The role of myocardial viability assessment in identifying patients with ischemic cardiomyopathy who will benefit from surgical revascularization is controversial. This study assessed myocardial ...viability and its relationship to long-term outcomes in 601 patients with ischemic cardiomyopathy who were assigned to surgical revascularization plus medical therapy or medical therapy alone.
A complete guide to non-invasive imaging techniques in cardiology Todays imaging technologies offer cardiologists more ways than ever to diagnose conditions of the heart without the need of ...endoscopies and other invasive procedures. Now in its third edition,Cardiac CT, PET and MRI continues to provide an in-depth explanation of these tools and their correct applications, while also exploring cardiac imagings most recent and groundbreaking developments. This wide-ranging guide places CT, PET and MRI in a practical context, illustrating clearly their respective functions as they apply to specific cardiological disorders and clinical situations. With the addition of seven new chapters, it also offers an expanded insight into PET ? an increasingly popular and affordable diagnostic utility, hitherto underexplored in texts devoted to imaging. Cardiac CT, PET and MRI includes: Clinically focused examinations of CT, PET and MRI ? the three most popular non-invasive imaging modalities Illustrative full-color photos and images Access to a companion website featuring additional content Cardiologists, radiologists, nuclear medicine physicians, physicists, and imaging technologists alike will find the third edition of Cardiac CT, PET and MRI an informative and accessible resource with a direct use in their day-to-day practice.
Objective The present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine ...whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction. Methods Of the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery. Results Surgical ventricular reconstruction resulted in improved survival compared with coronary artery bypass grafting alone when the postoperative end-systolic volume index was 70 mL/m2 or less. However, the opposite was true for patients achieving a postoperative volume index greater than 70 mL/m2 . A reduction in the end-systolic volume index of 30% or more compared with baseline was an infrequent event in both treatment groups and did not produce a statistically significant survival benefit with ventricular reconstruction. Conclusions In patients undergoing coronary artery bypass grafting plus surgical ventricular reconstruction, a survival benefit was realized compared with bypass alone, with the achievement of a postoperative end-systolic volume index of 70 mL/m2 or less. Extensive ventricular remodeling at baseline might limit the ability of ventricular reconstruction to achieve a sufficient reduction in volume and clinical benefit.
As a noninvasive tool, myocardial deformation imaging may facilitate the early detection of cardiac dysfunction. However, normal reference ranges of myocardial strain and strain rate (SR) based on ...large-scale East Asian populations are still lacking. This study aimed to provide reference values of left ventricular (LV) and right ventricular (RV) strain and SR based on a large cohort of healthy Chinese adults using cardiovascular magnetic resonance (CMR) feature tracking (FT).
Five hundred and sixty-six healthy Chinese adults (55.1% men) free of hypertension, diabetes, and obesity were included. On cine CMR, biventricular global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), and the peak radial, circumferential, and longitudinal systolic, and diastolic SRs (PSSRR, PSSRC, PSSRL, PDSRR, PDSRC, and PDSRL), and regional radial and circumferential strain at the basal, mid-cavity, and apical levels were measured. Associations of global and regional biventricular deformation indices with age and sex were investigated.
Women demonstrated greater magnitudes of LV GRS (37.6 ± 6.1% vs. 32.1 ± 5.3%), GCS (- 20.7 ± 1.9% vs. - 18.8 ± 1.9%), GLS (- 17.8 ± 1.8% vs. - 15.6 ± 1.8%), RV GRS (25.1 ± 7.8% vs. 22.1 ± 6.7%), GCS (- 14.4 ± 3.6% vs. - 13.2 ± 3.2%), GLS (- 22.4 ± 5.2% vs. - 20.2 ± 4.6%), and biventricular peak systolic and diastolic SR in all three coordinate directions (all P < 0.05). For the LV, aging was associated with increasing amplitudes of GRS, GCS, and decreasing amplitudes of PDSRR, PDSRC, PDSRL (all P < 0.05). For the RV, aging was associated with an increase in the magnitudes of GRS, GCS, GLS, PSSRR, PSSRC, PSSRL, and a decrease in the magnitude of PDSRR, PDSRC (all P < 0.05). Biventricular radial and circumferential strain measurements at the basal, mid-cavity, and apical levels were all significantly related to age and sex in both sexes (all P < 0.05).
We provide age- and sex-specific normal values of biventricular strain and SR based on a large sample of healthy Chinese adults with a broad age range. These results may be served as a reference standard for cardiac function assessment, especially for the Chinese population.
