201
|
Won K, Park H, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim Y, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee S, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Bax JJ, Min JK, Chang H. Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease. Clin Cardiol 2022; 45:873-881. [PMID: 35673995 PMCID: PMC9346967 DOI: 10.1002/clc.23870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atherosclerosis-related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain ) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease. HYPOTHESIS Normal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease. METHODS We analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow-up. All participants were divided into two groups of normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period. RESULTS Compared to participants with normal SBPmaintain , those with ≥elevated SBPmaintain had higher annualized total PVC (mm3 /year) (0.0 [0.0-2.2] vs. 4.1 [0.0-13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBPmaintain (β = .23) and follow-up high-density lipoprotein cholesterol (β = -0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBPmaintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59-0.81; p < .05). SBPmaintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51-10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01-1.06) independently influenced coronary plaque progression (all p < .05). CONCLUSION Normal SBPmaintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.
Collapse
Affiliation(s)
- Ki‐Bum Won
- Department of Cardiology, Dongguk University Ilsan HospitalDongguk University College of MedicineGoyangSouth Korea,Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | - Hyung‐Bok Park
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyCatholic Kwandong University International St. Mary's HospitalIncheonSouth Korea
| | - Ran Heo
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of Cardiology, Hanyang University Seoul HospitalHanyang University College of MedicineSeoulSouth Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
| | - Fay Y. Lin
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear MedicineGerman Heart Center MunichMunichGermany
| | - Yong‐Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | | | | | | | - Matthew J. Budoff
- Department of MedicineLundquist Institute at Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Ilan Gottlieb
- Department of RadiologyCasa de Saude São JoseRio de JaneiroBrazil
| | - Eun Ju Chun
- Seoul National University Bundang HospitalSungnamSouth Korea
| | | | - Erica Maffei
- Department of RadiologyArea Vasta 1/ASUR MarcheUrbinoItaly
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal,Nova Medical SchoolLisbonPortugal
| | - Jonathon A. Leipsic
- Department of Medicine and RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sang‐Eun Lee
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Sanghoon Shin
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Jung Hyun Choi
- Department of CardiologyPusan University HospitalBusanSouth Korea
| | - Renu Virmani
- Department of PathologyCVPath InstituteGaithersburgMarylandUSA
| | - Habib Samady
- Department of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Daniel S. Berman
- Department of Imaging and MedicineCedars Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie‐Josée and Henry R. Kravis Center for Cardiovascular HealthNew YorkNew YorkUSA
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - James K. Min
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Hyuk‐Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| |
Collapse
|
202
|
Tatlisu MA, Atici A, Ozcan FB, Çelik M, Kirac E, Baycan OF, Caliskan M. A Associação de TWEAK com Calcificação da Artéria Coronária em Pacientes com Doença Renal Crônica. Arq Bras Cardiol 2022; 119:436-445. [PMID: 35703664 PMCID: PMC9438529 DOI: 10.36660/abc.20210599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Fundamento O receptor fraco indutor de apoptose semelhante a fator de necrose tumoral solúvel (sTWEAK) é um membro da superfamília de TNF que tem um papel crítico na proliferação e inflamação na circulação arterial. Objetivos Este estudo prospectivo tem o objetivo de mostrar a relação entre os níveis de sTWEAK e calcificação da artéria coronária (CAC) em pacientes com doença renal crônica (DRC). Métodos Este estudo prospectivo incluiu 139 pacientes consecutivos que passaram por angiografia coronariana por tomografia computadorizada, por qualquer motivo, para síndromes coronarianas agudas, de agosto de 2020 a fevereiro de 2021. Um total de 12 pacientes foi excluído do estudo devido aos critérios de exclusão. Os pacientes foram divididos em dois grupos com base em terem um escore CAC menor que 400 (n=84) ou um escore de 400 ou mais (n=43). A significância foi presumida em p-valor bilateral <0,05. Resultados À medida que o escore CAC aumentou, os níveis de sTWEAK diminuíram de forma estatisticamente significativa e detectou-se uma relação forte entre níveis de sTWEAK e escore CAC (r: -0,779, p<0,001). A análise ROC revelou que o nível de corte ideal de sTWEAK para prever o escore CAC de 400 era 761 pg/mL com uma sensibilidade de 71% e especificidade de 73% (AUC: 0,78; IC 95%: 0,70-0,85; p <0,001). Conclusões Embora os estudos em larga escala tenham demonstrado uma correlação positiva entre os níveis de TFGe e sTWEAK, alguns estudos detectaram que o aumento nos níveis de sTWEAK estão associados a mortalidade e gravidade do sistema da artéria coronária em pacientes com DRC. Nossos resultados comprovam nossa hipótese de que os níveis de sTWEAK mostram calcificação coronária em vez de outros tipos de placas ateroscleróticas.
