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Coronary Artery Disease: HELP
Articles by Jose Luis Zamorano
Based on 25 articles published since 2008
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Between 2008 and 2019, J. Zamorano wrote the following 25 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. 2018

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Petricevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis / Levine, Glenn N / Anonymous3740973. · ·Eur J Cardiothorac Surg · Pubmed #29045581.

ABSTRACT: -- No abstract --

2 Guideline [2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.] 2017

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Peticevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis. ·Cardiology, Inselspital, Bern. marco.valgimigli@insel.ch. ·Kardiol Pol · Pubmed #29251754.

ABSTRACT: -- No abstract --

3 Guideline 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013

Anonymous3190768 / Montalescot, Gilles / Sechtem, Udo / Achenbach, Stephan / Andreotti, Felicita / Arden, Chris / Budaj, Andrzej / Bugiardini, Raffaele / Crea, Filippo / Cuisset, Thomas / Di Mario, Carlo / Ferreira, J Rafael / Gersh, Bernard J / Gitt, Anselm K / Hulot, Jean-Sebastien / Marx, Nikolaus / Opie, Lionel H / Pfisterer, Matthias / Prescott, Eva / Ruschitzka, Frank / Sabaté, Manel / Senior, Roxy / Taggart, David Paul / van der Wall, Ernst E / Vrints, Christiaan J M / Anonymous3200768 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Cetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous3210768 / Knuuti, Juhani / Valgimigli, Marco / Bueno, Héctor / Claeys, Marc J / Donner-Banzhoff, Norbert / Erol, Cetin / Frank, Herbert / Funck-Brentano, Christian / Gaemperli, Oliver / Gonzalez-Juanatey, José R / Hamilos, Michalis / Hasdai, David / Husted, Steen / James, Stefan K / Kervinen, Kari / Kolh, Philippe / Kristensen, Steen Dalby / Lancellotti, Patrizio / Maggioni, Aldo Pietro / Piepoli, Massimo F / Pries, Axel R / Romeo, Francesco / Rydén, Lars / Simoons, Maarten L / Sirnes, Per Anton / Steg, Ph Gabriel / Timmis, Adam / Wijns, William / Windecker, Stephan / Yildirir, Aylin / Zamorano, Jose Luis. ·The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines. ·Eur Heart J · Pubmed #23996286.

ABSTRACT: -- No abstract --

4 Guideline [European practice guidelines on prevention of cardiovascular diseases: executive summary]. 2008

Graham, Ian / Atar, Dan / Borch-Johnsen, Knut / Boysen, Gudrun / Burell, Gunilla / Cifkova, Renata / Dallongeville, Jean / De Backer, Guy / Ebrahim, Shah / Gjelsvik, Bjørn / Herrmann-Lingen, Christoph / Hoes, Arno / Humphries, Steve / Knapton, Mike / Perk, Joep / Priori, Silvia G / Pyorala, Kalevi / Reiner, Zeljko / Ruilope, Luis / Sans-Menendez, Susana / Reimer, Wilma Scholteop / Weissberg, Peter / Wood, David / Yarnell, John / Zamorano, Jose Luis / Anonymous970596 / Anonymous980596. ·European Society of Cardiology ·G Ital Cardiol (Rome) · Pubmed #18383763.

ABSTRACT: -- No abstract --

5 Editorial Predictive Models of Atherosclerotic Cardiovascular Disease: In Search of the Philosopher's Stone of Cardiology. 2016

Zamorano, Jose L / Del Val, David. ·University Alcala de Henares, Hospital Ramon y Cajal, Madrid, Spain. Electronic address: zamorano@secardiologia.es. · University Alcala de Henares, Hospital Ramon y Cajal, Madrid, Spain. ·J Am Coll Cardiol · Pubmed #26791060.

ABSTRACT: -- No abstract --

6 Review Open issues in transcatheter aortic valve implantation. Part 1: patient selection and treatment strategy for transcatheter aortic valve implantation. 2014

Bax, Jeroen J / Delgado, Victoria / Bapat, Vinayak / Baumgartner, Helmut / Collet, Jean P / Erbel, Raimund / Hamm, Christian / Kappetein, Arie P / Leipsic, Jonathon / Leon, Martin B / MacCarthy, Philip / Piazza, Nicolo / Pibarot, Philippe / Roberts, William C / Rodés-Cabau, Josep / Serruys, Patrick W / Thomas, Martyn / Vahanian, Alec / Webb, John / Zamorano, Jose Luis / Windecker, Stephan. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands j.j.bax@lumc.nl. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands. · Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK. · Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. · Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. · Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Essen, Germany. · Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany. · Erasmus Medical Center, Rotterdam, The Netherlands. · St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital, New York, USA. · Cardiovascular Department, King's College Hospital, London, UK. · Interventional Cardiology, McGill University Health Center, Montreal, Canada Cardiovascular Surgery, German Heart Center Munich, Bavaria, Germany. · Quebec Heart and Lung Institute, Québec, Canada. · Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, TX, USA. · Department of Cardiology, Laval University, Quebec, Canada. · Bichat Hospital, University Paris VII, Paris, France. · Cardiac Imaging Department, University Hospital Ramon y Cajal, Madrid, Spain. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. ·Eur Heart J · Pubmed #25062952.

