Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial.

Background: ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease.

Methods: Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use.

Critical Assessment of the Management of Unstable Angina in a Specialized Cardiology Emergency Room.

Background: The management of unstable angina (UA) presents a challenge due to its subjective diagnosis and limited representation in randomized clinical trials that inform current practices.

Objectives: This study aims to identify key factors associated with the indication for invasive versus non-invasive stratification in this population and to evaluate factors associated with stratification test results.

Methods: This retrospective cohort study included patients hospitalized with UA over a consecutive 20-month period.

Impact of Complete Revascularization in the ISCHEMIA Trial.

Background: Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported.

Objectives: Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management.

Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease: The ISCHEMIA Trial.

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).

Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity.

Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy.

Methods: In total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy.

VO2max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease.

Background: The most widely used data for cardiorespiratory fitness (CRF) referrals are from the Cooper Clinic, which uses calculated maximal oxygen uptake (VO2max) values.

Objective: To develop CRF values from cardiopulmonary exercise testing (CPX) in a Brazilian population with high socioeconomic level and free of structural heart disease. VO2max testing results were compared with the Cooper Clinic and FRIEND Registry data.

Cardiorespiratory fitness data from 18,189 participants who underwent treadmill cardiopulmonary exercise testing in a Brazilian population.

Purpose: Cardiorespiratory fitness is inversely associated with a high risk of cardiovascular disease, all-cause mortality, and mortality attributable to various cancers. It is often estimated indirectly using mathematical formulas for estimating oxygen uptake. Cardiopulmonary exercise testing, especially oxygen uptake, represents the "gold standard" for assessing exercise capacity.

Myocardial scintigraphy in the evaluation of cardiac events in patients without typical symptoms.

Background: Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined.

Objective: To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years.

Prevalence of ischemia on myocardial perfusion scintigraphy of pre-and postmenopausal women.

Background: In postmenopausal women, the presence of risk factors for coronary artery disease (CAD) increases. However, the difference in prevalence of ischemia between pre- and postmenopausal women with multiple risk factors for CAD has not been well established.

Objectives: To compare the prevalence of ischemia on Tc99m-sestamibi myocardial perfusion scintigraphy (MPS) in pre- and postmenopausal women, and to evaluate whether menopause can be considered an independent risk predictor of ischemia in women with multiple risk factors for CAD.

Analysis of the sensitivity and specificity of noninvasive imaging tests for the diagnosis of renal artery stenosis.

Background: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality.

Objective: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis.

Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA.

There is a preponderance of evidence that, in the setting of an acute coronary syndrome, an invasive approach using coronary revascularization has a morbidity and mortality benefit. However, recent stable ischemic heart disease (SIHD) randomized clinical trials testing whether the addition of coronary revascularization to guideline-directed medical therapy (GDMT) reduces death or major cardiovascular events have been negative. Based on the evidence from these trials, the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline; the role of prompt revascularization is less precisely defined.

Diagnostic value of myocardial radionuclide imaging in patients with multivessel coronary disease.

Background: Myocardial perfusion radionuclide imaging (MPRI) is a noninvasive method extremely useful for evaluating ischemia in patients with coronary disease. However, the idea that this method would not be effective for patients with multivessel coronary disease is still entertained.

Objective: Assess the value of MPRI with gated-SPECT for tracing pharmacological stress-induced ischemia in patients with multivessel obstructive coronary disease.

Noninvasive assessment of patients undergoing percutaneous intervention in myocardial infarction.

Background: Restenosis after primary percutaneous coronary intervention (PPCI) remains an important clinical problem, even with stent implantation. The ability of noninvasive testing to diagnose restenosis has had only inconsistent demonstration.

Objective: Our objective was to evaluate the ability of exercise treadmill testing (ETT) and myocardial perfusion imaging (MPI) to diagnose restenosis in patients treated by PPCI within 12 hours of ST-elevation myocardial infarction (STEMI).

[Importance of parathyroid SPECT and 99mTc scintigraphy, and of clinical, laboratorial, ultrasonographic and citologic correlation in the pre-operative localization of the parathyroid adenoma - pictorial assay].

