Mayil Singram Krishnam

All Publications

• Transcatheter Aortic Valve Replacement in Patients With Interventricular Membranous Septal Aneurysms. JACC. Case reports Theriault-Lauzier, P., Dawson, L. P., Wong, C. C., Sharma, R. P., Fearon, W. F., Kang, G., MacArthur, J. W., Pogatchnik, B. P., Krishnam, M. S., Yeung, A. C. 2025; 30 (1): 102715

  Abstract

  Aneurysms of the interventricular membranous septum are a rare anatomical feature that can be detected incidentally on computed tomography or echocardiography. Such aneurysms can pose challenges in the treatment of patients with aortic valve stenosis. A case series of 2 patients with membranous septal aneurysms treated successfully with current-generation balloon-expandable and self-expanding transcatheter heart valves is presented here. Preprocedural, intraprocedural, and postprocedural echocardiographic, fluoroscopic, and computed tomographic images are presented to demonstrate the feasibility of transcatheter aortic valve replacement in this patient population. The implications for device sizing and deployment dynamics are also illustrated.

  View details for DOI 10.1016/j.jaccas.2024.102715

  View details for PubMedID 39822800

  View details for PubMedCentralID PMC11733575

• Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial. Circulation. Cardiovascular interventions Reynolds, H. R., Page, C. B., Shaw, L. J., Berman, D. S., Chaitman, B. R., Picard, M. H., Kwong, R. Y., Min, J. K., Leipsic, J., Mancini, G. B., Budoff, M. J., Hague, C. J., Senior, R., Szwed, H., Bhargava, B., Celutkiene, J., Gadkari, M., Bainey, K. R., Doerr, R., Ramos, R. B., Ong, P., Naik, S. R., Steg, P. G., Goetschalckx, K., Chow, B. J., Scherrer-Crosbie, M., Phillips, L., Mark, D. B., Spertus, J. A., Alexander, K. P., O'Brien, S. M., Boden, W. E., Bangalore, S., Stone, G. W., Maron, D. J., Hochman, J. S. 2024; 17 (12): e013743

  Abstract

  The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index.Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity.Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

  View details for DOI 10.1161/CIRCINTERVENTIONS.123.013743

  View details for PubMedID 39689188

• Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease. JACC. Cardiovascular imaging Wang, S., Kim, P., Wang, H., Ng, M. Y., Arai, A. E., Singh, A., Mushtaq, S., Sin, T. H., Tada, Y., Hillier, E., Jin, R., Mariager, C. Ø., Salerno, M., Pontone, G., Urmeneta Ulloa, J., Saeed, I. M., Patel, H., Goh, V., Madsen, S., Kim, W. Y., Singram Krishnam, M., Martínez de Vega, V., Maceira, A. M., Monmeneu, J. V., Pazhenkottil, A. P., Amir-Khalili, A., Benovoy, M., Friedrich, S., Janich, M. A., Friedrich, M. G., Patel, A. R. 2024

  Abstract

  Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using stress cardiovascular magnetic resonance (CMR) have been shown to identify epicardial coronary artery disease. However, comparative analysis between quantitative perfusion and conventional qualitative assessment (QA) remains limited.The aim of this multicenter study was to test the hypothesis that quantitative stress MBF (sMBF) and MPR analysis can identify obstructive coronary artery disease (obCAD) with comparable performance as QA of stress CMR performed by experienced physicians in interpretation.The analysis included 127 individuals (mean age 62 ± 16 years, 84 men [67%]) who underwent stress CMR. obCAD was defined as the presence of stenosis ≥50% in the left main coronary artery or ≥70% in a major vessel. Each patient, coronary territory, and myocardial segment was categorized as having either obCAD or no obCAD (noCAD). Global, per coronary territory, and segmental MBF and MPR values were calculated. QA was performed by 4 CMR experts.At the patient level, global sMBF and MPR were significantly lower in subjects with obCAD than in those with noCAD, with median values of sMBF of 1.5 mL/g/min (Q1-Q3: 1.2-1.8 mL/g/min) vs 2.4 mL/g/min (Q1-Q3: 2.1-2.7 mL/g/min) (P < 0.001) and median values of MPR of 1.3 (Q1-Q3: 1.0-1.6) vs 2.1 (Q1-Q3: 1.6-2.7) (P < 0.001). At the coronary artery level, sMBF and MPR were also significantly lower in vessels with obCAD compared with those with noCAD. Global sMBF and MPR had areas under the curve (AUCs) of 0.90 (95% CI: 0.84-0.96) and 0.86 (95% CI: 0.80-0.93). The AUCs for QA by 4 physicians ranged between 0.69 and 0.88. The AUC for global sMBF and MPR was significantly better than the average AUC for QA.This study demonstrates that sMBF and MPR using dual-sequence stress CMR can identify obCAD more accurately than qualitative analysis by experienced CMR readers.

