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Coronary Artery Disease: HELP
Articles by David A. Wood
Based on 20 articles published since 2010
(Why 20 articles?)
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Between 2010 and 2020, David Wood wrote the following 20 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Current status of transcatheter aortic valve replacement. 2012

Webb, John G / Wood, David A. ·St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada. john.webb@vch.ca ·J Am Coll Cardiol · Pubmed #22749306.

ABSTRACT: Surgical aortic valve replacement (SAVR) has long been the mainstay of therapy for severe aortic stenosis. However, transcatheter aortic valve replacement (TAVR) is now generally accepted as the new standard of care for patients with symptomatic aortic stenosis who are not candidates for open surgery. Arguably TAVR may also be a preferred alternative to SAVR in carefully selected high-risk, but still operable, patients in whom morbidity and mortality may be reduced. Although TAVR outcomes continue to improve, concerns remain with respect to vascular injury, stroke, paravalvular regurgitation, and valve durability. However, it seems likely that with ongoing refinement of transcatheter valve systems, techniques, and patient selection TAVR is becoming an increasingly appealing option for a much broader range of patients. Randomized trials and ongoing surveillance will play an important role as we enter a new era of rigorous clinical evaluation for minimally invasive therapies for structural heart disease.

2 Clinical Trial Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. 2011

Reynolds, Harmony R / Srichai, Monvadi B / Iqbal, Sohah N / Slater, James N / Mancini, G B John / Feit, Frederick / Pena-Sing, Ivan / Axel, Leon / Attubato, Michael J / Yatskar, Leonid / Kalhorn, Rebecca T / Wood, David A / Lobach, Iryna V / Hochman, Judith S. ·Cardiovascular Clinical Research Center, 530 First Ave SKI-9R, New York, NY 10016, USA. Harmony.Reynolds@NYUMC.org ·Circulation · Pubmed #21900087.

ABSTRACT: BACKGROUND: There is no angiographically demonstrable obstructive coronary artery disease (CAD) in a significant minority of patients with myocardial infarction, particularly women. We sought to determine the mechanism(s) of myocardial infarction in this setting using multiple imaging techniques. METHODS AND RESULTS: Women with myocardial infarction were enrolled prospectively, before angiography, if possible. Women with ≥50% angiographic stenosis or use of vasospastic agents were excluded. Intravascular ultrasound was performed during angiography; cardiac magnetic resonance imaging was performed within 1 week. Fifty women (age, 57±13 years) had median peak troponin of 1.60 ng/mL; 11 had ST-segment elevation. Median diameter stenosis of the worst lesion was 20% by angiography; 15 patients (30%) had normal angiograms. Plaque disruption was observed in 16 of 42 patients (38%) undergoing intravascular ultrasound. There were abnormal myocardial cardiac magnetic resonance imaging findings in 26 of 44 patients (59%) undergoing cardiac magnetic resonance imaging, late gadolinium enhancement (LGE) in 17 patients, and T2 signal hyperintensity indicating edema in 9 additional patients. The most common LGE pattern was ischemic (transmural/subendocardial). Nonischemic LGE patterns (midmyocardial/subepicardial) were also observed. Although LGE was infrequent with plaque disruption, T2 signal hyperintensity was common with plaque disruption. CONCLUSIONS: Plaque rupture and ulceration are common in women with myocardial infarction without angiographically demonstrable obstructive coronary artery disease. In addition, LGE is common in this cohort of women, with an ischemic pattern of injury most evident. Vasospasm and embolism are possible mechanisms of ischemic LGE without plaque disruption. Intravascular ultrasound and cardiac magnetic resonance imaging provide complementary mechanistic insights into female myocardial infarction patients without obstructive coronary artery disease and may be useful in identifying potential causes and therapies. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00798122.

3 Article Complete Revascularization with Multivessel PCI for Myocardial Infarction. 2019

Mehta, Shamir R / Wood, David A / Storey, Robert F / Mehran, Roxana / Bainey, Kevin R / Nguyen, Helen / Meeks, Brandi / Di Pasquale, Giuseppe / López-Sendón, Jose / Faxon, David P / Mauri, Laura / Rao, Sunil V / Feldman, Laurent / Steg, P Gabriel / Avezum, Álvaro / Sheth, Tej / Pinilla-Echeverri, Natalia / Moreno, Raul / Campo, Gianluca / Wrigley, Benjamin / Kedev, Sasko / Sutton, Andrew / Oliver, Richard / Rodés-Cabau, Josep / Stanković, Goran / Welsh, Robert / Lavi, Shahar / Cantor, Warren J / Wang, Jia / Nakamya, Juliet / Bangdiwala, Shrikant I / Cairns, John A / Anonymous2621051. ·From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada · the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom · the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.) · Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy · University Hospital La Paz, Madrid (J.L.-S., R.M.) · Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.) · Duke University Medical Center, Durham, NC (S.V.R.) · Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.) · Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.) · the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.) · and the Clinical Center of Serbia, Belgrade (G.S.). ·N Engl J Med · Pubmed #31475795.

