Diagnosis of Silent coronary Ischemia with selective Coronary Revascularization Might Improve 2-year Survival of patients with Critical Limb-threatening Ischemia
No Thumbnail Available
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Zināms, ka pacientiem ar perifēro artēriju okluzīvo slimību (PAOS) ir paaugstināts miokarda infarkta un nāves risks, kas bieži ir saistīts ar mēmu koronāro išēmiju, līdzpastāvošas koronāras sirds slimības (KSS) dēļ. Bieži novērots, ka pacientiem ar PAOS paralēli norit arī KSS, kas diagnosticēta ar preoperatīvo koronāro angiogrāfiju. Šī darba mērķis bija noteikt vai padziļināta pirmsoperatīva sirds išēmiskās slimības diagnosticēšana, izmantojot FFR-CT, var veicināt aprūpi, lai mazinātu infarkta un kardiovaskulārās nāves biežumu pēcoperācijas periodā.
FFR-CT ir jauna, neinvazīva koronāro asinsvadu izmeklēšanas metode, datortomogrāfijas koronarogrāfija ar atvasinātu frakcionēto plūsmas rezervi, kas ļauj identificēt pacientus ar hemodinamiski nozīmīgu koronāro stenozi un išēmiju. Tiek izmantoti datortomogrāfijas koronarogrāfijas sniegtie anatomiskie dati, lai aprēķinātu FFR vērtības visā koronārās asinsrites lokā.
Pētījumā tika salīdzinātas divas pacientu grupas- (1.) Pacienti bez kardiāliem simptomiem, kuriem tika veikta perifēro asinsvadu revaskularizācija un pirmsoperācijas FFR-CT un (2.) kontroles grupas pacienti no slimības vēsturēm, kuriem tika veikta standarta preoperatīvā izmeklēšana (bez FFR-CT). Izmantojot koronāro CTA, >50% stenoze tika diagnosticēta 70% pacientu, kur pretīm FFR-CT atklāja asimptomātisku koronāro išēmiju 68% pacientu un smagu išēmiju 53%. Vadoties pēc šiem datiem, pēcoperācijas koronāra revaskularizācija tika veikta 54 pacientiem. Pirmā pēcoperācijas gada beigās, FFR-CT grupā, kardiovaskulārās nāves un miokarda infarkta gadījumi tika novēroti mazāk, kā arī šīs grupas pacienti bija ar uzlabotu dzīvildzi un dzīves kvalitāti.
Šis pētījums pierāda, ka izmantojot FFR-CT pirmsoperācijas laikā pacientiem, ar perifēro artēriju okluzīvo slimību, kuriem paredzēta apakšējo ekstremitāšu ķirurģiska revaskularizācija, ir iespējams identificēt augsta riska pacientus ar mēmo koronāro išēmiju. Salīdzinājumā ar standarta pirmsoperatīvo sirds un asinsvadu izmeklēšanu, pastiprināta uzmanība tika pievērsta kardiovaskulārajam stāvoklim pēcoperācijas periodā. Apvienojot šo un plānveida koronāro revaskularizāciju pacientiem ar asimptomātisku išēmiju, ir rezultatīvi mazāka kardiovaskulārā mirstība un miokarda infarkta gadījumi, kā arī uzlabota dzīves kvalitāte un dzīvildze pirmajā pēcoperācijas gadā
Šis rezultāts ir ļoti nozīmīgs, jo var veicināt multidisciplināras komandas pieeju, lai uzlabotu pacienta klīnisko iznākumu.