The rationale and design of the Surgical Treatment for Ischemic Heart Failure (STICH) trial Velazquez, Eric J., MD, FACC; Lee, Kerry L., PhD; O’Connor, Christopher M., MD, FACC ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
12/2007, Letnik:
134, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objectives The rationale and design of the Surgical Treatment for Ischemic Heart Failure trial is described. Before the Surgical Treatment for Ischemic Heart Failure trial, less than 1000 patients ...with ischemic cardiomyopathy had been studied in randomized comparisons of medical therapy versus coronary artery bypass grafting. Trial data reflect how these therapies were delivered more than 20 years ago and do not indicate the relative benefits of medical therapy versus coronary artery bypass grafting in contemporary practice. Methods Randomization of consenting patients with heart failure, left ventricular ejection fraction of 0.35 or less, and coronary artery disease is based on whether patients are judged by attending physicians to be candidates only for coronary artery bypass grafting or can be treated with medical therapy without coronary artery bypass grafting. Patients eligible for surgical ventricular reconstruction because of significant anterior wall akinesis or dyskinesis but ineligible for medical therapy are randomly assigned to coronary artery bypass grafting with or without surgical ventricular reconstruction. Patients eligible for medical therapy are randomly assigned between medical therapy only and medical therapy with coronary artery bypass grafting. Patients eligible for all 3 are randomly assigned evenly to medical therapy only, medical therapy and coronary artery bypass grafting, or medical therapy and coronary artery bypass grafting and surgical ventricular reconstruction. Major substudies will examine quality of life, cost-effectiveness, changes in left ventricular volumes, effect of myocardial viability, selected biomarkers, and selected polymorphisms on treatment differences. Results Enrollment is now complete in both STICH hypotheses. Follow-up will continue until sufficient end points are available to address both hypotheses with at least 90% power. The primary outcome of hypothesis 2 is expected to be reported in 2009. The primary outcome of hypothesis 1 is expected to be reported in 2011. Conclusions The Surgical Treatment for Ischemic Heart Failure trial is a National Heart, Lung, and Blood Institute–funded multicenter international randomized trial addressing 2 specific primary hypotheses: (1) coronary artery bypass grafting with intensive medical therapy improves long-term survival compared with survival with medical therapy alone, and (2) in patients with anterior left ventricular dysfunction, surgical ventricular reconstruction to a more normal left ventricular size plus coronary artery bypass grafting improves survival free of subsequent hospitalization for cardiac cause when compared with that with coronary artery bypass grafting alone.
The clinical value of myocardial torsion quantification in prognostic assessment and risk stratification of various cardiovascular diseases is gradually being recognized. However, normal values of ...left and right ventricular (LV and RV) torsion and torsion rates (TRs) have not been fully determined, and their correlation with age and gender has not been well studied.
To establish normal ranges of biventricular torsion, peak systolic and diastolic TRs using magnetic resonance feature tracking (MR-FT) technique based on a large sample of healthy adults, and further investigate their relationship with age and gender.
Retrospective.
566 Healthy adults (312 males, aged 43 ± 10 years; 254 females, aged 43 ± 11 years).
1.5T/gradient echo.
Biventricular torsion, peak systolic, and diastolic TRs.
Shapiro-Wilk test, Student's t-test, Mann-Whitney-U test, linear regression, intraclass correlation coefficient, Bland-Altman analysis. Differences were regarded as statistically significant at P < 0.05.
Women demonstrated greater magnitudes of left ventricle (LV) torsion (1.23 ± 0.44 vs. 1.00 ± 0.42°/cm), peak systolic TR (9.69 ± 3.70 vs. 8.27 ± 3.73°/cm*sec), peak diastolic TR (-7.78 ± 2.82 vs. -6.06 ± 2.44°/cm*sec), and RV torsion (2.20 ± 1.23 vs. 1.65 ± 1.11°/cm*sec), peak systolic TR (16.07 ± 8.18 vs. 12.62 ± 7.08°/cm*sec), peak diastolic TR (-15.39 ± 6.53 vs. -11.70 ± 6.03°/cm*sec). For both genders, the magnitudes of LV and RV torsion, peak systolic, and diastolic TRs increased linearly with age. All the measurements of biventricular torsion, peak systolic and diastolic TRs achieved good to excellent intraobserver and interobserver reproducibility, with all intraclass correlation coefficients >0.70.
The present study systematically provided age- and sex-stratified reference values for LV and RV torsion and TRs using MR-FT technique. Women and aging are associated with greater magnitudes of biventricular torsion, peak systolic, and diastolic TRs.