ABSTRACT: An exponential increase in the use of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis has been witnessed over the recent years. The current article reviews different areas of uncertainty related to patient selection. The use and limitations of risk scores are addressed, followed by an extensive discussion on the value of three-dimensional imaging for prosthesis sizing and the assessment of complex valve anatomy such as degenerated bicuspid valves. The uncertainty about valvular stenosis severity in patients with a mismatch between the transvalvular gradient and the aortic valve area, and how integrated use of echocardiography and computed tomographic imaging may help, is also addressed. Finally, patients referred for TAVI may have concomitant mitral regurgitation and/or coronary artery disease and the management of these patients is discussed.

7 Review Multidetector computed tomography in previous coronary artery bypass grafting: implications for secondary revascularisation. 2009

Marcos-Alberca, Pedro / Zamorano, José Luis / Escaned, Javier / Pozo-Osinalde, Eduardo / Fernández-Golfín, Covadonga / Macaya, Carlos. ·Unidad de Imagen Cardiovascular, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain. pmarcosa.hcsc@salud.madrid.org ·EuroIntervention · Pubmed #19736069.

ABSTRACT: Coronary artery bypass grafting (CABG) is the most effective revascularisation treatment for advanced coronary heart disease. Atherosclerotic disease may compromise graft patency in the follow-up. As a result, it is not unusual for patients to present with angina requiring evaluation. When present, graft disease or progression of the disease in native vessels can be treated by means of percutaneous coronary intervention (PCI) or by repeated bypass surgery. The utility of modern helical ultrafast multidetector computed tomography (MDCT) in the evaluation of the patency of arterial or vein coronary grafts and thereby avoiding the need of a coronary angiography (CA) in the majority of patients is well established using 16 or 64-slice scanners. Although the accuracy of MDCT in the study of native coronary vessels in operated patients is more challenging, modern multislice computed tomography technology (64-slice) is especially useful in the non-invasive evaluation of patients with previous CABG with chest pain or equivalent symptoms, but with inconclusive or contradictory results in exercise or pharmacological stress tests. MDCT emerges as an attractive imaging technique, not only in the study of symptomatic patients with previous CABG, but also in the planning of secondary revascularisation procedures, either percutaneous, surgical or hybrid procedures.

8 Review Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. 2009

Senior, Roxy / Becher, Harald / Monaghan, Mark / Agati, Luciano / Zamorano, Jose / Vanoverschelde, Jean Louis / Nihoyannopoulos, Petros. ·Department of Cardiology, Northwick Park Hospital, Imperial College, London, Harrow HA1 3UJ, UK. roxysenior@cardiac-research.org ·Eur J Echocardiogr · Pubmed #19270054.

ABSTRACT: This paper examines the evidence for contrast echocardiography, both for improving assessment of left ventricular structure and function compared with unenhanced echocardiography and for the identification of myocardial perfusion. Based on the evidence, recommendations are proposed for the clinical use of contrast echocardiography.

9 Clinical Trial Detection of coronary artery disease with perfusion stress echocardiography using a novel ultrasound imaging agent: two Phase 3 international trials in comparison with radionuclide perfusion imaging. 2009

Senior, Roxy / Monaghan, Mark / Main, Michael L / Zamorano, Jose L / Tiemann, Klaus / Agati, Luciano / Weissman, Neil J / Klein, Allan L / Marwick, Thomas H / Ahmad, Masood / DeMaria, Anthony N / Zabalgoitia, Miguel / Becher, Harald / Kaul, Sanjiv / Udelson, James E / Wackers, Frans J / Walovitch, Richard C / Picard, Michael H / Anonymous2740619. ·Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex HAI 3UJ, UK. roxysenior@cardiac-research.org ·Eur J Echocardiogr · Pubmed #19131498.

ABSTRACT: AIMS: To determine if perfusion stress echocardiography (PSE) with Imagify (perflubutane polymer microspheres) is comparable to stress perfusion imaging using (99m)Tc single photon emission computed tomography (SPECT) for coronary artery disease (CAD) detection. PSE is a novel technique for evaluating myocardial perfusion. RAMP (real-time assessment of myocardial perfusion)-1 and -2 were international, Phase 3 trials that evaluated the ability of PSE with Imagify, to detect CAD. METHODS AND RESULTS: Chronic, stable, chest pain patients (n=662) underwent Imagify PSE and gated SPECT imaging at rest and during dipyridamole stress. Independent blinded cardiologists [three PSE readers per trial, and four SPECT readers (one for RAMP-1, three for RAMP-2)] interpreted images. CAD was defined by quantitative coronary angiography or 90-day outcome with clinical review. Accuracy, sensitivity, and specificity were evaluated using non-inferiority analysis (one-sided alpha=0.025) compared with SPECT. SPECT results for RAMP-1 and -2 were: accuracy (70%, 67%), sensitivity (78%, 61%), and specificity (64%, 76%). Accuracy of all six PSE readers was non-inferior to SPECT (66-71%, PImagify PSE was well-tolerated. Its diagnostic performance in chest pain patients is comparable with SPECT perfusion imaging.

10 Article Multivariate analysis for coronary heart disease in heterozygote familial hypercholesterolemia patients. 2018

Sánchez Muñoz-Torrero, Juan Francisco / Rivas, Maria D / Zamorano, Jose / Joya-Vázquez, Pedro Pablo / de Isla, Leopoldo Perez / Padro, Teresa / Mata, Pedro / The Safeheart Investigators, ?. ·Department of Internal Medicine, Hospital San Pedro de Alcantara, Caceres, Spain. · Research Unit, Hospital San Pedro de Alcantara, Caceres, Spain. · Digestive Unit, Hospital General de Llerena, Llerena, Spain. · Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain. · Centro de Investigacion Cardiovascular CSIC-ICCC, Hospital Sant Pau & IIB-Sant Pau, & CIBEROBN, ISC III, Barcelona, Spain. · Fundacion Hipercolesterolemia Familial, Madrid, Spain. ·Per Med · Pubmed #29714125.

