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Coronary Artery Disease: HELP
Articles by Tara L. Sedlak
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, Tara Sedlak wrote the following 11 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Ischemia and No Obstructive Coronary Artery Disease ( INOCA ): What Is the Risk? 2018

Herscovici, Romana / Sedlak, Tara / Wei, Janet / Pepine, Carl J / Handberg, Eileen / Bairey Merz, C Noel. ·1 Barbra Streisand Women's Heart Center Cedars-Sinai Smidt Heart Institute Los Angeles CA. · 2 Vancouver General Hospital Vancouver British Columbia Canada. · 3 University of Florida Gainesville FL. ·J Am Heart Assoc · Pubmed #30371178.

ABSTRACT: -- No abstract --

2 Review Recent Developments in Sex-Related Differences in Presentation, Prognosis, and Management of Coronary Artery Disease. 2018

Parvand, Mahraz / Rayner-Hartley, Erin / Sedlak, Tara. ·Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: tara.sedlak@vch.ca. ·Can J Cardiol · Pubmed #29571423.

ABSTRACT: Coronary artery disease (CAD) is the most prevalent type of heart disease among women and men. Sex-related differences in the presentation, prognosis, and management of patients with CAD has been increasingly studied. Compared with men, women are more likely to present with multiple comorbidities, have a higher prevalence of psychological risk factors, and present with atypical symptoms. These factors, along with delays in seeking medical attention, might contribute to sex-related treatment differences in women with stable angina and acute coronary syndrome. This review article highlights recent evidence examining sex-related differences in stable CAD patients with obstructive CAD, nonobstructive CAD, as well as myocardial infarction.

3 Article Coronary lumen volume to myocardial mass ratio in primary microvascular angina. 2017

Grover, Rominder / Leipsic, Jonathon A / Mooney, John / Kueh, Shaw-Hua / Ohana, Mickael / Nørgaard, Bjarne L / Eftekhari, Ashkan / Bax, Jeroen J / Murphy, Darra T / Hague, Cameron J / Seidman, Michael A / Blanke, Philipp / Sedlak, Tara / Sellers, Stephanie L. ·Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada. · Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: jleipsic@providencehealth.bc.ca. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. · Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Department of Pathology, St Paul's Hospital, Vancouver, Canada. · Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada; Leslie Diamond Women's Heart Health Clinic, Vancouver General Hospital, Vancouver, Canada. · Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada. ·J Cardiovasc Comput Tomogr · Pubmed #28993120.

ABSTRACT: BACKGROUND: Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. METHODS: A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden. V/M was extracted off site (Heartflow Inc; Redwood City, CA) employing allometric scaling laws that allow the definition of the coronary circulation beyond the epicardium. FFR RESULTS: A total of 30 patients with MVA and 32 matched controls were included in the study. Mean total coronary lumen volume (2302 mm CONCLUSION: Patients with microvascular angina demonstrate a significantly lower coronary CTA-derived coronary volume/myocardial mass ratio than asymptomatic controls.

4 Article Yield of Cardiac Magnetic Resonance Imaging in Patients With Acute Coronary Syndrome and No Obstructive Coronary Artery Disease. 2017

Parvand, Mahraz / Starovoytov, Andrew / Sedlak, Tara L. ·From the *Providence Health Care Research Institute, Vancouver, British Columbia, Canada; and †Vancouver General Hospital, Vancouver, British Columbia, Canada. ·Crit Pathw Cardiol · Pubmed #28509705.

ABSTRACT: PURPOSE: Ten percent to 25% of women and 6%-10% of men with acute coronary syndrome (ACS) are found to have no obstructive coronary artery disease (CAD) on coronary computed tomography angiogram or invasive coronary angiography. The etiology of presentation is often unclear. We examined the diagnostic yield of cardiac magnetic resonance imaging (CMR) in patients with signs and symptoms suggestive of an ACS and no obstructive CAD. METHODS: We retrospectively studied patients with signs and symptoms suggestive of an ACS and no obstructive CAD on coronary computed tomography angiogram or invasive coronary angiography who had CMR performed at St. Paul's Hospital, British Columbia, Canada, from 2013 to 2015. No obstructive CAD was defined as <50% stenosis in any epicardial artery. We compared CMR diagnostic yield in troponin-positive and troponin-negative patients and determined the etiology of presentation in each category. We also examined gender differences. RESULTS: Ninety-eight patients met inclusion criteria. The average age was 55.8 years, 70% were female, and 60% were troponin positive upon presentation. Abnormal CMR was observed in 35.7% of patients, yielding a diagnosis in 27.9% of females and 53.5% of males (P = 0.02). Troponin-positive patients had a significantly higher prevalence of an abnormal CMR than did troponin-negative patients (44.1% vs. 23.1%; P = 0.03). Myocarditis was more common in troponin-positive patients (25.4% vs. 2.6%; P = 0.002). CONCLUSIONS: Forty-four percent of patients with positive troponin and with signs and symptoms suggestive of an ACS, no obstructive CAD on invasive coronary angiography or coronary computed tomography angiogram, and unclear diagnosis had abnormalities on CMR that identified the diagnosis. CMR should be considered in patients with positive troponin values when the etiology for their presentation is unclear.