3 TECHNICAL EFFICACY: Stage 2.
.2661 Preamble This document was developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents (ECDs) and cosponsored by the American College of ...Radiology (ACR), American Heart Association (AHA), North American Society for Cardiovascular Imaging (NASCI), and the Society for Cardiovascular Magnetic Resonance (SCMR), to provide a perspective on the current state of cardiovascular magnetic resonance (CMR). Often the topic is the subject of ongoing investigation. ...the reader should view the ECD as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not be available or the evidence to date is not widely accepted. ...some topics covered by ECDs will be addressed subsequently by the ACCF/AHA Practice Guidelines Committee. Peer Reviewer Representation Consultant Speaker Ownership/Partnership/Principal Research Institutional, Organizational, or Other Financial Benefit Expert Witness Dr. James C. Carr Official Reviewer--North American Society for Cardiovascular Imaging None None None None None None Dr. Michael G. Del Core Official Reviewer--ACCF Board of Governors None None None None None None Dr. Andre Duerinckx Official Reviewer--American College of Radiology None None None Philips Medical Systems Schering-Plough None None Dr. Mark J. Eisenberg Official Reviewer--ACCF Task Force on Clinical Expert Consensus Documents None None None None None None Dr. Victor A. Ferrari Official Reviewer-- Society for Cardiovascular Magnetic Resonance Imaging None None None None None None Dr. Gautham Reddy Official Reviewer--American College of Radiology None None None None None None Dr. Orlando Simonetti Official Reviewer--North American Society for Cardiovascular Imaging None None * Siemens Healthcare None None None Dr. James E. Udelson Official Reviewer--ACCF Board of Trustees; American Heart Association None None None None None None Dr. Sanjay Kaul Content Reviewer--ACCF Task Force on Clinical Expert Consensus Documents None None None None None None Dr. Debabrata Mukherjee Content Reviewer--ACCF Task Force on Clinical Expert Consensus Documents None None None None None None Dr. Robert S. Rosenson Content Reviewer--ACCF Task Force on Clinical Expert Consensus Documents Abbott Anthera AstraZeneca* Daiichi Sankyo LipoScience* Roche None LipoScience* None Grain Board None Dr. Jonathan W. Weinsaft Content Reviewer--*Individual None None None Lantheus Medical Imaging None None * This table represents the relevant relationships with industry and other entities that were disclosed by reviewers at the time of peer review. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10 000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year.
A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart ...Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine Endorsed by the American College of Emergency Physicians In general, use of cardiac RNI for diagnosis and risk assessment in intermediate- and high-risk patients with coronary artery disease (CAD) was viewed favorably, while testing in low-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Given the iterative nature of the process, readers are counseled not to compare too closely individual appropriate use ratings among modalities rated at different times over the past 2 years. Since this process is iterative and evolving, readers are counseled that individual appropriate use ratings among modalities rated at different times over the past 2 years may not be consistent.\n Manesh R. Patel None None None None None None Dr. Eric D. Peterson None None None Bristol-Myers Squibb/Sanofi Aventis Merck Schering-Plough St. Jude None None Dr. Michael J. Wolk None None None None None None Cardiac Radionuclide Imaging Appropriate Use Criteria Indication Reviewers Dr. James Arrighi None None None None None None Dr. Robert O. Bonow Bristol-Myers Squibb Medical Imaging Edwards Lifesciences None None None None None Dr. Lee A. Fleisher None None None None None Preoperative potassium Preoperative potassium level Dr. Julius M. Gardin None CV Therapeutics Pfizer Takeda None Merck None None Dr. Raymond J. Gibbons Cardiovascular Clinical Studies (WOMEN study) Consumers Union TIMI 37A None None Kai Pharmaceuticals King Pharmaceuticals Radiant Medical TargeGen Ther Ox None None Dr. John A. Gillespie None None None None None None Dr. Bennett S. Greenspan None None None None None None Dr. Rory Hachamovitch Bristol-Myers Squibb Medical Imaging GE Healthcare None Astellas Bracco Diagnostics GE Healthcare Siemens None None Dr. Warren R. Janowitz None None None None None None Dr. Christopher M. Kramer Siemens None None Astellas GlaxoSmithKline Merck Siemens None None Dr. Michael H. Picard Acusphere None None Edwards Lifesciences None None Dr. Michael Poon None None None None None None Dr. Miguel A. Quinones None None None None None Diet pills and valve disease Dr. Raymond F. Stainback None None None None None None Dr. Mark I. Travin None None None None None Adding exercise to pharmacologic stress ECG stress testing and ordering nuclear studies Dr. Samuel Wann None None None None None None Dr. R. Parker Ward None None None Pfizer None None Dr. Neil J. Weissman Takeda Wyeth None None Acusphere Arena Pharmaceutical ATS Biotronik Boston Scientific Edwards Lifesciences Lipid Science Point Biomedical Sorin Carbomedics Spectranetics St. Jude Zilver None Anorexic agents Dr. Jack A. Ziffer Tyco Healthcare None CV Therapeutics Spectrum Dynamics Bristol-Myers Squibb CV Therapeutics None None Dr. William A. Zoghbi None None None None None None * ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM CARDIAC RADIONUCLIDE IMAGING APPROPRIATE USE CRITERIA WRITING GROUP, TECHNICAL PANEL, TASK FORCE, AND INDICATION REVIEWERS--RELATIONSHIPS WITH INDUSTRY AND OTHER ENTITIES (IN ALPHABETICAL ORDER) This table represents the relevant relationships of committee members with industry and other entities that were reported orally at the initial writing committee meeting and updated in conjunction with all meetings and conference calls of the writing committee during the document development process.
