Exercise training after primary angioplasty
peter gheeraert1999, Journal of Nuclear Cardiology
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Abstract
Peri-operative myocardial infarction (MI) is a major cause of mortality and morbidity following peripheral vascular surgery. Recently the efficacy of stress perfusion imaging to assess these patients has been questioned. This study aimed to prospectively determine the value of clinical assessment, electrocardiographic assessment, blood pool ventriculography and dipyridamole thallium scintigraphy in predicting peri-operative MI in sequential unselected patients(n=298). Stress-redistribution gated planar perfusion scans were performed followed by gated blood pool ventriculography. Patients were screened for a peri-operative MI by daily CK-MB isoenzymes and ECGs. Thallium scans were reported semiqnantitatively, independently on two occasions to yield global stress defect and a reversibility indices. Left and right ventricular ejection fractions (LVEF,RVEF) were obtained from the blood pool ventriculograms. There were 21 patients vcho sustained a perioperative MI. The occurrence of a peri-operative MI was associated with reversibility score (12 versus 6, p<.000I,Mann,Whitney). Additionally, LVEF was significantly lower in patients in those with events (3 I+10.5 versus 38+_11.7,p<.02), but there was no difference in RVEF. There were 25 patients with a moderate or large reversible defect of whom 3 had events, giving a sensitivity of 14% and a specificity of 95%. Multivariate analysis showed reversibility index to be the most powerful predictor ofperi-operative ML In conclusion stress T120t scintigraphy is the investigation of choice in pre-operative risk stratification.
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Korean circulation journal, 2014
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The American Journal of Cardiology, 1998
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The International Journal of Cardiovascular Imaging, 2005
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Journal of Nuclear Cardiology, 2012
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Cardiac risk assessment before non-cardiac surgery
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Nuclear medicine review. Central & Eastern Europe, 2001
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Journal of Nuclear Cardiology, 2009
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European Heart Journal, 2011
Although pre-revascularization ischaemia testing is recommended, the interaction between the extent of ischaemia and myocardial scar with performance of revascularization on patient survival is unclear. Methods and results We identified 13 969 patients who underwent adenosine or exercise stress SPECT myocardial perfusion scintigraphy (MPS). The percent myocardium ischaemic (%I) and fixed (%F) were calculated using 5 point/20-segment MPS scoring. Patients lost to follow-up (2.8%) were excluded leaving 13 555 patients [35% with history (Hx) of known coronary artery disease (CAD), 65% exercise stress, 61% male, age 66 + 12]. Follow-up was performed at 12-18 months for early revascularization and at .7 years for all-cause death (ACD) (mean follow-up 8.7 + 3.3 years). All-cause death was modelled using Cox proportional hazards modelling adjusting for logistic-based propensity scores, MPS, revascularization, and baseline characteristics. During FU, 3893 ACD (29%, 3.3%/year) and 1226 early revascularizations (9.0%) occurred. After risk-adjustment, a three-way interaction was present between %I, early revascularization, and HxCAD, such that %I identified a survival benefit with early revascularization in patients without prior myocardial infarction (MI), whereas no such benefit was present in patients with prior MI (overall model x 2 ¼ 3932, P , 0.001; interaction P , 0.021). Further modelling revealed that after excluding patients with scar .10% total myocardium, %I identified a survival benefit in all patients. Conclusion In this large observational series with long-term follow-up, patients with significant ischaemia and without extensive scar were likely to realize a survival benefit from early revascularization. In contrast, the survival of patients with minimal ischaemia was superior with medical therapy without early revascularization.
