Publications by authors named "Joao V Vitola"
Temporal trends in the contribution of modifiable cardiovascular risk factors to cardiovascular and all-cause mortality in patients undergoing myocardial perfusion imaging in a large city in Brazil.
Int J Cardiol
August 2024
Background: Most cardiovascular (CV) events stem from modifiable risk factors, but it remains uncertain whether their impact on mortality has decreased in recent years as a result of treatment, particularly in low- and middle-income countries. We evaluated the temporal trends in the population attributable fraction (PAF) of modifiable risk factors to CV mortality in patients undergoing myocardial perfusion imaging (MPI) for suspected coronary artery disease in a large city in Brazil.
Methods: The cohort comprised 25,127 patients without established CV disease undergoing MPI in a referral center in Curitiba, Brazil, from 2010 to 2018.
Introduction: Ivabradine reduces heart rate (HR), episodes of angina, and nitrate consumption, and increases exercise capacity in patients with chronic angina (CA). In this exploratory study, myocardial perfusion scintigraphy (MPS) was used to evaluate changes in the percentage of myocardial ischemia after ivabradine therapy in patients with CA.
Methods: This prospective, open-label, single-arm study included patients with CA receiving maximum tolerated doses of beta blockers, who had a resting HR ≥ 70 bpm and had experienced ischemia according to MPS during an exercise test at baseline.
Article Synopsis
- The study aimed to evaluate the recovery of cardiac diagnostic procedure volumes in Oceania during the COVID-19 pandemic by comparing data from March 2019, April 2020, and April 2021 across various health facilities.
- Results showed that 11,902 procedures were performed in April 2021, slightly below pre-pandemic levels, while the rest of the world had similar recovery rates, indicating a small decline in both regions.
- Although there were no significant differences in overall recovery rates, anatomical coronary testing in Oceania demonstrated poorer recovery compared to the rest of the world, raising concerns about specific diagnostic procedures.
Article Synopsis
- The COVID-19 pandemic significantly disrupted cardiovascular care, particularly affecting noninvasive testing for coronary artery disease (CAD), with unclear trends across different income levels.
- A global survey by the International Atomic Energy Agency included data from 669 centers in 107 countries, revealing that traditional tests decreased by 14%, while advanced tests increased by 15% from 2019 to 2021.
- The rise in advanced testing mainly occurred in high- and upper middle-income countries, highlighting a growing disparity in CAD diagnostic practices between wealthier and lower-income nations.
Background: Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C).
Background: Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability).
Article Synopsis
- The study aimed to assess how diagnostic cardiovascular procedure volumes rebounded in the U.S. and abroad during the year after COVID-19 hit, relying on data from 669 facilities worldwide.
- In the early pandemic (April 2020), procedure volumes dropped significantly but showed a better recovery in U.S. facilities by April 2021 compared to non-U.S. facilities, although high-income non-U.S. countries showed similar recovery rates as the U.S.
- Regional variations within the U.S. were noted, with the Midwest having the highest recovery rate, but no specific factors were found to predict recovery levels from the initial drop in procedure volumes.
Background: Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown.
Objectives: The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.
Methods: One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status).
Article Synopsis
- The study investigates how the COVID-19 pandemic affected cardiac diagnostic services globally, examining changes in testing practices and provider stress levels.
- Researchers conducted a survey from 669 centers across 107 countries and found a 64% reduction in cardiac procedure volumes during the pandemic, with recovery varying significantly between high-income and lower-income countries.
- Results indicated a shift from traditional stress testing to advanced imaging techniques, alongside widespread psychological stress among healthcare providers, which hindered the recovery of cardiac testing services, especially in lower-income regions.
Article Synopsis
- The COVID-19 pandemic significantly disrupted cardiac diagnostic procedures in Latin America, with volumes dropping by 36% in March 2020 and 82% by April 2020 compared to the previous year.
- Key tests like echocardiograms and exercise treadmill tests saw the most dramatic declines, with reductions of up to 91%.
- The study found that changes in social distancing were more closely linked to these volume reductions than the actual incidence of COVID-19 cases, highlighting the need for better management of healthcare access during pandemics.
Article Synopsis
- The COVID-19 pandemic led to a significant decline in cardiovascular diagnostic procedures in Asia, with procedure volumes dropping by 47% from March 2019 to March 2020, and even more in low-income countries where reductions reached 81%.
- A worldwide survey by the International Atomic Energy Agency highlighted that recovery began in some regions like Eastern Asia, especially China, between March and April 2020.
- Changes in practices included the implementation of physical distancing and restricting visitors; however, COVID testing was infrequently conducted, despite being more common in one-third of Eastern Asian facilities.
