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Abstract The ODYSSEY OUTCOMES trial, comprising over 47 000 patient-years of placebo-controlled observation, demonstrated important reductions in the risk of recurrent ischaemic cardiovascular events with the monoclonal antibody to proprotein convertase subtilisin/kexin type 9 alirocumab, as well as lower all-cause death. These benefits were observed in the context of substantial and persistent lowering of low-density lipoprotein cholesterol with alirocumab compared with that achieved with placebo. The safety profile of alirocumab was indistinguishable from matching placebo except for a ∼1.7% absolute increase in local injection site reactions. Further, the safety of alirocumab compared with placebo was evident in vulnerable groups identified before randomization, such as the elderly and those with diabetes mellitus, previous ischaemic stroke, or chronic kidney disease. The frequency of adverse events and laboratory-based abnormalities was generally similar to that in placebo-treated patients. Thus, alirocumab appears to be a safe and effective lipid-modifying treatment over a duration of at least 5 years. Graphical Abstract Graphical Abstract Overview of the clinical efficacy and safety of alirocumab as observed in the ODYSSEY OUTCOMES clinical trial. MACE, major adverse cardiovascular event.

Transient ischemic dilation (TID) of the left ventricle (LV) has not been validated as a marker of extensive coronary artery disease (CAD) for studies using a cadmium-zinc-telluride (CZT) camera with upright imaging. TID ratios were obtained from upright stress and rest images on a CZT camera. Separate cut-off values were determined for exercise and for regadenoson stress. The cutoffs were then applied to 28 patients with extensive CAD and 101 patients without extensive CAD. With treadmill exercise, an upright TID ratio ≥1.16 provided a positive predictive value of 50% and a negative predictive value of 85.4% for the identification of extensive CAD. In the regadenoson group, an upright TID ratio of 1.29 provided a positive predictive value of 20% and a negative predictive value of 75.9%. Although not an independent predictor of extensive CAD in all subjects, in subjects with a normal upright LVEF, it provided a predictive value by receiver operating characteristics comparable to the SSS. Increased upright TID measurements on a CZT camera are associated with extensive CAD. The upright TID measurements can serve in an adjunctive role to SSS, and may be most effective in patients with a normal upright exercise LVEF.

Diagnostic performance of stress-only imaging using a Cadmium-Zinc-Telluride (CZT) camera has not been directly compared in the same patients to stress-only attenuation-corrected conventional Anger camera images. 112 subjects with correlative coronary angiographic data and 40 subjects with <5% pre-test likelihood of coronary disease completed attenuation-corrected stress-only images on a conventional Anger camera and uncorrected upright and supine stress images on a CZT camera. Two readers provided independent, blinded interpretations of stress-only images. Upright and supine stress-only CZT images and attenuation-corrected Anger camera images provided similar positive (reader 1/reader 2, 50.0%/44.1% vs 46.4%/51.9%) and negative (66.7%/64.0% vs 67.9%/67.7%) predictive values (all P = NS) for obstructive coronary artery disease; however, the sensitivity was higher (81.3% vs 58.3%, P = .05), specificity lower (29.7% vs 50.0%, P = .005), and normalcy rate lower (87.5% vs 100%, P = .025) with attenuation-corrected Anger camera images for the first reader with no significant differences between cameras for the second reader. Stress-only upright and supine CZT imaging was non-inferior statistically to attenuation-corrected stress-only Anger camera imaging. Nevertheless, stress-only CZT imaging may be associated with reduced diagnostic sensitivity for some readers compared to attenuation-corrected Anger camera images, which may be less acceptable clinically compared to stress plus rest images.

Little is known concerning the significance of lung activity of the sympathetic neuronal imaging agent 123I-MIBG in heart failure patients and healthy subjects. 123I-MIBG activity was assessed in lung, heart, and mediastinum regions of interest on early and late planar images in 951 heart failure patients and 94 controls. Cox regression analyses were performed to identify factors associated with outcome events during a median 17 month follow-up. Heart failure subjects with pulmonary disease had significantly reduced late lung-to-mediastinum (L/M) ratios compared to heart failure subjects without pulmonary disease. Late L/M ratio was greater in heart failure subjects without outcome events than either subjects with events or healthy controls. L/M ratio was an independent predictor of all-cause mortality. Subjects with combined favorable prognosis L/M ratio ≥ 1.7 and heart-to-mediastinum ratio (H/M) ≥ 1.6 had a significantly lower 2-year mortality (2.0%) than subjects with unfavorable L/M ratio < 1.7 and H/M ratio < 1.6 (17.7% 2-year mortality, P < .0008). Increased 123I-MIBG lung activity in heart failure subjects, compared to controls, is associated with a relatively low risk of adverse events, including all-cause mortality. L/M ratio may, therefore, be useful to provide incremental prognostic information on 123I-MIBG imaging.

Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis and is defined as the ratio of maximal blood flow in a stenotic artery to normal maximal flow. It can be easily measured during coronary angiography by calculating the ratio of distal coronary pressure to the aortic pressure. FFR in a normal coronary artery equals 1.0. An FFR value of ≤0.80 indicates ischemia with an accuracy of more than 90%. The information provided by FFR is similar to that obtained with myocardial perfusion studies, but it is more specific and has a better spatial resolution, because every artery or segment is analyzed separately. This review outlines the utility of FFR in a number of conditions including multivessel disease, left main coronary artery stenosis, bifurcation lesions, myocardial bridging and myocardial viability. Furthermore, this review discusses the correlations between FFR with intravascular ultrasound and the economic considerations of the procedure in patients with coronary artery disease.

Background Only few studies addressed the topic of Fibromyalgia Syndrome (FMS) effects on geriatric population quality of life and drug usage. The objective of this study was to demonstrate the significant impact of FMS in terms of quality of life (QOL) in geriatric aged patients. Methods 80 patients were studied, 40 with FMS according to FMS 2016 classification criteria, and 40 non-FMS controls. The patients were all above the age of 65 years. The FMS and control group completed Widespread Pain Index (WPI) and Symptom Severity Score (SSS). Three questionnaires, Fibromyalgia Impact Questionnaire (FIQ), Short Form (SF-36) Questionnaire, and Health Assessment Questionnaire Disability Index (HAQ-DI) were completed. These with additional medical records were used to classify symptoms and severity in both groups. Results Fibromyalgia patients demonstrated significant higher disability scores, (FIQ of 79.5 vs. 33.9, p<.01, and HAQ-DI of 2.00 vs. 1.00, p<.01 for FMS vs. non-FMS, respectively), and lower social functioning in comparison to non-FMS controls (SF-36 of social functioning 0.31 vs. 0.92, p<.01 for FMS vs. non-FMS, respectively). The FMS group had a higher use of pain management medications (opioid use of 12 patients vs. 0, p<.01, use of non-steroidal anti-inflammatory drugs by 11 FMS patients vs. 4 non-FMS controls, p<.01). Conclusions Patients with FMS older than 65 years of age demonstrate poorer outcomes and worse symptoms in comparison to matched-aged non-FMS control group. An association was found between FMS and the effect on the quality of life in this population.