ABSTRACT: BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).

4 Article Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey. 2018

Kotseva, Kornelia / Wood, David / De Bacquer, Dirk / Anonymous4190950. ·1 National Heart and Lung Institute, Imperial College London, UK. · 2 Department of Public Health, University of Ghent, Belgium. ·Eur J Prev Cardiol · Pubmed #29873511.

ABSTRACT: Aim The purpose of this study was to describe the proportions of patients referred to and attending cardiac rehabilitation programmes in Europe and to compare lifestyle and risk factor targets achieved according to participation in a cardiac rehabilitation programme. Methods The EUROASPIRE IV cross-sectional survey was undertaken in 78 centres from 24 European countries. Consecutive patients aged <80 years with acute coronary syndromes and/or revascularization procedures were interviewed at least six months after their event. Results A total of 7998 patients (24% females) were interviewed. Overall, 51% were advised to participate in a cardiac rehabilitation programme and 81% of them attended at least half of the sessions; being 41% of the study population. Older patients, women, those at low socio-economic status or enrolled with percutaneous coronary intervention and unstable angina, as well as those with a previous history of coronary disease, heart failure, hypertension or dysglycaemia were less likely to be advised to follow a cardiac rehabilitation programme. People smoking prior to the recruiting event were less likely to participate. The proportions of patients achieving lifestyle targets were higher in the cardiac rehabilitation programme group as compared to the non-cardiac rehabilitation programme group: stopping smoking (57% vs 47%, p < 0.0001), recommended physical activity levels (47% vs 38%, p < 0.0001) and body mass index<30 kg/m

5 Article The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA 2017

Shahim, Bahira / De Bacquer, Dirk / De Backer, Guy / Gyberg, Viveca / Kotseva, Kornelia / Mellbin, Linda / Schnell, Oliver / Tuomilehto, Jaakko / Wood, David / Rydén, Lars. ·Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden bahirashahim@gmail.com. · Department of Public Health, Ghent University, Ghent, Belgium. · Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, U.K. · Forschergruppe Diabetes e.V., Munich, Germany. · Disease Risk Unit, National Institute for Health and Welfare, Helsinki, Finland. · Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. ·Diabetes Care · Pubmed #28637653.

ABSTRACT: OBJECTIVE: Three tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A RESEARCH DESIGN AND METHODS: FPG, 2h-PG, and HbA RESULTS: Complete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA CONCLUSIONS: The 2h-PG, in contrast to FPG and HbA

6 Article Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort. 2017

Morbach, Caroline / Wagner, Martin / Güntner, Stefan / Malsch, Carolin / Oezkur, Mehmet / Wood, David / Kotseva, Kornelia / Leyh, Rainer / Ertl, Georg / Karmann, Wolfgang / Heuschmann, Peter U / Störk, Stefan. ·Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. · Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany. · Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany. · Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. · Department of Public Health, University of Ghent, Ghent, Belgium. · Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany. · Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. Stoerk_S@ukw.de. · Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany. Stoerk_S@ukw.de. ·BMC Cardiovasc Disord · Pubmed #28476146.

ABSTRACT: BACKGROUND: Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. METHODS: Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. RESULTS: 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. CONCLUSIONS: In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. TRIAL REGISTRATION: This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.

7 Article Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV. 2016

Gyberg, Viveca / De Bacquer, Dirk / Kotseva, Kornelia / De Backer, Guy / Schnell, Oliver / Tuomilehto, Jaakko / Wood, David / Rydén, Lars. ·Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden. · Department of Public Health, Ghent University, Ghent, Belgium. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. · Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany. · Danube-University Krems, Krems, Austria. · Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. · Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. · Dasman Diabetes Institute, Kuwait City, Kuwait. ·BMJ Open · Pubmed #27932342.

