Alexander Ivanov

Correlation between pericardial, mediastinal, and intrathoracic fat volumes with the presence and severity of coronary artery disease, metabolic syndrome, and cardiac risk factors

AIMSnTo investigate the association of pericardial, mediastinal, and intrathoracic fat volumes with the presence and severity of coronary artery disease (CAD), metabolic syndrome (MS), and cardiac risk factors (CRFs).nnnMETHODS AND RESULTSnTwo hundred and sixteen consecutive patients who underwent cardiac magnetic resonance (CMR) imaging and had a coronary angiogram within 12 months of the CMR were studied. Fat volume was measured by drawing region of interest curves, from short-axis cine views from base to apex and from a four-chamber cine view. Pericardial fat, mediastinal fat, intrathoracic fat (addition of pericardial and mediastinal fat volumes), and fat ratio (pericardial fat/mediastinal fat) were analysed for their association with the presence and severity of CAD (determined based on the Duke CAD Jeopardy Score), MS, CRFs, and death or myocardial infarction on follow-up. Pericardial fat volume was significantly greater in patients with CAD when compared with those without CAD [38.3 ± 25.1 vs. 31.9 ± 21.4 cm(3) (P = 0.04)]. A correlation between the severity of CAD and fat volume was found for pericardial fat (β = 1, P < 0.01), mediastinal fat (β = 1, P = 0.03), intrathoracic fat (β = 2, P = 0.01), and fat ratio (β = 0.005, P = 0.01). These correlations persisted for all four thoracic fat measurements even after performing a stepwise linear regression analysis for relevant risk factors. Patients with MS had significantly greater mediastinal and intrathoracic fat volumes when compared with those without MS [126 ± 33.5 vs. 106 ± 30.1 cm(3) (P < 0.01) and 165 ± 54.9 vs. 140 ± 52 cm(3) (P < 0.01), respectively]. However, there was no significant difference in pericardial fat, mediastinal fat, intrathoracic fat, or fat ratio between patients with or without myocardial infarction during the follow-up [33.6 ± 22.1 vs. 35.7 ± 23.8 cm(3) (P = 0.67); 115 ± 26.2 vs. 114 ± 33.8 cm(3) (P = 0.84); 149 ± 44.7 vs. 150 ± 55.7 cm(3) (P = 0.95); and 0.27 ± 0.15 vs. 0.28 ± 0.14 (P = 0.70), respectively]. There was no significant difference in pericardial fat, mediastinal fat, intrathoracic fat, or fat ratio between patients who were alive compared with those who died during follow-up [36.6 ± 26.6 vs. 35.3 ± 23.2 cm(3) (P = 0.76); 114 ± 40.2 vs. 114 ± 31.4 cm(3) (P = 0.95); 150 ± 64.7 vs. 149 ± 52.5 cm(3) (P = 0.92); and 0.29 ± 0.15 vs. 0.28 ± 0.14 (P = 0.85), respectively].nnnCONCLUSIONnOur study confirms an association between pericardial fat volume with the presence and severity of CAD. Furthermore, an association between mediastinal and intrathoracic fat volumes with MS was found.

Do pulmonary function tests improve risk stratification before cardiothoracic surgery

OBJECTIVEnTo assess the added value of pulmonary function tests (PFTs) and different classifications of chronic obstructive pulmonary disease (COPD) to the Society of Thoracic Surgeons (STS) risk model using a clinical definition of lung disease for predicting outcomes after cardiothoracic (CT) surgery.nnnMETHODSnWe evaluated consecutive patients who underwent nonemergency cardiac surgery and underwent PFTs before CT surgery. We used the STS risk model 2.73 to estimate the postoperative risk for respiratory failure (RF; defined as the need for mechanical ventilation for ≥72 hours, or reintubation), prolonged postoperative stay (PPLS; defined as >14 days), and 30-day all-cause mortality. We plotted the receiver operating characteristics curve for STS score for each adverse event, and compared the resulting area under the curve (AUC) with the AUC after adding PFT parameters and COPD classifications.nnnRESULTSnOf the 1412 patients with a calculated STS score, 751 underwent PFTs. The AUC of the STS score was 0.65 (95% confidence interval [CI], 0.55-0.74) for RF, 0.67 (95% CI, 0.6-0.74) for prolonged postoperative length of stay (PPLS), and 0.74 (95% CI, 0.6-0.87) for death. None of the PFT parameters or COPD classifications added to the predictive ability of STS for RF, PPLS, or 30-day mortality.nnnCONCLUSIONSnAdding individual PFT parameters or different COPD classifications to STS score calculated using clinically based classification of lung disease did not improve model discrimination. Thus, routine preoperative PFTS may have limited clinical utility in patients undergoing CT surgery when the STS score is readily available.

Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease

ObjectivesTo assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain.BackgroundSPECT imaging is the most utilized outpatient procedure in the United States. The diagnostic accuracy of SPECT can be limited by soft tissue attenuation and low spatial resolution. Stress CMR has much higher spatial resolution and without the susceptibility to soft tissue attenuation.MethodsEighty-seven patients without a history of CAD presenting to the ED with chest pain were prospectively enrolled. Patients underwent both stress CMR and stress SPECT imaging within 12xa0hours of presentation. Both the stress imaging tests were interpreted immediately for clinical purposes and coronary angiography was performed if either was abnormal. Patients were considered to have significant CAD if identified by angiography (≥50%) or if a cardiac event (cardiac death, myocardial infarction or revascularization) occurred during follow-up (mean 2.6xa0±xa01.1xa0years).ResultsThirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (≥50%). The remaining patients were followed for 2.6xa0±xa01.1xa0years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively.ConclusionStress CMR has similar diagnostic accuracy as stress SPECT in diagnosis of CAD.

