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1.
Rev Cardiovasc Med ; 23(4): 145, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-39076213

RESUMO

The use of coronary physiology in patients with chronic coronary syndromes is highly variable, and the evidence base complex. Tests of coronary physiology have traditionally been invasive (e.g., fractional flow reserve), but novel non-invasive methods are now available which provide additional anatomical information (e.g., computed tomography-based fractional flow reserve and angiogram-derived physiology). This review summarises the evidence for and against the relative value of these tests for patients being investigated for chest pain that may represent chronic coronary syndromes, and for those triaged to percutaneous coronary intervention.

2.
J Cardiovasc Comput Tomogr ; 18(1): 33-42, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37872028

RESUMO

BACKGROUND: A score combining the burden of stenosis severity on coronary computed tomography angiography (CCTA) and flow impairment by fractional flow reserve derived from computed tomography (FFRCT) may be a better predictor of clinical events than either parameter alone. METHODS: The Functional FFRCT Score (FFS) combines CCTA and FFRCT parameters in an allocated point-based system. The feasibility of the FFS was assessed in cohort of 72 stable chest pain patients with matched CCTA and FFRCT datasets. Validation was performed using 2 cohorts: (a) 4468 patients from the ADVANCE Registry to define its association with revascularization and major adverse cardiovascular events (MACE); (b) 212 patients from the FORECAST trial to determine predictors of MACE. RESULTS: The median calculation time for the FFS was 10 (interquartile range 6-17) seconds, with strong intra-operator and inter-operator agreement (Cohen's Kappa 0.89 (±0.37, p â€‹< â€‹0.001) and 0.83 (±0.04, p â€‹< â€‹0.001, respectively). The FFS correlated strongly with both the CT-SYNTAX and the Functional CT-SYNTAX scores (rS â€‹= â€‹0.808 for both, p â€‹< â€‹0.001). In the ADVANCE cohort the FFS had good discriminatory abilities for revascularization with an area under the curve of 0.82, 95 â€‹% confidence interval (CI) 0.81-0.84, p â€‹< â€‹0.001. Patients in the highest FFS tertile had significantly higher rates of revascularization (61 â€‹% vs 5 â€‹%, p â€‹< â€‹0.001) and MACE (1.9 â€‹% vs 0.5 â€‹%, p â€‹= â€‹0.001) compared with the lowest FFS tertile. In the FORECAST cohort the FFS was an independent predictor of MACE at 9-month follow-up (hazard ratio 1.04, 95 â€‹% CI 1.01-1.08, p â€‹< â€‹0.01). CONCLUSION: The FFS is a quick-to-calculate and reproducible score, associated with revascularization and MACE in two distinct populations of stable symptomatic patients.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Angiografia Coronária/métodos , Valor Preditivo dos Testes , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos
3.
Open Heart ; 10(1)2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37130658

RESUMO

OBJECTIVE: The training of interventional cardiologists (ICs), non-interventional cardiologists (NICs) and cardiac surgeons (CSs) differs, and this may be reflected in their interpretation of invasive coronary angiography (ICA) and management plan. Availability of systematic coronary physiology might result in more homogeneous interpretation and management strategy compared with ICA alone. METHODS: 150 coronary angiograms from patients with stable chest pain were presented independently to three NICs, three ICs and three CSs. By consensus, each group graded (1) coronary disease severity and (2) management plan, using options: (a) optimal medical therapy alone, (b) percutaneous coronary intervention, (c) coronary artery bypass graft or (d) more investigation required. Each group was then provided with fractional flow reserve (FFR) from all major vessels and asked to repeat the analysis. RESULTS: There was only 'fair' level of agreement of management plan among ICs, NICs and CSs (kappa 0.351, 95% CI 0.295-0.408, p<0.001) based on ICA alone (complete agreement in 35% of cases), which almost doubled to 'good' level (kappa 0.635, 95% CI 0.572-0.697, p<0.001) when comprehensive FFR was available (complete agreement in 66% of cases). Overall, the consensus management plan changed in 36.7%, 52% and 37.3% of cases for ICs, NICs and CSs, respectively, when FFR data were available. CONCLUSIONS: Compared with ICA alone, the availability of systematic FFR of all major coronary arteries produced a significantly more concordant interpretation and more homogeneous management plan among IC, NIC and CS specialists. Comprehensive physiological assessment may be of value in routine care for Heart Team decision-making. TRIAL REGISTRATION NUMBER: NCT01070771.