ABSTRACT: AIM: rs599839 polymorphism has been related with low levels of cholesterol and reduced coronary heart disease (CHD). METHODS: We investigated the frequency of this polymorphism in patients with heterozygous familial hypercholesterolemia (HeFH) in the Spanish familial hypercholesterolemia cohort, 230 with and 202 without CHD. Results & discussion: A lower G-allele prevalence was observed in HeFH patients with CHD with respect to controls, 35 versus 45%, respectively (p = 0.029), suggesting a protective effect. However, it was found that there was no association between rs599839 alleles and CHD in the multivariate analysis. CONCLUSION: The frequency of the protective G-allele of the rs599839 polymorphism was lower in HeFH patients with CHD compared with those HeFH patients without CHD. However, its role in HeFH may be masked by very high levels of cholesterol.

11 Article Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study. 2017

Nicoll, Rachel / Zhao, Ying / Wiklund, Urban / Diederichsen, Axel / Mickley, Hans / Ovrehus, Kristian / Zamorano, Jose / Gueret, Pascal / Schmermund, Axel / Maffei, Erica / Cademartiri, Filippo / Budoff, Matt / Henein, Michael. ·Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden. · Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. · Department of Radiation Sciences, Biomedical Engineering, Umea University, Umeå, Sweden. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Cardiology, Odense University Hospital, Denmark; Vejle Hospital, Vejle, Denmark. · University Alcala, Hospital Ramon y Cajal, Madrid, Spain. · University Hospital Henri Mondor, Creteil, Paris, France. · Bethanien Hospital, Frankfurt, Germany. · Centre de Recherche & Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, QC, Canada. · Centre de Recherche & Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, QC, Canada; Department of Radiology, Erasmus Medical Center University, Rotterdam, the Netherlands. · Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA. · Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden. Electronic address: michael.henein@umu.se. ·J Diabetes Complications · Pubmed #28499962.

ABSTRACT: BACKGROUND AND AIMS: Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score. METHODS: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring. RESULTS: Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively. CONCLUSION: In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes.

12 Article Characteristics and outcomes of atrial fibrillation patients with or without specific symptoms: results from the PREFER in AF registry. 2016

Bakhai, Ameet / Darius, Harald / De Caterina, Raffaele / Smart, Angela / Le Heuzey, Jean-Yves / Schilling, Richard John / Zamorano, José Luis / Shah, Mit / Bramlage, Peter / Kirchhof, Paulus. ·Royal Free London NHS Trust, Barnet Hospital, London, UK. · Vivantes Clinics for Health, Berlin, Germany. · G. d'Annunzio University, Chieti-Pescara, Italy. · Daiichi Sankyo UK Ltd, Gerrards Cross, UK. · Georges Pompidou Hospital, René Descartes University, Paris, France. · Cardiology Department, Barts and The London School of Medicine and Dentistry, London, UK. · Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain. · Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany. · University of Birmingham, Institute of Cardiovascular Sciences and SWBH and UHB NHS trusts, Birmingham, UK. ·Eur Heart J Qual Care Clin Outcomes · Pubmed #29474715.

ABSTRACT: Aims: Atrial fibrillation (AF) is a common condition that is a major cause of stroke. A significant proportion of patients with AF are not classically symptomatic at diagnosis or soon after diagnosis. There is little information comparing their characteristics, treatment, and outcomes of patients with symptoms, which predominate in clinical trials to those without. Methods and results: We analysed data from the Prevention of Thromboembolic Events-European Registry in Atrial Fibrillation. This was a prospective, real-world registry with a 12-month follow-up that included AF patients aged 18 years and over. Patients were divided into those with and without AF symptoms using the European Heart Rhythm Association (EHRA) score (Category I vs. Categories II-IV). Of the 6196 patients (mean age 72 years) with EHRA scores available, 501 (8.1%) were asymptomatic. A lower proportion of asymptomatic patients was female (22.8 vs. 41.2%), with less noted to have heart failure and coronary artery disease (P < 0.01 for all). There were no differences in terms of the prevalence of diabetes, obesity, or prior stroke. Asymptomatic patients had a lower CHA2DS2-VASc score (2.9 ± 1.7 vs. 3.4 ± 1.8; P < 0.01) and HAS-BLED score (1.8 ± 1.1 vs. 2.1 ± 1.2; P < 0.01). During the 1-year follow-up, adverse events occurred at similar frequencies in asymptomatic and symptomatic patients (1.6 vs. 0.8% for ischaemic stroke; P = 0.061; 1.4 vs. 1.3% for transient ischaemic attack; P = 0.840). Patients with higher CHA2DS2-VASc and HAS-BLED scores experienced more events, independent of symptoms. Antithrombotic therapy was comparable for both groups at baseline and at follow-up. Conclusions: The similar clinical characteristics and frequency of adverse events between asymptomatic and symptomatic AF patients revives the question of whether screening programmes to detect people with asymptomatic AF are worthwhile, particularly in those aged 65 and over potentially likely to have clinical and economic benefits from anticoagulants. This evidence may be informative if clinicians may not be comfortable participating in future clinical trials, leaving asymptomatic patients with AF and high stroke risk without anticoagulation.