5 Article Cardiac Medication Use in Patients with Acute Myocardial Infarction and Nonobstructive Coronary Artery Disease. 2017

Adatia, Falisha / Galway, Shannon / Grubisic, Maja / Lee, May / Daniele, Patrick / Humphries, Karin H / Sedlak, Tara L. ·1 Vancouver General Hospital , Vancouver, Canada . · 2 University of British Columbia , Vancouver, Canada . · 3 BC Centre for Improved Cardiovascular Health , Vancouver, Canada . ·J Womens Health (Larchmt) · Pubmed #28384014.

ABSTRACT: IMPORTANCE: Patients with acute myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) have an elevated cardiac event rate, suggesting that these patients may benefit from cardiac medication. OBJECTIVE: We evaluated the rates of cardiac medication use 3 months before angiography and 3 months following clinically indicated angiography for MI in patients with no CAD, nonobstructive CAD, and obstructive CAD. We also examined the sex differences in cardiac medication use 3 months following angiography in patients by extent of angiographic CAD. METHODS: We studied patients ≥20 years old with MI undergoing coronary angiography in British Columbia, Canada, from January 1, 2008, to March 31, 2010 (n = 3,841). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through British Columbia PharmaNet for angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, and antiplatelet agents. Optimal medical therapy (OMT) was defined as filled prescriptions for all three: ACE-Is/ARBs, beta-blockers, and statins. RESULTS: Following angiography, in all medication categories except CCBs, patients with no CAD and nonobstructive CAD had significantly lower rates of prescriptions filled than patients with obstructive CAD (all p < 0.001). After adjusting for age and prior medication use, patients with nonobstructive CAD were still less likely to receive these medications than patients with obstructive CAD, including OMT with an odds ratio = 0.25 (95% confidence interval: 0.18-0.36). There were no significant sex differences in medication use 3 months postangiography. CONCLUSIONS: In post-MI patients, medication use following angiography is significantly lower in nonobstructive CAD than obstructive CAD at 3 months. While sex was not an independent predictor of medication use 3 months post-catheterization, future studies should explore methods of improving medication use in both females and males with nonobstructive CAD post-MI.

6 Article Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease. 2017

Galway, Shannon / Adatia, Falisha / Grubisic, Maja / Lee, May / Daniele, Patrick / Humphries, Karin H / Sedlak, Tara L. ·1 Department of Medicine, Vancouver General Hospital , Vancouver, Canada . · 2 University of British Columbia , Vancouver, Canada . · 3 BC Centre for Improved Cardiovascular Health , Vancouver, Canada . ·J Womens Health (Larchmt) · Pubmed #28384013.

ABSTRACT: BACKGROUND: Treatment of patients with stable angina and nonobstructive coronary artery disease (CAD) has not been well characterized. We comparatively evaluated medication use in males and females with stable angina with no CAD, nonobstructive CAD, and obstructive CAD. METHODS: We studied all patients ≥20 years old with stable angina undergoing coronary angiography in British Columbia (BC), Canada, from January 2008 to March 2010 (n = 7,535). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1%-49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through BC PharmaNet for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, antiplatelet agents, and prescriptions for all three ACE-I/ARBs, beta-blockers, and statins (combination therapy). RESULTS: Following angiography, patients with no and nonobstructive CAD had significantly lower rates of prescription use of all medications, including combination therapy, than patients with obstructive CAD (p < 0.001). Use of ACE-I/ARBs, beta-blockers, statins, and combination therapy did not differ by sex, but females had higher use of CCB in all CAD groups, and clopidogrel in nonobstructive and obstructive CAD groups, compared to males. CONCLUSIONS: In patients with stable angina, medication use following angiography is low in nonobstructive CAD with only 58.9% prescribed a statin and 19.4% on combination therapy at 3 months. There are no important sex differences in medication use in any CAD category post-angiography. Future studies should explore methods of improving quality of care in patients with nonobstructive CAD.