  View details for DOI 10.1016/j.jcmg.2024.07.023

  View details for PubMedID 39297850

• Wideband radiofrequency pulse sequence for evaluation of myocardial scar in patients with cardiac implantable devices FRONTIERS IN RADIOLOGY Shah, N. D., Krishnam, M., Venkatesh, B., Khan, F., Smith, M., Jones, D. R., Koon, P., Mao, X., Janich, M. A., Brau, A. S., Salerno, M., Dash, R., Chan, F., Yang, P. C. 2024; 4: 1327406

  Abstract

  Cardiac magnetic resonance is a useful clinical tool to identify late gadolinium enhancement in heart failure patients with implantable electronic devices. Identification of LGE in patients with CIED is limited by artifact, which can be improved with a wide band radiofrequency pulse sequence.The authors hypothesize that image quality of LGE images produced using wide-band pulse sequence in patients with devices is comparable to image quality produced using standard LGE sequences in patients without devices.Two independent readers reviewed LGE images of 16 patients with CIED and 7 patients without intracardiac devices to assess for image quality, device-related artifact, and presence of LGE using the American Society of Echocardiography/American Heart Association 17 segment model of the heart on a 4-point Likert scale. The mean and standard deviation for image quality and artifact rating were determined. Inter-observer reliability was determined by calculating Cohen's kappa coefficient. Statistical significance was determined by T-test as a p {less than or equal to} 0.05 with a 95% confidence interval.All patients underwent CMR without any adverse events. Overall IQ of WB LGE images was significantly better in patients with devices compared to standard LGE in patients without devices (p = 0.001) with reduction in overall artifact rating (p = 0.05).Our study suggests wide-band pulse sequence for LGE can be applied safely to heart failure patients with devices in detection of LV myocardial scar while maintaining image quality, reducing artifact, and following routine imaging protocol after intravenous gadolinium contrast administration.

  View details for DOI 10.3389/fradi.2024.1327406

  View details for Web of Science ID 001294434000001

  View details for PubMedID 39175870

  View details for PubMedCentralID PMC11339872

• Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial. Circulation. Cardiovascular interventions Pracoń, R., Spertus, J. A., Broderick, S., Bangalore, S., Rockhold, F. W., Ruzyllo, W., Demchenko, E., Nageh, T., Grossman, G. B., Mavromatis, K., Manjunath, C. N., Smanio, P. E., Stone, G. W., Mancini, G. B., Boden, W. E., Newman, J. D., Reynolds, H. R., Hochman, J. S., Maron, D. J. 2024: e013435

  Abstract

  ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease.Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use.Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14-2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78-12.86] and 2.63 [95% CI, 1.51-4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23-3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34-2.40]). Baseline low-density lipoprotein cholesterol <70 mg/dL was associated with a lower risk of angiography (HR, 0.65 [95% CI, 0.46-0.91) but not baseline ischemia severity nor the presence of multivessel or proximal left anterior descending artery stenosis >70% on coronary computed tomography angiography.Among ISCHEMIA participants randomized to the conservative strategy, angiography within 6 months of randomization was performed in <10% of patients. It was associated with frequent or increasing baseline angina and poor quality of life but not with objective markers of disease severity. Well-controlled baseline low-density lipoprotein cholesterol was associated with a reduced likelihood of angiography. These findings point to the importance of a comprehensive assessment of symptoms and a review of guideline-directed medical therapy goals when deciding the initial treatment strategy for chronic coronary disease.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

  View details for DOI 10.1161/CIRCINTERVENTIONS.123.013435

  View details for PubMedID 38629312

• Microvascular Obstruction and Intramyocardial Hemorrhage in Reperfused Myocardial Infarctions: Pathophysiology and Clinical Insights From Imaging. JACC. Cardiovascular imaging Vora, K. P., Kumar, A., Krishnam, M. S., Prato, F. S., Raman, S. V., Dharmakumar, R. 2024

  Abstract

  Microvascular injury immediately following reperfusion therapy in acute myocardial infarction (MI) has emerged as a driving force behind major adverse cardiovascular events in the postinfarction period. Although postmortem investigations and animal models have aided in developing early understanding of microvascular injury following reperfusion, imaging, particularly serial noninvasive imaging, has played a central role in cultivating critical knowledge of progressive damage to the myocardium from the onset of microvascular injury to months and years after in acute MI patients. This review summarizes the pathophysiological features of microvascular injury and downstream consequences, and the contributions noninvasive imaging has imparted in the development of this understanding. It also highlights the interventional trials that aim to mitigate the adverse consequences of microvascular injury based on imaging, identifies potential future directions of investigations to enable improved detection of disease, and demonstrates how imaging stands to play a major role in the development of novel therapies for improved management of acute MI patients.

