The Experts below are selected from a list of 276 Experts worldwide ranked by ideXlab platform
Elieser Kaplinsky - One of the best experts on this subject based on the ideXlab platform.
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underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium 201 single photon emission computed tomographic myocardial perfusion imaging in patients taking Antianginal drugs
Journal of the American College of Cardiology, 1998Co-Authors: Tali Sharir, Babeth Rabinowitz, Shy Livschitz, Israel Moalem, Jack Baron, Elieser KaplinskyAbstract:Abstract Objectives. This study evaluated the diagnostic value of dipyridamole plus low level treadmill exercise (dipyridamole stress) thallium-201 single-photon emission computed tomography (SPECT) in patients taking Antianginal drugs. Background. Dipyridamole stress is the major substitute for maximal exercise in patients referred for myocardial perfusion imaging. Although Antianginal drugs are commonly suspended before exercise, dipyridamole stress is usually performed without discontinuing these drugs. Methods. Twenty-six patients underwent two dipyridamole perfusion studies: the first without (SPECT-1) and the second with (SPECT-2) Antianginal treatment. Twenty-one patients (81%) received calcium antagonists, 19 (73%) received nitrates, and 8 (31%) received beta-blockers. Eighteen of the patients underwent coronary angiography. Data are presented as the mean value ± SD. Results. Visual scoring yielded significantly larger and more severe reversible perfusion defects for SPECT-1 than for SPECT-2. Quantitative analysis showed larger perfusion defects on stress images of SPECT-1 in the left anterior descending coronary artery (LAD) (25 ± 21% vs. 17 ± 15%, p = 0.003), left circumflex coronary artery (LCx) (56 ± 35% vs. 48 ± 36%, p = 0.03) and right coronary artery (RCA) (36 ± 27% vs. 25 ± 24%, p = 0.008) territories. Individual vessel sensitivities in the LAD, LCx and RCA territories were 93%, 79% and 100% for SPECT-1 and 64%, 50% and 70% for SPECT-2, respectively. These differences were highly significant for the LAD (p = 0.004) and LCx (p = 0.00004) territories. The overall individual vessel sensitivity of SPECT-1 was significantly higher than that of SPECT-2 (92% vs. 62%, p = 0.000003). Specificity was not significantly different in SPECT-1 compared with SPECT-2 (80% and 93%, p = 0.33). Conclusions. Continued use of Antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.
William E Boden - One of the best experts on this subject based on the ideXlab platform.
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Contemporary Management of Patients with Stable Ischemic Heart Disease
Compuscript, 2019Co-Authors: Radmila Lyubarova, Joshua Schulman-marcus, William E BodenAbstract:The overall goals of therapy for patients with stable ischemic heart disease are to minimize the likelihood of death while maximizing health and function. Initial risk assessment with noninvasive testing is indicated to determine whether invasive evaluation is needed in addition to medical therapy. All patients with stable ischemic heart disease need optimal medical therapy, which includes risk factor management with lifestyle modifications and pharmacologic therapy. First-line pharmacologic therapy is focused on preventing myocardial infarction and death with antiplatelet agents, lipid-lowering therapy, and antihypertensive therapies. In addition, Antianginal therapy and anti-ischemic therapy are indicated to alleviate symptoms, reduce ischemia, and improve quality of life. The commonly used Antianginal agents include nitrates, beta-blockers, calcium channel blockers, and ranolazine. When medical therapy is not adequate to relieve angina, revascularization with percutaneous coronary intervention or coronary artery bypass grafting is indicated. We review the indications and evidence for Antianginal agents and other therapies for angina
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Antianginal agents for the management of stable ischemic heart disease a review
Cardiology in Review, 2016Co-Authors: Purav Mody, Mandeep S Sidhu, Emmanouil S Brilakis, Joseph Sacco, Subhash Banerjee, William E BodenAbstract:Antianginal medications are an important aspect of optimal medical therapy for the management of angina in patients with stable ischemic heart disease. The lack of a standardized definition of effective Antianginal therapy and the lack of clear understanding of the underlying evidence have often been cited as reasons for the large variations in the use of these particular classes of pharmacologic agents in contemporary clinical practice. Hence, we performed a search of the PubMed database and identified published manuscripts examining the effect of common Antianginal agents on improving anginal parameters and on important clinical outcomes such as mortality, myocardial infarction, and repeat revascularization from multiple large randomized, controlled trials, systematic reviews, meta-analyses, and outcomes data from observational studies in patients with stable ischemic heart disease. The most commonly used Antianginal agents (beta-blockers, nitrates, calcium channel blockers, and ranolazine) demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial in the setting of depressed left ventricular systolic function. In contrast, recent evidence points toward the lack of similar benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction. No survival benefit has been identified with the use of calcium channel blockers, nitrates, or ranolazine. Currently, guidance regarding objective measurement and up titration of Antianginal therapy is missing. There is an unmet need for development of potentially novel and clinically relevant methodology to assess the intensity and/or efficacy of Antianginal therapy.