13 Article Gender and age effects on risk factor-based prediction of coronary artery calcium in symptomatic patients: A Euro-CCAD study. 2016

Nicoll, R / Wiklund, U / Zhao, Y / Diederichsen, A / Mickley, H / Ovrehus, K / Zamorano, J / Gueret, P / Schmermund, A / Maffei, E / Cademartiri, F / Budoff, M / Henein, M. ·Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden. · Department of Radiation Sciences, Biomedical Engineering, Umea University, Umeå, Sweden. · Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Cardiology, Odense University Hospital, Denmark; Vejle Hospital, Vejle, Denmark. · University Alcala, Hospital Ramon y Cajal, Madrid, Spain. · University Hospital Henri Mondor, Creteil, Paris, France. · Bethanien Hospital, Frankfurt, Germany. · Centre de Recherche & Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, QC, Canada. · Centre de Recherche & Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, QC, Canada; Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands. · Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, USA. · Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden. Electronic address: michael.henein@umu.se. ·Atherosclerosis · Pubmed #27494449.

ABSTRACT: BACKGROUND AND AIMS: The influence of gender and age on risk factor prediction of coronary artery calcification (CAC) in symptomatic patients is unclear. METHODS: From the European Calcific Coronary Artery Disease (EURO-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and USA. All of them underwent risk factor assessment and CT scanning for CAC scoring. RESULTS: The prevalence of CAC among females was lower than among males in all age groups. Using multivariate logistic regression, age, dyslipidaemia, hypertension, diabetes and smoking were independently predictive of CAC presence in both genders. In addition to a progressive increase in CAC with age, the most important predictors of CAC presence were dyslipidaemia and diabetes (β = 0.64 and 0.63, respectively) in males and diabetes (β = 1.08) followed by smoking (β = 0.68) in females; these same risk factors were also important in predicting increasing CAC scores. There was no difference in the predictive ability of diabetes, hypertension and dyslipidaemia in either gender for CAC presence in patients aged <50 and 50-70 years. However, in patients aged >70, only dyslipidaemia predicted CAC presence in males and only smoking and diabetes were predictive in females. CONCLUSIONS: In symptomatic patients, there are significant differences in the ability of conventional risk factors to predict CAC presence between genders and between patients aged <70 and ≥70, indicating the important role of age in predicting CAC presence.

14 Article Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population. 2016

Liga, Riccardo / Vontobel, Jan / Rovai, Daniele / Marinelli, Martina / Caselli, Chiara / Pietila, Mikko / Teresinska, Anna / Aguadé-Bruix, Santiago / Pizzi, Maria Nazarena / Todiere, Giancarlo / Gimelli, Alessia / Chiappino, Dante / Marraccini, Paolo / Schroeder, Stephen / Drosch, Tanja / Poddighe, Rosa / Casolo, Giancarlo / Anagnostopoulos, Constantinos / Pugliese, Francesca / Rouzet, Francois / Le Guludec, Dominique / Cappelli, Francesco / Valente, Serafina / Gensini, Gian Franco / Zawaideh, Camilla / Capitanio, Selene / Sambuceti, Gianmario / Marsico, Fabio / Filardi, Pasquale Perrone / Fernández-Golfín, Covadonga / Rincón, Luis M / Graner, Frank P / de Graaf, Michiel A / Stehli, Julia / Reyes, Eliana / Nkomo, Sandy / Mäki, Maija / Lorenzoni, Valentina / Turchetti, Giuseppe / Carpeggiani, Clara / Puzzuoli, Stefano / Mangione, Maurizio / Marcheschi, Paolo / Giannessi, Daniela / Nekolla, Stephan / Lombardi, Massimo / Sicari, Rosa / Scholte, Arthur J H A / Zamorano, José L / Underwood, S Richard / Knuuti, Juhani / Kaufmann, Philipp A / Neglia, Danilo / Gaemperli, Oliver / Anonymous460862. ·Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. · Institute of Clinical Physiology, CNR, Pisa, Italy. · Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland. · Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland. · Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain. · Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany. · Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy. · Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK. · Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK. · Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France. · Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. · Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy. · Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy. · Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. · Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. · Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK. · Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. · Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Institute of Clinical Physiology, CNR, Pisa, Italy Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland oliver.gaemperli@usz.ch. ·Eur Heart J Cardiovasc Imaging · Pubmed #26992419.

ABSTRACT: AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR≤0.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.

15 Article Effect of Coronary Atherosclerosis and Myocardial Ischemia on Plasma Levels of High-Sensitivity Troponin T and NT-proBNP in Patients With Stable Angina. 2016

Caselli, Chiara / Prontera, Concetta / Liga, Riccardo / De Graaf, Michiel A / Gaemperli, Oliver / Lorenzoni, Valentina / Ragusa, Rosetta / Marinelli, Martina / Del Ry, Silvia / Rovai, Daniele / Giannessi, Daniela / Aguade-Bruix, Santiago / Clemente, Alberto / Bax, Jeroen J / Lombardi, Massimo / Sicari, Rosa / Zamorano, José / Scholte, Arthur J / Kaufmann, Philipp A / Knuuti, Juhani / Underwood, S Richard / Clerico, Aldo / Neglia, Danilo. ·From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.) · Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.) · Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.) · Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.) · University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.) · Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.) · Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.) · University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.) · University of Turku and Turku University Hospital, Turku, Finland (J.K.) · and Imperial College London, United Kingdom (S.R.U.). ·Arterioscler Thromb Vasc Biol · Pubmed #26868212.