  View details for DOI 10.1016/j.jcmg.2024.02.003

  View details for PubMedID 38613553

• Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial. Journal of the American Heart Association Reynolds, H. R., Cyr, D. D., Merz, C. N., Shaw, L. J., Chaitman, B. R., Boden, W. E., Alexander, K. P., Rosenberg, Y. D., Bangalore, S., Stone, G. W., Held, C., Spertus, J., Goetschalckx, K., Bockeria, O., Newman, J. D., Berger, J. S., Elghamaz, A., Lopes, R. D., Min, J. K., Berman, D. S., Picard, M. H., Kwong, R. Y., Harrington, R. A., Thomas, B., O'Brien, S. M., Maron, D. J., Hochman, J. S., ISCHEMIA Research Group *, Mavromatis, K., Linefsky, J., Miller, T., Banerjee, S., Reynolds, H. R., Newman, J. D., Bangalore, S., Donnino, R. M., Phillips, L. M., Saric, M., Abdul-Nour, K., Stone, P. H., Jang, J. J., Yee, G., Weitz, S., Arnold, S., O'Keefe, J. H., Shapiro, M. D., El-Hajjar, M., Sidhu, M. S., Fein, S. A., Torosoff, M. T., Lyubarova, R., Mookherjee, S., Drzymalski, K., McFalls, E. O., Garcia, S. A., Bertog, S. C., Siddiqui, R. A., Ishani, A., Hansen, R. A., Khouri, M. G., Goldberg, J. L., Goldweit, R., Cohen, R. A., Mirrer, B., Navarro, V., Winchester, D. E., Kronenberg, M., Rogal, P., McFarren, C., Heitner, J. F., Dauber, I. M., Cannan, C., Sudarshan, S., Mehta, P. K., McDaniel, M., Lerakis, S., Quyyumi, A., Wenger, N. K., Hedgepeth, C. M., Hurlburt, H., Rosen, A., Sahul, Z., Booth, D., Leung, S., Abdel-Latif, A., Reda, H., Ziada, K., Setty, S., Barua, R. S., Hage, F., Caldeira, C., Davies, J. E., Leesar, M., Heo, J., Iskandrian, A., Al Solaiman, F., Singh, S., Dajani, K., El-Hajjar, M., Der Mesropian, P., Sacco, J., McCandless, B., Orgera, M., Sidhu, M. S., Arif, I., Kerr, H., Trejo Gutierrez, J. F., Fletcher, G., Lane, G. E., Neeson, L. M., Parikh, P. P., Pollak, P. M., Shapiro, B. P., Landolfo, K., Gemignani, A., O'Rourke, D., Meadows, J. L., Call, J. T., Hannan, J., Bojar, R., Kumar, D., Mukai, J., Martin, E. T., Vorobiof, G., Moorman, A., Kinlay, S., Hamburger, R. J., Rocco, T. P., Bhatt, D. L., Croce, K., Quin, J. A., Anumpa, J., Zenati, M., Faxon, D. P., Rayos, G., Seedhom, A., Sullenberger, L., Kumkumian, G., Sedlis, S. P., Donnino, R. M., Lorin, J., Tamis-Holland, J. E., Kornberg, R., Leber, R., Saba, S., Lee, M. W., Small, D. R., Nona, W., Alexander, P. B., Rehman, I., Badami, U., Marzo, K., Robbins, I. H., Levite, H. A., Shetty, S., Patel, M., Hamroff, G. S., Little, R. W., Zimbelman, B. D., Lui, C. Y., Smith, B. R., Vezina, D. P., Khor, L. L., Abraham, J. D., Bull, D. A., McKellar, S. H., Booth, D., Kotter, J., Abdel-Latif, A., Hu, B., Labovitz, A. J., Berlowitz, M., Rogal, P., McFarren, C., Matar, F., Caldeira, C., Maron, D. J., Rodriguez, F., Schnittger, I., Fearon, W. F., Deedwania, P., Reddy, K., Sweeny, J., Spizzieri, C., Hochberg, C. P., Salerno, W. D., Wyman, R., Zarka, A., Shah, A. V., Haldis, T., Kohn, J. A., Girotra, S., Almousalli, O., Krishnam, M. S., Milliken, J. C., Patel, P. M., Seto, A. H., Harley, K. T., Gibson, M. A., Allen, B. J., Coram, R., Thomas, S., Schwartz, R. G., Chen, W., El Shahawy, M., Stafford, J., Abernethy, W. B., Zurick, A., Meyer, T. M., Morford, R. G., Rutkin, B., Bokhari, S., Sokol, S. I., Meisner, J., Hamzeh, I., Misra, A., Wall, M., De Rosen, V. L., Alam, M., Turner, M. C., Mulhearn, T. J., Good, A. P., Shammas, N. W., Chilton, R., Nguyen, P. K., Jezior, M., Gordon, P. C., Crain, T., Stenberg, R., Pedalino, R. P., Wiesel, J., Juang, G. J., Al-Amoodi, M., Wohns, D., Lader, E. W., Mumma, M., Dharmarajan, L., McGarvey, J. F., Downes, T. R., Luckasen, G. J., Cheong, B., Potluri, S., Mastouri, R. A., Breall, J. A., Revtyak, G. E., Bazeley, J. W., Li, D., Giedd, K., Old, W., Burt, F., Sokhon, K., Gopal, D., Valeti, U. S., Kobashigawa, J., Govindan, S. C., Nair, R. G., Manjunath, C. N., Moorthy, N., Manjunath, S. C., Narayanappa, S., Pandit, N., Nath, R. K., Dwivedi, S. K., Narain, V. S., Chandra, S., Wander, G. S., Tandon, R., Ralhan, S., Aslam, N., Goyal, A., Bhargava, B., Karthikeyan, G., Ramakrishnan, S., Seth, S., Yadav, R., Singh, S., Roy, A., Parakh, N., Verma, S. K., Narang, R., Mishra, S., Naik, N., Sharma, G., Choudhary, S. K., Patel, C., Gulati, G., Sharma, S., Bahl, V. K., Mathew, A., Punnoose, E., Gadkari, M. A., Gadage, S., Pillay, T. U., Satheesh, S., Mathur, A., Kaul, U., Christopher, J., Menon, R., Kumar, N., Oomman, A., Mao, R., Solomon, H., Naik, S., Khan, S. P., Christopher, J., Kumar, N., Grant, P., Kachru, R., Ajit