John A Spertus - One of the best experts on this subject based on the ideXlab platform.
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Antianginal therapy before percutaneous coronary intervention
Circulation-cardiovascular Interventions, 2013Co-Authors: William B Borden, John A Spertus, Alvin I Mushlin, Matthew T Roe, Lisa A Mccoy, Rita F RedbergAbstract:Background—The regional variability of percutaneous coronary intervention (PCI) rates may be explained by variations in the medical treatment of stable coronary artery disease. We sought to determine whether greater regional use of Antianginal medications in PCI patients is associated with lower regional rates of PCI. Methods and Results—Using CathPCI Registry and Dartmouth Atlas data, we examined patients undergoing elective PCI for stable coronary artery disease from January 1, 2009, through March 31, 2011, and calculated rates of providing ≥2 Antianginal medicines before PCI. We regressed the hospital referral region rates of PCI per 1000 Medicare enrollees in 2007 on the regions’ rates of providing ≥2 Antianginal medications before PCI. Among 300 772 PCI procedures, 32.8%, 48.3%, 16.1%, and 2.8% of patients were on 0, 1, 2, or ≥3 Antianginal medications, respectively. The median rate of providing ≥2 Antianginal medications before PCI was 18.9%. Although substantial variability existed across hospital ...
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evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina results from the terisa randomized clinical trial type 2 diabetes evaluation of ranolazine in subjects with chronic stable angina
Journal of the American College of Cardiology, 2013Co-Authors: Mikhail N Kosiborod, John A Spertus, Suzanne V Arnold, Darren K Mcguire, Patrick Yue, Ori Benyehuda, Amos Katz, Philip G Jones, Ann Olmsted, Luiz BelardinelliAbstract:Objectives This study sought to examine the efficacy of ranolazine versus placebo on weekly angina frequency and sublingual nitroglycerin use in subjects with type 2 diabetes mellitus, coronary artery disease (CAD), and chronic stable angina who remain symptomatic despite treatment with up to 2 Antianginal agents. Background Patients with diabetes have more extensive CAD than those without diabetes, and a high burden of angina. Ranolazine is not only effective in treating angina but also may improve glycemic control, thus providing several potential benefits in this high-risk group. We conducted a randomized trial to test the Antianginal benefit of ranolazine in patients with diabetes and stable angina. Methods TERISA (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina) was an international, randomized, double-blind trial of ranolazine versus placebo in patients with diabetes, CAD, and stable angina treated with 1 to 2 Antianginals. After a single-blind, 4-week placebo run-in, patients were randomized to 8 weeks of double-blind ranolazine (target dose 1000 mg bid) or placebo. Anginal episodes and nitroglycerin use were recorded with daily entry into a novel electronic diary. Primary outcome was the average weekly number of anginal episodes over the last 6 weeks of the study. Results A total of 949 patients were randomized across 104 centers in 14 countries. Mean age was 64 years, 61% were men, mean diabetes duration was 7.5 years, and mean baseline HbA1c was 7.3%. Electronic diary data capture was 98% in both groups. Weekly angina frequency was significantly lower with ranolazine versus placebo (3.8 [95% confidence interval (CI): 3.6 to 4.1] episodes vs. 4.3 [95% CI: 4.0 to 4.5] episodes, p = 0.008), as was the weekly sublingual nitroglycerin use (1.7 [95% CI: 1.6 to 1.9] doses vs. 2.1 [95% CI: 1.9 to 2.3] doses, p = 0.003). There was no difference in the incidence of serious adverse events between groups. Conclusions Among patients with diabetes and chronic angina despite treatment with up to 2 agents, ranolazine reduced angina and sublingual nitroglycerin use and was well tolerated. (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina [TERISA]; NCT01425359)
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testing the effectiveness of converting patients to long acting Antianginal medications the quality of life in angina research trial quart
American Heart Journal, 2001Co-Authors: John A Spertus, Tim Dewhurst, Cynthia M Dougherty, Paul NicholAbstract:Abstract Objective Our purpose was to test the hypothesis that converting patients with stable angina to long-acting Antianginal medications would improve their functional status, symptom control, treatment satisfaction, and quality of life. Methods and Results A single-blind randomized trial of 100 patients with stable coronary artery disease was performed in the outpatient clinic of a Veterans Affairs Health System. Outpatients with chronic stable angina taking at least 2 Antianginal medications were studied. Patients were randomized to one of two treatments: optimal adjustment of their usual Antianginal medications or conversion to solely long-acting medications (long-acting diltiazem ± nitroglycerin patches ± atenolol) with subsequent optimization. The primary outcome was the 3-month change in Seattle Angina Questionnaire scores. Although no differences in physical limitation scores were noted, patients randomized to receive long-acting medications had improved symptom control (3-month improvement in anginal stability [19.1 vs 5.6, P =.02] and anginal frequency [17.8 vs 5.5, P =.006]), more treatment satisfaction (3-month improvement of 8.2 vs 3.0, P =.057), and better quality of life (3-month improvement of 11.2 vs 5.6, P =.09) compared with patients whose pretrial medications were optimized. The improvement in symptom control was statistically significant. Conclusion Converting patients with chronic, stable angina to long-acting Antianginal medications resulted in substantial improvements in symptom control with a trend toward better treatment satisfaction and quality of life. (Am Heart J 2001;141:550-8.)