ABSTRACT: BACKGROUND: WHO advocates 2-hour oral glucose tolerance test (OGTT) for detecting diabetes mellitus (DM). OGTT is the most sensitive method to detect DM in patients with coronary artery disease (CAD). Considered time consuming, the use of OGTT is unsatisfactory. A 1-hour plasma glucose (1hPG) test has not been evaluated as an alternative in patients with CAD. OBJECTIVES: To create an algorithm based on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 1hPG limiting the need of a 2-hour plasma glucose (2hPG) in patients with CAD. METHODS: 951 patients with CAD without DM underwent OGTT. A 2hPG≥11.1 mmol/L was the reference for undiagnosed DM. The yield of HbA1c, FPG and 1hPG was compared with that of 2hPG. RESULTS: Mean FPG was 6.2±0.9 mmol/L, and mean HbA1c 5.8±0.4%. Based on 2hPG≥11.1 mmol/L 122 patients (13%) had DM. There was no value for the combination of HbA1c and FPG to rule out or in DM (HbA1c≥6.5%; FPG≥7.0 mmol/L). In receiver operating characteristic analysis a 1hPG≥12 mmol/L balanced sensitivity and specificity for detecting DM (both=82%; positive and negative predictive values 40% and 97%). A combination of FPG<6.5 mmol/L and 1hPG<11 mmol/L excluded 99% of DM. A combination of FPG>8.0 mmol/L and 1hPG>15 mmol/L identified 100% of patients with DM. CONCLUSIONS: Based on its satisfactory accuracy to detect DM an algorithm is proposed for screening for DM in patients with CAD decreasing the need for a 2-hour OGTT by 71%.

8 Article The Impact of Left Ventricular Mass on Diastolic Blood Pressure Targets for Patients With Coronary Artery Disease. 2016

Rabkin, Simon W / Shiekh, Imran Amin / Wood, David A. ·Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; rabkin@mail.ubc.ca. · Fiona Stanley Hospital (Cardiology), Perth, Western Australia, Australia. · Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; ·Am J Hypertens · Pubmed #27312942.

ABSTRACT: BACKGROUND: Defining the optimal diastolic blood pressure (DBP) for patients with hypertension and coronary artery disease (CAD) is an ongoing challenge in part because of the concern that low DBP may have adverse cardiac effects (the J curve hypothesis). METHODS: Left ventricular mass (LV mass) was measured on the echocardiogram of individuals (N = 92) with CAD who had coronary blood flow (CBF) in the left anterior descending (LAD) artery estimated from artery diameter and DBP distal to coronary stenosis. RESULTS: CBF approached 0 in a small but defined proportion of persons at DBP of 70mm Hg. CBF was significantly lower in persons with higher LV mass (above the median of 83g/m(2)) when DBP was ≥75mm Hg. Higher electrocardiogram QRS voltage (sum of S V1 and R in V6), in the absence of LV hypertrophy (LVH), identified persons with significantly lower CBF at DBP ≥ 80mm Hg. In multivariate analysis, LV mass was a significant CBF determinant after adjusting for DBP and CAD severity. LV mass has a major impact on CBF when DBP is >70mm Hg, while DBP is the primary determinant of CBF when DBP is ≤70mm Hg. Multivariate analysis confirmed a significant interaction between LV mass and DBP. CONCLUSIONS: DBP ≤ 70mm Hg is associated with a progressively greater proportion in whom CBF in the LAD approaches 0. For DBP > 70mm Hg, persons with higher LV mass, even in the absence of LVH, have lower CBF, suggesting LV mass is an important consideration when DBP is reduced in patients with CAD.