Kumar, V. K., Ganapathi, S., Jayakumar, K., Sivadasanpillai, H., Sasidharan, B., Kapilamoorthy, T. R., Christopher, J., Polamuri, P., Kaul, U., Senior, R., Elghamaz, A., Gurunathan, S., Karogiannis, N., Shah, B. N., Trimlett, R. H., Rubens, M. B., Nicol, E. D., Mittal, T. K., Hampson, R., Gamma, R. A., de Belder, M. A., Thambyrajah, J., Nageh, T., Davies, J. R., Lindsay, S. J., Kurian, J., Jamil, H., Raheem, O., Hoye, A., Donnelly, P., Valecka, B., Chauhan, A., Barr, C., Alfakih, K., Byrne, J., Webb, I., Henriksen, P., OKane, P., de Silva, R., Conway, D. S., Sirker, A. A., Hoole, S. P., Witherow, F. N., Johnston, N., Harbinson, M., Walsh, S., Douglas, H., Luckie, M., Sobolewska, J., Jeetley, P., Patel, N., Kotecha, T., Travill, C., Karimullah, I., Al-Bustami, M., Braganza, D., Henderson, R., Pointon, K., Naik, S., Mathew, T., Berry, C., Collison, D., Roditi, G., Moriarty, A. J., Glover, J. D., Pradhan, J., Mikhail, G., Francis, D. P., Gosselin, G., Diaz, A., Rheault, P., Barrero, M., Gagne, C., Pepin-Dubois, Y., Costa, R., Sia, Y. T., Lemay, C., Gisbert, A., Gervais, P., Rheault, A., Phaneuf, D. C., Gosselin, G., Garg, P., Chow, B. J., Hessian, R. C., Beanlands, R. S., Davies, R. F., Bainey, K. R., Cheema, A. N., Bagai, A., Wald, R., Goodman, S., Graham, J. J., Peterson, M., Chow, C., Abramson, B., Cheema, A. N., Vakani, M. T., Cha, J., Howarth, A. G., Wong, G., Uxa, A., Galiwango, P., Kassam, S., Mukherjee, A., Ricci, A. J., Lam, A., Mehta, S., Udell, J., Genereux, P., Hameed, A., Daba, L., Hueb, W., Rezende, P. C., Silva, E. E., Hueb, A. C., Smanio, P. E., de Quadros, A. S., Kalil, R. A., da Costa Vieira, J. L., Grossmann, G., de Oliveira, P. P., Bridi, L., Savaris, S., Vitola, J. V., Cerci, R. J., Farias, F. R., Fernandes, M. M., Marin-Neto, J. A., Schmidt, A., de Oliveira Lima Filho, M., Oliveira, R. M., Chierice, J. R., Polanczyk, C. A., Furtado, M. V., Smidt, L. F., Carvalho, A. C., Pucci, G., Lyra, F., Junior, A. R., Dracoulakis, M. D., Lima, R. G., Figueiredo, E., Caramori, P. R., Tumelero, R., Dall'Orto, F., Mesquita, C. T., Colafranseschi, A. S., Oliveira, A. C., Carvalho, L. A., Palazzo, I. C., Sousa, A. S., da Silva, E. E., de Barros, P. G., de Padua Silva Baptista, L., Rodrigues, M. J., de Resende, M. V., Saraiva, J. F., Costantini, C., Demkow, M., Pracon, R., Kepka, C., Teresinska, A., Kryczka, K., Henzel, J., Solecki, M., Kaczmarska, E., Mazurek, T., Drozdz, J., Czarniak, B., Frach, M., Szymczyk, K., Niedzwiecka, I., Sobczak, S., Ciurus, T., Jakubowski, P., Misztal-Teodorczyk, M., Teodorczyk, D., Fratczak, A., Szkopiak, M., Lebioda, P., Wlodarczyk, M., Plachcinska, A., Kusmierek, J., Miller, M., Marciniak, H., Wojtczak-Soska, K., Luczak, K., Tarchalski, T., Cichocka-Radwan, A., Szwed, H., Szulczyk, G. A., Witkowski, A., Kukula, K., Celinska-Spodar, M., Zalewska, J., Gajos, G., Bury, K., Pruszczyk, P., Roik, M., Loboz-Grudzien, K., Sokalski, L., Brzezinska, B., Lesiak, M., Lanocha, M., Reczuch, K. W., Kalarus, Z., Swiatkowski, A., Szulik, M., Musial, W. J., Bockeria, L., Petrosyan, K., Trifonova, T., Chernyavskiy, A. M., Kretov, E. I., Grazhdankin, I. O., Bershtein, L. L., Sayganov, S. A., Kuzmina-Krutetskaya, A. M., Zbyshevskaya, E. V., Katamadze, N. O., Demchenko, E. A., Kozlov, P. S., Kozulin, V. Y., Lubinskaya, E. I., Lopez-Sendon, J., Castro, A., Salicio, E. R., Guzman, G., Galeote, G., Valbuena, S., Peteiro, J., Martinez-Ruiz, M. D., Perez-Fernandez, R., Cuenca-Castillo, J. J., Flores-Rios, X., Prada-Delgado, O., Barge-Caballero, G., Juanatey, J. R., Bayarri, M. S., Nunez, V. P., Sanchez, R. O., Alvarez, B. C., Gil, C. P., Monzonis, A. M., Sionis, A., Perales, M. V., Padro, J. M., Penaranda, A. S., Picart, J. G., Iglesias, A. G., Marimon, X. G., Llado, G. P., Costa, F. C., Miro, V., Diez, J. L., Calvillo, P., Ortuno, F. M., Chavarri, M. V., Montolliu, A. T., Bermudez, E. P., De