Journal ArticleDOI
Additive Prognostic Value of Coronary Flow Reserve in Patients With Chest Pain Syndrome and Normal or Near-Normal Coronary Arteries
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In patients with angiographically normal or near-normal coronary arteries and preserved at-rest regional and global left ventricular function at baseline and during stress, CFR adds incremental value to the prognostic stratification achieved with clinical and angiographic data.Abstract:
In patients with angiographically normal coronary arteries and chest pain, pharmacologic stress echocardiography can identify a subgroup of patients with a less benign prognosis. Coronary flow reserve (CFR) in the left anterior descending artery (LAD) can currently be combined with wall motion analysis during vasodilator stress echocardiography. The aim of this study was to assess the prognostic value of CFR response in patients with normal coronary arteries and normal wall motion during stress. We selected 394 patients (171 men, 61 +/- 11 years of age) who underwent dipyridamole stress echocardiography (0.84 mg/kg over 6 minutes) with 2-dimensional echocardiography and CFR evaluation of the LAD by Doppler. All had angiographically nonsignificant (<50% quantitatively assessed) stenosis in any major vessel, normal left ventricular function (wall motion score index 1), and test negativity for conventional wall motion criteria. Images were independently read by a core laboratory for wall motion and a core laboratory for CFR. Mean CFR was 2.5 +/- 0.6 and 87 patients (22%) had an abnormal CFR <2. During a median follow-up of 51 months, 31 events occurred, namely 4 deaths and 27 nonfatal myocardial infarctions (3 ST-elevated myocardial infarctions and 24 non-ST-elevated myocardial infarctions). Kaplan-Meier survival estimates for hard events showed a better outcome for those patients with a normal CFR compared with those with an abnormal CFR (96% vs 55%, p = 0.001, at 48 months of follow-up). In conclusion, in patients with angiographically normal or near-normal coronary arteries and preserved at-rest regional and global left ventricular function at baseline and during stress, CFR adds incremental value to the prognostic stratification achieved with clinical and angiographic data.read more
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Journal ArticleDOI
2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
Gilles Montalescot,Udo Sechtem,Stephan Achenbach,Felicita Andreotti,Chris Arden,Andrzej Budaj,Raffaele Bugiardini,Filippo Crea,Thomas Cuisset,Carlo Di Mario,J. Rafael Ferreira,Bernard J. Gersh,Anselm K. Gitt,Jean-Sébastien Hulot,Nikolaus Marx,Lionel H. Opie,Matthias Pfisterer,Eva Prescott,Frank Ruschitzka,Manel Sabaté,Roxy Senior,David P. Taggart,Ernst E. van der Wall,Christiaan J. Vrints,José Luis Zamorano,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Robert Fagard,Roberto Ferrari,David Hasdai,Arno W. Hoes,Paulus Kirchhof,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Per Anton Sirnes,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Marco Valgimigli,Marc J. Claeys,Norbert Donner-Banzhoff,Herbert Frank,Christian Funck-Brentano,Oliver Gaemperli,José Ramón González-Juanatey,Michalis Hamilos,Steen Husted,Stefan James,Kari Kervinen,Steen Dalby Kristensen,Aldo P. Maggioni,Axel R. Pries,Francesco Romeo,Lars Rydén,Maarten L. Simoons,Ph. Gabriel Steg,Adam Timmis,Aylin Yildirir +68 more
TL;DR: The If Inhibitor Ivabradine in Patients With Coronary Artery Disease and Left Ventricular Dysfunction is evaluated as well as patients with Diabetes mellitus for Optimal management of Multivessel disease.
Journal ArticleDOI
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.
Juhani Knuuti,William Wijns,Antti Saraste,Davide Capodanno,Emanuele Barbato,Christian Funck-Brentano,Eva Prescott,Robert F. Storey,Christi Deaton,Thomas Cuisset,Stefan Agewall,Kenneth Dickstein,Thor Edvardsen,Javier Escaned,Bernard J. Gersh,Pavel Svitil,Martine Gilard,David Hasdai,Robert Hatala,Felix Mahfoud,Josep Masip,Claudio Muneretto,Marco Valgimigli,Stephan Achenbach,Jeroen J. Bax +24 more
TL;DR: In this article, the authors present guidelines for the management of patients with coronary artery disease (CAD), which is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries.
