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https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#1
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28719492/fifty-men-3510-marathons-cardiac-risk-factors-and-coronary-artery-calcium-scores
#2
William O Roberts, Robert S Schwartz, Ross F Garberich, Samantha Carlson, Thomas Knickelbine, Jonathan G Schwartz, Gretchen Peichel, John R Lesser, Kelly Wickstrom, Kevin M Harris
INTRODUCTION/PURPOSE: Many male marathon runners have elevated coronary artery calcium (CAC) scores despite high physical activity. We examined the association between CAC scores, cardiovascular risk factors, and lifestyle habits in long term marathoners. METHODS: We recruited men who had run ≥1 marathon annually for 25 consecutive years. CAC was assessed using coronary computed tomography angiography. Atherosclerotic cardiovascular disease (CAD) risk factors were measured with a 12-lead ECG, serum lipid panel, height, weight, resting blood pressure and heart rate, and a risk factor questionnaire...
July 17, 2017: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/28549119/systematic-review-of-cost-effectiveness-of-myocardial-perfusion-scintigraphy-in-patients-with-ischaemic-heart-disease-a-report-from-the-cardiovascular-committee-of-the-european-association-of-nuclear-medicine-endorsed-by-the-european-association-of-cardiovascular
#3
Elin Trägårdh, Siok Swan Tan, Jan Bucerius, Alessia Gimelli, Oliver Gaemperli, Oliver Lindner, Denis Agostini, Christopher Übleis, Roberto Sciagrà, Riemer H Slart, S Richard Underwood, Fabien Hyafil, Marcus Hacker, Hein J Verberne
Coronary artery disease (CAD) is a major cause of death and disability. Several diagnostic tests, such as myocardial perfusion scintigraphy (MPS), are accurate for the detection of CAD, as well as having prognostic value for the prediction of cardiovascular events. Nevertheless, the diagnostic and prognostic value of these tests should be cost-effective and should lead to improved clinical outcome. We have reviewed the literature on the cost-effectiveness of MPS in different circumstances: (i) the diagnosis and management of CAD; (ii) comparison with exercise electrocardiography (ECG) and other imaging tests; (iii) as gatekeeper to invasive coronary angiography (ICA), (iv) the impact of appropriate use criteria; (v) acute chest pain, and (vi) screening of asymptomatic patients with type-2 diabetes...
May 1, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28473507/cost-effectiveness-of-anatomical-and-functional-test-strategies-for-stable-chest-pain-public-health-perspective-from-a-middle-income-country
#4
Eduardo G Bertoldi, Steffen F Stella, Luis Eduardo P Rohde, Carisi A Polanczyk
OBJECTIVES: The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). SETTING: Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system...
May 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28320636/the-significance-of-equivocal-exercise-treadmill-ecg-for-intermediate-risk-chest-pain-assessment-insight-from-coronary-ct-angiography-data
#5
Gary T E Lau, Henry Wei, Jo Wickham, Andrew C Y To
BACKGROUND: Exercise treadmill test (ETT) is commonly the first-line investigation in troponin-negative chest pain patients. Inconclusive results are common and often lead to repeated functional testings. Coronary computed tomographic angiography (CCTA) has excellent negative predictive value for coronary artery disease detection and may play an important role in their diagnostic workup. We aim to analyse ETT and CCTA findings to understand their modern roles in intermediate risk chest pain population with inconclusive ETT...
March 1, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28317171/combination-of-change-in-hematological-parameters-with-exercise-stress-test-to-predict-coronary-artery-disease
#6
Ahmet Korkmaz, Abdulkadir Yıldız, Pınar Türker Duyuler, Serkan Duyuler, Samet Yılmaz, Funda Basyigit, Ozgul Ucar Elalmis, Umit Guray, Mehmet Ileri
OBJECTIVE: Treadmill exercise stress testing for identifying patients with a higher likelihood of coronary artery disease (CAD) before elective coronary angiography is recommended in the current guidelines. In this study, we aimed to evaluate the changes in the hematological parameters before and after exercise stress test in relation with the presence of CAD. METHODS: A total of 113 patients with chest pain who underwent treadmill exercise testing and coronary angiography were included in this study...
March 20, 2017: Journal of Clinical Laboratory Analysis
https://www.readbyqxmd.com/read/28289841/role-of-exercise-cardiogoniometry-in-coronary-artery-disease-diagnostics
#7
A Weber, J Smid, B Luani, R C Braun-Dullaeus, I Tanev
BACKGROUND: The use of noninvasive diagnostics in coronary artery disease remains underdeveloped. To date, there is no simple and inexpensive method that can lead to a reliable diagnosis. Aside from costly and elaborate imaging techniques, exercise ECG, with its rather moderate sensitivity and specificity, is the main diagnostic method available. METHODS: In this prospective study of 109 patients, the diagnostic value of cardiogoniometry (CGM), a three-dimensional, computer-analyzed vector cardiogram, was determined before and after physical stress, and the results were compared with those obtained from a stress test...