La Morena, G., Blancas, M. G., Luena, J. E., Fernandez-Aviles, F., Chen, J., Wu, Y., Ma, Y., Yang, Y., Ji, Z., Yang, X., Lin, W., Zeng, H., Fu, X., Yang, B., Wang, S., Cheng, G., Zhao, Y., Fang, X., Zeng, Q., Su, X., Li, Q., Nie, S., Yu, Q., Wang, J., Zhang, S., Liu, Z., Perna, G. P., Marini, M., Gabrielli, G., Provasoli, S., Verna, E., Monti, L., Nardi, B., Di Chiara, A., Mortara, A., Galvani, M., Ottani, F., Sicuro, M., Calabro, P., Formisano, T., Tarantini, G., Cucchini, U., Andres, A. L., Racca, E., Briguori, C., Amati, R., Vergoni, W., Russo, A., Fanelli, R., Poh, K., Chai, P., Lau, T., Loh, J. P., Tay, E. L., Teoh, K., Teo, L. L., Ong, C., Wong, R. C., Loh, P., Kofidis, T., Chan, W. X., Chan, K. H., Foo, D., Kong, J. L., Er, C. M., Jafary, F. H., Chua, T., Doerr, R., Stumpf, J., Matschke, K., Simonis, G., Kadalie, C. T., Sechtem, U., Ong, P., Schulze, P. C., Goebel, B., Lenk, K., Nickenig, G., Schuchlenz, H., Weikl, S., Lang, I. M., Huber, K., Jakl-Kotauschek, G., Vertes, A., Varga, A., Fontos, G., Merkely, B., Kerecsen, G., Hinic, S., Zdravkovic, M., Mudrenovic, V., Crnokrak, B., Beleslin, B. D., Boskovic, N. N., Petrovic, M. T., Dobric, M. R., Markovic, Z. Z., Mladenovic, A. S., Cemerlic-Adjic, N., Davidovic, G., Vucic, R., Dekleva, M. N., Stankovic, G., Apostolovic, S., Escobedo, J., Baleon-Espinosa, R., Campos-Santaolalla, A. S., Duran-Cortes, E., Flores-Palacios, J. M., Garcia-Rincon, A., Jimenez-Santos, M., Penafiel, J. V., Ortega-Ramirez, J. A., Valdespino-Estrada, A., Rosas, E. A., Selvanayagam, J. B., Joseph, M. X., Thambar, S. T., Beltrame, J. F., Hillis, G. S., Thuaire, C., Dutoiu, T., Steg, P. G., Juliard, J., Slama, M. S., El Mahmoud, R., Nicollet, E., Goube, P., Barone-Rochette, G., Furber, A., Biere, L., Laucevicius, A., Celutkiene, J., Kedhi, E., Timmer, J., Hermanides, R., Kaplan, E., Riezebos, R. K., Samadi, P., van Dongen, E., Niehe, S. R., Suryapranata, H., van Vugt, S., Ramos, R., Cacela, D., Santana, A., Fiarresga, A., Sousa, L., Marques, H., Patricio, L., Bernanrdes, L., Rio, P., Carvalho, R., Ferreira, R., Silva, T., Rodrigues, I., Modas, P., Portugal, G., Fragata, J., Pinto, F. J., Menezes, M. N., Lopes, G. C., Almeida, A. G., Silva, P. C., Nobre, A., Francisco, A. R., Ferreira, N., Lopes, R. L., Guzman, L., Figal, J. C., Mendiz, O., Cortes, C., Favaloro, R. R., Alvarez, C., Courtis, J., Zeballos, G., Schiavi, L., Rubio, M., Devlin, G. P., Fisher, R., Stewart, R. A., White, H. D., Benatar, J., Kedev, S., Mitevska, I. P., Kostovska, E. S., Pejkov, H., Held, C., Eggers, K., Frostfelt, G., Johnston, N., Olsowka, M., Akerblom, A., Soveri, I., Aspberg, J., Sharir, T., Elian, D., Kerner, A., Massalha, S., Fukuda, K., Kohsaka, S., Yasuda, S., Nishimura, S., Goetschalckx, K., Van de Werf, F., Claes, K., Hung, C., Yun, C., Hou, C. J., Kuo, J., Yeh, H., Hung, T., Li, J., Chien, C., Tsai, C., Liu, C., Yu, F., Lin, Y., Lan, W., Yen, C., Tsai, J., Sung, K., Ntsekhe, M., Pandie, S., Viljoen, C. A., De Andrade, M., Moccetti, T., Rossi, M. G., Abdelhamid, M., Adel, A., Kamal, A., Mahrous, H., El Kaffas, S., El Fishawy, H., Pop, C., Claudia, M., Popescu, B. A., Ginghina, C., Deleanu, D., Iliescu, V. A., Al-Mallah, M. H., Aljzeeri, A., Najm, H., Alghamdi, A., Ramos, W. E., Kuanprasert, S., Prommintikul, A., Nawarawong, W., Woragidpoonpol, S., Tepsuwan, T., Taksaudom, N., Rimsukcharoenchai, C., Euathrongchit, J., Wannasopha, Y., Yamwong, S., Sritara, P., Aramcharoen, S., Meemuk, K., Khairuddin, A., Hadi, H. A., Yahaya, S. A. 2024: e029850