Objective: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach.

Materials And Methods: The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed.

Evaluation of prescription of exercise, for rehabilitation of coronary artery disease patients by myocardial scintigraphy.

Background: It is advisable that the intensity of the exercises for rehabilitation of patients with coronary artery disease does not cause myocardial ischemia.

Objective: Compare the capacity of myocardial tomographic scintigraphy with the electrocardiogram capacity in ischemia detection during rehabilitation session.

Methods: Twenty six patients with coronary artery disease, undergoing the rehabilitation program and with previous scintigraphy, with transient hypo-uptake have been administered a new injection of MIBI-Tc-99m during a training session when they were also monitored with dynamic electrocardiography.

Biological factors and overestimation of left ventricular ejection fraction by gated SPECT.

Background: Some patients present an overestimated left ventricular ejection fraction (LVEF) on electrocardiogram-gated myocardial scintigraphy (gated SPECT).

Objective: To establish the relationship between biological factors and overestimated LVEF.

Methods: We selected 3838 patients who underwent gated SPECT between May 20, 2000 and September 16, 2005 with normal perfusion images and LVEF > or =50%.

Coronary artery disease in asymptomatic type-2 diabetic women. A comparative study between exercise test, cardiopulmonary exercise test, and dipyridamole myocardial perfusion scintigraphy in the identification of ischemia.

Background: Cardiovascular disease is the leading cause of morbidity and mortality among diabetic individuals. Myocardial ischemia is frequently asymptomatic, thus leading to a late diagnosis and worse prognosis. Diabetic women are known to have a cardiovascular death risk higher than that in men.

Association between risk factors for coronary artery disease and coronary disease in patients undergoing myocardial perfusion scintigraphy.

Objectives: To establish the degree of association between cardiovascular risk factors and the presence of coronary artery disease (CAD) in a group of patients undergoing myocardial perfusion scintigraphy (MPS).

Methods: The study included 7183 patients who had undergone MPS. Using logistic regression analysis the odds ratios for the following risk factors were evaluated: age, gender, family history, body mass index, smoking, dyslipidemia, diabetes mellitus (DM) and systemic hypertension.

[Cardiovascular disease in diabetic women without cardiac symptoms].

Cardiovascular disease is the main cause of cardiac death among diabetic patients. The myocardial ischemia is frequently asymptomatic, leading to late diagnosis and making prognosis worse. This is particularly true for women, for whom this diagnostic is possibility often disregarded.

Indication of myocardial perfusion scintigraphy for coronary artery disease detection based on clinical-epidemiological and treadmill test evidences.

Objective: To establish when the myocardial perfusion scintigraphy (MPS) should be performed based on well-defined information obtained from treadmill test results and clinical-epidemiological parameters for coronary artery disease (CAD).

Methods: 2,100 patients who underwent MPS were classified according to the results of scintigraphy, the Duke score and a clinical-epidemiological score based on Framingham study. The patients with positive results on MPS were followed to define whether the results were true positives.

[Adenosine myocardial perfusion SPECT with Tc-99m-MIBI in patients with obstructive coronary artery disease: correlation between quantitative coronary angiography and intravascular ultrasound measurements].

Objective: To correlate myocardial perfusion scintigraphy (MPS) with Tc-99m-MIBI and adenosine infusion using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).

Methods: Seventy patients with coronary artery disease (CAD) referred for myocardial perfusion scintigraphy (MPS) with MIBI and adenosine were studied. Clinical, electrocardiographic (ECG), and scintigraphic findings were correlated with variables of visual and quantitative angiographic analysis, as well as to those of IVUS.

Clinical significance of transient left ventricular dilation assessed during myocardial Tc-99m sestamibi scintigraphy.

Objective: To assess the clinical significance of transient ischemic dilation of the left ventricle during myocardial perfusion scintigraphy with stress/rest sestamibi.

Methods: The study retrospectively analyzed 378 patients who underwent myocardial perfusion scintigraphy with stress/rest sestamibi, 340 of whom had a low probability of having ischemia and 38 had significant transient defects. Transient ischemic dilation was automatically calculated using Autoquant software.