9 Article Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. 2015

Gyberg, Viveca / De Bacquer, Dirk / De Backer, Guy / Jennings, Catriona / Kotseva, Kornelia / Mellbin, Linda / Schnell, Oliver / Tuomilehto, Jaakko / Wood, David / Rydén, Lars / Amouyel, Philippe / Bruthans, Jan / Conde, Almudena Castro / Cifkova, Renata / Deckers, Jaap W / De Sutter, Johan / Dilic, Mirza / Dolzhenko, Maryna / Erglis, Andrejs / Fras, Zlatko / Gaita, Dan / Gotcheva, Nina / Goudevenos, John / Heuschmann, Peter / Laucevicius, Aleksandras / Lehto, Seppo / Lovic, Dragan / Miličić, Davor / Moore, David / Nicolaides, Evagoras / Oganov, Raphael / Pająk, Andrzej / Pogosova, Nana / Reiner, Zeljko / Stagmo, Martin / Störk, Stefan / Tokgözoğlu, Lale / Vulic, Dusko / Anonymous4140844. ·Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. vivecagyberg@gmail.com. · Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. vivecagyberg@gmail.com. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. Dirk.DeBacquer@UGent.be. · Department of Public Health, Ghent University, Ghent, Belgium. Dirk.DeBacquer@UGent.be. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. guy.debacker@ugent.be. · Department of Public Health, Ghent University, Ghent, Belgium. guy.debacker@ugent.be. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. c.jennings@imperial.ac.uk. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. c.jennings@imperial.ac.uk. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. k.kotseva@imperial.ac.uk. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. k.kotseva@imperial.ac.uk. · Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. linda.mellbin@ki.se. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. linda.mellbin@ki.se. · Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany. Oliver.Schnell@lrz.uni-muenchen.de. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. jaakko.tuomilehto@thl.fi. · Centre for Vascular Prevention, Danube-University Krems, Krems, Austria. jaakko.tuomilehto@thl.fi. · Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. jaakko.tuomilehto@thl.fi. · Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain. jaakko.tuomilehto@thl.fi. · Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. jaakko.tuomilehto@thl.fi. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. d.wood@imperial.ac.uk. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. d.wood@imperial.ac.uk. · Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. Lars.Ryden@ki.se. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. Lars.Ryden@ki.se. · Institut Pasteur de Lille, Inserm U744, Université Lille Nord de France, 1 rue du Professeur Calmette B.P. 245, 59019, Lille, France. Philippe.amouyel@pasteur-lille.Fr. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. jan.bruthans@seznam.cz. · Center for Cardiovascular Prevention, 1st School of Medicine, Charles University and Thomayer Hospital, Vídeňská 800, 140 59, Prague, Czech Republic. jan.bruthans@seznam.cz. · Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain. almudenacastroconde@yahoo.es. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. renata.cifkova@ftn.cz. · Center for Cardiovascular Prevention, 1st School of Medicine, Charles University and Thomayer Hospital, Vídeňská 800, 140 59, Prague, Czech Republic. renata.cifkova@ftn.cz. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. j.deckers@erasmusmc.nl. · Thoraxcenter's Department of Cardiology, Dr Molewaterplein 50, 3000 DR, Rotterdam, The Netherlands. j.deckers@erasmusmc.nl. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. johan.desutter@ugent.be. · Department of Internal Medicine, University of Ghent, De Pintelaan 185, 9000, Ghent, Belgium. johan.desutter@ugent.be. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. mdilic@bih.net.ba. · Clinical Center University of Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina. mdilic@bih.net.ba. · Department of Cardiology of Shupyk's Medical Academy of Postgraduate Education, 9 Dorohozhyts'ka str, Kiev, 04112, Ukraine. marinadolzhenko@mail.ru. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. a.a.erglis@stradini.lv. · University of Latvia, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia. a.a.erglis@stradini.lv. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. zlatko.fras@telemach.net. · Preventive Cardiology Unit, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia. zlatko.fras@telemach.net. · Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia. zlatko.fras@telemach.net. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. dgaita@cardiologie.ro. · Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie "Victor Babes", Timisoara, Romania. dgaita@cardiologie.ro. · Department of Cardiology, National Heart Hospital, 65, Konyovitsa, 1309, Sofia, Bulgaria. ngotcheva@abv.bg. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. igoudev@cc.uoi.gr. · Cardiology Department of Medical School, University of Ioannina, Ioannina, Greece. igoudev@cc.uoi.gr. · Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. E_Heuschma_P@klinik.uni-wuerzburg.de. · Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. E_Heuschma_P@klinik.uni-wuerzburg.de. · Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany. E_Heuschma_P@klinik.uni-wuerzburg.de. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. alius@cardio.it. · Clinic of Cardiovascular Diseases of Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania. alius@cardio.it. · Heart and Vascular Medicine of Vilnius University Hospital Santariskiu Clinics, Santariskiu 2, 08661, Vilnius, Lithuania. alius@cardio.it. · Kuopio University Hospital, Rakennus 5/6. Kerros, Puijonlaaksontie 2, 70210, Kuopio, Finland. seppo.lehto@varkaus.fi. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. draganl1@sbb.rs. · Clinic for Internal Medicine Intermedica, Jovana Ristica 20/2, 18000, Nis, Serbia. draganl1@sbb.rs. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. d.milicic@mail.inet.hr. · University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kispaticeva 12, HR-10000, Zagreb, Croatia. d.milicic@mail.inet.hr. · The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. David.Moore@amnch.ie. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. evnicor@cytanet.com.cy. · University of Nicosia Medical School, Nicosia General Hospital, 2029 Strovolos, Nicosia, Cyprus. evnicor@cytanet.com.cy. · National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, 10 Petroverigsky per, 101990, Moscow, Russia. oganov@gnicpm.ru. · Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jafiellonian University Medical College, Grzegórzecka 20, 31-531, Cracow, Poland. andrzej.pajak@uj.edu.pl. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. NPogosova@gnicpm.ru. · Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention, National Research Centre for Preventive Medicine, 10 Petroverigsky per, 101953, Moscow, Russia. NPogosova@gnicpm.ru. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. zreiner@kbc-zagreb.hr. · University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. zreiner@kbc-zagreb.hr. · Department of Heart failure and Valve Disease, Skåne University Hospital, Lund, Sweden. Martin.Stagmo@skane.se. · Comprehensive Heart Failure Centre and Department of Medicine I, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany. Stoerk_S@medizin.uni-wuerzburg.de. · European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. lalet@hacettepe.edu.tr. · Hacettepe University, 06690, Ankara, Turkey. lalet@hacettepe.edu.tr. · Centre for Medical Research, School of Medicine, University of Banja Luka, Vuka Karadzica 6, 78000, Banja Luka, Republic of Srpska, Bosnia and Herzegovina. dule@blic.net. ·Cardiovasc Diabetol · Pubmed #26427624.