  Abstract

  BACKGROUND: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management.METHODS AND RESULTS: The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions.CONCLUSIONS: Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial.REGISTRATION: URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.

  View details for DOI 10.1161/JAHA.122.029850

  View details for PubMedID 38410945

• Non-electrocardiogram-gated, free-breathing, off-resonance reduced, high-resolution, whole-heart myocardial T2 * mapping at 3 T within 5 min. Magnetic resonance in medicine Guan, X., Yang, H. J., Zhang, X., Wang, N., Han, H., Tang, R., Hu, Z., Youssef, K., Vora, K., Krishnam, M. S., Christodoulou, A. G., Li, D., Sharif, B., Dharmakumar, R. 2024

  Abstract

  Widely used conventional 2D T2 * approaches that are based on breath-held, electrocardiogram (ECG)-gated, multi-gradient-echo sequences are prone to motion artifacts in the presence of incomplete breath holding or arrhythmias, which is common in cardiac patients. To address these limitations, a 3D, non-ECG-gated, free-breathing T2 * technique that enables rapid whole-heart coverage was developed and validated.A continuous random Gaussian 3D k-space sampling was implemented using a low-rank tensor framework for motion-resolved 3D T2 * imaging. This approach was tested in healthy human volunteers and in swine before and after intravenous administration of ferumoxytol.Spatial-resolution matched T2 * images were acquired with 2-3-fold reduction in scan time using the proposed T2 * mapping approach relative to conventional T2 * mapping. Compared with the conventional approach, T2 * images acquired with the proposed method demonstrated reduced off-resonance and flow artifacts, leading to higher image quality and lower coefficient of variation in T2 *-weighted images of the myocardium of swine and humans. Mean myocardial T2 * values determined using the proposed and conventional approaches were highly correlated and showed minimal bias.The proposed non-ECG-gated, free-breathing, 3D T2 * imaging approach can be performed within 5 min or less. It can overcome critical image artifacts from undesirable cardiac and respiratory motion and bulk off-resonance shifts at the heart-lung interface. The proposed approach is expected to facilitate faster and improved cardiac T2 * mapping in those with limited breath-holding capacity or arrhythmias.

  View details for DOI 10.1002/mrm.29968

  View details for PubMedID 38174593

• Transfemoral tricuspid valve replacement and one-year outcomes: the TRISCEND study. European heart journal Kodali, S., Hahn, R. T., Makkar, R., Makar, M., Davidson, C. J., Puthumana, J. J., Zahr, F., Chadderdon, S., Fam, N., Ong, G., Yadav, P., Thourani, V., Vannan, M. A., O'Neill, W. W., Wang, D. D., Tchétché, D., Dumonteil, N., Bonfils, L., Lepage, L., Smith, R., Grayburn, P. A., Sharma, R. P., Haeffele, C., Babaliaros, V., Gleason, P. T., Elmariah, S., Inglessis-Azuaje, I., Passeri, J., Herrmann, H. C., Silvestry, F. E., Lim, S., Fowler, D., Webb, J. G., Moss, R., Modine, T., Lafitte, S., Latib, A., Ho, E., Goldberg, Y., Shah, P., Nyman, C., Rodés-Cabau, J., Bédard, E., Brugger, N., Sannino, A., Mack, M. J., Leon, M. B., Windecker, S. 2023

  Abstract

  For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter tricuspid valve (TV) intervention studies have shown significant improvements in functional status and quality of life associated with right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained improvements in these outcomes.The prospective, single-arm, multicentre TRISCEND study enrolled 176 patients to evaluate the safety and performance of transcatheter TV replacement in patients with ≥moderate, symptomatic TR despite medical therapy. Major adverse events, reduction in TR grade and haemodynamic outcomes by echocardiography, and clinical, functional, and quality-of-life parameters are reported to one year.Enrolled patients were 71.0% female, mean age 78.7 years, 88.0% ≥ severe TR, and 75.4% New York Heart Association classes III-IV. Tricuspid regurgitation was reduced to ≤mild in 97.6% (P < .001), with increases in stroke volume (10.5 ± 16.8 mL, P < .001) and cardiac output (0.6 ± 1.2 L/min, P < .001). New York Heart Association class I or II was achieved in 93.3% (P < .001), Kansas City Cardiomyopathy Questionnaire score increased by 25.7 points (P < .001), and six-minute walk distance increased by 56.2 m (P < .001). All-cause mortality was 9.1%, and 10.2% of patients were hospitalized for heart failure.In an elderly, highly comorbid population with ≥moderate TR, patients receiving transfemoral EVOQUE transcatheter TV replacement had sustained TR reduction, significant increases in stroke volume and cardiac output, and high survival and low hospitalization rates with improved clinical, functional, and quality-of-life outcomes to one year. Funded by Edwards Lifesciences, TRISCEND ClinicalTrials.gov number, NCT04221490.

  View details for DOI 10.1093/eurheartj/ehad667

  View details for PubMedID 37930776

• The 2022 FASEB Virtual Catalyst Conference on the Cardiac Interatrial Septum and Stroke Risk, December 7, 2022. FASEB journal : official publication of the Federation of American Societies for Experimental Biology Schilling, J., Lin, J. P., Mankad, S. V., Krishnam, M. S., Ning, M., Patel, P. M., Kim, C. K., Kapoor, R., Di Tullio, M. R., Jung, J., Kim, J. K., Fisher, M. J. 2023; 37 (9): e23122

  Abstract

  There is emerging evidence that the cardiac interatrial septum has an important role as a thromboembolic source for ischemic strokes. There is little consensus on treatment of patients with different cardiac interatrial morphologies or pathologies who have had stroke. In this paper, we summarize the important background, diagnostic, and treatment considerations for this patient population as presented during the Federation of American Societies for Experimental Biology (FASEB) Virtual Catalytic Conference on the Cardiac Interatrial Septum and Stroke Risk, held on December 7, 2022. During this conference, many aspects of the cardiac interatrial septum were discussed. Among these were the embryogenesis of the interatrial septum and development of anatomic variants such as patent foramen ovale and left atrial septal pouch. Also addressed were various mechanisms of injury such as shunting physiologies and the consequences that can result from anatomic variants, as well as imaging considerations in echocardiography, computed tomography, and magnetic resonance imaging. Treatment options including anticoagulation and closure were addressed, as well as an in-depth discussion on whether the left atrial septal pouch is a stroke risk factor. These issues were discussed and debated by multiple experts from neurology, cardiology, and radiology.