Patients with peripheral arterial occlusive disease (PAD) are known to be at increased risk of myocardial infarction and death, often due to silent coronary ischemia, due to coexisting coronary heart disease (CHD). PAD patients are often observed to have a concomitant CHD diagnosed by preoperative coronary angiography. The aim of this paper was to determine whether a more thorough preoperative diagnosis of ischemic heart disease using FFR-CT before limb salvage surgery with selective postoperative coronary revascularization can reduce the incidence of postoperative cardiac events and mortality, as well as improve patients' quality of life. FFR-CT is a novel, non-invasive coronary imaging modality, computed tomography coronarography with fractional flow reserve derivation, which allows identification of patients with haemodynamically significant coronary stenosis and ischemia. Anatomical data provided by computed tomography coronary angiography are used to calculate FFR values throughout the coronary circulation. Two groups of patients were compared in the study- (1) patients without cardiac symptoms who underwent peripheral revascularization and preoperative FFR-CT and (2) control patients from medical records who underwent standard preoperative imaging (without FFR-CT). Using coronary CTA, >50% stenosis was diagnosed in 70% of patients, where in contrast FFR-CT revealed asymptomatic coronary ischaemia in 68% of patients and severe ischaemia in 53%. Based on these data, postoperative coronary revascularisation was performed in 54 patients. At the end of the first postoperative year, fewer cardiovascular deaths and myocardial infarctions were observed in the FFR-CT group, and patients in this group had improved survival and quality of life. This study demonstrates that the use of preoperative FFR-CT in patients with peripheral arterial occlusive disease scheduled for lower limb surgical revascularisation can identify high-risk patients with silent coronary ischemia. Compared with standard preoperative cardiovascular examination, increased attention was paid to the cardiovascular status in the postoperative period. Combining this with elective coronary revascularisation in patients with asymptomatic ischemia results in lower cardiovascular mortality and myocardial infarction, and improved quality of life and survival in the first postoperative year This result is highly significant as it may contribute to a multidisciplinary team approach to improve the clinical outcome of the patient.
Patients with peripheral arterial occlusive disease (PAD) are known to be at increased risk of myocardial infarction and death, often due to silent coronary ischemia, due to coexisting coronary heart disease (CHD). PAD patients are often observed to have a concomitant CHD diagnosed by preoperative coronary angiography. The aim of this paper was to determine whether a more thorough preoperative diagnosis of ischemic heart disease using FFR-CT before limb salvage surgery with selective postoperative coronary revascularization can reduce the incidence of postoperative cardiac events and mortality, as well as improve patients' quality of life. FFR-CT is a novel, non-invasive coronary imaging modality, computed tomography coronarography with fractional flow reserve derivation, which allows identification of patients with haemodynamically significant coronary stenosis and ischemia. Anatomical data provided by computed tomography coronary angiography are used to calculate FFR values throughout the coronary circulation. Two groups of patients were compared in the study- (1) patients without cardiac symptoms who underwent peripheral revascularization and preoperative FFR-CT and (2) control patients from medical records who underwent standard preoperative imaging (without FFR-CT). Using coronary CTA, >50% stenosis was diagnosed in 70% of patients, where in contrast FFR-CT revealed asymptomatic coronary ischaemia in 68% of patients and severe ischaemia in 53%. Based on these data, postoperative coronary revascularisation was performed in 54 patients. At the end of the first postoperative year, fewer cardiovascular deaths and myocardial infarctions were observed in the FFR-CT group, and patients in this group had improved survival and quality of life. This study demonstrates that the use of preoperative FFR-CT in patients with peripheral arterial occlusive disease scheduled for lower limb surgical revascularisation can identify high-risk patients with silent coronary ischemia. Compared with standard preoperative cardiovascular examination, increased attention was paid to the cardiovascular status in the postoperative period. Combining this with elective coronary revascularisation in patients with asymptomatic ischemia results in lower cardiovascular mortality and myocardial infarction, and improved quality of life and survival in the first postoperative year This result is highly significant as it may contribute to a multidisciplinary team approach to improve the clinical outcome of the patient.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Perifēro artēriju okluzīva slimība, koronāra sirds slimība, mēma koronārā išēmija, datortomogrāfijas koronarogrāfija ar atvasinātu frakcionēto plūsmas rezervi (FFR-CT), koronāro artēriju revaskularizācija, dzīvildze pēc perifēro artēriju revaskularizācijas., Peripheral artery disease, coronary heart disease, silent coronary ischemia, coronary computed tomography-derived fractional flow reserve (FFR-CT), coronary artery revascularization, survival after peripheral artery revascularization.