Babeth Rabinowitz - One of the best experts on this subject based on the ideXlab platform.
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underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium 201 single photon emission computed tomographic myocardial perfusion imaging in patients taking Antianginal drugs
Journal of the American College of Cardiology, 1998Co-Authors: Tali Sharir, Babeth Rabinowitz, Shy Livschitz, Israel Moalem, Jack Baron, Elieser KaplinskyAbstract:Abstract Objectives. This study evaluated the diagnostic value of dipyridamole plus low level treadmill exercise (dipyridamole stress) thallium-201 single-photon emission computed tomography (SPECT) in patients taking Antianginal drugs. Background. Dipyridamole stress is the major substitute for maximal exercise in patients referred for myocardial perfusion imaging. Although Antianginal drugs are commonly suspended before exercise, dipyridamole stress is usually performed without discontinuing these drugs. Methods. Twenty-six patients underwent two dipyridamole perfusion studies: the first without (SPECT-1) and the second with (SPECT-2) Antianginal treatment. Twenty-one patients (81%) received calcium antagonists, 19 (73%) received nitrates, and 8 (31%) received beta-blockers. Eighteen of the patients underwent coronary angiography. Data are presented as the mean value ± SD. Results. Visual scoring yielded significantly larger and more severe reversible perfusion defects for SPECT-1 than for SPECT-2. Quantitative analysis showed larger perfusion defects on stress images of SPECT-1 in the left anterior descending coronary artery (LAD) (25 ± 21% vs. 17 ± 15%, p = 0.003), left circumflex coronary artery (LCx) (56 ± 35% vs. 48 ± 36%, p = 0.03) and right coronary artery (RCA) (36 ± 27% vs. 25 ± 24%, p = 0.008) territories. Individual vessel sensitivities in the LAD, LCx and RCA territories were 93%, 79% and 100% for SPECT-1 and 64%, 50% and 70% for SPECT-2, respectively. These differences were highly significant for the LAD (p = 0.004) and LCx (p = 0.00004) territories. The overall individual vessel sensitivity of SPECT-1 was significantly higher than that of SPECT-2 (92% vs. 62%, p = 0.000003). Specificity was not significantly different in SPECT-1 compared with SPECT-2 (80% and 93%, p = 0.33). Conclusions. Continued use of Antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.
Shy Livschitz - One of the best experts on this subject based on the ideXlab platform.
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underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium 201 single photon emission computed tomographic myocardial perfusion imaging in patients taking Antianginal drugs
Journal of the American College of Cardiology, 1998Co-Authors: Tali Sharir, Babeth Rabinowitz, Shy Livschitz, Israel Moalem, Jack Baron, Elieser KaplinskyAbstract:Abstract Objectives. This study evaluated the diagnostic value of dipyridamole plus low level treadmill exercise (dipyridamole stress) thallium-201 single-photon emission computed tomography (SPECT) in patients taking Antianginal drugs. Background. Dipyridamole stress is the major substitute for maximal exercise in patients referred for myocardial perfusion imaging. Although Antianginal drugs are commonly suspended before exercise, dipyridamole stress is usually performed without discontinuing these drugs. Methods. Twenty-six patients underwent two dipyridamole perfusion studies: the first without (SPECT-1) and the second with (SPECT-2) Antianginal treatment. Twenty-one patients (81%) received calcium antagonists, 19 (73%) received nitrates, and 8 (31%) received beta-blockers. Eighteen of the patients underwent coronary angiography. Data are presented as the mean value ± SD. Results. Visual scoring yielded significantly larger and more severe reversible perfusion defects for SPECT-1 than for SPECT-2. Quantitative analysis showed larger perfusion defects on stress images of SPECT-1 in the left anterior descending coronary artery (LAD) (25 ± 21% vs. 17 ± 15%, p = 0.003), left circumflex coronary artery (LCx) (56 ± 35% vs. 48 ± 36%, p = 0.03) and right coronary artery (RCA) (36 ± 27% vs. 25 ± 24%, p = 0.008) territories. Individual vessel sensitivities in the LAD, LCx and RCA territories were 93%, 79% and 100% for SPECT-1 and 64%, 50% and 70% for SPECT-2, respectively. These differences were highly significant for the LAD (p = 0.004) and LCx (p = 0.00004) territories. The overall individual vessel sensitivity of SPECT-1 was significantly higher than that of SPECT-2 (92% vs. 62%, p = 0.000003). Specificity was not significantly different in SPECT-1 compared with SPECT-2 (80% and 93%, p = 0.33). Conclusions. Continued use of Antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.