Background
While reference values of left atrial (LA) deformation parameters in Western populations have been established, reference data in healthy Asian populations are limited.
Purpose
To ...establish age‐ and sex‐specific reference values for LA strain and strain rate (SR) based on a large sample of healthy Chinese adults using magnetic resonance‐feature tracking (MR‐FT).
Study Type
Retrospective.
Population
Four hundred and eight healthy Chinese adults (220 males, aged 43.5 ± 11.5 years; 188 females, aged 45.3 ± 12.8 years).
Field Strength/Sequence
1.5 T/balanced steady‐state free precession.
Assessment
Reservoir strain (εs), conduit strain (εe), booster strain (εa), peak positive SR (SRs), peak early negative SR (SRe), and peak late negative SR (SRa) were obtained by MR‐FT.
Statistical Tests
We used Shapiro–Wilk test, Student's t‐test, Mann–Whitney U‐test, linear regression, and coefficient of determination (r2).
Results
Women demonstrated significantly greater LA strain (εs %: 44.0 ± 9.9 vs. 38.3 ± 8.7; εe %: 26.7 ± 8.0 vs. 22.3 ± 6.8; εa %: 17.3 ± 4.4 vs. 16.0 ± 3.8) and SR (SRs /second: 1.8 ± 0.5 vs. 1.6 ± 0.4; SRe /second: −2.5 ± 0.9 vs. −2.1 ± 0.7; SRa /second: −1.9 ± 0.6 vs. −1.8 ± 0.5) than men. For both sexes, aging was significantly associated with decreased εs, SRs, εe, and SRe (r2 = 0.07, r2 = 0.05, r2 = 0.19, and r2 = 0.24 for men; r2 = 0.13, r2 = 0.11, r2 = 0.31, and r2 = 0.46 for women), and significantly increased εa (r2 = 0.03 and r2 = 0.05 for men and women). There was no significant correlation between age and SRa in both sexes (P = 0.057 and P = 0.377 for men and women, respectively).
Data Conclusion
We provide age‐ and sex‐specific reference values for LA strain and SR based on a large sample of healthy Chinese adults using MR‐FT.
Level of Evidence
3
Technical Efficacy Stage
5
Although right atrial (RA) myocardial deformation has important implications for patient diagnosis, prognosis, and risk stratification, its implementation in clinical practice has been hampered by ...limited normal reference values, especially in Asian populations.
To establish age- and sex-specific reference values for RA strain, strain rate (SR), and displacement based on a large sample of healthy Chinese adults using MR-feature tracking (MR-FT).
Retrospective.
524 healthy Chinese adults (287 male; mean age 43.7 ± 11.9 years).
1.5T/balanced steady-state free precession.
RA deformation parameters, including reservoir, conduit, and booster strain (εs, εe, and εa), peak positive, early negative, and late negative SR (SRs, SRe, and SRa), and total, passive, and active displacement (Ds, De, and Da), were assessed using MR-FT.
Student's t-test, one-way ANOVA, coefficients of determination (r
), intraclass correlation coefficients (ICC), and Bland-Altman plots. A P value <0.05 was considered significant.
Women demonstrated significantly greater magnitudes of RA deformation parameters than men: εs (57.4% ± 15.1% vs. 44.3% ± 12.6%), εe (37.5% ± 13.4% vs. 27.4% ± 10.9%), εa (19.9% ± 5.7% vs. 16.9% ± 5.0%), SRs (2.62 ± 0.88 sec
vs. 2.00 ± 0.63 sec
), SRe (-2.98 ± 1.26 sec
vs. -2.16 ± 0.92 sec
), SRa (-2.28 ± 0.75 sec
vs. -1.84 ± 0.62 sec
), Ds (-7.80 ± 1.90 mm vs. -7.46 ± 1.70 mm), and De (-4.84 ± 1.31 mm vs. -4.49 ± 1.21 mm). For both sexes, aging was significantly associated with decreased RA reservoir and conduit function (εs, SRs, Ds, εe, SRe, and De), and with increased εa and Da. RA deformation measurements had good to excellent intraobserver and interobserver reproducibility, with ICCs ranging from to 0.790 to 0.972.
This study provides age- and sex-specific reference values of RA strain, SR, and displacement based on a large cohort of healthy Chinese adults using MR-FT.
3 TECHNICAL EFFICACY: Stage 2.
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