ABSTRACT: BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54% and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0% (53 mmol/mol) in 95 and 53% and 11% of those with previously known diabetes had an HbA1c >9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.

10 Article Reducing Premature Cardiovascular Morbidity and Mortality in People With Atherosclerotic Vascular Disease: The World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease. 2015

Perel, Pablo / Avezum, Alvaro / Huffman, Mark / Pais, Prem / Rodgers, Anthony / Vedanthan, Rajesh / Wood, David / Yusuf, Salim. ·World Heart Federation, Geneva, Switzerland, and the London School of Hygiene & Tropical Medicine, London, United Kingdom. Electronic address: Pablo.Perel@worldheart.org. · Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. · Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · St. John's Research Institute, Bangalore, India. · The George Institute for Global Health, Sydney, New South Wales, Australia. · International Centre for Circulatory Health, Imperial College London, London, United Kingdom. · Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. ·Glob Heart · Pubmed #26213297.

ABSTRACT: -- No abstract --

11 Article EURObservational research programme: EUROASPIRE. 2015

Kotseva, Kornelia / Rydén, Lars / De Backer, Guy / De Bacquer, Dirk / Wood, David. · ·Eur Heart J · Pubmed #25899410.

ABSTRACT: -- No abstract --

12 Article Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV--a survey from the European Society of Cardiology. 2015

Gyberg, Viveca / De Bacquer, Dirk / Kotseva, Kornelia / De Backer, Guy / Schnell, Oliver / Sundvall, Jouko / Tuomilehto, Jaakko / Wood, David / Rydén, Lars / Anonymous4500820. ·Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm 171 76, Sweden Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden vivecagyberg@gmail.com. · Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Public Health, Ghent University, Ghent, Belgium. · Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. · Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany. · Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Disease Risk Unit, National Institute for Health and Welfare, Helsinki, Finland. · Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Centre for Vascular Prevention, Danube-University Krems, Krems, Austria Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. · Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm 171 76, Sweden. ·Eur Heart J · Pubmed #25670820.

ABSTRACT: AIMS: Three methods are used to identify dysglycaemia: fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG) from the oral glucose tolerance test (OGTT), and glycated haemoglobin A1c (HbA1c). The aim was to describe the yield and concordance of FPG, HbA1c, and 2hPG alone, or in combination, to identify dysglycaemia in patients with coronary artery disease. METHODS AND RESULTS: In EUROASPIRE IV, a cross-sectional survey of patients aged 18-80 years with coronary artery disease in 24 European countries, 4004 patients with no reported history of diabetes had FPG, 2hPG, and HbA1c measured. All participants were divided into different glycaemic categories according to the ADA and WHO criteria for dysglycaemia. Using all screening tests together, 1158 (29%) had undetected diabetes. Out of them, the proportion identified by FPG was 75%, by 2hPG 40%, by HbA1c 17%, by FPG + HbA1c 81%, and by OGTT (=FPG + 2hPG) 96%. Only 7% were detected by all three methods FPG, 2hPG, and HbA1c. The ADA criteria (FPG + HbA1c) identified 90% of the population as having dysglycaemia compared with 73% with the WHO criteria (OGTT = FPG + 2hPG). Screening according to the ADA criteria for FPG + HbA1c identified 2643 (66%) as having a 'high risk for diabetes', while the WHO criteria for FPG + 2hPG identified 1829 patients (46%). CONCLUSION: In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients.

