell, Amparo Villablanca, Eileen Hsich
Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies...
July 17, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28670181/transient-ischemic-dilation-ratio-in-regadenoson-single-isotope-gated-single-photon-emission-computed-tomography-myocardial-perfusion-imaging
#8
Manolo Rubio, Andre Dias, Nikoloz Koshkelashvili, Jose N Codolosa, Mauricio Jalife-Bucay, Mary Rodriguez-Ziccardi, Aman M Amanullah
Single isotope 99mTc single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is the most commonly used protocol for nuclear stress testing. Transient ischemic dilation of the left ventricle (TID) has been considered a specific marker of severe coronary artery disease (CAD). Recent publications have questioned the clinical utility of TID, specifically with regadenoson as a stressor and 4DM-SPECT software for TID analysis. These findings have not been demonstrated using other imaging packages...
July 2017: World Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/28610801/effect-of-myocardial-infarction-with-nonobstructive-coronary-arteries-on-physical-capacity-and-quality-of-life
#9
MULTICENTER STUDY
Maria Daniel, Stefan Agewall, Kenneth Caidahl, Olov Collste, Christina Ekenbäck, Mats Frick, Shams Y-Hassan, Logman Henareh, Tomas Jernberg, Karin Malmqvist, Karin Schenck-Gustafsson, Peder Sörensson, Örjan Sundin, Claes Hofman-Bang, Per Tornvall
Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), including Takotsubo syndrome (TS), are considered to have a better survival compared with those with coronary heart disease (CHD). Studies of patients with MINOCA measuring physical and mental function including matched control groups are lacking. The aim of this study was to determine the physical capacity and quality of life in patients with MINOCA. One-hundred patients with MINOCA along with TS (25%) were investigated from 2007 to 2011...
August 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28607128/relationship-of-hypertension-to-coronary-atherosclerosis-and-cardiac-events-in-patients-with-coronary-computed-tomographic-angiography
#10
MULTICENTER STUDY
Rine Nakanishi, Lohendran Baskaran, Heidi Gransar, Matthew J Budoff, Stephan Achenbach, Mouaz Al-Mallah, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Benjamin J W Chow, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Ricardo Cury, Gudrun Feuchtner, Yong-Jin Kim, Jonathon Leipsic, Philipp A Kaufmann, Erica Maffei, Gilbert Raff, Leslee J Shaw, Todd C Villines, Allison Dunning, Hugo Marques, Gianluca Pontone, Daniele Andreini, Ronen Rubinshtein, Jeroen Bax, Erica Jones, Niree Hindoyan, Millie Gomez, Fay Y Lin, James K Min, Daniel S Berman
Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease...
August 2017: Hypertension
https://www.readbyqxmd.com/read/28605043/typical-angina-is-associated-with-greater-coronary-endothelial-dysfunction-but-not-abnormal-vasodilatory-reserve
#11
Ahmed AlBadri, Derek Leong, C Noel Bairey Merz, Janet Wei, Eileen M Handberg, Chrisandra L Shufelt, Puja K Mehta, Michael D Nelson, Louise E Thomson, Daniel S Berman, Leslee J Shaw, Galen Cook-Wiens, Carl J Pepine
BACKGROUND: Typical angina (TA) is defined as substernal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin. Women and elderly patients are usually have atypical symptoms both at rest and during stress, often in the setting of nonobstructive coronary artery disease (CAD). HYPOTHESIS: To further understand this, we performed subgroup analysis comparing subjects who presented with TA vs nontypical angina (NTA) using baseline data of patients with nonobstructive CAD and coronary microvascular dysfunction (CMD) enrolled in a clinical trial...
June 12, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28585034/myocardial-perfusion-imaging-in-women-for-the-evaluation-of-stable-ischemic-heart-disease-state-of-the-evidence-and-clinical-recommendations
#12
Viviany R Taqueti, Sharmila Dorbala, David Wolinsky, Brian Abbott, Gary V Heller, Timothy M Bateman, Jennifer H Mieres, Lawrence M Phillips, Nanette K Wenger, Leslee J Shaw
This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events...
June 5, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28540214/coronary-microvascular-dysfunction-in-women-with-nonobstructive-ischemic-heart-disease-as-assessed-by-positron-emission-tomography
#13
REVIEW
Roxana Campisi, Fernando D Marengo
Traditional approaches for risk assessment of ischemic heart disease (IHD) are based on the physiological consequences of an epicardial coronary stenosis. Of note, normal coronary arteries or nonobstructive coronary artery disease (CAD) is a common finding in women with signs and symptoms of ischemia. Therefore, assessment of risk based on a coronary stenosis approach may fail in women. Positron emission tomography (PET) quantifies absolute myocardial blood flow (MBF) which may help to elucidate other mechanisms involved such as endothelial dysfunction and alterations in the smooth muscle cell relaxation responsible for IHD in women...