  View details for DOI 10.1096/fj.202300897

  View details for PubMedID 37606555

• The utility of time resolved magnetic resonance angiography in differentiating vascular malformations. Clinical imaging Bista, B., Yousra, A., Bosemani, T., Gedeon, D., Bista, A., Shrestha, S., Krishnam, M. 2023; 101: 150-155

  Abstract

  PURPOSE: The objective is to show that TR-MRA is a useful non-invasive technique without ionizing radiation of traditional angiography in evaluating VMs.MATERIALS AND METHODS: Retrospective search utilizing M-Power for MRA studies done at 3T (Trio, Siemens) with both 3D contrast enhanced TR-MRA and 3D CE-MRA sequences from 2009 to 2018 were obtained after IRB approval. The images were blindly reviewed by two experienced cardiovascular radiologists for informations regarding vascular malformations with the ability to separate arteries and veins without any overlay or contamination in real time. Both TR-MRA and 3D CE-MRA images were carefully evaluated. The following characteristics: flow rate, size, type, feeding vessels, draining vessels and clots were evaluated. The findings were then compared to the Catheter Angiography for the patients that had catheter angiography study.RESULTS: The M-Power search resulted a total of 69 patients (24 males, 45 females, age range 11days to 74years). Of those 69, there were 25 patients with confirmatory Catheter Angiography study. The radiologists characterized VMs as 19 high flow VMs, 47 slow flow VMs, 2 lymphatic malformations and 1 no flow VM. Of those with Cath, there was 100% concordance with the TR-MRA.CONCLUSION: TR-MRA provides functional characterization of a VM that cannot be determined with CE-MRA alone. This is critical in treatment planning with high-flow VMs.

  View details for DOI 10.1016/j.clinimag.2023.06.010

  View details for PubMedID 37364365

• Intramyocardial hemorrhage drives fatty degeneration of infarcted myocardium. Nature communications Cokic, I., Chan, S. F., Guan, X., Nair, A. R., Yang, H., Liu, T., Chen, Y., Hernando, D., Sykes, J., Tang, R., Butler, J., Dohnalkova, A., Kovarik, L., Finney, R., Kali, A., Sharif, B., Bouchard, L. S., Gupta, R., Krishnam, M. S., Vora, K., Tamarappoo, B., Howarth, A. G., Kumar, A., Francis, J., Reeder, S. B., Wood, J. C., Prato, F. S., Dharmakumar, R. 2022; 13 (1): 6394

  Abstract

  Sudden blockage of arteries supplying the heart muscle contributes to millions of heart attacks (myocardial infarction, MI) around the world. Although re-opening these arteries (reperfusion) saves MI patients from immediate death, approximately 50% of these patients go on to develop chronic heart failure (CHF) and die within a 5-year period; however, why some patients accelerate towards CHF while others do not remains unclear. Here we show, using large animal models of reperfused MI, that intramyocardial hemorrhage - the most damaging form of reperfusion injury (evident in nearly 40% of reperfused ST-elevation MI patients) - drives delayed infarct healing and is centrally responsible for continuous fatty degeneration of the infarcted myocardium contributing to adverse remodeling of the heart. Specifically, we show that the fatty degeneration of the hemorrhagic MI zone stems from iron-induced macrophage activation, lipid peroxidation, foam cell formation, ceroid production, foam cell apoptosis and iron recycling. We also demonstrate that timely reduction of iron within the hemorrhagic MI zone reduces fatty infiltration and directs the heart towards favorable remodeling. Collectively, our findings elucidate why some, but not all, MIs are destined to CHF and help define a potential therapeutic strategy to mitigate post-MI CHF independent of MI size.

  View details for DOI 10.1038/s41467-022-33776-x

  View details for PubMedID 36302906

• Heart transplantation with concomitant reoperative total aortic arch replacement in a patient with end-stage heart failure and chronic aortic arch dissection. JTCVS techniques Kasinpila, P., Krishnam, M., Woo, Y. J. 2022; 15: 144-146

  View details for DOI 10.1016/j.xjtc.2022.07.014

  View details for PubMedID 36276674

• Constrictive Pericarditis Revealing Rare Case of ALH Amyloidosis With Underlying Lymphoplasmacytic Lymphoma (Waldenstrom Macroglobulinemia). JACC. Case reports Ho, V. V., O'Sullivan, J. W., Collins, W. J., Ozdalga, E., Bell, C. F., Shah, N. D., Krishnam, M. S., Ozawa, M. G., Witteles, R. M. 2022; 4 (5): 271-275

  Abstract

  We present a case of pericardial amyloidosis with associated lymphoplasmacytic lymphoma in a patient with chronic worsening shortness of breath and cough. This case highlights the wide variation in the presentation of cardiac amyloidosis, and the rare occurrence of clinically significant light-chain and heavy-chain amyloidosis in the pericardium.(Level of Difficulty: Advanced.).

  View details for DOI 10.1016/j.jaccas.2022.01.007

  View details for PubMedID 35257101

• Initial Invasive or Conservative Strategy for Stable Coronary Disease. The New England journal of medicine Maron, D. J., Hochman, J. S., Reynolds, H. R., Bangalore, S. n., O'Brien, S. M., Boden, W. E., Chaitman, B. R., Senior, R. n., López-Sendón, J. n., Alexander, K. P., Lopes, R. D., Shaw, L. J., Berger, J. S., Newman, J. D., Sidhu, M. S., Goodman, S. G., Ruzyllo, W. n., Gosselin, G. n., Maggioni, A. P., White, H. D., Bhargava, B. n., Min, J. K., Mancini, G. B., Berman, D. S., Picard, M. H., Kwong, R. Y., Ali, Z. A., Mark, D. B., Spertus, J. A., Krishnan, M. N., Elghamaz, A. n., Moorthy, N. n., Hueb, W. A., Demkow, M. n., Mavromatis, K. n., Bockeria, O. n., Peteiro, J. n., Miller, T. D., Szwed, H. n., Doerr, R. n., Keltai, M. n., Selvanayagam, J. B., Steg, P. G., Held, C. n., Kohsaka, S. n., Mavromichalis, S. n., Kirby, R. n., Jeffries, N. O., Harrell, F. E., Rockhold, F. W., Broderick, S. n., Ferguson, T. B., Williams, D. O., Harrington, R. A., Stone, G. W., Rosenberg, Y. n. 2020