Journal ArticleDOI
Coronary Microvascular Dysfunction
J. Roberto Duran,George Taffet +1 more
TL;DR: CFR, defined as the ratio of coronary blood flow (CBF) at maximal dilation to CBF at baseline, is impaired in patients with CMD.
Journal ArticleDOI
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Martha Gulati,Phillip D. Levy,Debabrata Mukherjee,Ezra A. Amsterdam,Deepak L. Bhatt,Kim K. Birtcher,Ron Blankstein,Jack H. Boyd,Renee P. Bullock-Palmer,Theresa Conejo,Deborah B. Diercks,Federico Gentile,John P Greenwood,Erik P. Hess,Steven M. Hollenberg,Wael A Jaber,Hani Jneid,Jose A. Joglar,David A. Morrow,Robert E. O'Connor,Michael A. Ross,Leslee J. Shaw +21 more
TL;DR: The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain this paper provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain.
Journal ArticleDOI
Coronary microvascular dysfunction: mechanisms and functional assessment.
TL;DR: The coronary microvasculature (vessels <300 μm in diameter) cannot be directly imaged in vivo, but a number of invasive and non-invasive techniques, each with relative advantages and pitfalls, can be used to assess parameters that depend directly on coronary microvascular function as discussed by the authors.
References
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Journal ArticleDOI
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
J.-P Bassand,Christian W. Hamm,Diego Ardissino,Eric Boersma,A Budaj,Francisco Fernández-Avilés,Keith A.A. Fox,David Hasdai,Erik Magnus Ohman,Lars Wallentin,William Wijns +10 more
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means.
Journal ArticleDOI
ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain
Philip Greenland,Robert O. Bonow,Bruce H. Brundage,Matthew J. Budoff,Mark J. Eisenberg,Scott M. Grundy,Michael S. Lauer,Wendy S. Post,Paolo Raggi,Rita F. Redberg,George P. Rodgers,Leslee J. Shaw,Allen J. Taylor,William S. Weintraub,Robert A. Harrington,Jonathan Abrams,Jeffrey L. Anderson,Eric R. Bates,Cindy L. Grines,Mark A. Hlatky,Robert C. Lichtenberg,Jonathan R. Lindner,Gerald M. Pohost,Richard S. Schofield,Samuel J. Shubrooks,James H. Stein,Cynthia M. Tracy,Robert A. Vogel,Deborah J. Wesley +28 more
TL;DR: The CAC Measurement Method helps clarify the role of risk assessment in Cardiovascular Medicine and current approaches to Global Risk Assessment and to match the intensity of intervention with the severity of risk.
Book
Coronary Microvascular Dysfunction
Paolo G. Camici,Filippo Crea +1 more
TL;DR: This review discusses the pathogenesis and management of coronary microvascular dysfunction and factors to consider in clinical management are the cause of the dysfunction and whether it is iatrogenic, whether obstructive coronary artery disease is present, and whether myocardial disease ispresent.
Journal ArticleDOI
Abnormal Subendocardial Perfusion in Cardiac Syndrome X Detected by Cardiovascular Magnetic Resonance Imaging
Jonathan R. Panting,Peter D. Gatehouse,Guang-Zhong Yang,Frank Grothues,David N. Firmin,Peter Collins,Dudley J. Pennell +6 more
TL;DR: Cardiovascular magnetic resonance imaging demonstrates subendocardial hypoperfusion during the intravenous administration of adenosine, which is associated with intense chest pain, and supports the notion that the chest pain may have an ischemic cause.
Journal ArticleDOI
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
TL;DR: ‘Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes’ recently published in European Heart Journal 1 rightly dedicates space to the pitfalls that can be encountered when reading presentation ECGs, but there is an important omission.
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