ABSTRACT: OBJECTIVE: Circulating levels of high-sensitivity cardiac troponin T (hs-cTnT) and N terminal pro brain natriuretic peptide (NT-proBNP) are predictors of prognosis in patients with coronary artery disease (CAD). We aimed at evaluating the effect of coronary atherosclerosis and myocardial ischemia on cardiac release of hs-cTnT and NT-proBNP in patients with suspected CAD. APPROACH AND RESULTS: Hs-cTnT and NT-proBNP were measured in 378 patients (60.1±0.5 years, 229 males) with stable angina and unknown CAD enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. All patients underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography to assess the presence and characteristics of CAD. An individual computed tomographic angiography score was calculated combining extent, severity, composition, and location of plaques. In the whole population, the median (25-75 percentiles) value of plasma hs-cTnT was 6.17 (4.2-9.1) ng/L and of NT-proBNP was 61.66 (31.2-132.6) ng/L. In a multivariate model, computed tomographic angiography score was an independent predictor of the plasma hs-cTnT (coefficient 0.06, SE 0.02; P=0.0089), whereas ischemia was a predictor of NT-proBNP (coefficient 0.38, SE 0.12; P=0.0015). Hs-cTnT concentrations were significantly increased in patients with CAD with or without myocardial ischemia (P<0.005), whereas only patients with CAD and ischemia showed significantly higher levels of NT-proBNP (P<0.001). CONCLUSIONS: In patients with stable angina, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, also in the absence of ischemia, suggesting an ischemia-independent mechanism of hs-cTnT release. Obstructive CAD causing myocardial ischemia is associated with increased levels of NT-proBNP.

16 Article Intravenous ivabradine for control of heart rate during coronary CT angiography: A randomized, double-blind, placebo-controlled trial. 2015

Cademartiri, Filippo / Garot, Jerome / Tendera, Michal / Zamorano, Jose Luis. ·Department of Radiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands. Electronic address: filippocademartiri@gmail.com. · Department of Cardiovascular Magnetic Resonance, Institut Cardiovasculaire Paris Sud, Hospital Jacques Cartier, Generale de Santé, Massy, France. · 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland. · Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain. ·J Cardiovasc Comput Tomogr · Pubmed #26088378.

ABSTRACT: BACKGROUND: Low heart rates (HRs) are preferable for coronary CT angiography (CTA). We evaluated the use of an intravenous bolus of ivabradine, a selective sinus node inhibitor, to lower HR before coronary CTA in a prospective, randomized, double-blind, placebo-controlled multicenter trial. METHODS: A total of 370 patients scheduled for CTA, with sinus rhythm ≥70 beats/min but ineligible for intravenous beta-blockers, were randomized to an intravenous bolus of 10 mg (HR, 70-79 beats/min) or 15 mg (HR ≥80 beats/min) ivabradine or placebo. Primary end point was the proportion of patients achieving HR ≤65 beats/min at the initiation of coronary CTA (Ta). RESULTS: Baseline HR was 79 ± 8.5 beats/min. At Ta, HR ≤65 beats/min was achieved in 55% of the ivabradine group vs. 23% for placebo (P < .0001) and in 68% vs. 16% 1-hour after bolus administration (P < .0001). Contrast-enhanced coronary CTA was performed in 87% of the ivabradine group vs. 65% for placebo (P < .0001). Mean HR at Ta was 67 ± 10 beats/min for ivabradine vs. 75 ± 10 beats/min for placebo (P < .0001). Procedural convenience was scored better with ivabradine ("good" or "very good" in 79% vs 63% for placebo; P = .0005). The effective radiation dose of contrast-enhanced CTA was 13 ± 7 mSv for ivabradine vs. 16 ± 7 mSv for placebo (P < .05). Ivabradine was well tolerated. CONCLUSIONS: An intravenous bolus of ivabradine achieves rapid, safe, and sustained HR lowering during coronary CTA, increasing procedural convenience and reducing radiation exposure vs placebo.

17 Article Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. 2015

Neglia, Danilo / Rovai, Daniele / Caselli, Chiara / Pietila, Mikko / Teresinska, Anna / Aguadé-Bruix, Santiago / Pizzi, Maria Nazarena / Todiere, Giancarlo / Gimelli, Alessia / Schroeder, Stephen / Drosch, Tanja / Poddighe, Rosa / Casolo, Giancarlo / Anagnostopoulos, Constantinos / Pugliese, Francesca / Rouzet, Francois / Le Guludec, Dominique / Cappelli, Francesco / Valente, Serafina / Gensini, Gian Franco / Zawaideh, Camilla / Capitanio, Selene / Sambuceti, Gianmario / Marsico, Fabio / Perrone Filardi, Pasquale / Fernández-Golfín, Covadonga / Rincón, Luis M / Graner, Frank P / de Graaf, Michiel A / Fiechter, Michael / Stehli, Julia / Gaemperli, Oliver / Reyes, Eliana / Nkomo, Sandy / Mäki, Maija / Lorenzoni, Valentina / Turchetti, Giuseppe / Carpeggiani, Clara / Marinelli, Martina / Puzzuoli, Stefano / Mangione, Maurizio / Marcheschi, Paolo / Mariani, Fabio / Giannessi, Daniela / Nekolla, Stephan / Lombardi, Massimo / Sicari, Rosa / Scholte, Arthur J H A / Zamorano, José L / Kaufmann, Philipp A / Underwood, S Richard / Knuuti, Juhani / Anonymous6770821. ·From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.) · Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy · Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland · Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland (A.T.) · Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain (S.A.-B., M.N.P.) · Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany (S.S., T.D.) · Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy (R.P., G.C.) · Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece (C.A.) · Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom (C.A., F.P.) · Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France (F.R., D.L.G.) · Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi (F.C., S.V., G.G.) and Don Carlo Gnocchi Foundation, IRCCS (G.F.G.), Florence, Italy · Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy (C.Z., S.C., G.S.) · Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (F.Marsico, P.P.F.) · Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain (C.F.-G., L.M.R., J.L.Z. ·Circ Cardiovasc Imaging · Pubmed #25711274.