13 Article Readiness for smoking cessation in coronary heart disease patients across Europe: Results from the EUROASPIRE III survey. 2015

Prugger, Christof / Wellmann, Jürgen / Heidrich, Jan / De Bacquer, Dirk / De Backer, Guy / Périer, Marie-Cécile / Empana, Jean-Philippe / Reiner, Željko / Fras, Zlatko / Jennings, Catriona / Kotseva, Kornelia / Wood, David / Keil, Ulrich / Anonymous3970815. ·INSERM, Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, France christof.prugger@inserm.fr. · Institute of Epidemiology and Social Medicine, University of Münster, Germany. · Institute of Epidemiology and Social Medicine, University of Münster, Germany Epidemiological Cancer Registry North Rhine-Westphalia, Germany. · Department of Public Health, University of Ghent, Belgium. · INSERM, Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, France. · Department of Internal Medicine, University of Zagreb, Croatia. · Department of Vascular Medicine, Preventive Cardiology Unit, University Medical Centre Ljubljana, Slovenia Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia. · Cardiovascular Medicine, Imperial College London, UK. ·Eur J Prev Cardiol · Pubmed #25516535.

ABSTRACT: BACKGROUND: Readiness for smoking cessation is an important predictor of quit attempts and cessation success. We aimed to investigate the prevalence and correlates of readiness for smoking cessation in coronary heart disease (CHD) patients. DESIGN: The EUROpean Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey is a cross-sectional study conducted in 2006-2007 among CHD patients <80 years of age from 22 European regions. METHODS: Patients were interviewed on average 15 months after hospital admission for an acute coronary event or procedure. Readiness for smoking cessation was assessed using the smoking stages of change (SSC) short form questionnaire. Breath carbon monoxide was measured to validate self-reported non-smoking. RESULTS: Among 2585 patients who were smoking prior to hospital admission, 25.6%, 16.8%, 8.1%, 5.6% and 44.0% were in the precontemplation (no intention to quit), contemplation (thinking of quitting), preparation (planning to quit), action (having quit within six months) and maintenance (having quit more than six months ago) stages, respectively. Significant multivariable correlates of advancement in SSC showed positive associations of older age and attended cardiac rehabilitation and negative associations of severe depressive symptoms, longer smoking duration and environmental tobacco smoke (ETS) exposure. CONCLUSIONS: One-quarter of CHD patients across Europe who were smoking prior to hospitalisation have no intention to quit, and an additional quarter is thinking of quitting or planning to quit. Patients who are younger, do not attend cardiac rehabilitation, have severe depressive symptoms, have been smoking for longer periods of time and are exposed to ETS may need to be specifically targeted in cessation interventions.

14 Article Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III cross-sectional study. 2015

Gyberg, Viveca / Kotseva, Kornelia / Dallongeville, Jean / Backer, Guy De / Mellbin, Linda / Rydén, Lars / Wood, David / Bacquer, Dirk De / Anonymous220790. ·Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Sweden Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden vivecagyberg@gmail.com. · Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK. · Laboratoire d'Épidémiologie et de Santé Publique, Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, France. · Department of Public Health, Ghent University, Belgium. · Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Sweden. ·Eur J Prev Cardiol · Pubmed #24691153.

ABSTRACT: PURPOSE: The aim was to investigate the use of cardioprotective drug therapies (aspirin or other antiplatelet agents, β-blockade, renin-angiotensin-aldosterone-system-blockade (RAAS-blockade) and statins) and treatment targets achieved in a large cohort of patients with established coronary artery disease and diabetes across Europe. METHODS AND RESULTS: EUROASPIRE III is an observational cross-sectional study of stable coronary artery disease patients aged 18-80 years from 76 centres in 22 European countries conducted in 2006-2007. The glycaemic status (prevalent, incident or no diabetes), the guideline treatment targets achieved and the use of pharmacotherapies were assessed at one visit 6-36 months after the index event. Of all 6588 patients investigated (women 25%), 4295 (65%) had no diabetes, 752 (11%) had incident diabetes and 1541 (23%) had prevalent diabetes. All four drugs were used in 44% of the patients with no diabetes, 51% with incident diabetes and 50% with prevalent diabetes respectively. Individual prescriptions for patients with no, incident and prevalent diabetes were respectively: aspirin or other antiplatelet agents 91, 93, and 91%; β-blockers: 81, 84, and 79%; RAAS-blockers: 77, 76, and 68%; statins: 80, 80, and 79%. The proportion of patients with coronary artery disease and prevalent diabetes reaching the treatment targets were 20% for blood pressure, 53% for low density lipoprotein cholesterol (LDL-cholesterol) and 22% for haemoglobin A1c (HbA1c). CONCLUSION: This European study demonstrates a low use of cardioprotective drug therapies among patients with a combination of coronary artery disease and diabetes, which will be contributing to the poor achievement of risk factor treatment targets for cardiovascular prevention.