7 Article Circulating progenitor cells and coronary microvascular dysfunction: Results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction Study (WISE-CVD). 2016

Mekonnen, Girum / Hayek, Salim S / Mehta, Puja K / Li, Qunna / Mahar, Ernestine / Mou, Liping / Kenkre, Tanya S / Petersen, John W / Azarbal, Babak / Samuels, Bruce / Anderson, R David / Sedlak, Tara / Zaya, Melody / Agarwal, Megha / Haftbaradaran, Afsaneh / Minissian, Margo / Handberg, Eileen / Pepine, Carl J / Cogle, Christopher R / Bairey Merz, C Noel / Waller, Edmund K / Quyyumi, Arshed A. ·Emory University School of Medicine, Atlanta, GA, USA. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA. · University of Pittsburgh, Pittsburgh, PA, USA. · University of Florida, Gainesville, FL, USA. · University of British Columbia, Canada. · Emory University School of Medicine, Atlanta, GA, USA. Electronic address: aquyyum@emory.edu. ·Atherosclerosis · Pubmed #27596135.

ABSTRACT: BACKGROUND AND AIMS: Ischemia stimulates a reparative response resulting in mobilization of circulating progenitor cells (CPCs). We hypothesized that women with chronic myocardial ischemia from coronary microvascular disease (CMD) will mobilize CPCs. METHODS: In 123 women with ischemic symptoms and signs but no obstructive coronary artery disease (CAD) enrolled in the Women's Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction Study (WISE-CVD), we measured coronary flow reserve (CFR) in response to intracoronary adenosine. Peripheral blood CPCs were measured using flow cytometry for expression of CD34, CD133, CXCR4, and VEGFR2. RESULTS: Subjects were 53 ± 11 years, BMI 30 ± 8; 44% hypertensive, 11% diabetic, 23% hyperlipidemic and 7% smokers. Lower CFR correlated inversely with higher levels of hematopoietic-enriched CD34+ (r = -0.23, p = 0.011), CD34+/CD133+ (r = -0.24, p = 0.008), and CD34+/CXCR4+ (r = -0.19, p = 0.036) cells. In multivariable regression analyses, after adjusting for traditional cardiovascular risk factors, lower CFR remained significantly associated with elevated levels of CD34+ (β -0.18, p = 0.042), CD34+/CD133+ (β -0.24, p = 0.036), and CD34+/CXCR4+ (β -0.22, p = 0.050) cells. We found no association between CFR and CD34+/VEGFR2+ cells. CONCLUSIONS: In women with non-obstructive CAD, impaired CFR is associated with higher levels of CPCs, suggesting that chronic myocardial ischemia from CMD stimulates CPC mobilization. The functional significance of elevated CPCs in these subjects requires further investigation as a potential biomarker and treatment target.

8 Article Ischemic Predictors of Outcomes in Women With Signs and Symptoms of Ischemia and Nonobstructive Coronary Artery Disease. 2016

Sedlak, Tara L / Guan, Meijiao / Lee, May / Humphries, Karin H / Johnson, B Delia / Pepine, Carl J / Merz, C Noel Bairey. ·Vancouver General Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada3British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. · Department of Cardiovascular Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. · Department of Epidemiology, University of Florida, Gainesville. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California. ·JAMA Cardiol · Pubmed #27438329.

ABSTRACT: -- No abstract --

9 Article Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease. 2016

Izadnegahdar, Mona / Mackay, Martha / Lee, May K / Sedlak, Tara L / Gao, Min / Bairey Merz, C Noel / Humphries, Karin H. ·From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada · Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada · BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.) · Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.) · and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.). ·Circ Cardiovasc Qual Outcomes · Pubmed #26908856.

ABSTRACT: BACKGROUND: The joint contribution of sex, ethnicity, and initial clinical presentation to the long-term outcomes of patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina, in whom there is angiographic evidence for obstructive coronary artery disease, remains unknown. METHODS AND RESULTS: We conducted a population-based cohort study on 49 556 adult ACS or stable angina patients with angiographic evidence of obstructive coronary artery disease (≥ 50% stenosis) in British Columbia. The 2-year composite outcome was all-cause death and hospital readmissions for myocardial infarction, heart failure, cerebrovascular accident, or angina after the index angiography. Sex and ethnic differences in the composite outcome were examined by clinical presentation using the Cox proportional-hazards and logistic regression models. Overall, 25.6% were women, 9.5% were South Asians, 3.0% were Chinese, and 65.9% presented with ACS. Regardless of ethnicity, women were more likely than men to have adverse outcomes, but the magnitude of the sex difference was greater in the ACS patients (P(interaction) for sex and clinical presentation=0.03). Angina readmission accounted for 45% of the composite outcome and was the main component for all groups with the exception of Chinese women with ACS. Furthermore, women were more likely than men to be readmitted for angina (odds ratio [95% confidence interval], 1.13 [1.04-1.22]). CONCLUSIONS: Higher rates of adverse events among women with obstructive coronary artery disease, regardless of ethnicity, as well as high rates of angina readmission, highlight the need for more targeted interventions to reduce the burden of angina because this presentation is clearly not benign.

