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Functional imaging after the "ISCHEMIA" trial.
Arch Cardiovasc Dis
November 2023
Cardiovascular Magnetic Resonance Laboratory, institut cardiovasculaire Paris Sud, hôpital privé Jacques-Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France. Electronic address:
Previous randomized trials have shown a lack of benefits from the addition of revascularization to optimal medical therapy versus optimal medical therapy alone in patients with stable ischaemic heart disease at relatively low risk (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]), and in diabetic patients with stable ischaemic heart disease (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics [BARI 2D]). More recently, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) randomized clinical trial showed similar results in patients with moderate-severe ischaemia on functional testing (imaging or stress electrocardiogram) and at least one significant (> 50%) coronary stenosis in a major epicardial coronary artery on coronarography computed coronary angiography. Although the ISCHEMIA trial adds pivotal knowledge regarding the management of and decision-making in stable patients, this study has prompted a great debate about the role of functional imaging for diagnosis, risk stratification and therapeutic decision-making.
View Article and Find Full Text PDF[Prognostic value of the presence of a chronic total occlusion in patients with acute myocardial infarction].
Rev Med Chil
February 2022
Hospital Guillermo Grant Benavente, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Background: The presence of a chronic total occlusion (CTO) in a non-infarct-related artery in patients with acute myocardial infarction (AMI), may be a sign of bad prognosis.
Aim: To estimate the long-term survival of patients with AMI who were studied with coronarography during 2013-2014 who had one or more CTO in a non-infarct-related artery.
Material And Methods: Review of coronary angiograms performed between 2013 and 2014 to patients with an AMI.
Validation of Coronary Angiography-Derived Vessel Fractional Flow Reserve in Heart Transplant Patients with Suspected Graft Vasculopathy.
Diagnostics (Basel)
September 2021
Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium.
Cardiac transplant-related vasculopathy remains a leading cause of morbidity and mortality in heart transplant (HTx) recipients. Recently, coronary angiography-derived vessel fractional flow reserve (vFFR) has emerged as a new diagnostic computational tool to functionally evaluate the severity of coronary artery disease. Although vFFR estimates have been shown to perform well against invasive FFR in atherosclerotic coronary artery disease, data on the use of vFFR in heart transplant recipients suffering from cardiac transplant-related arteriopathy are lacking.
View Article and Find Full Text PDFCase 294: Catastrophic Antiphospholipid Syndrome.
Radiology
October 2021
From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.).
History A 50-year-old woman presented to the emergency department of our hospital with a 2-day history of lower limb pain associated with unusual asthenia and diffuse arthralgia over the past 3 weeks. She was a native of Guinea and had lived in France for most of her life, working as a personal care assistant. Her only medical history of note was an occurrence of fetal death at 12 weeks gestation when she was 35 years old.
View Article and Find Full Text PDFCase 294.
Radiology
June 2021
From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.).
History A 50-year-old woman presented to the emergency department of our hospital with a 2-day history of lower limb pain associated with unusual asthenia and diffuse arthralgia over the past 3 weeks. She was a native of Guinea and had lived in France for most of her life, working as a personal care assistant. Her only medical history of note was an occurrence of fetal death at 12 weeks gestation when she was 35 years old.
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