Enlarging saphenous vein graft aneurysm.

1Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, New York 2Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, New York 3Department of Medicine, New York Methodist Hospital, Brooklyn, New York Correspondence Iosif Gulkarov MD, Department of Cardiothoracic Surgery, New York Methodist Hospital, 263 Seventh Avenue, Suite 4H, Brooklyn, NY 11215. Email: iog9001@med.cornell.edu

EFFECT OF COFFEE OR TEA CONSUMPTION ON MORTALITY AND MORBIDITY: A NETWORK META-ANALYSIS OF 58 STUDIES

Tea and coffee are the primary sources of caffeine in the world. Previous studies and meta-analyses suggested a U-shaped relationship between morbidity and coffee dose. On other hand recent large epidemiological study favored tea over coffee for morbidity prevention. We aimed to compare health

BIVALIRUDIN WITH PROVISIONAL GLYCOPROTEIN IIB/IIIA INHIBITORS COMPARED TO HEPARIN WITH PLANNED OR PROVISIONAL GLYCOPROTEIN IIB/IIIA INHIBITORS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: NETWORK META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

In some randomized clinical trials (RCT), bivalirudin(Biv) -based anticoagulation led to reduced mortality compared with heparin(Hep) -based regimens during PCI. The mortality benefit may be related to lower rates of major bleeding (MB), at the expense of higher rates of early stent thrombosis (ST

Right atrial volume indexed by cardiovascular magnetic resonance as a predictor of mortality in patients with heart failure with reduced ejection fraction

Background Right Atrial Volume Indexed (RAVI) measured by echocardiogram was identified to be an independent predictor of morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Meta-Analysis Global Group in Chronic heart failure (MAGGIC) risk score is a robust tool in predicting mortality in HF patients. The aim of this study is to evaluate RAVI by cardiac magnetic resonance (CMR) imaging as an independent predictor of all-cause mortality in patients with HFrEF and to compare it with the validated risk score

Prevalence of dysfunctional but viable myocardium in patients with ischemic cardiomyopathy - results from clinical scans performed in 2010-2014 at four U.S. hospitals

Background Assessment of viability in patients with ischemic cardiomyopathy (ICM) prior to possible revascularization has fallen out of favor after the STITCH trial, which failed to demonstrate a benefit of echocardiography or nuclear viability testing. CMR assessment of viability by directly visualizing the transmural extent of both viable and nonviable myocardium offers unique advantages which have not been explored in large trials. Several small studies have shown significant contractile improvement after revascularization of dysfunctional segments with residual viability by CMR. The objective of this study was to determine the prevalence of residual viability over the entire range of severity of dysfunction in patients with ICM.

Importance of papillary muscle infarction detected by cardiac magnetic resonance imaging in predicting cardiovascular events

BACKGROUNDnRecent studies suggest that papillary muscle infarction (PMI) following recent myocardial infarction (MI) correlates with adverse cardiovascular outcomes. The purpose of this study is to determine the prevalence and prognostic significance of PMI by cardiac magnetic resonance (CMR) in a large cohort of patients.nnnMETHODSnRetrospective study of patients who underwent CMR between January 2007 and December 2009 were evaluated for the presence of PMI in one or both of the left ventricle papillary muscles. The primary outcome was a time to a combined endpoint of all-cause mortality and worsening heart failure. Secondary outcomes were time to individual components of the combined outcome.nnnRESULTSn419 patients were included in our analysis, 232 patients (55%) had ischemic cardiomyopathy. Patients were followed at six-month intervals for a median follow-up time of 3.7 (interquartile range (IQR): 1.6; 6.3) years after initial imaging. During this period 196 patients (46.8%) had a primary outcome and 92 patients (22%) died. PM infarct was identified in 204 (48.7%) patients with twice as many posteromedial (PRM) (27%) than anterolateral (ARL) lesions (11%) and a similar number with infarct in both (11%). There was no association between studied outcomes and the presence of PMI in either PRM or ARL PM. The presence of infarct in both PM was a predictor of both the primary outcome (HR 1.69, CI[1.01-2.86], p<0.049.) and mortality (HR 1.69, CI[1.01-4.2], p<0.046).nnnCONCLUSIONnThe presence of infarct in either papillary muscle was not associated with outcomes. However, infarct involving both papillary muscles was associated with worse outcomes.

Myocardial Viability and Revascularization: Current Understanding and Future Directions

The initial observation of functional recovery in dysfunctional myocardium following revascularization led to the introduction of the concept of hibernating myocardium. Since then, the pathophysiologic basis of hibernating myocardium has been well described. Multiple imaging modalities have been utilized to prospectively detect viable myocardium and thus predict its functional recovery following revascularization. It has been hypothesized that viability imaging will be instrumental in the selection of patients with ischemic cardiomyopathy likely to benefit from revascularization. Multiple observational studies built a large body of evidence supporting this concept. However, data from prospective studies failed to substantiate utility of viability testing. This review aims to summarize the current literature and describe the role of viability imaging in current clinical practice as well as future directions.