15 Article Myocardial perfusion pressure in patients with hypertension and coronary artery disease: implications for DBP targets in hypertension management. 2013

Rabkin, Simon W / Waheed, Aiza / Poulter, Rohan S / Wood, David. ·Department of Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada. simon.rabkin@mail.ubc.ca ·J Hypertens · Pubmed #23511338.

ABSTRACT: BACKGROUND: The target blood pressure (BP) in patients with hypertension and coronary artery disease (CAD) has been controversial. Whether patients with both diabetes mellitus and CAD should follow targets for either diabetes mellitus or CAD is uncertain. Focusing only on one determinant of coronary blood flow (CBF) - myocardial perfusion pressure (MPP) - coronary BP in patients with hypertension was used to estimate the impact of setting BP targets. METHODS: A consecutive series of 101 patients referred for coronary angiography for stable angina pectoris or possible CAD had BP measurements proximal and distal to coronary artery stenosis. Fractional flow reserve (FFR) was measured from adenosine-induced maximal hyperemia. DBP after the coronary stenosis was the MPP. The most severe coronary lesion for each person was selected. RESULTS: Of 101 patients, 65.0 ± 10.6 years (mean ± SD), there were 69 with hypertension and 33 with diabetes mellitus of whom 25 had diabetes mellitus along with hypertension. In hypertension, FFR was 0.83 ± 0.08, range from 0.49 to 0.97, with 40% having FFR less than 0.8. There was a significant linear relationship between systemic DBP and MPP. CBF approximates zero with MMP of 50  mmHg under resting conditions and 40  mmHg with coronary vasodilatation. On the basis of our findings in hypertension, if DBP were 80, 70, 65 and 60  mmHg, 1.4, 7.1, 15.7 and 54.3%, respectively, of patients would have an MPP of less than 50  mmHg. The values were similar for patients with diabetes mellitus. CONCLUSION: In our patient group with moderate coronary artery stenosis, a target DBP of 60  mmHg or less would be associated with unacceptably low MPPs. In patients with diabetes mellitus, the presence and severity of CAD stenosis may be more important factor in setting BP targets for treatment of hypertension. Because the degree of coronary stenosis is unknown in most patients with hypertension and CAD, guideline recommendations should consider cautioning clinicians about the potential for myocardial ischaemia at low DBP.

16 Article A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography. 2013

Leipsic, Jonathon / LaBounty, Troy M / Ajlan, Amr M / Earls, James P / Strovski, E / Madden, Mark / Wood, David A / Hague, Cameron J / Poulter, Rohan / Branch, Kelly / Cury, Ricardo C / Heilbron, Brett / Taylor, Carolyn / Grunau, Gilat / Haiducu, Lawrence / Min, James K. ·Department of Radiology and Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada. JLeipsic@providencehealth.bc.ca ·J Cardiovasc Comput Tomogr · Pubmed #23452996.

ABSTRACT: BACKGROUND: Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. OBJECTIVE: We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. METHODS: Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3-5) compared with nondiagnostic (score 1-2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed. RESULTS: No difference in demographics between groups (P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA (P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA (P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups (P= NS for all). CONCLUSIONS: Coronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing.

17 Article Spontaneous coronary artery dissection in patients with fibromuscular dysplasia: a case series. 2012

Saw, Jacqueline / Poulter, Rohan / Fung, Anthony / Wood, David / Hamburger, Jaap / Buller, Christopher E. ·Department of Cardiology, Vancouver General Hospital, Vancouver, Canada and the Department of Cardiology, St. Michael's Hospital, Toronto, Canada. jsaw@mail.ubc.ca ·Circ Cardiovasc Interv · Pubmed #22338003.

ABSTRACT: -- No abstract --

18 Article Development and validation of the fractional flow reserve (FFR) angiographic scoring tool (FAST) to improve the angiographic grading and selection of intermediate lesions that require FFR assessment. 2012

Hoole, Stephen P / Seddon, Michael D / Poulter, Rohan S / Starovoytov, Andrew / Wood, David A / Saw, Jacqueline. ·Vancouver General Hospital, Vancouver, British Columbia, Canada. ·Coron Artery Dis · Pubmed #22107802.