ABSTRACT: BACKGROUND: The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. METHODS AND RESULTS: A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). CONCLUSIONS: In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979199.

18 Article Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients. 2014

Kalra, Paul R / García-Moll, Xavier / Zamorano, José / Kalra, Philip A / Fox, Kim M / Ford, Ian / Ferrari, Roberto / Tardif, Jean-Claude / Tendera, Michal / Greenlaw, Nicola / Steg, Ph Gabriel / Anonymous1320801. ·Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom; NHLI Imperial College, ICMS, London, United Kingdom. · Unitat Hospitalització, Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. · University Hospital Ramón y Cajal, Madrid, Spain. · Salford Royal NHS Foundation Trust, Salford, United Kingdom. · NHLI Imperial College, ICMS, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom. · University of Glasgow, Glasgow, United Kingdom. · Department of Cardiology, Azienda Ospedaliero-Universitaria di Ferrara, Ospedale di Cona, Cona, Italy. · Montreal Heart Institute, Université de Montreal, Montreal, Canada. · Medical University of Silesia, Katowice, Poland. ·PLoS One · Pubmed #25051258.

ABSTRACT: PURPOSE: To assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease. METHODS: 22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2. RESULTS: Mean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR. CONCLUSIONS: Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564.

19 Article Inadequate heart rate control despite widespread use of beta-blockers in outpatients with stable CAD: findings from the international prospective CLARIFY registry. 2014

Tendera, Michal / Fox, Kim / Ferrari, Roberto / Ford, Ian / Greenlaw, Nicola / Abergel, Hélène / Macarie, Cezar / Tardif, Jean-Claude / Vardas, Panos / Zamorano, José / Gabriel Steg, P / Anonymous7150800. ·Medical University of Silesia, Katowice, Poland. · NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. Electronic address: k.fox@rbht.nhs.uk. · Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy. · University of Glasgow, Glasgow, UK. · INSERM U-1148, Paris, France; Université Paris Diderot, Paris, France; AP-HP, Hôpital Bichat, Paris, France. · C.C. Iliescu Emergency Cardiovascular Diseases Institute, Bucharest, Romania. · Montreal Heart Institute, Université de Montreal, Montreal, Canada. · University Hospital of Heraklion, Heraklion, Greece. · Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain. · NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK; INSERM U-1148, Paris, France; Université Paris Diderot, Paris, France; AP-HP, Hôpital Bichat, Paris, France. ·Int J Cardiol · Pubmed #25042656.

ABSTRACT: BACKGROUND: To use CLARIFY, a prospective registry of patients with stable CAD (45 countries), to explore heart rate (HR) control and beta-blocker use. METHODS: We analyzed the CLARIFY population according to beta-blocker use via descriptive statistics with Pearson's χ(2) test for comparisons, as well as a multivariable stepwise model. RESULTS: Data on beta-blocker use was available for 32,914 patients, in whom HR was 68 ± 11 bpm; patients with angina, previous myocardial infarction, and heart failure had HRs of 69 ± 12, 68 ± 11, and 70 ± 12 bpm, respectively. 75% of these patients were receiving beta-blockers. Bisoprolol (34%), metoprolol tartrate (16%) or succinate (13%), atenolol (15%), and carvedilol (12%) were mostly used; mean dosages were 49%, 76%, 35%, 53%, and 45% of maximum doses, respectively. Patients aged <65 years were more likely to receive beta-blockers than patients ≥ 75 years (P<0.0001). Gender had no effect. Subjects with HR ≤ 60 bpm were more likely to be on beta-blockers than patients with HR ≥ 70 bpm (P<0.0001). Patients with angina, previous myocardial infarction, heart failure, and hypertension were more frequently receiving beta-blockers (all P<0.0001), and those with PAD and asthma/COPD less frequently (both P<0.0001). Beta-blocker use varied according to geographical region (from 87% to 67%). CONCLUSIONS: Three-quarters of patients with stable CAD receive beta-blockers. Even so, HR is insufficiently controlled in many patients, despite recent guidelines for the management of CAD. There is still much room for improvement in HR control in the management of stable CAD.

20 Article Demographic and clinical characteristics of patients with stable coronary artery disease: results from the CLARIFY registry in Spain. 2014

Zamorano, José L / García-Moll, Xavier / Ferrari, Roberto / Greenlaw, Nicola. ·Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: zamorano@secardiologia.es. · Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. · Servicio de Cardiología, Hospital Universitario de Ferrara, Ferrara, Italy. · Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom. ·Rev Esp Cardiol (Engl Ed) · Pubmed #24952393.