Article Synopsis
- This study analyzed the impact of the COVID-19 pandemic on cardiovascular procedure volumes in the U.S. compared to non-U.S. institutions, finding significant declines across both areas.
- In April 2020, U.S. facilities experienced a 68% reduction in procedures, similar to the 63% decline in non-U.S. locations, but U.S. invasive coronary angiography procedures dropped more steeply (69% vs. 53%).
- The study also noted more U.S. facilities adopted telehealth and patient screening measures, with volume reductions varying by region—most significantly in the Northeast and Midwest.
Article Synopsis
- The INCAPS COVID Oceania study investigated how the COVID-19 pandemic affected the volume of cardiac procedures in the Oceania region by comparing data from March 2019 to April 2020.
- A significant reduction of 52.2% in cardiac diagnostic procedures was noted in Oceania, which was less severe than the global reduction of 75.9%.
- The decrease varied by procedure type, with transthoracic echocardiography down 51.6% and transoesophageal echocardiography decreased by 74%; overall, recommendations to limit COVID-19 spread likely influenced these drops.
Objectives: This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED).
Background: Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols.
Article Synopsis
- The COVID-19 pandemic significantly disrupted the diagnosis and treatment of cardiovascular diseases, which are the leading cause of death worldwide, leading to a drastic reduction in procedural volumes globally.* -
- A global survey revealed that cardiovascular diagnostic procedures decreased by around 42% in March 2020 and 64% by April 2020 compared to the same months in the previous year, with non-invasive tests like echocardiography and stress tests experiencing even steeper declines.* -
- The impact was more pronounced in countries with lower GDP, where facilities experienced 22% more reduction in procedures and had less access to personal protective equipment and telehealth options, highlighting the unequal effects of the pandemic on healthcare services.*
The purpose of this study was to compare F-FDG PET/CT and CT performance in guiding percutaneous biopsies with histologic confirmation of lung lesions. We prospectively evaluated 341 patients, of whom 216 underwent F-FDG PET/CT-guided biopsy and 125 underwent CT-guided biopsy. The pathology results, lesion size, complications, and rebiopsy rate in the 2 groups were evaluated.
View Article and Find Full Text PDFBackground: Patient exposure to radiation during the management of coronary heart disease (CHD) can be reduced with more efficient technologies in nuclear medicine, such as the Cadmium-Zinc-Telluride (CZT) gamma-camera for myocardial perfusion imaging (MPI) studies. However, it has been suggested that CZT has lower specificity, which might lead to more downstream radiological procedures, particularly among obese individuals.
Methods And Results: We evaluated 244 patients with suspected CHD who underwent CZT-SPECT and matched 1:1 according to sex, age, and body mass index (BMI) with those undergoing MPI study with the Anger gamma-camera (Anger-SPECT).
Background: Obesity is associated with an increased risk of type 2 diabetes mellitus (DM), ischemic heart disease (IHD) and cardiovascular mortality. Several studies have demonstrated the diagnostic and prognostic value of single photon computed tomography-myocardial perfusion scintigraphy (SPECT-MPI) in the evaluation of patients with suspected IHD, including in obese population. Data on clinical risk factors and their association with abnormal myocardial perfusion in obese patients are scarce in the Brazilian population.
View Article and Find Full Text PDFWe discuss premature deaths due to coronary heart disease (CHD) in developing countries and the importance of a comprehensive approach, involving clinical judgement, prevention, appropriate use of technology to diagnose and guide CHD treatment. Healthcare policies and levels of knowledge vary tremendously resulting heterogeneous utilization of diagnostic strategies and treatments worldwide. Many countries with high mortality have low utilization of non-invasive cardiac imaging.
View Article and Find Full Text PDFBackground: Consistency of results between different readers is an important issue in medical imaging, as it affects portability of results between institutions and may affect patient care. The International Atomic Energy Agency (IAEA) in pursuing its mission of fostering peaceful applications of nuclear technologies has supported several training activities in the field of nuclear cardiology (NC) and SPECT myocardial perfusion imaging (MPI) in particular. The aim of this study was to verify the outcome of those activities through an international clinical audit on MPI where participants were requested to report on studies distributed from a core lab.
View Article and Find Full Text PDFThere remains a clinical question of which patients benefit from revascularization of non-culprit coronary artery stenosis in the setting of acute ST-segment elevation myocardial infraction (STEMI). This is a large population of patients with prior studies showing 40 to 70% of patients with STEMI having non-culprit stenosis. This article reviews the current state of the literature evaluating outcomes of those previously randomized to revascularization of non-culprit stenosis around the time of the STEMI.
View Article and Find Full Text PDFBackground: There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort.
Methods: Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA).