| 1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145:e895-e1032. |
Review/Other-Dx |
N/A |
The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. |
No results stated in the abstract. |
4 |
| 2. Correction to: Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023;147:e622. |
Review/Other-Dx |
N/A |
To provide a correction to the Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. |
No results stated in the abstract. |
4 |
| 3. Heidenreich PA, Fonarow GC, Opsha Y, et al. Economic Issues in Heart Failure in the United States. J Card Fail 2022;28:453-66. |
Review/Other-Dx |
N/A |
This review was sponsored by the Heart Failure Society of America and describes the growing economic burden of heart failure for the health care system in the United states. |
No results stated in the abstract. |
4 |
| 4. Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106(24):3068-3072. |
Observational-Dx |
3757 men & 4472 women |
To understand the Lifetime risk for developing congestive heart failure. |
Among Framingham Heart Study subjects who were free of CHF at baseline, we determined the lifetime risk for developing overt CHF at selected index ages. We followed 3757 men and 4472 women from 1971 to 1996 for 124 262 person-years; 583 subjects developed CHF and 2002 died without prior CHF. At age 40 years, the lifetime risk for CHF was 21.0% (95% CI 18.7% to 23.2%) for men and 20.3% (95% CI 18.2% to 22.5%) for women. Remaining lifetime risk did not change with advancing index age because of rapidly increasing CHF incidence rates. At age 80 years, the lifetime risk was 20.2% (95% CI 16.1% to 24.2%) for men and 19.3% (95% CI 16.5% to 22.2%) for women. Lifetime risk for CHF doubled for subjects with blood pressure >/=160/100 versus <140/90 mm Hg. In a secondary analysis, we only considered those who developed CHF without an antecedent myocardial infarction; at age 40 years, the lifetime risk for CHF was 11.4% (95% CI 9.6% to 13.2%) for men and 15.4% (95% CI 13.5% to 17.3%) for women. |
2 |
| 5. Merlo M, Pivetta A, Pinamonti B, et al. Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years. Eur J Heart Fail. 2014;16(3):317-324. |
Observational-Tx |
853 IDCM patients |
To analyse the long-term prognostic impact of evidence-based integrated therapeutic strategies in patients with idiopathic dilated cardiomyopathy (IDCM). |
From 1978 to 2007, 853 IDCM patients (45 +/- 15 years, 72% males) were enrolled and classified as follows: Group 1, 110 patients (12.8%) enrolled during 1978-1987; Group 2, 376 patients (44.1%) enrolled during 1988-1997; Group 3, 367 patients (43.1%) enrolled during 1998-2007. ACE-inhibitors/angiotensin receptor blockers were administered in 34%, 93%, and 93% (P <0.001), and beta-blockers in 11%, 82%, and 86% (P <0.001) in Groups 1, 2, and 3, respectively; implantable cardioverter-defibrillator (ICD) were implanted in 2%, 14%, and 13% (P = 0.005); mean time to device implantation was lower in Group 3. At 8 years, heart transplant (HTx)-free survival rates were 55%, 71%, and 87% in Groups 1, 2, and 3, respectively (P <0.001). Similar progressive improvement was found for pump-failure death (DHF)/HTx, while survival free from sudden death (SD) was significantly improved only in Group 3. Multivariable models considering competing risk indicated early diagnosis (i.e. a baseline less advanced disease stage) and tailored medical therapy (HR 0.44, CI 95% 0.19-0.98) as independent protectors against DHF/HTx. Concerning SD, lower left ventricular ejection fraction emerged as a predictor, while ICD was the only therapy with a protective role (HR 0.08, CI 95% 0.01-0.61). Treatment with digitalis emerged as a predictor of both DHF/HTx and SD. |
2 |
| 6. Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3):344-350. |
Review/Other-Dx |
N/A |
To test the hypothesis that the incidence of heart failure has declined and survival after heart failure diagnosis has improved over time but that secular trends have diverged by sex. |
The incidence of heart failure was higher among men (378/100 000 persons; 95% confidence interval [CI], 361-395 for men; 289/100 000 persons; 95% CI, 277-300 for women) and did not change over time among men or women. After a mean follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred, including 1930 among women and 1417 among men. Survival after heart failure diagnosis was worse among men than women (relative risk, 1.33; 95% CI, 1.24-1.43) but overall improved over time (5-year age-adjusted survival, 43% in 1979-1984 vs 52% in 1996-2000, P<.001). However, men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons. |
4 |
| 7. Shah KS, Xu H, Matsouaka RA, et al. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol 2017;70:2476-86. |
Review/Other-Dx |
39,982 patients |
This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF =50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF =40%). |
A total of 39,982 patients from 254 hospitals who were admitted for HF between 2005 and 2009 were included: 18,299 (46%) had HFpEF, 3,285 (8.2%) had HFbEF, and 18,398 (46%) had HFrEF. Overall, median survival was 2.1 years. In risk-adjusted survival analysis, all 3 groups had similar 5-year mortality (HFrEF 75.3% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.958 to 1.022]; HFbEF 75.7% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.947 to 1.046]). In risk-adjusted analyses, the composite of mortality and rehospitalization was similar for all subgroups. Cardiovascular and HF readmission rates were higher in those with HFrEF and HFbEF compared with those with HFpEF. When compared with the U.S. population, HF patients across all age and EF groups had markedly lower median survival. |
4 |
| 8. Roger VL. Epidemiology of Heart Failure: A Contemporary Perspective. Circ Res 2021;128:1421-34. |
Review/Other-Dx |
N/A |
To focus on the most recent studies identified by searching the Medline database for publications with the subject headings heart failure (HF), epidemiology, prevalence, incidence, trends between 2010 and present. |
No results stated in the abstract. |
4 |
| 9. Hancock HC, Close H, Mason JM, et al. High prevalence of undetected heart failure in long-term care residents: findings from the Heart Failure in Care Homes (HFinCH) study. Eur J Heart Fail. 2013;15(2):158-165. |
Review/Other-Dx |
1172 residents |
To ascertain heart failure prevalence and clinical management in this population. |
A total of 405 residents, aged 65-100 years, in 33 UK care facilities were prospectively enrolled between April 2009 and June 2010. The presence of heart failure was determined using European Society of Cardiology guidelines, modified where necessary for immobility. Evaluation of symptoms and signs, functional capacity, and quality of life, portable on-site echocardiography, and medical record review were completed in 399 cases. The point prevalence of heart failure was 22.8% [n = 91, 95% confidence interval (CI) 18.8-27.2%]; of these, 62.7% (n = 57, 95% CI 59.6-66.5%) had heart failure with preserved ejection fraction and 37.3% had left ventricular systolic dysfunction (n = 34, 95% CI 34.8-40.5%). A total of 76% (n = 61) of previous diagnoses of heart failure were not confirmed, and up to 90% (n = 82) of study cases were new. No symptoms or signs were reliable predictors of heart failure. |
4 |
| 10. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147-239. |
Review/Other-Dx |
N/A |
Evidence-based guidelines for the management of heart failure. |
No results stated in the abstract. |
4 |
| 11. Bolen MA, Bin Saeedan MN, Rajiah P, et al. ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update. J Am Coll Radiol 2022;19:S37-S52. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for dyspnea-suspected cardiac origin (ischemia already excluded). |
No results stated in abstract. |
4 |
| 12. Rajiah P, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded). J Am Coll Radiol 2021;18:S83-S105. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for nonischemic myocardial disease with clinical manifestations (ischemic cardiomyopathy already excluded). |
No results stated in abstract. |
4 |
| 13. Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 2021;23:352-80. |
Review/Other-Dx |
N/A |
To provide a universal definition of HF that is clinically relevant, simple but conceptually comprehensive, with the ability to sub-classify and to encompass stages within, with universal applicability globally, and with prognostic and therapeutic validity and acceptable sensitivity and specificity. |
No results stated in the abstract. |
4 |
| 14. Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93(5):841-842. |
Review/Other-Dx |
N/A |
To report the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. |
No results stated in abstract. |
4 |
| 15. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2 |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 16. Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A. Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT. American Journal of Emergency Medicine. 36(6):1014-1017, 2018 Jun.Am J Emerg Med. 36(6):1014-1017, 2018 Jun. |
Observational-Dx |
140 patients |
To compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard. |
A total of 140 patients were recruited from eligible 144 patients. The final study population was 132 for abdominal and 130 for thorax examinations. In this study, AUC of E-FAST was 0.71 for abdominal free fluid, 0.87 for pneumothorax and 1.00 for pleural effusion. The sensitivity was 42.9% and specificity was 98.4%. The +LR for abdominal free fluid was 26.8 and -LR was 0.58. |
2 |
| 17. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients?. Injury. 41(5):479-83, 2010 May. |
Observational-Dx |
3181 patients |
To determine whether the FAST exam is reliable in severely injured patients. |
3181 patients with blunt abdominal trauma included into the study were divided into the three groups according to the ISS. The mean ISS was 7.9+/-3.97, 19.6+/-2.48 and 41.3+/-11.95 in Groups 1, 2 and 3, respectively. The accuracy of ultrasound was 90.6% in the group of patients with the highest ISS (>or=25) compared with 97.5 and 97.1 for Groups 1 and 2 (p<0.001). Similarly, ultrasound had a significantly lower sensitivity, specificity, PPV and NPV for patients in Group 3 compared with the first two groups (p<0.001). There was a significantly lower sensitivity in Group 2 compared with Group 1 (p<0.001), but no differences in specificity, accuracy, PPV or NPV were demonstrated. |
3 |
| 18. Laselle BT, Byyny RL, Haukoos JS, et al. False-negative FAST examination: associations with injury characteristics and patient outcomes. Ann Emerg Med. 60(3):326-34.e3, 2012 Sep. |
Observational-Dx |
332 patients |
To estimate associations between false-negative Focused assessment with sonography in trauma (FAST) results and patient characteristics, specific abdominalorgan injuries, and patient outcomes. |
During the study period, 332 patients met inclusion criteria. Median age was 32 years (interquartile range 23 to 45 years), 67% were male patients, the median Injury Severity Score was 27 (interquartile range 17 to 41), and 162 (49%) had a false-negative FAST result. Head injury was positively associated with false negative FAST result (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.5 to 15.7), whereas severe abdominal injury was negatively associated (OR 0.3; 95% CI 0.1 to 0.5). Injuries to the spleen (OR 0.4; 95% CI 0.24 to 0.66), liver (OR 0.36; 95% CI 0.21 to 0.61), and abdominal vasculature (OR 0.17; 95% CI 0.07 to 0.38) were also negatively associated with false-negative FAST result. False-negative FAST result was not associated with mortality (OR 0.89; 95% CI 0.42 to 1.9), prolonged ICU length of stay (relative risk 0.88; 95% CI 0.69 to 1.12), or total hospital length of stay (relative risk 0.92; 95% CI 0.76 to 1.12). However, patients with false-negative FAST results were substantially less likely to require therapeutic laparotomy (OR 0.31; 95% CI 0.19 to 0.52). |
2 |
| 19. Aziz W, Claridge S, Ntalas I, et al. Emerging role of cardiac computed tomography in heart failure. [Review]. ESC Heart Fail. 6(5):909-920, 2019 10. |
Review/Other-Dx |
N/A |
To the current applications of cardiac computed tomography (CT) to patients with heart failure and also the emerging areas of research where its clinical utility is likely to extend into the realm of treatment, procedural planning, and advanced heart failure therapy implementation. |
No results stated in the abstract. |
4 |
| 20. Peterzan MA, Rider OJ, Anderson LJ. The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure. Card Fail Rev 2016;2:115-22. |
Review/Other-Dx |
N/A |
To discuss the role of cardiovascular magnetic resonance imaging in heart failure. |
No results stated abstract. |
4 |
| 21. Kennedy S, Simon B, Alter HJ, Cheung P. Ability of physicians to diagnose congestive heart failure based on chest X-ray. J Emerg Med 2011;40:47-52. |
Observational-Dx |
55 |
To evaluate the ability of emergency physicians to recognize CHF on chest X-ray and the effect of level of training and confidence upon accuracy of interpretation. |
Physicians correctly identified the CHF chest X-rays 79% of the time (sensitivity 59%, specificity 96%; positive likelihood ratio 14.6, negative likelihood ratio 0.43). Accuracy ranged from a low of 78% among first-year residents to a high of 85% among attendings, and from 73% (confidence rating of 3/5) to 91% (confidence rating of 5/5). Increasing confidence was significantly correlated with accuracy across the spectrum (p 0.001). An accuracy of 95% among radiologists suggests that a negative X-ray does not rule out CHF. High specificity (96%) and low sensitivity (59%) suggest that emergency physicians are excellent at identifying CHF on X-ray when present, but under-call it frequently. Sensitivity may be much higher in real life given clinical correlation. Both increasedlevel of training and higher confidence significantly improved accuracy. |
3 |
| 22. Martindale JL, Wakai A, Collins SP, et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. [Review]. Acad Emerg Med. 23(3):223-42, 2016 Mar. |
Meta-analysis |
57 studies |
To perform a systematic review and meta-analysis of the operating characteristics of diagnostic elements available to the emergency physician for diagnosing Acute heart failure (AHF). Secondary objectives were to develop a test-treatment threshold model and to calculate interval likelihood ratios (LRs) for natriuretic peptides (NPs) by pooling patient-level results. |
Based on the included studies, the prevalence of AHF ranged from 29% to 79%. Index tests with pooled positive LRs >/= 4 were the auscultation of S3 on physical examination (4.0, 95% confidence interval [CI] = 2.7 to 5.9), pulmonary edema on both CXR (4.8, 95% CI = 3.6 to 6.4) and lung US (7.4, 95% CI = 4.2 to 12.8), and reduced ejection fraction observed on bedside echocardiogram (4.1, 95% CI = 2.4 to 7.2). Tests with low negative LRs were BNP < 100 pg/mL (0.11, 95% CI = 0.07 to 0.16), NT-proBNP < 300 pg/mL (0.09, 95% CI = 0.03 to 0.34), and B-line pattern on lung US LR (0.16, 95% CI = 0.05 to 0.51). Interval LRs of BNP concentrations at the low end of "positive" results as defined by a cutoff of 100 pg/mL were substantially lower (100 to 200 pg/mL; 0.29, 95% CI = 0.23 to 0.38) than those associated with higher BNP concentrations (1000 to 1500 pg/mL; 7.12, 95% CI = 4.53 to 11.18). The interval LR of NT-proBNP concentrations even at very high values (30,000 to 200,000 pg/mL) was 3.30 (95% CI = 2.05 to 5.31). |
Good |
| 23. Collins SP, Lindsell CJ, Yealy DM, et al. A comparison of criterion standard methods to diagnose acute heart failure. Congest Heart Fail. 2012;18(5):262-271. |
Observational-Dx |
483 patients |
To compare and contrast the clinical criterion standards currently used in a cohort of emergency department (ED) patients to diagnose acute heart failure syndromes (AHFS). |
Across all criterion standards, patients with AHFS were more likely to have a history of AHFS, congestion on physical examination and chest radiography, and elevated natriuretic peptide levels than those without AHFS. The standards agreed well (cardiology review vs hospital discharge diagnosis, kappa=0.74; cardiology review vs ED diagnosis, kappa=0.66; ED diagnosis vs hospital discharge diagnosis kappa=0.59). Each method had similar sensitivity but differing specificities. Different criterion standards identify different patients from among those being evaluated for AHFS. |
2 |
| 24. Maw AM, Hassanin A, Ho PM, et al. Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-analysis. JAMA netw. open. 2(3):e190703, 2019 03 01. |
Meta-analysis |
6 studies |
To compare the accuracy of lung ultrasonography (LUS) with the accuracy of chest radiography (CXR) in the diagnosis of cardiogenic pulmonary edema in adult patients presenting with dyspnea. |
The literature search yielded 1377 nonduplicate titles that were screened, of which 43 articles (3.1%) underwent full-text review. Six studies met the inclusion criteria, representing a total of 1827 patients. Pooled estimates for LUS were 0.88 (95% Cl, 0.75-0.95) for sensitivity and 0.90 (95% Cl, 0.88-0.92) for specificity. Pooled estimates for CXR were 0.73 (95% CI, 0.70-0.76) for sensitivity and 0.90 (95% CI, 0.75-0.97) for specificity. The relative sensitivity ratio of LUS, compared with CXR, was 1.2 (95% CI, 1.08-1.34; P?<?.001), but no difference was found in specificity between tests (relative specificity ratio, 1.0; 95% CI, 0.90-1.11; P?=?.96). |
Not Assessed |
| 25. Kelder JC, Cramer MJ, van Wijngaarden J, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011;124(25):2865-2873. |
Observational-Dx |
721 patients |
To determine the diagnostic value of history, physical examination, and subsequent additional testing including B-type natriuretic peptide (BNP) measurements to efficiently and accurately establish a diagnosis of new-onset heart failure in the domain of outpatients presenting with nonacute symptoms. |
his is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, electrocardiography (ECG), N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (P<0.0001). A simplified diagnostic rule was applied to 2 external validation datasets, resulting in c- statistics of 0.95 and 0.88, confirming the results. |
3 |
| 26. Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol. 2001;37(4):1042-1048. |
Observational-Dx |
2,671 participants |
To assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failure (CHF). |
At a mean follow-up of 5.2 years (range 0 to 6 years), 170 participants (6.4% of the cohort) developed CHF. Although 96% of these participants had normal or borderline ejection fraction (EF) at baseline, only 57% had normal or borderline EF at the time of hospitalization. In multivariate modeling, fractional shortening at the endocardium (relative risk [RR] 1.85 per 10-unit decrease, confidence interval [CI] 1.27 to 2.39), fractional shortening at the midwall (RR 1.29 per five-unit decrease, 95% CI 1.11-1.51) and peak Doppler peak E (RR 1.15 for each 0.1 M/s increment; CI 1.02 to 1.21) independently predicted incident CHF. Both high and low Doppler E/A ratios were predictive of incident CHF. |
3 |
| 27. Esposito R, Sorrentino R, Galderisi M. The use of transthoracic echocardiography for the assessment of left ventricular systolic and diastolic function in patients with suspected or ascertained chronic heart failure. Expert Rev Cardiovasc Ther. 2016;14(1):37-50. |
Review/Other-Dx |
N/A |
To review the use of transthoracic echocardiography for the assessment of left ventricular systolic and diastolic function in patients with suspected or ascertained chronic heart failure. |
No results stated in abstract. |
4 |
| 28. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 29(4):277-314, 2016 Apr. |
Review/Other-Dx |
N/A |
To simplify the recommendations for the evaluation of left ventricular diastolic function by echocardiography and thus increase the utility of the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines in daily clinical practice. |
No abstract available. |
4 |
| 29. Lee KC, Liu S, Callahan P, et al. Routine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat Echocardiography during Index Admission. J Am Soc Echocardiogr. 34(12):1253-1261.e4, 2021 12. |
Observational-Dx |
9,115 patients |
The goal of this retrospective analysis was to evaluate the impact of this disease-based ultrasound enhancing agents (UEA) protocol on the number of repeat transthoracic echocardiographic (TTE) examinations and length of stay (LOS) for an index heart failure (HF) admission. |
In the 9,115 admissions for HF (5,600 in the contrast group, 3,515 in the noncontrast group), 927 patients underwent repeat TTE studies (505 in the contrast group, 422 in the noncontrast group), which were considered justified in 823 patients. Of the 104 patients who underwent unjustified repeat TTE studies, 80 (76.7%) belonged to the noncontrast group and 24 to the contrast group. Also, UEA use increased from 50.4% in 2014 to 74.3%, and the rate of unjustified repeat studies decreased from 1.3% to 0.9%. The rates of unjustified repeat TTE imaging were 2.3% and 0.4% (in the noncontrast and contrast groups, respectively), and patients in the contrast group were less likely to undergo unjustified repeat examinations (odds ratio, 0.18; 95% CI, 0.12-0.29; P < .0001). The mean LOS was significantly lower in the contrast group (9.5 ± 10.5 vs 11.1 ± 13.7 days). The use of UEA in the first TTE study was also associated with reduced LOS (linear regression, ß1 = -0.47, P = .036), with 20% lower odds for odds of prolonged (>6 days) LOS. |
3 |
| 30. Mulvagh SL, Rakowski H, Vannan MA, et al. American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography. J Am Soc Echocardiogr 2008;21:1179-201; quiz 281. |
Review/Other-Dx |
N/A |
To present a consensus statement from the American Society of Echocardiography (ASE) on the clinical applications of ultrasonic contrast agents in echocardiography. |
No results stated in the abstract. |
4 |
| 31. van Riet EE, Hoes AW, Limburg A, Landman MA, van der Hoeven H, Rutten FH. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail. 2014;16(7):772-777. |
Review/Other-Dx |
1527 subjects |
To assess the prevalence of unrecognized heart failure in elderly patients presenting to primary care with shortness of breath on exertion. |
This was a cross-sectional selective screening study. Patients aged 65 years or over presenting to primary care with shortness of breath on exertion in the previous 12 months were eligible when not known to have an established, echocardiographic confirmed diagnosis of heart failure. All participants underwent history taking, physical examination, electrocardiography, and a blood test of N-terminal pro B-type natriuretic peptide (NTproBNP). Only those with an abnormal electrocardiogram or NTproBNP level exceeding the exclusionary cut-point for non-acute onset heart failure (>15 pmol/L ( approximately 125 pg/mL) underwent open-access echocardiography. An expert panel established presence or absence of heart failure according to the criteria of the European Society of Cardiology heart failure guidelines. The mean age of the 585 participants was 74.1 (SD 6.3) years, and 54.5% were female. In total, 92 (15.7%, 95% CI 12.9-19.0) participants had heart failure: 17 (2.9%, 95% CI 1.8-4.7) had heart failure with a reduced ejection fraction (</=45%), 70 (12.0%, 95% CI 9.5-14.9) had heart failure with preserved ejection fraction, and five (0.9%, 95% CI 0.3-2.1) had isolated right-sided heart failure. |
4 |
| 32. Morris DA, Boldt LH, Eichstadt H, Ozcelik C, Haverkamp W. Myocardial systolic and diastolic performance derived by 2-dimensional speckle tracking echocardiography in heart failure with normal left ventricular ejection fraction. Circ Heart Fail. 2012;5(5):610-620. |
Observational-Dx |
450 patients |
To investigate the myocardial systolic and diastolic performance of the left ventricle (LV) in patients with heart failure with normal LV ejection fraction (HFNEF) through novel LV myocardial indices, which assess the systolic and diastolic function of the whole myocardium of the LV. |
LV myocardial systolic and diastolic performance were assessed as the average value of peak systolic strain and peak early-diastolic strain rate, respectively, in longitudinal, circumferential, and radial directions from all LV segments using 2-dimensional speckle-tracking echocardiography. We studied patients with HFNEF and a control group consisting of asymptomatic subjects with LV diastolic dysfunction of similar age, sex, and LV ejection fraction. A total of 322 patients were included (92 with HFNEF and 230 with asymptomatic LV diastolic dysfunction). Myocardial systolic and diastolic LV performance were significantly lower in HFNEF (20.13+/-6.02% and 1.14+/-0.27 s(-1)) than in patients with asymptomatic LV diastolic dysfunction (25.33+/-6.06% and 1.37+/-0.33 s(-1), respectively; all P<0.0001). In addition, patients with HFNEF with low systolic and diastolic LV myocardial performance had significantly higher LV filling pressures (17.1+/-6.6 and 17.6+/-6.3 versus 12.0+/-5.1 and 11.7+/-4.7, respectively; all P<0.001) and lower cardiac output (4.8+/-1.0 L/min and 4.9+/-1.1 L/min versus 5.7+/-1.2 L/min and 5.8+/-1.1 L/min, respectively; all P<0.001) than patients with normal LV myocardial performance. In relation to these findings, the symptomatic status (ie, New York Heart Association functional class) was significantly altered in those patients with low systolic and diastolic LV myocardial performance. |
2 |
| 33. Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H. Diagnostic Accuracy of Tissue Doppler Index E/e' for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. [Review]. J Am Heart Assoc. 5(1), 2016 Jan 25. |
Meta-analysis |
24 studies |
To review the Diagnostic Accuracy of Tissue Doppler Index E/e' for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction |
From the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/e' and invasive LVFP in preserved EF (>/=50%). In random-effects models, E/e' had poor to mediocre linear correlation with LVFP. Summary sensitivity and specificity (with 95% CIs) for the American Society of Echocardiography-recommended E/e' cutoffs (lateral, mean, and septal, respectively) to identify elevated LVFP was estimated by using hierarchical summary receiver operating characteristic analysis. Summary sensitivity was 30% (9-48%), 37% (13-61%), and 24% (6-46%), and summary specificity was 92% (82-100%), 91% (80-99%), and 98% (92-100%). Positive likelihood ratio (LR+) was <5 for lateral and mean E/e'. LR+ was slightly >10 for septal E/e' obtained from 4 studies (cumulative sample size <220). For excluding elevated LVFP, summary sensitivity for E/e' (lateral, mean, and septal, respectively) was 64% (38-86%), 36% (3-74%), and 50% (14-81%), while summary specificity was 73% (54-89%), 83% (49-100%), and 89% (66-100%). Because of data set limitations, meaningful inference for identifying HFpEF by using E/e' could not be drawn. With the use of quality assessment tool for diagnostic accuracy studies (Quality Assessment of Diagnostic Accuracy Studies questionnaire), we found substantial risks of bias and/or applicability. |
Inadequate |
| 34. Ezekowitz JA, McAlister FA, Howlett J, et al. A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort. ESC Heart Fail. 2018;5(1):19-26. |
Observational-Dx |
565 patients |
To test the utility of established criteria to classify patients with heart failure with a preserved ejection fraction (HF-PEF). |
For the diagnosis of HF-PEF, the positive likelihood ratios were 6.1, 6.9, and 4.8 for the Zile, European Society of Cardiology (ESC) 2007, and ESC 2016 criteria, respectively. The negative likelihood ratios were 0.58, 0.60, and 0.42 for the Zile, ESC 2007, and ESC 2016 criteria, respectively. All three criteria lacked sensitivity to detect HF-PEF (46.5%, 44.1%, and 51.8%, respectively) but were highly specific (92.4%, 93.9%, and 89%, respectively). We further evaluated the criteria to distinguish HF-PEF from other diagnoses after excluding heart failure with reduced ejection fraction; the results were similar. |
1 |
| 35. Melo RM, Melo EF, Biselli B, Souza GE, Bocchi EA. Clinical usefulness of coronary angiography in patients with left ventricular dysfunction. Arq Bras Cardiol. 2012;98(5):437-441. |
Review/Other-Dx |
107 patients |
To evaluate the prevalence of ischemic heart disease by angiographic criteria in patients with heart failure and reduced ejection fraction of unknown etiology, as well as its impact on therapy decisions. |
One hundred and seven patients were included in the analysis, with 51 (47.7%) patients in Group 1 and 56 (52.3%) in Group 2. The prevalence of ischemic heart disease was 9.3% (10 patients), and all belonged to Group 1 (p = 0.0001). During follow-up, only 4 (3.7%) were referred for CABG; 3 (2.8%) patients had procedure-related complications. |
4 |
| 36. Abunassar JG, Yam Y, Chen L, D'Mello N, Chow BJ. Usefulness of the Agatston score = 0 to exclude ischemic cardiomyopathy in patients with heart failure. Am J Cardiol. 2011;107(3):428-432. |
Observational-Dx |
738 patients |
To understand the potential application of the Agatston score in patients with heart failure (HF) |
Excluding patients with HF or LV dysfunction, 738 patients (mean age 52 ± 10 years, 43% men) had an Agatston score equal to 0. Of these, 18 (2%) had obstructive CAD (diameter stenosis =50%), 8 (1%) had diameter stenoses =70%, and none had high-risk CAD. The 74 patients with high-risk CAD without LV dysfunction had high Agatston scores (mean 895 ± 734, median 716, range 50 to 3,210). In total 153 patients with a history of HF and abnormal ejection fraction were identified. All 13 patients with ischemic cardiomyopathy had Agatston scores >0, whereas 46 of 140 patients (30.1%) with nonischemic causes had an Agatston score equal to 0. An Agatston score equal to 0 identified nonischemic causes with a specificity of 100% (confidence interval 90 to 100) and positive predictive value of 100% (confidence interval 90 to 100). Agatston score equal to 0 had incremental value to pretest probability for CAD. |
2 |
| 37. Premaratne M, Shamsaei M, Chow JD, et al. Using coronary calcification to exclude an ischemic etiology for cardiomyopathy: A validation study and systematic review. Int J Cardiol. 2017;230:518-522. |
Review/Other-Dx |
754 patients |
To determine the utility of an Agatston score equal 0 to exclude the diagnosis of ischemic cardiomyopathy |
Eighty-two patients were enrolled in the study and underwent CAC imaging with 81.7% patients having non-ischemic cardiomyopathy. An Agatston score=0 successfully excluded an ischemic etiology for cardiomyopathy with a specificity of 100% (CI: 74.7-100%) and a positive predictive value of 100% (CI: 85.0%-100%). A systematic literature review was performed and studies were deemed suitable for inclusion if: 1) patients with CHF, cardiomyopathy or LV dysfunction were enrolled, 2) underwent CAC imaging and patients were assessed for an Agatston score=0 or the absence of CAC, and 3) the final etiologic diagnosis (ischemic or non-ischemic) was provided. Eight studies provided sufficient information to calculate operating characteristics for an Agatston score=0 and were combined with our validation cohort for a total of 754 patients. An Agatston score=0 excluded ischemic cardiomyopathy with specificity and positive predictive values of 98.4% (CI: 95.6-99.5%), and 98.3% (CI: 95.5-99.5%), respectively. |
4 |
| 38. Sousa PA, Bettencourt N, Dias Ferreira N, et al. Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients. Rev Port Cardiol. 2014;33(10):629-636. |
Observational-Dx |
100 patients |
To assess the value of coronary multidetector computed tomography (MDCT) angiography in the exclusion of ischemic etiology in heart failure (HF) patients and to determine whether the Agatston calcium score could be used as a gatekeeper for CTA in this context. |
During this period 100 patients (mean age 57.3±10.5 years, 64% men) with HF and systolic dysfunction were referred for MDCT to exclude CAD. Median effective radiation dose was 4.8 mSv (interquartile range 5.8 mSv). Mean LVEF was 35±7.7% (range 20-48%) and median CAC score was 13 (interquartile range 212). Seven patients were in atrial fibrillation. Almost half of the patients (40%) had no CAC and none of these had significant stenosis on CTA. In an additional group of 33 patients CTA was able to confidently exclude obstructive CAD. Twenty-seven patients were classified as positive for CAD (16 due to CAC >400 and 11 with =50% stenosis) and were associated with lower LVEF (p=0.004). Of these, 21 patients subsequently underwent ICA: obstructive CAD was confirmed in nine and only six had criteria for ischemic cardiomyopathy. |
3 |
| 39. ten Kate GJ, Caliskan K, Dedic A, et al. Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. Eur J Heart Fail. 2013;15(9):1028-1034. |
Observational-Dx |
81 patients |
To evaluate the accuracy of cardiac computed tomography (CT) in distinguishing Coronary Artery Disease (CAD) and non-CAD heart failure (HF) and its effectiveness as a gatekeeper for invasive coronary angiography (ICA). |
We prospectively included 93 symptomatic patients with newly diagnosed HF of unknown aetiology (59 men; mean age 53 +/- 13) and EF <45%, and/or fractional shortening <25%, and/or end-diastolic LV diameter >60 mm (men) or >55 mm (women). In all patients, the CT calcium score (CTCS) was determined. CTCS = 0 excluded CAD HF. Additional CT coronary angiography (CTCA) was performed if CTCS >0. ICA was used as the gold standard for distinguishing between CAD and non-CAD HF in patients with >20% luminal diameter narrowing on CTCA. CAD HF was defined as >50% luminal diameter narrowing in either (i) the left main coronary artery or proximal left anterior descending coronary artery or (ii) in multiple coronary arteries. Diagnostic accuracy and follow-up data (20 +/- 16 months) were collected for all patients. CTCS = 0 ruled out CAD HF in 43 patients (46%). The CT algorithm had 100% sensitivity, 95% specificity, 67% positive predictive value, and 100% negative predictive value for detecting CAD HF. Patients with CTCS = 0 or non-CAD HF on CTCA had no coronary events during follow-up, and ICA could have been safely avoided in 76 out of 93 patients (82%). |
2 |
| 40. Assen MV, Vonder M, Pelgrim GJ, Von Knebel Doeberitz PL, Vliegenthart R. Computed tomography for myocardial characterization in ischemic heart disease: a state-of-the-art review. Eur Radiol Exp 2020;4:36. |
Review/Other-Dx |
N/A |
To provide an overview of the currently available computed tomography (CT) techniques for myocardial tissue characterization in ischemic heart disease, including CT perfusion and late iodine enhancement. |
No results stated in the abstract. |
4 |
| 41. Pattanayak P, Bleumke DA. Tissue characterization of the myocardium: state of the art characterization by magnetic resonance and computed tomography imaging. Radiol Clin North Am 2015;53:413-23. |
Review/Other-Dx |
N/A |
To review and focus on the field of cardiac magnetic resonance imaging (CMR) and the techniques of Late Gadolinium Enhancement (LGE) and T1 mapping, useful in the detection of myocardial scar and diffuse myocardial fibrosis respectively. |
No results stated in the abstract. |
4 |
| 42. Aitken M, Chan MV, Urzua Fresno C, et al. Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2022;304:566-79. |
Meta-analysis |
33 studies (1,997 total patients) |
To perform a systematic review and meta-analysis to compare the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) and fluorodeoxyglucose (FDG) positron emission tomography (PET) for cardiac sarcoidosis. |
Thirty-three studies were included (1997 patients, 687 with cardiac sarcoidosis); 17 studies evaluated cardiac MRI (1031 patients) and 26 evaluated FDG PET (1363 patients). Six studies directly compared cardiac MRI and PET in the same patients (303 patients). Cardiac MRI had higher sensitivity than FDG PET (95% vs 84%; P = .002), with no difference in specificity (85% vs 82%; P = .85). In a sensitivity analysis restricted to studies with direct comparison, point estimates were similar to those from the overall analysis: cardiac MRI and FDG PET had sensitivities of 92% and 81% and specificities of 72% and 82%, respectively. Covariate analysis demonstrated that sensitivity for FDG PET was highest with quantitative versus qualitative evaluation (93% vs 76%; P = .01), whereas sensitivity for MRI was highest with inclusion of T2 imaging (99% vs 88%; P = .001). Thirty studies were at risk of bias. |
Good |
| 43. Martineau P, Gregoire J, Harel F, Pelletier-Galarneau M. Assessing cardiovascular infection and inflammation with FDG-PET. Am J Nucl Med Mol Imaging 2021;11:46-58. |
Review/Other-Dx |
N/A |
To review established and emerging applications for cardiovascular infection and inflammation imaging with fluoro-deoxyglucose positron emission tomography (FDG-PET) and present typical examples of representative pathologies. |
No results available in the abstract. |
4 |
| 44. Khalaf S, Al-Mallah MH. Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond. [Review]. Methodist Debakey Cardiovasc J. 16(2):122-129, 2020 Apr-Jun. |
Review/Other-Dx |
N/A |
This review discusses the role of positron emission tomography (PET) imaging in assessing myocardial viability, inflammatory cardiomyopathies, and endocarditis; describes the different protocols needed to acquire images for specific imaging tests; and examines imaging interpretation for each image dataset-including identification of the mismatch defect in viability imaging, which is associated with significant improvement in LV function after revascularization. |
No results stated in the abstract. |
4 |
| 45. Contaldi C, Dellegrottaglie S, Mauro C, et al. Role of Cardiac Magnetic Resonance Imaging in Heart Failure. [Review]. Heart Fail Clin. 17(2):207-221, 2021 Apr. |
Review/Other-Tx |
N/A |
To describes the current role and potential future applications of cardiac magnetic resonance (CMR) for the management of heart failure (HF). |
No results stated in the abstract. |
4 |
| 46. Lum YH, McKenzie S, Brown M, Hamilton-Craig C. Impact of cardiac magnetic resonance imaging on heart failure patients referred to a tertiary advanced heart failure unit: improvements in diagnosis and management. Intern Med J. 49(2):203-211, 2019 Feb. |
Observational-Dx |
114 patients |
To examine how cardiac magnetic resonance (CMR), compared with routine echocardiography, affects the diagnosis and management of patients with heart failure (HF). |
A total of 114 new HF referrals was included. Evaluation of HF of uncertain aetiology (70%) was the most common indication for CMR. In 20% of cases, CMR led to a completely new diagnosis or diagnostic confirmation of suspicions raised by echocardiography. Clinical decision-making was altered in 48%, with the greatest impact on decisions regarding revascularisation. Overall, CMR had a significant impact on 50% of patients. In a multivariable model, the only independent variable significantly associated with clinical impact was the presence/absence of late gadolinium enhancement (P < 0.001). Importantly, body mass index, echocardiography image quality and the presence of sinus rhythm did not show statistical significance in the multivariate analysis. |
3 |
| 47. Won E, Donnino R, Srichai MB, et al. Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction. Am J Cardiol. 2015;116(7):1082-1087. |
Observational-Dx |
81 patients |
To determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (</=40%) left ventricular ejection fraction (HFrEF). |
Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (C-statistic 0.85, 95% confidence interval 0.76 to 0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, whereas the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. |
2 |
| 48. Valle-Munoz A, Estornell-Erill J, Soriano-Navarro CJ, et al. Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure. Eur J Echocardiogr. 2009;10(8):968-974. |
Observational-Dx |
100 patients |
To evaluate the ability of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) to identify acute new-onset heart failure (HF) with left ventricular systolic dysfunction (LVSD), whether or not in relation to underlying coronary artery disease (CAD), in patients with no clinical evidence of associated ischaemic cardiomyopathy. |
Hundred consecutive patients admitted with acute new-onset decompensated HF and EF <40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis > or =70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80-91) and specificity of 92.4% (95% CI, 87-96), respectively, with a negative predictive value of 96% (95% CI, 90-99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814-0.998). |
2 |
| 49. Assomull RG, Shakespeare C, Kalra PR, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation. 2011;124(12):1351-1360. |
Observational-Dx |
124 patients |
To assess the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance coronary angiography (CA) as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients. |
One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system. |
2 |
| 50. Hamilton-Craig C, Strugnell WE, Raffel OC, Porto I, Walters DL, Slaughter RE. CT angiography with cardiac MRI: non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure. Int J Cardiovasc Imaging. 2012;28(5):1111-1122. |
Observational-Dx |
28 patients |
To prospectively compare standard-of-care invasive catheter angiography (iCA) and echocardiography to a novel non-invasive strategy of both Coronary Computed Tomographic Angiography (CCTA) and Cardiovascular MRI (CMR) to determine the etiology of myocardial dysfunction. |
426 coronary segments from 28 prospectively enrolled patients were analyzed by CCTA and quantitative iCA. The per-patient sensitivity and specificity of CCTA was 100% and 90%, respectively, negative predictive value (NPV) 100%, positive predictive value (PPV) 78%. Mean ejection fraction by CMR was 24%. Presence of ischemic-type LGE on CMR conferred a 67% sensitivity, 100% specificity, 90% NPV and 100% PPV. Combining CCTA with CMR conferred 100% specificity, 100% sensitivity, 100% PPV and 100% NPV for detection or exclusion of coronary disease. In patients with negative CCTA all invasive angiograms could have been avoided. In addition, two patients with no ischemic LGE by CMR had severe coronary disease on both CCTA and iCA, indicating global hibernation. |
1 |
| 51. Ojrzynska-Witek N, Marczak M, Mazurkiewicz L, et al. Role of cardiac magnetic resonance in heart failure of initially unknown etiology: A 10-year observational study. Kardiol Pol. 80(3):278-285, 2022. |
Observational-Dx |
243 patients |
To evaluate the role of cardiac magnetic resonance (CMR) imaging to identify the etiology of heart failure (HF) and to evaluate the impact of CMR on diagnosis and patient management. |
The study sample included 243 patients: 173 (71.2%) patients were male, and the mean (SD) age was 44.0 (15.2) years. All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% of cases. In 94 patients (38.7%), CMR led to a new diagnosis. In 41 patients (16.9%), patient management was changed by CMR. The latter group comprised patients with coronary artery disease, amyloidosis, valvular disease, and cardiomyopathies other than dilated, namely hypertrophic, restrictive, and left ventricular noncompaction. |
3 |
| 52. Kanagala P, Cheng ASH, Singh A, et al. Diagnostic and prognostic utility of cardiovascular magnetic resonance imaging in heart failure with preserved ejection fraction - implications for clinical trials. J Cardiovasc Magn Reson. 20(1):4, 2018 01 11. |
Observational-Dx |
154 patients |
To phenotype patients with heart failure with preserved ejection fraction (HFpEF) using multiparametric stress cardiovascular magnetic resonance imaging (CMR) and to assess the relationship to clinical outcomes. |
CMR detected previously undiagnosed pathology in 42 patients (27%), who had similar baseline characteristics to those without a new diagnosis. These diagnoses consisted of: coronary artery disease (n = 20, including 14 with 'silent' infarction), microvascular dysfunction (n = 11), probable or definite hypertrophic cardiomyopathy (n = 10) and constrictive pericarditis (n = 5). Four patients had dual pathology. During follow-up (median 623 days), patients with a new CMR diagnosis were at higher risk of adverse outcome for the composite endpoint (log rank test: p = 0.047). In multivariate Cox proportional hazards analysis, a new CMR diagnosis was the strongest independent predictor of adverse outcome (hazard ratio: 1.92; 95% CI: 1.07 to 3.45; p = 0.03). |
3 |
| 53. Paterson DI, Wells G, Erthal F, et al. OUTSMART HF: A Randomized Controlled Trial of Routine Versus Selective Cardiac Magnetic Resonance for Patients With Nonischemic Heart Failure (IMAGE-HF 1B). Circulation. 141(10):818-827, 2020 03 10. |
Observational-Dx |
500 patients |
Our primary hypothesis was that routine use of cardiac magnetic resonance (CMR) will yield more specific diagnoses in nonischemic heart failure (HF). Our secondary hypothesis was that routine use of CMR will improve patient outcomes. |
A total of 500 patients (344 male) with mean age 59±13 years were randomized. The routine and selective CMR strategies had similar rates of specific HF causes at 3 months clinical follow-up (44% versus 50%, respectively; P=0.22). At image interpretation, rates of specific HF causes were also not different between routine and selective CMR (34% versus 30%, respectively; P=0.34). However, 24% of patients in the selective group underwent a nonprotocol CMR. Patients with specific HF causes had more clinical events than those with nonspecific caused on the basis of imaging classification (19% versus 12%, respectively; P=0.02), but not on clinical assessment (15% versus 14%, respectively; P=0.49). |
2 |
| 54. Backhaus SJ, Lange T, George EF, et al. Exercise Stress Real-Time Cardiac Magnetic Resonance Imaging for Noninvasive Characterization of Heart Failure With Preserved Ejection Fraction: The HFpEF-Stress Trial. Circulation. 143(15):1484-1498, 2021 04 13. |
Observational-Dx |
75 patients |
We hypothesized that real-time cardiac magnetic resonance (RT-CMR) exercise imaging with pathophysiologic data at excellent temporal and spatial resolution may represent a contemporary noninvasive alternative for diagnosing heart failure with preserved ejection fraction (HFpEF). |
Patients with HFpEF (n=34; median pulmonary capillary wedge pressure at rest, 13 mm?Hg; at stress, 27 mm?Hg) had higher E/e' (12.5 versus 9.15), NT-proBNP (N-terminal pro–B-type natriuretic peptide; 255 versus 75 ng/L), and LA volume index (43.8 versus 36.2 mL/m2) compared with patients with noncardiac dyspnea (n=34; rest, 8 mm?Hg; stress, 18 mm?Hg; P=0.001 for all). Seven patients were excluded because of the presence of non-HFpEF cardiac disease causing dyspnea on imaging. There were no differences in RT-CMR left ventricular total and early diastolic filling at rest and during exercise stress (P=0.164) between patients with HFpEF and noncardiac dyspnea. RT-CMR revealed significantly impaired LA total and early (P<0.001) diastolic emptying in patients with HFpEF during exercise stress. RT-CMR exercise stress LA long axis strain was independently associated with HFpEF (adjusted odds ratio, 0.657 [95% CI, 0.516–0.838]; P=0.001) after adjustment for clinical and imaging measures and emerged as the best predictor for HFpEF (area under the curve at rest 0.82 versus exercise stress 0.93; P=0.029). |
2 |
| 55. Byrne C, Hasbak P, Kjaer A, Thune JJ, Kober L. Impaired myocardial perfusion is associated with increasing end-systolic- and end-diastolic volumes in patients with non-ischemic systolic heart failure: a cross-sectional study using Rubidium-82 PET/CT. BMC Cardiovasc Disord 2019;19:68. |
Observational-Dx |
151 patients |
The aim of this study was to investigate whether there is an association between increasing end-systolic- and end-diastolic volumes (ESV and EDV) and myocardial flow reserve (MFR) in these patients measured with Rubidium-82 positron emission tomography computed tomography (82Rb-PET/CT) as a quantitative myocardial perfusion gold-standard. |
Median age was 62 years (55-69 years) and 31% were women. Mean MFR was 2.38 (2.24-2.52). MFR decreased significantly with both increasing ESVI (estimate - 3.7%/10 ml/m2; 95% confidence interval [CI] -5.6 to - 1.8; P < 0.001) and increasing EDVI (estimate - 3.5%/10 ml/m2; 95% CI -5.3 to - 1.6; P < 0.001). Results remained significant after multivariable adjustment. Additionally, coronary vascular resistance during stress increased significantly with increasing ESVI (estimate: 3.1 mmHg/(ml/g/min) per (10 ml/m2); 95% CI 2.0 to 4.3; r = 0.41; P < 0.0001) and increasing EDVI (estimate: 2.7 mmHg/(ml/g/min) per (10 ml/m2); 95% CI 1.6 to 3.8; r = 0.37; P < 0.0001). |
3 |
| 56. Gulati V, Ching G, Heller GV. The role of radionuclide imaging in heart failure. J Nucl Cardiol. 2013;20(6):1173-1183. |
Review/Other-Dx |
N/A |
To assess the role of radionuclide imaging in heart failure (HF). |
No results stated in abstract. |
4 |
| 57. Danias PG, Ahlberg AW, Clark BA, 3rd, et al. Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy. Am J Cardiol 1998;82:1253-8. |
Observational-Dx |
37 patients |
To determine whether exercise technetium-99m sestamibi gated single-photon emission computed tomography (SPECT) accurately distinguishes between patients with ischemic cardiomyopathy and patients with nonischemic left ventricular systolic dysfunction. |
Thirty-seven adults with a left ventricular ejection fraction = 35%, including 24 patients with nonischemic cardiomyopathy and 13 patients with ischemic cardiomyopathy, were prospectively evaluated using symptom-limited metabolic exercise treadmill testing with technetium-99m sestamibi gated SPECT imaging. Interpretation of myocardial perfusion and regional wall motion was performed, using a 17-segment model. Summed stress, rest, and reversibility perfusion defect scores were determined, and the variance of segmental wall motion scores was computed. Summed stress, rest, and reversibility perfusion defect scores were significantly lower in nonischemic cardiomyopathy patients, compared with those with ischemic cardiomyopathy (summed stress defect score: 6.9 ± 3.8 vs 32.9 ± 7.7, respectively, p < 0.001). Variability in segmental wall motion was also significantly lower in patients with nonischemic cardiomyopathy compared with those with ischemic cardiomyopathy (variance: 0.3 ± 0.3 vs 1.2 ± 0.8, respectively, p < 0.001). |
2 |
| 58. Danias PG, Papaioannou GI, Ahlberg AW, et al. Usefulness of electrocardiographic-gated stress technetium-99m sestamibi single-photon emission computed tomography to differentiate ischemic from nonischemic cardiomyopathy. Am J Cardiol 2004;94:14-9. |
Observational-Dx |
164 patients |
To examine the clinical usefulness of stress technetium-99m sestamibi ECG-gated SPECT in the differentiation of ischemic cardiomyopathy from nonischemic cardiomyopathy in a consecutive series of patients with moderate to severe left ventricular systolic dysfunction who were referred for stress myocardial perfusion imaging and subsequently underwent coronary angiography. |
We examined the clinical value of stress electrocardiographic gated (ECG-gated) single-photon emission computed tomography (SPECT) to identify ischemic cardiomyopathy and detect coronary artery disease (CAD) in 164 patients without known CAD, ejection fraction =40% by ECG-gated SPECT, and subsequent coronary angiography. Summed stress, rest, and difference scores were measured from the SPECT studies, and regional wall motion variance was calculated from the ECG-gated images. Sensitivity and 95% confidence intervals for the diagnosis of ischemic cardiomyopathy and for detection of any CAD (>50% diameter stenosis) were estimated using previously defined cutoffs for summed stress score and regional wall motion variance. For the diagnosis of ischemic cardiomyopathy, sensitivity of stress SPECT (summed stress score >8) was 87% (95% confidence interval [CI] 78 to 95), with a specificity of 63% (95% CI 60 to 82). The addition of wall motion information (summed stress score >8 or regional wall motion variance >0.114) increased sensitivity to 88% (95% CI 80 to 96) and decreased specificity to 45% (95% CI 35 to 55). If reversibility was also taken into account (summed stress score >8, regional wall motion variance >0.114, or summed difference score >0), sensitivity further increased to 94% (95% CI 88 to 100) and specificity decreased to 32% (95% CI 23 to 41). For detection of any CAD, the combined approach using stress perfusion, reversibility, and region of wall motion had a sensitivity of 94% (95% CI 89 to 99) and a specificity of 45% (95% CI 35 to 57). |
3 |
| 59. Soman P, Lahiri A, Mieres JH, et al. Etiology and pathophysiology of new-onset heart failure: evaluation by myocardial perfusion imaging. J Nucl Cardiol 2009;16:82-91. |
Observational-Dx |
201 patients |
To report results of The Investigation of Myocardial Gated SPECT Imaging (IMAGING) in heart failure (HF) trial that was designed to determine the prevalence of CAD, reversible ischemia, prior myocardial infarction (MI), and preserved left ventricular (LV) systolic function using myocardial perfusion imaging (MPI) in patients hospitalized with their first episode of HF, and to assess the performance characteristics of MPI for the diagnosis of extensive coronary artery disease (CAD), which is potentially etiologically relevant to HF in these patients. |
SPECT MPI revealed a broad range of ejection fractions with preserved systolic function in 36% of patients. Forty-one percent of patients had normal perfusion. In the remaining patients, perfusion abnormalities were predominantly due to prior myocardial infarction, with extensive ischemia seen only in 6%. Among patients who underwent coronary angiography, SPECT performance characteristics revealed excellent negative predictive value (96%) for extensive coronary artery disease (CAD). In multivariable analyses, the extent of perfusion abnormality and advancing age predicted the presence of extensive CAD. |
2 |
| 60. Gowdar S, Ahlberg AW, Rai M, et al. Risk stratification with vasodilator stress SPECT myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol. 27(6):2320-2331, 2020 12. |
Observational-Dx |
503 patients |
To investigate the prognostic efficacy of vasodilator stress myocardial perfusion imaging (MPI) in the setting of elevated cardiac troponin to accurately risk stratify these higher-risk patients. |
A total of 503 patients were followed for an averageof 33.6 ± 16.2 months, with a mean age of 69.3 years;53.7% male; and a majority (88.7%) of them undergoingvasodilator stress. A significant increase in all-causemortality was seen based on the severity of TPD resultsfor all vasodilators (P\ .0001) and regadenoson(P\.0001). Similar prognostic ability was seen forcardiac mortality. This association was maintained evenafter adjustment for cardiac risk factors, previouscoronary disease, and troponin quartiles. MPI results(stress TPD and LVEF) added to traditional cardiac riskfactors, and troponin values resulted in a significantincremental increase in the ability to predict all-causeand cardiac mortality, and stress TPD remained independentlypredictive for both all-cause and cardiacmortality in a multivariate model. |
3 |
| 61. Jacobson AF, Narula J, Tijssen J. Analysis of Differences in Assessment of Left Ventricular Function on Echocardiography and Nuclear Perfusion Imaging. Am J Cardiol. 156:85-92, 2021 10 01. |
Observational-Dx |
985 HF patients, 110 control subjects |
To focus on comparison of echocardiography and myocardial perfusion imaging (MPI) single-photon emission computed tomography (SPECT) core lab left ventricular (LV) ejection fraction (EF) results in order to identify factors associated with discrepancies between the 2 LVEF determinations and assess the clinical significance of the magnitude of those differences. |
879 HF and 101 control subjects had core lab analyses of echo and MPI (mean time between procedures 7-8 days). LVEF differences were analyzed using one-way analysis of variance and Bland-Altman plots. Relationships between LVEF differences and patient characteristics and outcome endpoints (mortality and arrhythmias) were explored with logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analyses. There was a systematic difference between the 2 modalities; echo LVEF was higher with more severe LV dysfunction, MPI LVEF higher when systolic function was normal. LVEF results were within ±5% in only 37% of HF and 23% of control subjects. Considering discordance around the LVEF threshold 35%, there was disagreement between the 2 methods in 305 HF subjects (35%). Male gender (odds ratio (OR) = 0.200), atrial fibrillation (OR = 2.314), higher body mass index (OR = 1.051) and lower LV end-diastolic volume (OR = 0.985) were the strongest predictors of methodologic discordance. Cardiac event rates were highest if both LVEF values were =35% and lowest when both LVEF values were >35%. |
2 |
| 62. Travin MI. Cardiac radionuclide imaging to assess patients with heart failure. Semin Nucl Med. 2014;44(4):294-313. |
Review/Other-Dx |
N/A |
To review Cardiac radionuclide imaging to assess patients with heart failure |
No results stated in abstract. |
4 |
| 63. Beton O, Kurmus O, Asarcikli LD, Alibazoglu B, Alibazoglu H, Yilmaz MB. The practical value of technetium-99m-MIBI SPET to differentiate between ischemic and non-ischemic heart failure presenting with exertional dyspnea. Hellenic J Nucl Med. 19(2):147-54, 2016 May-Aug. |
Observational-Dx |
179 patients |
To differentiate ischemic heart failure (HF) from non-ischemic HF in patients presenting with non-acute onset exertional dyspnea using technetium-99m methoxyisobutylisonitrile gated single photon emission tomography ((99m)Tc-MIBI gSPET) imaging. |
Of the 179 patients, 127 had ischemic HF and 52 had non-ischemic HF. There was no difference between ischemic and non-ischemic groups in terms of age, gender, body mass index, any smoking history, diabetes mellitus, history of hypertension and hyperlipidemia. Global dysfunction of left ventricle was more common in non-ischemic HF group than ischemic HF group (82.7% vs 41.7% respectively, P<0.001). Presence of severe (3+/4+) ischemia and large perfusion defect were higher in ischemic HF group compared to non-ischemic HF group (45.7% vs 15.4%, P<0.001 and 23.6% vs 3.8%, P=0.003, respectively). Summed stress score (SSS), summed rest score and summed difference score were higher in ischemic HF group compared to non-ischemic HF group (P<0.001, P<0.001, and P=0.021, respectively). In multivariate analysis, absence of global dysfunction (P<0.001, OR=10.338, 95%CI: 3.937-27.405) and SSS (P<0.001, OR=1.208, 95%CI: 1.090-1.339) were the independent predictors of ischemic HF. Absence of global dysfunction had 58.3% sensitivity and 86.7% specificity for diagnosis of ischemic HF at gSPET imaging in patients presenting with newly diagnosed HF and exertional dyspnea without concomitant chest pain (AUC=0.705, 95%CI: 0.632-0.771, P<0.001), whereas SSS>8 had 65.4% sensitivity and 75.0% specificity (AUC=0.732, 95%CI: 0.661-0.795, P<0.001). |
3 |
| 64. Vachalcova M, Valocik G, Kurecko M, et al. The three-dimensional speckle tracking echocardiography in distinguishing between ischaemic and non-ischaemic aetiology of heart failure. ESC Heart Fail. 7(5):2297-2304, 2020 10. |
Observational-Dx |
40 patients |
The aim of this pilot study was to compare selected three-dimensional speckle tracking echocardiography (3D STE) parameters in patients with ischaemic and non-ischaemic aetiology of heart failure (HF) and to identify indices that can differentiate the two pathologies. |
Forty patients with left ventricular ejection fraction (LVEF) = 40% were included to the study: 20 patients (age 63 ± 9.0 years, LVEF 29.0 ± 11.3%) with ischaemic cardiomyopathy and 20 patients (age 64.0 ± 11.0 years, LVEF 27.3 ± 7.5%) with non-ischaemic cardiomyopathy. All patients underwent two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography. Standard echocardiographic parameters, global longitudinal strain, and rotational parameters of left ventricle (LV) were assessed using 3D speckle tracking (3D STE). There were no differences in standard and STE parameters between the two groups. Among rotational parameters, the LV apical rotation (4.9 ± 3.5° vs. 2.3 ± 2.4°, P = 0.0022) was significantly higher in patients with ischaemic HF. Among all echocardiographic parameters, a cut-off value of 3.28° (area under the curve 0.78; 95% confidence interval, 0.62 to 0.93) was able to distinguish the ischaemic and non-ischaemic aetiology of HF with a sensitivity of 80% and specificity of 75%. |
2 |
| 65. Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovasc Ultrasound 2017;15:7. |
Review/Other-Dx |
N/A |
This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease. |
No results stated in the abstract. |
4 |
| 66. Donal E, Thebault C, Lund LH, et al. Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13(8):656-665. |
Observational-Dx |
21 patients; 15 controls |
To analyse the myocardial characteristics at rest and during a sub-maximal exercise test in patients with heart failure preserved ejection fraction (HFPEF). |
Standardized sub-maximal exercise stress echocardiography was performed in (i) 21 patients from the Karolinska Rennes Prospective Study of Heart Failure with Preserved Left Ventricular Ejection Fraction HFPEF registry, whose LVEF was >/=45% and (ii) 15 control patients free of any manifestations of HF. During a sub-maximal exercise test, LV systolic function measured as a global four-chamber longitudinal strain was -17+/-5% in patients with HFPEF vs. -22+/-4% in controls (P<0.001), LV longitudinal diastolic relaxation, expressed as e' (septal and lateral walls averaged) was 9+/-2 cm/s in patients vs. 15+/-4 cm/s in controls (P<0.001), and RV longitudinal systolic function, expressed as RV s', was 14+/-3 cm/s in patients vs. 18+/-1 cm/s in controls (P=0.03). LV afterload (arterial elastance) was 2.7+/-1 mmHg/mL and was correlated with a decrease in LV longitudinal strain (R=0.51, P<0.01) during exercise. |
2 |
| 67. Meluzin J, Sitar J, Kristek J, et al. The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction. Eur J Echocardiogr. 2011;12(8):591-602. |
Review/Other-Dx |
98 patients; 16 controls |
To determine the prevalence of isolated exercise-induced heart failure with normal ejection fraction (HFNEF) and to assess whether disturbances in left ventricular (LV) or right ventricular longitudinal systolic function are associated with the diagnosis of HFNEF. |
Eighty-four patients with exertional dyspnoea and normal left ventricular ejection fraction (LV EF) and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF. |
4 |
| 68. Belyavskiy E, Morris DA, Url-Michitsch M, et al. Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study. ESC Heart Fail. 6(1):146-153, 2019 02. |
Observational-Dx |
13 patients |
The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). |
Patients with suspected HFpEF (left ventricular ejection fraction = 50%, exertional dyspnoea, septal E/e' at rest 9–14, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two-dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT-proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO2 = 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e' ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e' with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e' was significantly linked to worse peak VO2, and the combination of an increase of both E/e' and TR velocity was associated with elevated NT-proBNP values during exercise. |
3 |
| 69. Benz DC, Kaufmann PA, von Felten E, et al. Prognostic Value of Quantitative Metrics From Positron Emission Tomography in Ischemic Heart Failure. JACC Cardiovasc Imaging. 14(2):454-464, 2021 02. |
Observational-Dx |
254 patients |
The aim of this study was to investigate the prognostic and clinical value of quantitative positron emission tomographic (PET) metrics in patients with ischemic heart failure. |
MACE occurred in 170 patients (67%) during a median follow-up of 3.3 years. In a multivariate Cox proportional hazards model including multiple quantitative PET metrics, only MFR predicted MACE significantly (p = 0.013). Beyond age, symptom severity, diabetes mellitus, previous myocardial infarction or revascularization, 3-vessel disease, renal insufficiency, ejection fraction, as well as presence and burden of ischemia, scar, and hibernating myocardium, MFR was strongly associated with MACE (adjusted hazard ratio per increase in MFR by 1: 0.63; 95% confidence interval: 0.45 to 0.91). Incorporation of MFR into a risk assessment model incrementally improved the prediction of MACE (likelihood ratio chi-square test [16] = 48.61 vs. chi-square test [15] = 39.20; p = 0.002). |
3 |
| 70. Bock A, Estep JD. Myocardial viability: heart failure perspective. [Review]. Curr Opin Cardiol. 34(5):459-465, 2019 09. |
Review/Other-Dx |
N/A |
This review highlights the different imaging modalities available to assess myocardial viability in patients with heart failure and coronary artery disease (CAD) being considered for revascularization. |
Myocardial viability can be determined by a variety of cardiac imaging modalities. Recent studies have confirmed the use of cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and CAD, suggesting that those who undergo revascularization but have evidence of residual viable or ‘jeopardized’ myocardium have increased mortality compared with those who achieve complete revascularization. The PET and Recovery Following Revascularization (PARR)-2 trial assessed whether viability noted on PET imaging in patients with severe LV dysfunction correlated with recovery of LV function and response to revascularization. The 5-year extension of the PARR-2 study noted a significant decrease in the composite outcome of cardiac death, myocardial infarction, or cardiac hospitalization in patient assessments adherent to PET-guided viability recommendations. |
4 |
| 71. Mc Ardle B, Shukla T, Nichol G, et al. Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease. Circ Cardiovasc Imaging 2016;9. |
Observational-Dx |
392 patients |
To present the 5-year follow-up results from the PARR-2 study to evaluate whether a positron emission tomography (PET)-guided approach to revascularization in patients with suspected ischemic cardiomyopathy results in a clinical benefit over the long term. |
PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62–1.07]; P=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54–0.99; P=0.042). |
2 |
| 72. Assadi H, Jones R, Swift AJ, Al-Mohammad A, Garg P. Cardiac MRI for the prognostication of heart failure with preserved ejection fraction: A systematic review and meta-analysis. Magn Reson Imaging. 76:116-122, 2021 02. |
Meta-analysis |
9 studies |
This systematic review and meta-analysis aim to synthesise and consolidate the current literature on cardiac magnetic resonance imaging (MRI) for prognostication of heart failure with preserved ejection fraction (HFpEF). |
Initial screening identified 97 studies. From these, only nine (9%) studies met all the criteria. The main cardiac MRI methods that demonstrated association to prognosis in HFpEF included late gadolinium enhancement (LGE) assessment of scar (n = 3), tissue characterisation with T1-mapping (n = 4), myocardial ischaemia (n = 1) and right ventricular dysfunction (RVSD) (n = 1). The pooled HR for all 9 studies was 1.52 (95% CI 1.05-1.99, P < 0.01). Sub-evaluation by cardiac MRI methods revealed varying HRs: LGE (net n = 402, HR = 1.6, 95% CI 0.42-2.78, P = 0.008); T1-mapping (n = 1623, HR = 1.25, 95% CI 0.891-1.60, P < 0.001); myocardial ischaemia or RVSD (n = 325, HR = 3.19, 95% CI 0.30-6.08, P = 0.03). |
Good |
| 73. Di Marco A, Anguera I, Schmitt M, et al. Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis. [Review]. JACC Heart Fail. 5(1):28-38, 2017 01. |
Meta-analysis |
29 studies |
The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM). |
Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8; p = 0.008). |
Good |
| 74. Klem I, Shah DJ, White RD, et al. Prognostic value of routine cardiac magnetic resonance assessment of left ventricular ejection fraction and myocardial damage: an international, multicenter study. Circ Cardiovasc Imaging 2011;4:610-9. |
Observational-Dx |
1,560 patients |
To examine the prognostic value of a routine cardiac magnetic resonance (CMR) assessment of left ventricular ejection fraction (LVEF) and myocardial damage in a broad, real-life population enrolled consecutively from several centers. |
From 10 centers in 6 countries, consecutive patients undergoing routine CMR assessment of LVEF and myocardial damage by cine and delayed-enhancement imaging (DE-CMR), respectively, were screened for enrollment. Clinical data, CMR protocol information, and findings were collected at all sites and submitted to the data coordinating center for verification of completeness and analysis. The primary end point was all-cause mortality. A total of 1560 patients (age, 59±14 years; 70% men) were enrolled. Mean LVEF was 45±18%, and 1049 (67%) patients had hyperenhanced tissue (HE) on DE-CMR indicative of damage. During a median follow-up time of 2.4 years (interquartile range, 1.2, 2.9 years), 176 (11.3%) patients died. Patients who died were more likely to be older (P<0.0001), have coronary disease (P=0.004), have lower LVEF (P<0.0001), and have more segments with HE (P<0.0001). In multivariable analysis, age, LVEF, and number of segments with HE were independent predictors of mortality. Among patients with near-normal LVEF (=50%), those with above-median HE (>4 segments) had reduced survival compared to patients with below- or at-median HE (P=0.02). |
2 |
| 75. Alba AC, Gaztanaga J, Foroutan F, et al. Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy: An International, Multi-Institutional Study of the MINICOR Group. Circ Cardiovasc Imaging 2020;13:e010105. |
Observational-Dx |
1,672 patients |
To retrospectively study associations between late gadolinium enhancement (LGE) presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). |
We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0–4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03–2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20–3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. |
3 |
| 76. Ge Y, Antiochos P, Steel K, et al. Prognostic Value of Stress CMR Perfusion Imaging in Patients With Reduced Left Ventricular Function. JACC Cardiovasc Imaging 2020;13:2132-45. |
Observational-Dx |
582 patients |
The aim of this study was to investigate the prognostic value of stress cardiac magnetic resonance imaging (CMR) in patients with reduced left ventricular (LV) systolic function. |
Among 582 patients (mean age 62 ± 12 years, 34% women), 40% had a history of congestive heart failure, and the median LV ejection fraction was 39% (interquartile range: 28% to 45%). At median follow-up of 5.0 years, 97 patients had experienced the primary outcome, and 182 patients had experienced the secondary outcome. Patients with no CMR evidence of ischemia or late gadolinium enhancement (LGE) experienced an annual primary outcome event rate of 1.1%. The presence of ischemia, LGE, or both was associated with higher event rates. In a multivariate model adjusted for clinical covariates, ischemia and LGE were independent predictors of the primary (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.68 to 4.14; p < 0.001; and HR: 1.86; 95% CI: 1.05 to 3.29; p = 0.03) and secondary (HR: 2.14; 95% CI: 1.55 to 2.95; p < 0.001; and HR 1.70; 95% CI: 1.16 to 2.49; p = 0.007) outcomes. The addition of ischemia and LGE led to improved model discrimination for the primary outcome (change in C statistic from 0.715 to 0.765; p = 0.02). The presence and extent of ischemia were associated with higher rates of use of downstream coronary angiography, revascularization, and cost of care spent on ischemia testing. |
3 |
| 77. Pezel T, Hovasse T, Sanguineti F, et al. Long-Term Prognostic Value of Stress CMR in Patients With Heart Failure and Preserved Ejection Fraction. JACC Cardiovasc Imaging 2021;14:2319-33. |
Observational-Dx |
1,203 patients |
The objectives of this study were to investigate the long-term prognostic value of inducible myocardial ischemia assessed by vasodilator stress cardiovascular magnetic resonance (CMR) in patients with HFpEF. |
Among the 1,203 patients with HFpEF (73 ± 13 years of age; 29% males) who underwent stress CMR and completed follow-up (6.9 years interquartile range [IQR]: 6.7 to 7.7 years]), 108 experienced a MACE (9%). Kaplan-Meier analysis showed inducible ischemia and LGE were significantly associated with MACE (HR: 6.63; 95% confidence interval [CI]: 4.54 to 9.69; and HR: 2.56; 95% CI: 1.60 to 4.09, respectively; both p < 0.001) and secondary outcomes (HR: 8.40; 95% CI: 6.31 to 11.20; p < 0.001; and HR: 1.87; 95% CI: 1.27 to 2.76, respectively; p = 0.002). In multivariate analysis, inducible ischemia and LGE were independent predictors of MACE (HR: 6.10; 95% CI: 4.14 to 9.00; p < 0.001 and HR: 1.62; 95% CI: 1.06 to 2.49; p = 0.039; respectively). |
2 |
| 78. Dall'Armellina E, Morgan TM, Mandapaka S, et al. Prediction of cardiac events in patients with reduced left ventricular ejection fraction with dobutamine cardiovascular magnetic resonance assessment of wall motion score index. J Am Coll Cardiol 2008;52:279-86. |
Observational-Dx |
200 patients |
To assess the utility of dobutamine cardiovascular magnetic resonance (DCMR) results for predicting cardiac events in individuals with reduced left ventricular ejection fraction (LVEF). |
After accounting for risk factors associated with coronary arteriosclerosis and MI, a stress induced increase in WMSI during DCMR was associated with future cardiac events (p< 0.001). After accounting for resting LVEF, a DCMR stress induced change in WMSI added significantly to predicting future cardiac events (p=0.003), but this predictive value was confined primarily to those with a LVEF >40%. |
3 |
| 79. Madsen EB, Gilpin E, Slutsky RA, Ahnve S, Henning H, Ross J, Jr. Usefulness of the chest x-ray for predicting abnormal left ventricular function after acute myocardial infarction. Am Heart J. 1984;108(6):1431-1436. |
Observational-Dx |
229 patients |
To investigate the relationship between roentgenographic findings and left ventricular function assessed by a predischarge left ventricular ejection fraction (EF) study in patients with acute myocardial infarction (AMI). |
At discharge 134 patients (59%) had abnormal ejection fraction (less than 0.51) and 35 had pulmonary venous congestion (15%). The sensitivity of the x-ray for detecting an abnormal ejection fraction was 20% when pulmonary venous congestion was observed on the discharge x-ray film (specificity 92% and predictive value 77%), 52% if pulmonary venous congestion was present on any x-ray film during the hospitalization (specificity 74% and predictive value 73%), and 47% if the cardiothoracic ratio was abnormal (greater than or equal to 0.50) on the discharge x-ray film (specificity and predictive value 66%). |
3 |
| 80. Kandolin RM, Wiefels CC, Mesquita CT, et al. The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function. [Review]. Can J Cardiol. 35(8):1015-1029, 2019 08. |
Review/Other-Dx |
N/A |
This review describes the current evidence and controversies for viability imaging to direct revascularization decisions and the impact on patient outcomes. |
No results stated in the abstract. |
4 |
| 81. Prastaro M, D'Amore C, Paolillo S, et al. Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. Heart Fail Rev. 2015;20(3):305-316. |
Review/Other-Dx |
N/A |
To review Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. |
No results stated in abstract. |
4 |
| 82. Grayburn PA, Appleton CP, DeMaria AN, et al. Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: the Beta-blocker Evaluation of Survival Trial (BEST). J Am Coll Cardiol. 2005;45(7):1064-1071. |
Observational-Dx |
336 patients |
To determine echocardiographic predictors of outcome in patients with advanced heart failure (HF) due to severe left ventricular (LV) systolic dysfunction in the Beta-blocker Evaluation of Survival Trial (BEST). |
On multivariable analysis adjusted for clinical covariates, only LV end-diastolic volume index predicted death (events = 75), with a cut point of 120 ml/m(2). Three echocardiographic variables predicted the combined end point of death (events = 75), HF hospitalization (events = 97), and transplant (events = 9): LV end-diastolic volume index, mitral deceleration time, and the vena contracta width of magnetic resonance (MR). Optimal cut points for these variables were 120 ml/m(2), 150 ms, and 0.4 cm, respectively. |
3 |
| 83. Saito M, Negishi K, Eskandari M, et al. Association of left ventricular strain with 30-day mortality and readmission in patients with heart failure. J Am Soc Echocardiogr. 2015;28(6):652-666. |
Observational-Dx |
468 patients |
To determine the association of Left ventricular (LV) strain with 30-day Heart failure (HF) readmission, independent of and incremental to clinical and basic echocardiographic parameters. |
Readmission within 30 days (n = 92 patients [20%]) was associated with greater impairment of LV global longitudinal strain [GLS] (-8.6% [interquartile range, -10.9% to -5.9%] vs -11.1% [interquartile range, -14.6% to -7.7%], P < .01). The association of GLS with readmission (hazard ratio, 1.13; 95% confidence interval, 1.07-1.19; P < .01) was independent of age, male gender, systolic blood pressure, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and comorbidity, as well as renal function, sodium, hematocrit, LV mass, left atrial size, and mitral regurgitation. Global circumferential strain was associated with outcome but not was independent after adjustment with echocardiographic parameters. In sequential models for 30-day outcome, GLS added incremental information to clinical parameters and LV ejection fraction and significantly improved reclassification (categorical net reclassification improvement, 0.34; P = .04) when LV ejection fraction was >50%. |
3 |
| 84. Trobs SO, Prochaska JH, Schwuchow-Thonke S, et al. Association of Global Longitudinal Strain With Clinical Status and Mortality in Patients With Chronic Heart Failure. JAMA Cardiol. 6(4):448-456, 2021 04 01. |
Observational-Dx |
2,186 patients |
To assess the factors associated with global longitudinal strain (GLS) and its prognostic value in patients with chronic heart failure (HF). |
In the study sample, data on GLS were available on 2440 individuals, of whom 2186 (mean [SD] age, 65.0 [10.5] years; 1418 [64.9%] men) were classified as having AHA HF stages A to D. Mean (SD) GLS worsened across AHA stages from stage A (n?=?434; -19.44 [3.15%]) to stage B (n?=?629; -18.01 [3.46%]) to stages C/D (n?=?1123; -15.52 [4.64%]). Age (ß?=?-0.27; 95% CI, -0.47 to -0.067; per decade, P?=?.009), female sex (ß?=?-1.2; 95% CI, -1.6 to -0.77; per decade, P?<?.001), obesity (ß?=?0.64; 95% CI, 0.25-1.0; P?=?.001), atrial fibrillation (ß?=?1.2; 95% CI, 0.69-1.6; P?<?.001), myocardial infarction (ß?=?1.5; 95% CI, 1.00-2.1; P?<?.001), and estimated glomerular filtration rate (ß?=?-0.53; 95% CI, -0.73 to -0.32; per SD, P?<?.001) were independently associated with GLS in multivariable regression analysis. Global longitudinal strain was associated with the severity of HF as reflected by N-terminal prohormone B-type natriuretic protein (NT-proBNP) levels after additionally adjusting for cardiac structure and function (P?<?.001). During follow-up, GLS was associated with all-cause mortality (hazard ratio [HR] per SD, 1.55; 95% CI, 1.19-2.01; P?<?.001) and cardiac death (HR per SD, 2.32; 95% CI, 1.57-3.42; P?<?.001) independent of image quality, observer variability, clinical profile, HF medications, NYHA class, and cardiac structure and function. After further adjustment for the NT-proBNP level, GLS remained associated with cardiac death (HR per SD, 1.60; 95% CI, 1.07-2.41; P?=?.02) but not all-cause mortality (HR per SD, 1.26; 95% CI, 0.95-1.66; P?=?.11). |
3 |
| 85. Kalra R, Gupta K, Sheets R, et al. Cardiac Function and Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial). Am J Cardiol. 129:46-52, 2020 08 15. |
Observational-Dx |
1,767 patients |
To hypothesize that impairment in the echocardiographic indices of left ventricle (LV) function would have differing relative predictive values for the risk of sudden cardiac death (SCD)/aborted cardiac arrest (ACA) in patients with heart failure with preserved ejection fraction (HFpEF). Also, to present an investigation that evaluates these hypotheses in the Treatment of Heart Failure with Preserved Ejection Fraction with Aldosterone (TOPCAT) trial. To evaluate the association between key echocardiographic markers of left ventricle (LV) systolic/diastolic function and sudden cardiac death (SCD) and/or aborted cardiac arrest (ACA). |
A retrospective cohort design was used. Cox proportional hazards and Poisson regression models were used to determine the associations between the risk of SCD/ACA and echocardiographic parameters: diastolic dysfunction grade, left ventricle ejection fraction, and LV global longitudinal strain (GLS) during follow-up. Impaired left ventricle ejection fraction and GLS were associated with SCD/ACA in univariate models (p?=?0.007 and 0.002, respectively), but not diastolic function grade. After multivariate adjustment, only GLS remained a significant predictor of the incidence rate of SCD/ACA (p?=?0.006). There was a 58% increase in the hazard of incident SCD/ACA for every 1 unit increase in GLS (1.58, 95%CI: 1.12 to 2.22, p?=?0.009). |
3 |
| 86. Bosso G, Valvano A, Guarnaccia F, et al. Adherence to guidelines in the management of patients with chronic heart failure follow-up: role of periodic echocardiographic examinations. J Cardiovasc Med (Hagerstown). 21(3):216-222, 2020 Mar. |
Experimental-Dx |
436 patients |
The Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure follow-up, was aimed to determine if periodic echocardiographic evaluations could improve the prognosis of CHF patients and/or increase the adherence to the guidelines. |
The number of vascular events that occurred resulted as similar in both the groups: there were 78 hospitalizations (37 in Group A vs. 41 in Group B); 9 home-treated vascular events (4 in Group A and five in Group B); and 16 cardiovascular deaths (9 and 7, respectively). The adherence to the guidelines at the end of the trial resulted as significantly improved in both the groups in comparison with the basal evaluation, without differences between the two groups. |
3 |
| 87. Vizzardi E, D'Aloia A, Giubbini R, et al. Effect of spironolactone on left ventricular ejection fraction and volumes in patients with class I or II heart failure. Am J Cardiol. 2010;106(9):1292-1296. |
Experimental-Dx |
168 patients |
To evaluate the effects of 6-month administration of spironolactone in addition to standard heart failure (HF) therapy on left ventricular (LV) systolic and diastolic functions and the functional capacity of patients with low to moderate grade HF (NYHA class I to II). |
One hundred sixty-eight patients with New York Heart Association (NYHA) class I to II HF and LV ejection fraction </=40% were randomized to spironolactone or placebo and assessed by echocardiography, gated single-photon emission computed tomography, technetium-99m sestamibi single-photon emission computed tomographic radionuclide ventriculography, and cardiopulmonary exercise testing at baseline and after 6 months of treatment. In the spironolactone group LV ejection fraction increased from 35.2 +/- 0.7% to 39.1 +/- 3.5% (p <0.001), with a decrease in LV end-diastolic and end-systolic volumes and myocardial mass and an improvement in LV diastolic filling pattern. Cardiopulmonary exercise testing parameters did not change. |
1 |
| 88. Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Clinical utility of the 2016 ASE/EACVI recommendations for the evaluation of left ventricular diastolic function in the stratification of post-discharge prognosis in patients with acute heart failure. Eur Heart J Cardiovasc Imaging. 20(10):1129-1137, 2019 Oct 01. |
Observational-Dx |
481 patients |
To assess the impact of left ventricular diastolic dysfunction (LVDD) grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute heart failure (HF) and compare with the previous 2009 algorithm (DD2009). |
The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (? = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan-Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17-3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI -7% to 30%, P = 0.23). |
2 |
| 89. Bhella PS, Pacini EL, Prasad A, et al. Echocardiographic indices do not reliably track changes in left-sided filling pressure in healthy subjects or patients with heart failure with preserved ejection fraction. Circ Cardiovasc Imaging. 2011;4(5):482-489. |
Observational-Dx |
47 patients |
To estimate changes in filling pressures associated with the titration of medical therapy in patients with heart failure. |
Forty-seven volunteers were enrolled: 11 highly screened elderly outpatients with a clear diagnosis of heart failure with preserved ejection fraction(HFpEF), 24 healthy elderly subjects, and 12 healthy young subjects. Each patient underwent right heart catheterization with simultaneous transthoracic echo. Pulmonary capillary wedge pressure (PCWP) and key echo indices (E/e' and E/Vp) were measured at two baselines and during 4 preload altering maneuvers: lower body negative pressure -15 mm Hg; lower body negative pressure -30 mm Hg; rapid saline infusion of 10 to 15 mL/kg; and rapid saline infusion of 20 to 30 mL/kg. A random coefficient mixed model regression of PCWP versus E/e' and PCWP versus E/Vp was performed for (1) a composite of all data points and (2) a composite of all data points within each of the 3 groups. Linear regression analysis was performed for individual subjects. With this protocol, PCWP was manipulated from 0.8 to 28.8 mm Hg. For E/e', the composite random effects mixed model regression was PCWP=0.58xE/e'+7.02 (P<0.001), confirming the weak but significant relationship between these 2 variables. Individual subject linear regression slopes (range, -6.76 to 11.03) and r(2) (0.00 to 0.94) were highly variable and often very different than those derived for the composite and group regressions. For E/Vp, the composite random coefficient mixed model regression was PCWP=1.95xE/Vp+7.48 (P=0.005); once again, individual subject linear regression slopes (range, -16.42 to 25.39) and r(2) (range, 0.02 to 0.94) were highly variable and often very different than those derived for the composite and group regressions. |
2 |
| 90. Elhendy A, Sozzi F, van Domburg RT, et al. Effect of myocardial ischemia during dobutamine stress echocardiography on cardiac mortality in patients with heart failure secondary to ischemic cardiomyopathy. Am J Cardiol. 2005;96(4):469-473. |
Experimental-Dx |
528 patients |
To assess the effect of ischemia during dobutamine stress echocardiography (DSE) on cardiac mortality in patients with heart failure. |
Annual rates of cardiac death were 4.8% in patients who did not have ischemia, 5.5% in those who had ischemia and underwent revascularization within 4 months, and 11.8% in those who had ischemia and were not revascularized (p <0.001 vs other groups). In a multivariate analysis model, independent predictors of cardiac death were diabetes (RR 2, 95% confidence interval 1.4 to 2.9), male gender (RR 1.7, 95% confidence interval 1.2 to 3.1), low-dose wall motion score index (RR 1.4, 95% confidence interval 1.2 to 2.6), and ischemia (RR 1.9, 95% confidence interval 1.3 to 3.2). Angina was not predictive of death. In patients who had ischemia, revascularization within 4 months after DSE was associated with decreased risk of cardiac death (RR 0.43, 95% confidence interval 0.3 to 0.8). |
2 |
| 91. Maskoun W, Mustafa N, Mahenthiran J, et al. Wall motion abnormalities with low-dose dobutamine predict a high risk of cardiac death in medically treated patients with ischemic cardiomyopathy. Clin Cardiol. 2009;32(7):403-409. |
Experimental-Dx |
245 patients |
To assess the prognostic value of low-dose stress-induced wall motion abnormalities (SWMA) in medically treated patients with ischemic cardiomyopathy. |
There were 123 cardiac deaths (52%) during follow-up of 4.1 +/- 3.3 years. Multivariate predictors of cardiac death were age (p = 0.002, hazard ratio [HR]: 1.03), diabetes (p = 0.028, HR: 1.54), New York Heart Association (NYHA) class III, IV heart failure (p = 0.001, HR: 1.94), the presence of peak dose SWMA (p < 0.001, HR: 2.59), and low-dose SWMA (p = 0.005, HR: 2.28). Survival of patients without ischemia was significantly better than those with peak-dose SWMA (p < 0.0001) and those with low-dose SWMA (p = 0.001). The survival of patients with low-dose SWMA was the same as those with peak-dose SWMA (p = 0.89). |
2 |
| 92. Sozzi FB, Elhendy A, Rizzello V, et al. Prognostic significance of akinesis becoming dyskinesis during dobutamine stress echocardiography. J Am Soc Echocardiogr. 2007;20(3):257-261. |
Observational-Dx |
731 patients |
To assess the long-term outcome of patients with Akinesis becoming dyskinesis (AKBD) during dobutamine stress echocardiography (DSE). |
Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 +/- 0.56 in patients with AKBD versus 2.3 +/- 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). |
2 |
| 93. Donal E, Lund LH, Oger E, et al. Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study. Eur Heart J Cardiovasc Imaging. 2016;17(1):106-113. |
Observational-Dx |
203 patients |
To describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. |
Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT-pro-BNP >300 pg/mL (BNP > 100 pg/mL) and LVEF > 45% and reassessed by exercise echo-Doppler after 4-8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow-up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty-six patients (43%) died or were hospitalized for HF (primary outcome). The mean +/- SD workload was 45 +/- 14 watts (W). Mean +/- SD resting LVEF and LV global longitudinal strain was 57.6 +/- 9.5% and -14.5 +/- 4.2%, respectively. Mean +/- SD resting E/e' was 11.3 +/- 4.7 and 13.1 +/- 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P = 0.03). Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 +/- 0.5 and 3.7 +/- 0.5 m/s (P = 0.01). Exercise TR was independently associated with HF-hospitalization or death after adjustment on baseline clinical and biological characteristics. |
2 |
| 94. Fabiani I, Pugliese NR, Galeotti GG, et al. The Added Value of Exercise Stress Echocardiography in Patients With Heart Failure. Am J Cardiol. 123(9):1470-1477, 2019 05 01. |
Observational-Dx |
105 patients |
To test the hypothesis that simultaneous exercise stress echocardiography (ESE) assessment of cardiac index (CI) and pulmonary congestion by lung ultrasound (LUS) (B-lines) is valuable for risk stratification of heart failure (HF) outpatients. |
We enrolled 105 HF patients (87 males; age 62 ± 11 years; New York Heart Association class I to III) with reduced left ventricular ejection fraction (30 ± 7%). Patients were classified into 4 profiles: (1) peak CI =4.0 l/min/m2 and peak B-lines <15 (no evidence of congestion or hypoperfusion, n = 47); (2) peak CI =4.0 l/min/m2 and peak B-lines =15 (congestion with adequate perfusion, n = 23); (3) peak CI <4.0 l/min/m2 and peak B-lines <15 (hypoperfusion without congestion, n = 13); and (4) peak CI <4.0 l/min/m2 and peak B-lines =15 (congestion and hypoperfusion, n = 22). There were 21 cardiovascular deaths and 18 hospitalizations for worsening HF during a median follow-up of 29 months. Multivariate predictors of the combined end point were peak hemodynamic profiles (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.19 to 2.21; p = 0.002), B-type natriuretic peptide (HR 1.00, 95% CI 1.00 to 1.01; p = 0.001), and rest E/e' (HR 1.09, 95% CI 1.03 to 1.15; p = 0.002). Survival analysis showed a worse survival in patients with ESE-derived D profile, followed by patients with C, B, and A profile (log-rank: chi-square = 40.5; p <0.0001). |
2 |
| 95. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 96. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