ABSTRACT: BACKGROUND: Visual angiographic assessment of intermediate coronary lesions is poor at determining the functional significance. We sought to identify independent clinical and angiographic parameters associated with stenosis functional significance and applied them in a weighted fractional flow reserve angiographic scoring tool (FAST) to improve intermediate lesion selection for fractional flow reserve (FFR) assessment. METHODS AND RESULTS: Data from 100 patients with intermediate lesions previously assessed by FFR were retrospectively analyzed, and four independent variables that predicted FFR of less than or equal to 0.8 were identified: quantitative coronary angiography percent diameter stenosis [odds ratio (OR) 1.22, P<0.001], length more than 20 mm (OR 7.6, P=0.004), stenosis haziness (OR 16.6, P=0.005), and multivessel disease (OR 7.8, P=0.019). Applying these variables into the FAST score, we prospectively assessed a further 109 intermediate lesions (prevalence of FFR ≤0.8 was 29% in this validation cohort) and found that FAST was highly discriminative, predicting an FFR of less than or equal to 0.8 with a c-statistic of 0.865 (95% confidence interval 0.793-0.937, P<0.0001). At the optimal cutoff value, FAST score of more than 2 had a negative predictive value of 96.5% and a sensitivity of 93.8%. It would have reduced the pressure wire usage in the validation cohort by 52.3% (57 out of 109 cases), with only two false negatives and associated cost savings. CONCLUSION: The FAST score is a simple angiographic assessment tool for intermediate lesions that comprises four angiographic variables. A score of 2 or lower indicates low likelihood of lesion hemodynamic significance.

19 Article Fame comes at a cost: a Canadian analysis of procedural costs in use of pressure wire to guide multivessel percutaneous coronary intervention. 2011

Hoole, Stephen P / Seddon, Michael D / Poulter, Rohan S / Mancini, G B John / Wood, David A / Saw, Jacqueline. ·Vancouver General Hospital, Vancouver, British Columbia, Canada. ·Can J Cardiol · Pubmed #21459275.

ABSTRACT: The FAME-study authors claimed that fractional flow reserve (FFR)-guided multivessel percutaneous coronary intervention (PCI) achieved superior clinical outcome and lower cost compared with no FFR. However, patients were intended to undergo multivessel PCI with drug eluting stents prior to randomization, which tipped the cost-analysis heavily in favour of FFR. We retrospectively evaluated 100 intermediate coronary lesions assessed by FFR, and determined whether to perform PCI based on visual angiographic assessment alone. We found that angiographic-guided treatment underestimated functional significance of intermediate lesions, resulting in fewer implanted stents compared to FFR guidance. This, in addition to the pressure wire cost, increased procedural expenditure 2- to 3-fold when using FFR-guidance.

20 Article Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. 2010

Masson, Jean-Bernard / Lee, May / Boone, Robert H / Al Ali, Abdullah / Al Bugami, Saad / Hamburger, Jaap / John Mancini, G B / Ye, Jian / Cheung, Anson / Humphries, Karin H / Wood, David / Nietlispach, Fabian / Webb, John G. ·St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. ·Catheter Cardiovasc Interv · Pubmed #20665855.

ABSTRACT: BACKGROUND: Coronary artery disease (CAD) negatively impacts prognosis of patients undergoing surgical aortic valve replacement and revascularization is generally recommended at the time of surgery. Implications of CAD and preprocedural revascularization in the setting of transcatheter aortic valve implantation (TAVI) are not known. METHOD: Patients who underwent successful TAVI from January 2005 to December 2007 were retrospectively divided into five groups according to the extent of CAD assessed with the Duke Myocardial Jeopardy Score: no CAD, CAD with DMJS 0, 2, 4, and > or =6. Study endpoints included 30-day and 1-year survival, evolution of symptoms, left ventricular ejection fraction (LVEF), and mitral regurgitation (MR) and need of revascularization during follow-up. RESULTS: One hundred and thirty-six patients were included, among which 104 (76.5%) had coexisting CAD. Thirty-day mortality in the five study groups was respectively 6.3, 14.6, 7.1, 5.6, and 17.7% with no statistically significant difference between groups (P = 0.56). Overall survival rate at one year was 77.9% (95% CL: 70.9, 84.9) with no difference between groups (P = 0.63). Symptoms, LVEF, and MR all significantly improved in the first month after TAVI, but the extent of improvement did not differ between groups (P > 0.08). Revascularization after TAVI was uncommon. CONCLUSION: The presence of CAD or nonrevascularized myocardium was not associated with an increased risk of adverse events in this initial cohort. On the basis of these early results, complete revascularization may not constitute a prerequisite of TAVI. This conclusion will require re-assessment as experience accrues in patients with extensive CAD.