BACKGROUND: Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS: This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS: 5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS: Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
Cardiovascular Agents/administration & dosage , Computed Tomography Angiography , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Heart Rate/drug effects , Ivabradine/administration & dosage , Multidetector Computed Tomography , Point-of-Care Testing , Administration, Oral , Adrenergic beta-1 Receptor Antagonists/administration & dosage , Aged , Female , Humans , Male , Metoprolol/administration & dosage , Middle Aged , Predictive Value of Tests , Retrospective Studies , Time Factors , Workflow
Molecular imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) serves numerous applications in clinical cardiology and research. Similar to other medical imaging technologies, this area has undergone and continues to experience rapid changes resulting from technological and medical advances. These have immediate impacts on diagnosis, treatment planning, and patient care, as well as supplying innovative tools for fundamental and translational research. A broad shift toward hybrid PET systems and incorporation of advanced computational tools has been accompanied by mechanism-specific, targeted radiopharmaceuticals that seek to address long-standing limitations in cardiac imaging. While this review addresses some of the still-emerging clinical uses of established radiopharmaceuticals, it too highlights newer imaging probes, applications, and imaging techniques and instrumentation on the horizon. We highlight molecular imaging advances in inflammatory and infiltrative myocardial conditions, heart metabolism, vascular and valvular diseases, neurohormonal dysregulation, and transformational technical advances such as the rise of artificial intelligence and theranostic approaches to cardiovascular disease.
Heart/diagnostic imaging , Molecular Imaging/trends , Cardiovascular Diseases/diagnostic imaging , Humans
PURPOSE: We aimed to investigate the association of atrial fibrillation (AF) recurrence with left atrial (LA) strain in nonvalvular paroxysmal AF patients after cryoablation. METHODS: We included 190 patients who underwent successful cryoablation due to paroxysmal AF. In addition to classical echocardiographic data, LA apical 2-chamber (A2C) strain, LA apical 4-chamber (A4C) strain, and LA global longitudinal strain (LA-GLS) values were calculated by speckle tracking echocardiography. Forty-eight-hour Holter monitoring was performed to all patients no later than 6 months after ablation. RESULTS: AF recurrence was detected in 42 patients (22.1%). End-systolic diameter, LA end-systolic diameter, LA-volume, LA-volume index, interatrial septum thickness, coronary sinus diameter, epicardial fat thickness (EFT), and septal E/E` ratio were significantly higher, LV-EF, IVRT, septal S and A` wave, lateral S wave, LA-A2C strain, LA-A4C strain, and LA-GLS were significantly lower in patients with AF recurrence. LA-GLS, LA-volume index, and EFT were found to be independent parameters for predicting AF recurrence. CONCLUSIONS: LA-GLS and LAVI should be included in routine evaluations to determine long-term AF recurrence preoperatively.
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Echocardiography , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Recurrence , Reproducibility of Results
Adipose Tissue/diagnostic imaging , Cardiovascular Diseases/etiology , Computed Tomography Angiography , Coronary Angiography , Elective Surgical Procedures/adverse effects , Pericardium/diagnostic imaging , Aged , Cardiovascular Diseases/diagnostic imaging , Cardiovascular Diseases/mortality , Female , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Predictive Value of Tests , Risk Factors , Time Factors , Treatment Outcome
OBJECTIVE: Morning blood pressure surge (MBPS) and orthostatic hypotension (OH) play a role in the occurrence of cardiovascular events. We aimed to investigate the association between MBPS and OH in hypertensive patients under treatment. PATIENTS AND METHODS: We prospectively included 297 patients (mean age: 53.8±10.7 years, male/female: 101/196) with essential hypertension. Tilt table testing was performed for the diagnosis of OH. OH was classified into three groups as initial OH (0-15 s), classical OH (15 s to 3 min), and delayed OH (3-30 min). Patients were categorized into two main groups: patient with OH or without OH. We used sleep-through MBPS. The MBPS was calculated as the difference between the average blood pressure (BP) during the 2 h after awakening and the lowest night-time BP. RESULTS: We detected initial OH in two patients, classic OH in seven patients, delayed OH in 20 patients, and delayed OH with syncope in two patients. MBPS, thiazide diuretic, and α-blocker treatments were found to be associated independently with the occurrence of OH. Every 10 mmHg increase in MBPS was found to increase the rate of development of OH by 29.6%. The cut-off value of MBPS obtained by the receiver operator characteristic curve analysis was 35 mmHg for the prediction of OH occurrence (sensitivity: 58.0%, specificity: 68.0%). The area under the curve was 0.657 (95% confidence interval: 0.553-0.771, P=0.004). CONCLUSION: OH is a major problem in hypertensive patients. Increased MBPS, which can be detected easily by 24-h ambulatory BP monitor, predicts the occurrence of OH independently.
Hypertension/complications , Hypertension/physiopathology , Hypotension, Orthostatic/complications , Hypotension, Orthostatic/diagnosis , Adrenergic alpha-Antagonists/therapeutic use , Adult , Aged , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory , Circadian Rhythm/physiology , Diuretics/therapeutic use , Female , Humans , Hypertension/drug therapy , Male , Middle Aged , Sleep , Thiazides/therapeutic use , Tilt-Table Test