  Abstract

  Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction.Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

  View details for DOI 10.1056/NEJMoa1915922

  View details for PubMedID 32227755

• Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease. The New England journal of medicine Spertus, J. A., Jones, P. G., Maron, D. J., Mark, D. B., O'Brien, S. M., Fleg, J. L., Reynolds, H. R., Stone, G. W., Sidhu, M. S., Chaitman, B. R., Chertow, G. M., Hochman, J. S., Bangalore, S. n. 2020

  Abstract

  In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status.We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy.Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4).Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).

  View details for DOI 10.1056/NEJMoa1916374

  View details for PubMedID 32227754

• Management of Coronary Disease in Patients with Advanced Kidney Disease. The New England journal of medicine Bangalore, S. n., Maron, D. J., O'Brien, S. M., Fleg, J. L., Kretov, E. I., Briguori, C. n., Kaul, U. n., Reynolds, H. R., Mazurek, T. n., Sidhu, M. S., Berger, J. S., Mathew, R. O., Bockeria, O. n., Broderick, S. n., Pracon, R. n., Herzog, C. A., Huang, Z. n., Stone, G. W., Boden, W. E., Newman, J. D., Ali, Z. A., Mark, D. B., Spertus, J. A., Alexander, K. P., Chaitman, B. R., Chertow, G. M., Hochman, J. S. 2020

  Abstract

  Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease.We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03).Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).

  View details for DOI 10.1056/NEJMoa1915925

  View details for PubMedID 32227756

• Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease. The New England journal of medicine Spertus, J. A., Jones, P. G., Maron, D. J., O'Brien, S. M., Reynolds, H. R., Rosenberg, Y. n., Stone, G. W., Harrell, F. E., Boden, W. E., Weintraub, W. S., Baloch, K. n., Mavromatis, K. n., Diaz, A. n., Gosselin, G. n., Newman, J. D., Mavromichalis, S. n., Alexander, K. P., Cohen, D. J., Bangalore, S. n., Hochman, J. S., Mark, D. B. 2020

  Abstract

  In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency.At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina).In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

  View details for DOI 10.1056/NEJMoa1916370

  View details for PubMedID 32227753

• Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial JAMA CARDIOLOGY Hochman, J. S., Reynolds, H. R., Bangalore, S., O'Brien, S. M., Alexander, K. P., Senior, R., Boden, W. E., Stone, G. W., Goodman, S. G., Lopes, R. D., Lopez-Sendon, J., White, H. D., Maggioni, A. P., Shaw, L. J., Min, J. K., Picard, M. H., Berman, D. S., Chaitman, B. R., Mark, D. B., Spertus, J. A., Cyr, D. D., Bhargava, B., Ruzyllo, W., Wander, G. S., Chernyavskiy, A. M., Rosenberg, Y. D., Maron, D. J., Mavromatis, K., Miller, T., Banerjee, S., Abdul-Nour, K., Stone, P. H., Jang, J. J., Weitz, S., Arnold, S., Shapiro, M. D., El-Hajjar, M., McFalls, E. O., Khouri, M., Goldberg, J. L., Goldweit, R., Cohen, R. A., Winchester, D. E., Kronenberg, M., Heitner, J. F., Dauber, I. M., Cannan, C., Sudarshan, S., Mehta, P. K., Hedgepeth, C. M., Sahul, Z., Booth, D., Setty, S., Barua, R. S., Hage, F., Dajani, K., El-Hajjar, M., Arif, I., Trejo (Gutierrez), J. F., Gemignani, A., Meadows, J. L., Call, J. T., Hannan, J., Martin, E. T., Vorobiof, G., Moorman, A., Kinlay, S., Rayos, G., Seedhom, A., Kumkumian, G., Sedlis, S. P., Tamis-Holland, J. E., Saba, S., Badami, U., Marzo, K., Robbins, I. H., Hamroff, G. S., Little, R. W., Lui, C. Y., Booth, D., Hu, B., Labovitz, A. J., Maron, D. J., Rodriguez, F., Deedwania, P., Sweeny, J., Spizzieri, C., Hochberg, C. P., Salerno, W. D., Wyman, R., Zarka, A., Haldis, T., Kohn, J. A., Girotra, S., Almousalli, O., Krishnam, M. S., Coram, R., Thomas, S., El Shahawy, M., Stafford, J., Abernethy, W. B., Zurick, A., Meyer, T. M., Rutkin, B., Bokhari, S., Sokol, S. I., Hamzeh, I., Turner, M. C., Good, A. P., Shammas, N. W., Chilton, R., Nguyen, P. K., Jezior, M., Gordon, P. C., Stenberg, R., Pedalino, R. P., Wiesel, J., Juang, G. J., Al-Amoodi, M., Wohns, D., Lader, E. W., Mumma, M., Dharmarajan, L., McGarvey, J. X., Downes, T. R., Cheong, B., Potluri, S., Mastouri, R. 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  View details for DOI 10.1001/jamacardio.2019.0014

  View details for Web of Science ID 000461901600018