ABSTRACT: INTRODUCTION AND OBJECTIVES: Coronary artery disease is associated with high morbidity and mortality. The objective of the CLARIFY registry is to study the treatment of outpatients with coronary artery disease in the setting of daily clinical practice. METHODS: The CLARIFY registry is a prospective registry conducted in 41 countries that included outpatients with stable coronary artery disease attending primary care or specialist units between October 2009 and June 2010. The present study describes the baseline characteristics of the Spanish cohort compared with the western European cohorts included in the registry. RESULTS: A total of 33,248 patients were included: 14,726 in western Europe and 2257 in Spain (selected by 192 cardiologists). The majority of the participants in Spain were men (81%) with a mean age of 65 years. There was a higher frequency of diabetes (34% vs 25%; P<.0001), coronary artery disease family history (19% vs 31%; P<.0001), myocardial infarction (64% vs 60%; P<.0001), and stroke (5% vs 3%; P=.0007) in the Spanish cohort than in the western European cohorts. The most common treatments in the Spanish sample were lipid-lowering drugs (96%), acetylsalicylic acid (89%), and beta-blockers (74%). CONCLUSIONS: Patients in the Spanish cohort are similar to those in the western European cohorts and seem to be representative of the Spanish population with coronary artery disease. Therefore, they form a suitable basis for the study of prognostic factors at 5-year follow-up.

21 Article Should computed tomography coronary angiography be aborted when the calcium score exceeds a certain threshold in patients with chest pain? 2013

de Agustin, Jose Alberto / Marcos-Alberca, Pedro / Fernández-Golfin, Covadonga / Feltes, Gisela / Nuñez-Gil, Ivan Javier / Almeria, Carlos / Rodrigo, Jose Luis / Arrazola, Juan / Pérez de Isla, Leopoldo / Macaya, Carlos / Zamorano, Jose. ·Instituto Cardiovascular, Unidad de Imagen Cardiaca, Hospital Universitario San Carlos, Profesor Martin Lagos, 28040 Madrid, Spain. albertutor@hotmail.com ·Int J Cardiol · Pubmed #22633672.

ABSTRACT: BACKGROUND: There is ongoing debate about whether a computed tomography coronary angiography (CTCA) should be aborted when the calcium score (CS) exceeds a certain threshold in patients with chest pain. The aim of this study was to discover whether specific "cutpoints" regarding coronary artery CS could be determined to predict severe coronary stenoses assessed by CTCA, thus identifying patients amenable to an invasive diagnostic approach. METHODS: 294 consecutive patients with chest pain of uncertain cause who were referred for non-invasive diagnostic CTCA were included. Subjects underwent Agatston CS and CTCA using current 64-slice technology. RESULTS: Severe coronary stenoses were noted in 75 of 294 (25.1%) patients on CTCA. A very high prevalence of severe coronary stenoses was found in patients with CS ≥ 400 (87.0%). The CS had area under the ROC curve 0.86 to predict severe coronary stenoses on CTCA. The best discriminant cut-off point was CS ≥ 400 (sensitivity of 55.3%, specificity of 93.5, positive predictive value of 85.8%, negative predictive value of 84.0%). Multivariable logistic regression analysis controlling for traditional risk factors showed CS ≥ 400 remained an independent predictor of severe coronary stenoses on CTCA (OR 14.553, 95% confidence interval 4.043 to 52.384, p<0.001). CONCLUSIONS: CS can be used as a "gatekeeper" to CTCA in patients with chest pain. Due to the very high prevalence of severe coronary stenoses in patients with CS ≥ 400, further evaluation with CTCA is not warranted as these patients should be referred to invasive coronary angiography, avoiding the repeated exposure to ionizing radiation and iodinated contrast.

22 Article Myocardial bridging assessed by multidetector computed tomography: likely cause of chest pain in younger patients with low prevalence of dyslipidemia. 2012

de Agustín, José Alberto / Marcos-Alberca, Pedro / Fernández-Golfín, Covadonga / Bordes, Sara / Feltes, Gisela / Almería, Carlos / Rodrigo, José Luis / Arrazola, Juan / Pérez de Isla, Leopoldo / Macaya, Carlos / Zamorano, José. ·Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, España. albertutor@hotmail.com ·Rev Esp Cardiol (Engl Ed) · Pubmed #22658689.

ABSTRACT: INTRODUCTION AND OBJECTIVES: The relationship between myocardial bridging and symptoms is still unclear. The purpose of our study was to assess the relationship between myocardial bridging detected by multidetector computed tomography and symptoms in a patient population with chest pain syndrome. METHODS: The study enrolled 393 consecutive patients without previous coronary artery disease studied for chest pain and referred to multidetector computed tomography between January 2007 and December 2010. Noninvasive coronary angiography was performed using multidetector computed tomography. Myocardial bridging was defined as part of a coronary artery completely surrounded by myocardium on axial and multiplanar reformatted images. RESULTS: Mean age was 64.6 (12.4) years and 44.8% were male. Multidetector computed tomography detected 86 myocardial bridging images in 82 of the 393 patients (20.9%). Left anterior descending was the most frequent coronary artery involved (87.2%). The prevalence of myocardial bridging was significantly higher in patients without significant atherosclerotic coronary stenosis on multidetector computed tomography (24.9% vs 15.0%; P=.02). Patients with myocardial bridging were younger (60.3 [13.8] vs 65.8 [11.9]; P<.001), had less prevalence of hyperlipidemia (29.3% vs 41.8%; P=.03), and more prevalence of cardiomyopathy (6.1% vs 1.6%, P=.02) compared with patients without myocardial bridging on multidetector computed tomography. CONCLUSIONS: Multidetector computed tomography is an easy and reliable tool for comprehensive in vivo diagnosis of myocardial bridging. The results of the present study suggest myocardial bridging is the cause of chest pain in a subgroup of younger aged patients with less prevalence of hyperlipidemia and more prevalence of cardiomyopathy than patients with significant atherosclerotic coronary artery disease on multidetector computed tomography. Full English text available from:www.revespcardiol.org.