Assuntos
Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Humanos , Angiografia Coronária , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Coração , Ponte de Artéria Coronária
4.
J Hypertens ; 40(4): 758-764, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35001033

RESUMO

OBJECTIVES: The risk profile of white-coat hypertension/effect (WCH/E) remains unclear. This study aimed to investigate the relationship between WCH/E, markers of cardiovascular risk and cerebrovascular events. METHODS: This is a sub-group analysis of The Arterial Stiffness In lacunar Stroke and Transient ischemic attack (ASIST) study, which recruited 96 patients aged at least 40 years old with a diagnosis of transient ischemic attack or lacunar stroke in the preceding 14 days. Thirty-two patients with target blood pressure (clinic blood pressure <140/90 mmHg and daytime ambulatory blood pressure <135/85 mmHg) and 30 patients with WCH/E (clinic blood pressure ≥140/90 mmHg and daytime ambulatory blood pressure <135/85 mmHg) were included in the analysis. RESULTS: Patients with WCH/E were older and had a higher BMI. Central SBP (145 ±â€Š13 vs. 118 ±â€Š8 mmHg, P < 0.001) and DBP (82 ±â€Š8 vs. 76 ±â€Š7 mmHg, P = 0.004) were higher in those with WCH/E. They also had higher arterial stiffness measured by carotid-femoral pulse wave velocity (11.9 ±â€Š3.0 vs. 9.6 ±â€Š2.3 m/s, P = 0.002) and cardio-ankle vascular index (10.3 ±â€Š1.3 vs. 9.4 ±â€Š1.7, P = 0.027). Regression analysis showed an independent relationship between WCH/E and both measures of arterial stiffness. Lacunar strokes were more prevalent in those with WCH/E (47 vs. 22%, P = 0.039) and individuals in this group were more likely to have had a lacunar stroke than a transient ischemic attack (odds ratio 9.6, 95% CI 1.5-62.6, P = 0.02). CONCLUSION: In this cohort of patients with lacunar stroke and transient ischemic attack, WCH/E was associated with elevated markers of cardiovascular risk and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Rigidez Vascular , Hipertensão do Jaleco Branco , Adulto , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Humanos , Análise de Onda de Pulso , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Rigidez Vascular/fisiologia , Hipertensão do Jaleco Branco/diagnóstico
5.
Ther Adv Cardiovasc Dis ; 14: 1753944720931637, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32580646

RESUMO

White coat hypertension (WCH) is characterised by an elevated clinic blood pressure (BP) with normal ambulatory or home BP. It is well recognised in clinical practice and occurs in approximately one-third of untreated patients with elevated clinic BP. Current evidence suggests that WCH is associated with cardiovascular risk factors, including the development of sustained hypertension and the presence of target organ damage. However, its effects on cardiovascular outcomes remain a matter of debate. There is also insufficient evidence from randomised controlled trials to determine whether WCH warrants treatment. This narrative review aims to provide an update on the current understanding of WCH. It focuses on the clinical characteristics and potential implications of WCH, its relationship to cardiovascular risk and the evidence regarding treatment. Gaps in existing research are also highlighted.


Assuntos
Pressão Sanguínea , Hipertensão do Jaleco Branco/fisiopatologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Progressão da Doença , Humanos , Visita a Consultório Médico , Fenótipo , Fatores de Risco , Resultado do Tratamento , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/tratamento farmacológico , Hipertensão do Jaleco Branco/epidemiologia
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