August 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28261908/acute-coronary-syndrome-screening-and-diagnostic-practice-variation
#8
Maame Yaa A B Yiadom, Xulei Liu, Conor M McWade, Dandan Liu, Alan B Storrow
BACKGROUND: In the absence of the existing acute coronary syndrome (ACS) guidelines directing the clinical practice implementation of emergency department (ED) screening and diagnosis, there is variable screening and diagnostic clinical practice across ED facilities. This practice diversity may be warranted. Understanding the variability may identify opportunities for more consistent practice. METHODS: This is a cross-sectional clinical practice epidemiology study with the ED as the unit of analysis characterizing variability in the ACS evaluation across 62 diverse EDs...
June 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28144449/intermediate-risk-chronic-stable-angina-neutrophil-lymphocyte-ratio-and-fibrinogen-levels-improved-predicting-angiographically-detected-coronary-artery-disease
#9
Habib Haybar, Ahmad Ahmadzadeh, Ahmadreza Assareh, Nader Afshari, Mohammadreza Bozorgmanesh, Mahdis Vakili
BACKGROUND: Coronary heart disease (CHD) is the leading cause of death worldwide. Research indicates that coronary atherosclerosis is the most frequent cause of CHD. Evidence is scarce concerning the clinical efficacy of fibrinogen or neutrophil-lymphocyte ratio (NLR) measurement in risk-stratifying patients with chronic stable angina. OBJECTIVES: To examine the independent and incremental prognostic value of fibrinogen and neutrophil-lymphocyte ratio (NLR) for angiographically-detected coronary artery disease (CAD)...
September 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28095950/ct-coronary-angiography-vs-coronary-artery-calcium-scoring-for-the-occupational-assessment-of-military-aircrew
#10
COMPARATIVE STUDY
Iain Parsons, Chris Pavitt, Rebecca Chamley, Jo d'Arcy, Ed Nicol
INTRODUCTION: To ensure flight safety military aircrew undergo regular clinical and occupational assessment. Coronary artery calcium scoring (CACS) has been established as an imaging modality to noninvasively assess coronary artery disease (CAD). CT coronary angiography (CTCA) potentially offers a more accurate assessment of CAD, but has not been formally assessed in military aircrew. This retrospective cohort study is designed to compare the theoretical differences in downstream investigations and occupational outcomes in aircrew with suspected CAD comparing CTCA with existing CACS pathways...
February 1, 2017: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/27896702/safety-of-regadenoson-stress-testing-in-patients-with-pulmonary-hypertension
#11
Victor M Moles, Thomas Cascino, Ashraf Saleh, Krasimira Mikhova, John J Lazarus, Michael Ghannam, Hong J Yun, Matthew Konerman, Richard L Weinberg, Edward P Ficaro, James R Corbett, Vallerie V McLaughlin, Venkatesh L Murthy
OBJECTIVES: We sought to determine the safety of regadenoson stress testing in patients with PH. BACKGROUND: PH is increasingly recognized at more advanced ages. As many as one-third of patients with PH have coronary artery disease. Because of their physical limitations, patients with PH are unable to adequately exercise. Regadenoson can potentially have an adverse impact due to their tenuous hemodynamics. Current guidelines suggest performing a coronary angiography in patients with PH who have angina or multiple coronary risk factors...
November 28, 2016: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/27664232/effectiveness-of-cardiogoniometry-compared-with-exercise-ecg-test-in-diagnosing-stable-coronary-artery-disease-in-women
#12
COMPARATIVE STUDY
I Zeljkovic, H Pintaric, M Vrsalovic, I Kruljac
Aims: To investigate the effectiveness of cardiogoniometry, a novel, non-invasive method, in diagnosing coronary artery disease (CAD) in women and compare it with exercise-ECG test, by using coronary angiography as a reference method. Methods: It was a single-centre, case-series study including consecutive female patients with stable angina pectoris (AP) undergoing coronary angiography. Exercise-ECG test, done according to the Bruce protocol, and cardiogoniometry were obtained prior to coronary angiography...
February 1, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27467388/prevalence-and-associated-clinical-characteristics-of-exercise-induced-st-segment-elevation-in-lead-avr
#13
James McKinney, Ian Pitcher, Christopher B Fordyce, Masoud Yousefi, Tee Joo Yeo, Andrew Ignaszewski, Saul Isserow, Sammy Chan, Krishnan Ramanathan, Carolyn M Taylor
BACKGROUND: Exercise-induced ST-segment elevation (STE) in lead aVR may be an important indicator of prognostically important coronary artery disease (CAD). However, the prevalence and associated clinical features of exercise-induced STE in lead aVR among consecutive patients referred for exercise stress electrocardiography (ExECG) is unknown. METHODS: All consecutive patients receiving a Bruce protocol ExECG for the diagnosis of CAD at a tertiary care academic center were included over a two-year period...
