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ECHONOMY
Tools for Echocardiographic Calculations
Muhamed Saric, MD, PhD
New York University
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Definition
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 | NIH-funded worldwide trial based at NYU |
| The study aim is to compare an initial invasive strategy of cath and
optimal revascularization (PCI or CABG) + optimal medical therapy (OMT),
with a conservative strategy of OMT alone, with cath reserved for OMT
failure. |
| Blinded coronary CTA is performed before randomization for patients
with eGFR 60 or above, to rule out left main disease. |
| Patients with eGFR 30-59 may be enrolled if the treating physician
does not believe left main disease is very likely
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Inclusion Criteria
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ORIGINAL CRITERIA : Moderate Ischemia
| Nuclear myocardial perfusion (=10% myocardium), OR |
| Echo or cardiac magnetic resonance wall motion (=3/16 segments with
stress-induced severe hypokinesis or akinesis), OR |
| Cardiac magnetic resonance perfusion (=12% myocardium) |
ANCILLARY CRITERIA : Mild ischemia
| Nuclear myocardial perfusion: 5-9% ischemic myocardium on exercise
testing, OR |
| Echo: 2 segments with dobutamine or exercise-induced severe
hypokinesis or akinesis, OR |
| CMR: 2 segments with stress-induced severe hypokinesis or akinesis |
In addition, must satisfy all 3 criteria below if exercise stress test;
or all criteria below except the workload if pharmacologic stress:
| Symptoms: Clinical history of typical angina or angina equivalent or
typical angina during the exercise or dobutamine stress test |
| Heart rate: < 80% of predicted maximum |
| Workload: < 7 mets |
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Exclusion Criteria
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| LVEF < 35% |
| History of unprotected left main stenosis >50% on prior coronary
computed tomography angiography (CCTA) or prior cardiac catheterization
(if available) |
| Prior known coronary anatomy unsuitable for either PCI or CABG |
| History of noncompliance with medical therapy |
| Acute coronary syndrome within the previous 2 months |
| PCI or CABG within the previous 12 months |
| Stroke within the previous 6 months or intracranial hemorrhage at any
time |
| NYHA class III-IV heart failure at entry or hospitalization for
exacerbation of chronic heart failure within the previous 6 months
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