Tools for Echocardiographic Calculations

Muhamed Saric, MD, PhD
New York University



bulletNIH-funded worldwide trial based at NYU
bulletThe 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.
bulletBlinded coronary CTA is performed before randomization for patients with eGFR 60 or above, to rule out left main disease.
bulletPatients with eGFR 30-59 may be enrolled if the treating physician does not believe left main disease is very likely

Inclusion Criteria

ORIGINAL CRITERIA : Moderate Ischemia

bulletNuclear myocardial perfusion (=10% myocardium), OR
bulletEcho or cardiac magnetic resonance wall motion (=3/16 segments with stress-induced severe hypokinesis or akinesis), OR
bulletCardiac magnetic resonance perfusion (=12% myocardium)


bulletNuclear myocardial perfusion: 5-9% ischemic myocardium on exercise testing, OR
bulletEcho: 2 segments with dobutamine or exercise-induced severe hypokinesis or akinesis, OR
bulletCMR: 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:

bulletSymptoms: Clinical history of typical angina or angina equivalent or typical angina during the exercise or dobutamine stress test
bulletHeart rate: < 80% of predicted maximum
bulletWorkload: < 7 mets


Exclusion Criteria

bulletLVEF < 35%
bulletHistory of unprotected left main stenosis >50% on prior coronary computed tomography angiography (CCTA) or prior cardiac catheterization (if available)
bulletPrior known coronary anatomy unsuitable for either PCI or CABG
bulletHistory of noncompliance with medical therapy
bulletAcute coronary syndrome within the previous 2 months
bulletPCI or CABG within the previous 12 months
bulletStroke within the previous 6 months or intracranial hemorrhage at any time
bulletNYHA class III-IV heart failure at entry or hospitalization for exacerbation of chronic heart failure within the previous 6 months