2016: PloS One
https://www.readbyqxmd.com/read/27380998/biomarkers-of-cardiovascular-stress-in-obstructive-sleep-apnea
#14
REVIEW
Micha T Maeder, Christian Mueller, Otto D Schoch, Peter Ammann, Hans Rickli
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder associated with "cardiovascular stress", i.e. cardiovascular risk factors, cardiovascular diseases, and an increased risk of heart failure, stroke, and death. Experimental and clinical studies have characterized potential underlying mechanisms including biventricular dysfunction, atherosclerosis, and arrhythmia. Assessment of these cardiovascular features of OSA requires a spectrum of clinical tools including ECG, echocardiography, exercise testing, and angiography...
September 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/27358706/head-to-head-comparison-of-stress-echocardiography-with-exercise-electrocardiography-for-the-detection-of-coronary-artery-stenosis-in-women
#15
Mi-Na Kim, Su-A Kim, Yong-Hyun Kim, Soon Jun Hong, Seong-Mi Park, Mi Seung Shin, Myung-A Kim, Kyoung-Soon Hong, Gil Ja Shin, Wan-Joo Shim
BACKGROUND: Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women...
June 2016: Journal of Cardiovascular Ultrasound
https://www.readbyqxmd.com/read/27353130/st-segment-heart-rate-hysteresis-improves-the-diagnostic-accuracy-of-ecg-stress-test-for-coronary-artery-disease-in-patients-with-left-ventricular-hypertrophy
#16
Marco Zimarino, Elena Montebello, Francesco Radico, Sabina Gallina, Matteo Perfetti, Francesco Iachini Bellisarii, Silva Severi, Ugo Limbruno, Michele Emdin, Raffaele De Caterina
BACKGROUND: The exercise electrocardiographic stress test (ExET) is the most widely used non-invasive diagnostic method to detect coronary artery disease. However, the sole ST depression criteria (ST-max) have poor specificity for coronary artery disease in patients with left ventricular hypertrophy. We hypothesised that ST-segment depression/heart rate hysteresis, depicting the relative behaviour of ST segment depression during the exercise and recovery phase of the test might increase the diagnostic accuracy of ExET for coronary artery disease detection in such patients...
October 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27335655/comparison-between-national-institute-for-health-and-care-excellence-nice-and-european-society-of-cardiology-esc-guidelines-for-the-diagnosis-and-management-of-stable-angina-implications-for-clinical-practice
#17
REVIEW
R Andrew Archbold
Cardiologists in the UK use clinical practice guidelines from the National Institute for Health and Care Excellence (NICE) and from the European Society of Cardiology (ESC) to aid clinical decision-making. This review compares their recommendations regarding stable angina. NICE's diagnostic algorithm changed clinical practice in the UK, with most cardiologists moving from the exercise ECG towards newer, more accurate imaging modalities such as CT and MRI for diagnostic testing in patients with a low or medium probability of coronary artery disease (CAD), and directly to invasive coronary angiography in patients with a high probability of CAD...
2016: Open Heart
https://www.readbyqxmd.com/read/27222386/occult-coronary-artery-disease-in-middle-aged-sportsmen-with-a-low-cardiovascular-risk-score-the-measuring-athlete-s-risk-of-cardiovascular-events-marc-study
#18
Thijs L Braber, Arend Mosterd, Niek H Prakken, Rienk Rienks, Hendrik M Nathoe, Willem P Mali, Pieter A Doevendans, Frank J Backx, Michiel L Bots, Diederick E Grobbee, Birgitta K Velthuis
BACKGROUND: Most exercise-related cardiac arrests in men aged ≥45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged ≥45 years without known cardiovascular disease...
October 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27219901/invasive-angiography-and-revascularization-in-patients-with-stable-angina-following-prior-coronary-artery-bypass-grafting-results-from-the-east-denmark-heart-registry
#19
Francis R Joshi, Luigi Biasco, Frants Pedersen, Lene Holmvang, Steffen Helqvist, Hans-Henrik Tilsted, Ulrik Abildgaard, Henning Kelbaek, Jens F Lassen, Erik Jørgensen, Ole De Backer, Thomas Engstrøm
BACKGROUND: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro-vascular coronary disease and it is not known how often targets for intervention are identified. METHODS: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014...
February 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27143676/quality-of-life-outcomes-with-anatomic-versus-functional-diagnostic-testing-strategies-in-symptomatic-patients-with-suspected-coronary-artery-disease-results-from-the-promise-randomized-trial
#20
RANDOMIZED CONTROLLED TRIAL
Daniel B Mark, Kevin J Anstrom, Shubin Sheng, Khaula N Baloch, Melanie R Daniels, Udo Hoffmann, Manesh R Patel, Lawton S Cooper, Kerry L Lee, Pamela S Douglas
BACKGROUND: The Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial found that initial use of ≥64 detector-row computed tomography angiography versus standard functional testing strategies (exercise ECG, stress nuclear methods, or stress echocardiography) did not improve clinical outcomes in 10 003 stable symptomatic patients with suspected coronary artery disease requiring noninvasive testing. Symptom burden and quality of life (QOL) were major secondary outcomes...
May 24, 2016: Circulation
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