10 Article Nonatherosclerotic coronary artery disease in young women. 2014

Saw, Jacqueline / Aymong, Eve / Mancini, G B John / Sedlak, Tara / Starovoytov, Andrew / Ricci, Donald. ·Vancouver General Hospital, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jsaw@mail.ubc.ca. · Vancouver General Hospital, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. ·Can J Cardiol · Pubmed #24726091.

ABSTRACT: BACKGROUND: Nonatherosclerotic coronary artery disease (NACAD) is an important cause of myocardial infarction (MI) in young women but is often missed on coronary angiography, especially spontaneous coronary artery dissection (SCAD). The prevalence of NACAD in young women has not been described. METHODS: We retrospectively reviewed all coronary angiograms of women aged 50 years and younger at Vancouver General Hospital from December 1, 2009 to November 30, 2011. The angiograms were reviewed by 2 experienced interventional cardiologists, and reported as normal (<30% stenosis), atherosclerotic coronary artery disease (ACAD), or NACAD. NACAD was further characterized as SCAD, coronary fibromuscular dysplasia (FMD), ectasia, vasculitis, embolism, congenital anomaly, or unclear etiology. RESULTS: Of 7605 coronary angiograms performed, 177 were done in women aged 50 years and younger. The mean age was 45.4 ± 4.9 (range, 31-50) years, 76 of 177 (42.9%) presented with acute coronary syndrome, and 66 were troponin-positive. Ninety-seven (54.8%) women had normal arteries, 54 (30.5%) had ACAD, 23 (13.0%) had NACAD, and 3 (1.7%) had unclear etiology. Of those with NACAD, SCAD was observed in 16 (all troponin-positive and 13 of 16 had noncoronary FMD), and 2 had irregular beading suspicious of coronary FMD. Coronary vasculitis was suspected in 2, and 5 had coronary ectasia. Among women with MI (66/177), 19 (28.8%) had normal arteries (3 Takotsubo cardiomyopathy), 24 (36.4%) had ACAD, 20 (30.3%) had NACAD, 16 (24.2%) had SCAD, and 3 had unclear etiology. CONCLUSIONS: NACAD was not rare among young women (aged 50 years and younger) undergoing coronary angiography and was an important cause of MI, accounting for 30%. SCAD was the most commonly encountered NACAD in young women, causing 24% of MIs.

11 Article Sex differences in clinical outcomes in patients with stable angina and no obstructive coronary artery disease. 2013

Sedlak, Tara L / Lee, May / Izadnegahdar, Mona / Merz, C Noel Bairey / Gao, Min / Humphries, Karin H. ·Vancouver General Hospital, Vancouver, British Columbia, Canada. ·Am Heart J · Pubmed #23816019.

ABSTRACT: BACKGROUND: We comparatively evaluated clinical outcomes in men and women presenting with stable angina with no coronary artery disease (CAD), nonobstructive CAD, and obstructive CAD on coronary angiography. METHODS: We studied all patients ≥20 years with stable angina, undergoing coronary angiography in British Columbia, Canada, from July 1999 to December 2002 (n = 13,695) with maximum follow-up to 3 years. No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Freedom from major adverse cardiac events (MACEs), which included the combined end points of all-cause mortality, nonfatal acute myocardial infarction, nonfatal stroke, and heart failure admissions, was estimated using the Kaplan-Meier method. Hazard ratios (HRs) and 95% CIs for MACE were estimated up to 3 years postcatheterization and compared between sex and CAD groups. RESULTS: Within the first year, women with nonobstructive CAD had a higher risk of MACE than men with nonobstructive CAD (adjusted HR 2.43, 95% CI 1.08-5.49). Furthermore, women with nonobstructive CAD had a 2.55-fold higher risk of MACE than women with no CAD (95% CI 1.33-4.88). In contrast, men with nonobstructive CAD had a similar risk as men with no CAD (adjusted HR 0.61, 95% CI 0.26-1.45). The differences in MACE according to extent of CAD were not evident in the longer term. CONCLUSIONS: Women with stable angina and nonobstructive CAD are 3 times more likely to experience a cardiac event within the first year of cardiac catheterization than men. A prospective trial to examine the impact of medical therapy on MACE in patients with nonobstructive CAD is warranted.