April 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28465992/stress-induced-worsening-of-left-ventricular-diastolic-function-as-a-marker-of-myocardial-ischemia
#14
Mohamad Jihad Mansour, Wael Aljaroudi, Ali Mroueh, Omar Hamoui, Walid Honeine, Nada Khoury, Jinane Abi Nassif, Elie Chammas
BACKGROUND: Echocardiography has been the subject of interest in diagnosing diastolic dysfunction and estimating left ventricular filling pressures (LVFPs). The present study is set to estimate the correlation between the worsening of diastolic parameters and the evidence of inducible ischemia during an exercise stress echocardiography (SE) in comparison with the results of coronary computed tomographic angiogram (CCTA). METHODS: A total of 191 consecutive patients from the executive screening program who underwent exercise SE followed by CCTA were evaluated...
April 2017: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/28389572/prognostic-value-of-noninvasive-cardiovascular-testing-in-patients-with-stable-chest-pain-insights-from-the-promise-trial-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain
#15
RANDOMIZED CONTROLLED TRIAL
Udo Hoffmann, Maros Ferencik, James E Udelson, Michael H Picard, Quynh A Truong, Manesh R Patel, Megan Huang, Michael Pencina, Daniel B Mark, John F Heitner, Christopher B Fordyce, Patricia A Pellikka, Jean-Claude Tardif, Matthew Budoff, George Nahhas, Benjamin Chow, Andrzej S Kosinski, Kerry L Lee, Pamela S Douglas
BACKGROUND: Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing. METHODS: In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA)...
June 13, 2017: Circulation
https://www.readbyqxmd.com/read/28387960/optimal-secondary-prevention-medication-use-in-acute-myocardial-infarction-patients-with-nonobstructive-coronary-artery-disease-is-modified-by-management-strategy-insights-from-the-triumph-registry
#16
Reynaria Pitts, Stacie L Daugherty, Fengming Tang, Philip Jones, P Michael Ho, Thomas T Tsai, John Spertus, Thomas M Maddox
BACKGROUND: Patients with acute myocardial infarction (AMI) and nonobstructive coronary artery disease (nonobCAD) may be perceived to be at lower risk for cardiac events, relative to those with obstructive CAD (obCAD), and thus less likely to receive optimal preventive medications in the year following AMI. HYPOTHESIS: We aimed to determine if AMI patients with nonobCAD, compared to obCAD, received lower rates of prevention medications in the year following AMI...
June 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28384014/cardiac-medication-use-in-patients-with-acute-myocardial-infarction-and-nonobstructive-coronary-artery-disease
#17
Falisha Adatia, Shannon Galway, Maja Grubisic, May Lee, Patrick Daniele, Karin H Humphries, Tara L Sedlak
IMPORTANCE: Patients with acute myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) have an elevated cardiac event rate, suggesting that these patients may benefit from cardiac medication. OBJECTIVE: We evaluated the rates of cardiac medication use 3 months before angiography and 3 months following clinically indicated angiography for MI in patients with no CAD, nonobstructive CAD, and obstructive CAD. We also examined the sex differences in cardiac medication use 3 months following angiography in patients by extent of angiographic CAD...
April 6, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28384013/sex-differences-in-cardiac-medication-use-post-catheterization-in-patients-undergoing-coronary-angiography-for-stable-angina-with-nonobstructive-coronary-artery-disease
#18
Shannon Galway, Falisha Adatia, Maja Grubisic, May Lee, Patrick Daniele, Karin H Humphries, Tara L Sedlak
BACKGROUND: Treatment of patients with stable angina and nonobstructive coronary artery disease (CAD) has not been well characterized. We comparatively evaluated medication use in males and females with stable angina with no CAD, nonobstructive CAD, and obstructive CAD. METHODS: We studied all patients ≥20 years old with stable angina undergoing coronary angiography in British Columbia (BC), Canada, from January 2008 to March 2010 (n = 7,535). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1%-49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively...
September 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28330658/nonobstructive-coronary-artery-disease-by-coronary-ct-angiography-improves%C3%A2-risk-stratification-and-allocation%C3%A2-of-statin%C3%A2-therapy
#19
Hamed Emami, Richard A P Takx, Thomas Mayrhofer, Sumbal Janjua, Jakob Park, Amit Pursnani, Ahmed Tawakol, Michael T Lu, Maros Ferencik, Udo Hoffmann
OBJECTIVES: This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA). BACKGROUND: Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy...
September 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28266736/cardiac-ct-angiography-in-the-emergency-room-apical-hypertrophic-cardiomyopathy-presenting-as-acute-coronary-syndrome
#20
Michael C Turner, Edmund K Kerut, James Mckinnie, Michael Davis, Christine Hinton
A 59-year-old male presented to the emergency room with symptoms of chest tightness and palpitations. Following conversion of atrial fibrillation to sinus rhythm, he had deep symmetrical T-wave changes on his electrocardiogram. Symptoms resolved almost immediately, and his initial troponin was negative. He underwent cardiac CT angiography utilizing an emergency room triage protocol which resulted in a diagnosis of nonobstructive coronary artery disease and apical hypertrophic cardiomyopathy. Following a hospital stay of less than 24 hours, he was discharged to outpatient follow-up on medical management and has remained asymptomatic over 6 months...
March 7, 2017: Echocardiography
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