23 Article Concomitant use of proton pump inhibitors and clopidogrel in patients with coronary, cerebrovascular, or peripheral artery disease in the factores de Riesgo y ENfermedad Arterial (FRENA) registry. 2011

Muñoz-Torrero, Juan Francisco Sánchez / Escudero, Domingo / Suárez, Carmen / Sanclemente, Carmen / Pascual, Ma Teresa / Zamorano, José / Trujillo-Santos, Javier / Monreal, Manuel / Anonymous5570681. ·Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain. ·J Cardiovasc Pharmacol · Pubmed #21164357.

ABSTRACT: BACKGROUND: Among patients receiving clopidogrel for coronary artery disease, concomitant therapy with proton pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events. PATIENTS AND METHODS: Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicenter, observational registry of consecutive outpatients with coronary artery disease, cerebrovascular disease, or peripheral artery disease. We retrospectively examined the influence of concomitant use of PPIs on outcome in patients receiving clopidogrel. RESULTS: As of March 2009, 1222 patients were using clopidogrel: 595 had coronary artery disease, 329 cerebrovascular disease, and 298 had peripheral artery disease. Of these, 519 (42%) were concomitantly using PPIs. Over a mean follow-up of 15 months, 131 patients (11%) had 139 subsequent ischemic events: myocardial infarction 44, ischemic stroke 40, and critical limb ischemia 55. Seventeen of them (13%) died within 15 days of the subsequent event. PPI users had a higher incidence of myocardial infarction (rate ratio, 2.5; 95% confidence interval [CI], 1.3-4.8), ischemic stroke (rate ratio, 1.9; 95% CI, 1.03-3.7), and a nonsignificantly higher rate of critical limb ischemia (rate ratio, 1.6; 95% CI, 0.95-2.8) than nonusers. On multivariate analysis, concomitant use of clopidogrel and PPIs was independently associated with an increased risk for subsequent ischemic events both in the whole series of patients (hazard ratio, 1.8; 95% CI, 1.1-2.7) and in those with cerebrovascular disease or peripheral artery disease (hazard ratio, 1.5; 95% CI, 1.01-2.4). CONCLUSIONS: In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke. This higher incidence persisted after multivariate adjustment.

24 Article Diastolic dysfunction in diabetic patients assessed with Doppler echocardiography: relationship with coronary atherosclerotic burden and microcirculatory impairment. 2009

Escaned, Javier / Colmenárez, Humberto / Ferrer, María Cruz / Gutiérrez, Marcos / Jiménez-Quevedo, Pilar / Hernández, Rosana / Alfonso, Fernando / Bañuelos, Camino / Deisla, Leopoldo Pérez / Zamorano, José Luis / Macaya, Carlos. ·Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, España. escaned@secardiologia.es ·Rev Esp Cardiol · Pubmed #20038406.

ABSTRACT: INTRODUCTION AND OBJECTIVES: Diabetes mellitus (DM) is associated with the development of both impaired left ventricular diastolic function (LVDF) and pathological changes in the coronary macro- and microcirculation. The aim of this study was to investigate the relationship between these manifestations of diabetic heart disease. METHODS: The severity of atherosclerosis in the left anterior descending coronary artery (LAD) was quantified using intravascular ultrasound (IVUS) in 13 patients with DM and ischemic heart disease. The coronary flow velocity reserve (CFVR), instantaneous hyperemic diastolic velocity pressure slope index (IHDVPS) and zero-flow pressure were derived from digital intracoronary pressure and flow velocity measurements. The relationships between indices of LVDF (i.e. E/A and E/e' ratios) and intracoronary measurements were assessed. RESULTS: The left ventricular ejection fraction was 66+/-7%, and the LVDF indices were: E/A=0.92+/-0.38 and E/e'=9.90+/-2.80. There was a direct proportional relationship (r=0.62; P=.02) between E/e' and coronary resistance (1.93+/-0.74 mmHg/s) and an inverse proportional relationship (r=-0.64; P=.02) between E/e' and IHDVPS (1.56+/-0.50 cm/s/mmHg). However, no significant relationship was found between either LVDF index and CFVR (2.43+/-0.56) or coronary zero-flow pressure (40.41+/-10.66 mmHg). The volume of atheroma in the proximal 20 mm of the LAD (179.34+/-57.48 .l, with an average plaque area of 8.39+/-2.20 mm2) was not related to either LVDF index. CONCLUSIONS: In patients with DM and coronary atherosclerosis, there appeared to be a relationship between LVDF impairment (assessed by the E/e' ratio) and structural changes in the microcirculation.

25 Minor Acute aortic dissection with ongoing right coronary artery and aortic valve involvement. 2012

Fernández-Jiménez, Rodrigo / Vivas, David / de Agustín, José Alberto / Kallmeyer, Andrea / Balbacid, Enrique / Acebal, Calos / Viliani, Dafne / Pérez de Isla, Leopoldo / Macaya, Carlos / Zamorano, José Luis. · ·Int J Cardiol · Pubmed #22541982.

ABSTRACT: -- No abstract --