Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain.

BACKGROUND: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. METHODS: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. RESULTS: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. CONCLUSIONS: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02400229.

Correction to: Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain.

An amendment to this paper has been published and can be accessed via the original article.

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

OBJECTIVES: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). METHODS: In this trial, patients with a low-to-intermediate pretest probability (10-60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. RESULTS: Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. CONCLUSIONS: The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. KEY POINTS: • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

[The clinical value of computer tomography (CT) of diagnostics of acute thorax pain--a literature review]. / Wartosc kliniczna tomografii komputerowej (CT) w diagnostyce ostrego bólu w klatce piersiowej--przeglad dostepnej literatury.

Conventional angiography of the coronary arteries is a standard in heart and coronary arteries diagnosis, sufficient to choose a treatment method. The introduction of 64-row multidetector computed tomography improved the imaging of coronary arteries by increasing its spatial and temporal resolution. It has been shown that the potential clinical value of CT angiography, including dual source computed tomography (DSCT), is based particularly on the exclusion of coronary artery disease and is now a recognized clinical indication in patients with equivocal stress test results. Detection of hemodynamically insignificant atherosclerotic plaques during CT angiography may be important from the clinical point of view. Rupture of those plaques is the reason of about 60% of acute coronary events. Myocardial infarction with ST-segment elevation is not an indication for CT angiography of the coronary arteries. Acute chest pain is the cause of approximately 6-8% of hospitalizations in the EU and the United States. According to the U.S. data about 50% of patients are admitted to a hospital for observation, and of those only 15% are finally diagnosed with acute coronary syndrome. On the other hand 2-5% of patients are incorrectly diagnosed and discharged home despite the occurrence of ACS. In spite of relatively frequent and easy to recognize symptoms, the subject literature states that diagnosis of more than 1/3 of patients with acute chest pain poses a considerable difficulty in the A&E departments. Problems with proper risk assessment and diagnosis of the disease result in unnecessary hospital admissions, implementation of expensive and often invasive diagnostic methods and generating costs borne by the health care system. There is a need to optimize the minimally invasive diagnostic methods, that allow reliable exclusion of coronary artery disease and acute coronary syndrome. In approximately 10 to 20% of all patients with chest pain neither ST segment elevation nor positive results of enzymatic tests are found, those are patients with low or intermediate risk of acute coronary syndrome. Currently, the most widely used diagnostic method in these patients is a stress test and other diagnostic tests. Coronary angiography and stress tests enable the detection of atherosclerotic lesions, which significantly narrow the artery lumen and reduce the myocardial perfusion. There is therefore the demand for a reliable and minimally invasive imaging method for assessing coronary arteries, which will enable excluding critical coronary artery stenosis or isolating, from a group of medium and low risk patients assessed with routine tests, those who should undergo immediate angiography and invasive treatment. CT angiography allows to assess the severity of coronary atherosclerosis. The possibility of vascular wall and plaque morphology evaluation may have a significant impact on the detection of atherosclerotic lesions of vulnerable character. CT angiography has already been used for the noninvasive assessment of plaque morphology in comparison with the standard, i.e. intracoronary ultrasound-ICUS. Intracoronary ultrasound is the most accurate method for the evaluation of stenosis and plaque morphology, but high costs and invasiveness limit its application. It is necessary to assess the extent to which the multidetector dual source computed tomography may be an alternative for the intracoronary ultrasound (ICUS). Recent years brought about extensive tests of a CT angiography diagnostic algorithm originally called "triple rule-out" (Scheme 1). This method refers to the population of patients without a definitive diagnosis after routine diagnostic tests. It is applied mainly to acute conditions with which a patient reports to the A&E department: myocardial infarction, pulmonary embolism, aortic dissecting aneurysm as well as changes in the chest and ascending aorta and pulmonary arteries. The authors of this paper deem it necessary to conduct further clinical trials on the usefulness and cost-effectiveness of CT angiography in different patient groups.

[Usefulness of two-dimensional echocardiography for evaluation of left ventricular aneurysm. Comparison with magnetic resonance imaging and intraoperative evaluation]. / Przydatnosc echokardiografii dwuwymiarowej w ocenie tetniaka lewej komory. Porównanie z metoda rezonansu magnetycznego oraz ocena sródoperacyjna.

UNLABELLED: Aim of the study was to validate 2D echocardiography (2DE) for quantifying left ventricular aneurysm (LVA). Assessment if the initial parameters of LVA size could predict the choice of surgical technique. MATERIAL AND METHOD: Group 1 consisted of 10 patients with LVA who underwent 2DE and magnetic resonance imaging (MRI) as a reference method. Apical 4-chamber plane was used in both techniques to determine LVA area and volume (area-length method). Group 2 consisted of 33 patients with LVA who underwent surgical endoventriculoplasty (EVP): 18 with patch (P), 15 without patch. 2DE was performed before and after surgical procedure. LVA-area, LVA-volume were determined. RESULTS: Group 1 (2DE/MRI): Mean LVA-area and LVA-volume in 2DE were 17.5 +/- 6 cm2 and 62.6 +/- 32 ml, respectively, and in MR, they were 20.9 +/- 7 cm2 and 65.5 +/- 35 ml, respectively. Excellent correlation was found between 2DE and MRI: r = 0.85 for LVA-area and r = 0.81 for LVA volume (p < 0.001). 2DE underestimated LVA measurements in comparison with MRI results. Group 2 (surgical patients): Mean LVA-area was 15 cm2, LVA-volume 50 ml. LVA exceeding 50 ml was considered as large. 2DE LVA size estimation was in agreement with surgical assessment. All but one patient with LVA-volume surpassing 56 ml were operated on with P. EVP without P was done for smaller LVA. CONCLUSION: 1. With MRI as a reference method, 2DE can accurately quantify LVA size providing information about disturbances in LV geometry. 2. 2DE parameters of LVA-area and LVA-volume are valuable in planning operative method of EVP.