Incremental prognostic value of exercise thallium-201 myocardial single-photon emission computed tomography late after coronary artery bypass surgery
Journal of the American College of Cardiology, 1995
Con: Preoperative thallium testing should not be performed routinely before vascular surgery
Journal of Cardiothoracic and Vascular Anesthesia, 2000
Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis
Journal of Nuclear Cardiology, 2017
Background. Comparing the prognostic value of a negative finding by stress single-photon emission computed tomography myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) may be useful to evaluate how better identify low-risk patients. We performed a meta-analysis to compare the long-term negative predictive value (NPV) of normal stress MPI and normal CCTA in subjects with suspected coronary artery disease (CAD). Methods and Results. Studies published between January 2000 and November 2016 were identified by database search. We included MPI and CCTA studies that followed-up ‡100 subjects for ‡5 years and providing data on clinical outcome for patients with negative tests. Summary risk estimates for normal perfusion at MPI or <50% coronary stenosis at CCTA were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. We identified 12 eligible articles (6 MPI and 6 CCTA) including 33,129 patients (26,757 in MPI and 6372 in CCTA studies) with suspected CAD. The pooled annualized event rate (AER) for occurrence of hard events (death and nonfatal myocardial infarction) was 1.06 (95% confidence interval, CI 0.49-1.64) in MPI and 0.61 (95% CI 0.35-0.86) in CCTA studies. The pooled NPV was 91% (95% CI 86-96) in MPI and 96 (95% CI 95-98) in CCTA studies. The summary rates between MPI and CCTA were not statistically different. At meta-regression analysis, no significant association between AER and clinical and demographical variables considered was found for overall studies. Conclusions. Stress MPI and CCTA have a similar ability to identify low-risk patients with suspected CAD.
Prognostic value of early exercise stress testing after successful coronary angioplasty: Importance of the degree of revascularization
American Heart Journal, 1989
The prognostic value of early exercise testing after successful coronary angioplasty was determined in 196 and 225 consecutive patients with single-vessel and multivessel coronary disease, respectively, who underwent a symptom-limited exercise test within 30 days of the procedure. The incidence of exercise-induced ST segment depression greater than or equal to 1 mm was significantly greater in patients with multivessel versus single-vessel disease (27% versus 14%; p less than 0.005) and in patients with multivessel coronary disease who had incomplete versus complete revascularization (36% versus 10%; p less than 0.001). An abnormal exercise ECG result was associated with a significantly increased risk of cardiac events in patients with multivessel disease but not in patients with single-vessel disease. Exercise-induced angina occurred in a small and similar proportion of patients with single and multivessel coronary disease (8% versus 12%). The presence of exercise-induced angina was associated with a higher incidence of follow-up cardiac events in patients with multivessel disease and incomplete revascularization (52% versus 33%; p less than 0.05). Exercise duration was significantly less in patients with multivessel disease who had a subsequent cardiac event compared with that in patients who did not have such an event (458 +/- 168 versus 519 +/- 156 seconds; p = 0.01). Thus an abnormal exercise ECG finding within 1 month of successful coronary angioplasty is predictive of subsequent cardiac events in patients who have multivessel disease. The prognostic content of the test might be further improved if the test were performed several months after the procedure when the risk of restenosis is greatest.
Myocardial perfusion scintigraphy in patients undergoing major non-vascular abdominal surgery
Annals of the Royal College of Surgeons of England, 1996
The prognostic value of myocardial perfusion scintigraphy is beginning to be recognised in patients undergoing cardiovascular surgery. The aim of this prospective study was to assess the predictive value of scintigraphy in elderly patients undergoing major non-vascular abdominal surgery. Adenosine stress thallium-201 (201Tl) single-photon emission tomography (SPET) was employed for imaging using a standard protocol. Patients over the age of 60 years (n = 55) with an intermediate to high likelihood of coronary artery disease were evaluated prospectively. The clinical outcome variables analysed were cardiac mortality and major cardiac morbidity occurring within 30 days of surgery. Cardiac events were cardiac death (n = 5), angina pectoris (n = 5), nonfatal mycardial infarction (n = 1), acute left ventricular failure (n = 2) and arrhythmias requiring treatment (n = 4). All cardiac events occurred in the first 10 postoperative days except one cardiac death which happened on the 29th pos...
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