Collapse
|
203
|
Krievins D, Zellans E, Latkovskis G, Babuskina I, Kumsars I, Jegere S, Zvaigzne L, Krievina AK, Erglis A, Zarins CK. Coronary Revascularization of Patients with Silent Coronary Ischemia May Reduce the Risk of Myocardial Infarction and Cardiovascular Death Following Carotid Endarterectomy. J Vasc Surg 2022; 76:750-759. [PMID: 35667605 DOI: 10.1016/j.jvs.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/03/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Major adverse cardiac events (MACE) are the primary cause of death following carotid endarterectomy (CEA). We sought to determine whether selective coronary revascularization of CEA patients with asymptomatic coronary ischemia can reduce the risk of MACE, myocardial infarction (MI) and cardiac death following endarterectomy compared to CEA patients receiving standard cardiac evaluation and care. METHODS Two groups of patients with no cardiac history or symptoms undergoing elective CEA were compared. Group I: patients enrolled in a prospective study of non-invasive pre-operative cardiac evaluation using coronary CT-derived fractional flow reserve (FFRCT) to detect asymptomatic (silent) coronary ischemia with selective post-operative coronary revascularization. Group II: matched Control patients with standard pre-operative cardiac evaluation and no post-operative coronary revascularization. Lesion-specific coronary ischemia in Group I was defined as FFRCT ≤0.80 distal to coronary stenosis with severe ischemia defined as FFRCT ≤0.75. Endpoints included MACE, cardiac death, MI, cardiovascular (CV) death, stroke and all-cause death through 3-year follow up. RESULTS Group I (n=100) and Group II (n=100) patients were similar in age (68 vs 67 years), gender (65% vs 62% male), co-morbidities and indications for CEA (53% vs 48% symptomatic carotid stenosis). In Group I FFRCT analysis revealed lesion-specific coronary ischemia in 57% of patients, severe coronary ischemia in 44%, left main ischemia in 7% and multivessel ischemia in 28%. The status of coronary ischemia in Group II was unknown. CEA was performed without complications in both groups and all patients received optimal post-operative medical therapy. In Group I, elective coronary revascularization was performed in 33 patients (27 PCI; 6 CABG) 1-3 months following CEA. Group II patients had no elective coronary revascularization. During 3-year follow-up, compared to Group II, Group I patients had fewer MACE (4% vs 17%, HR 0.21 [95% CI 0.07-0.63], P=.004), fewer cardiac deaths (2% vs 9%, HR 0.20 [95% CI 0.04-0.95], P=.030), fewer MIs (3% vs 17%, HR 0.16 [95% CI 0.05-0.54], P=.001) and fewer CV deaths (2% vs 12%, HR 0.16 [95% CI 0.004-0.07], P=0.009). There were no significant differences in the rates of stroke or all-cause death. CONCLUSIONS Pre-operative diagnosis of silent coronary ischemia with selective coronary revascularization following CEA may reduce the risk of MACE, cardiac death, MI and CV death during 3-year follow up compared to CEA patients receiving standard cardiac evaluation and care.
Collapse
Affiliation(s)
- Dainis Krievins
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia.
| | - Edgars Zellans
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | - Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | | | - Indulis Kumsars
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | - Sanda Jegere
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | - Ligita Zvaigzne
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | | | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia
| | | |
Collapse
|
204
|
Mortensen MB, Dzaye O, Razavi AC, Jensen JM, Steffensen FH, Bøtker HE, Cainzos-Achirica M, Sørensen HT, Maeng M, Blaha MJ, Nasir K, Nørgaard BL. Association between REDUCE-IT criteria, coronary artery disease severity and cardiovascular events: The Western Denmark Heart Registry. Eur J Prev Cardiol 2022; 29:1802-1810. [PMID: 35653637 DOI: 10.1093/eurjpc/zwac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/11/2022]
Abstract
AIMS The REDUCE-IT trial demonstrated that icosapent ethyl lowered the risk of atherosclerotic cardiovascular disease (ASCVD) among patients with elevated triglycerides. However, how to appropriately implement its use in clinical practice is not well-defined.We aimed to determine whether plaque burden as assessed by coronary artery calcium (CAC) could stratify ASCVD risk among patients eligible for icosapent ethyl. METHODS AND RESULTS Among 23,759 patients who underwent computed tomography angiography (CTA) in the Western Denmark Heart Registry, we identified eligibility for the REDUCE-IT trial. A total of 2146 participants (9%) met enrollment criteria for REDUCE-IT. During a median of 4.3 years of follow-up, 146 ASCVD events occurred. Overall, there was a stepwise increase in ASCVD event rates per 1,000 person-years with increasing CAC (CAC = 0: 10.5, CAC 1-299: 18.7, CAC ≥300: 49.8). REDUCE-IT eligible patients with CAC ≥300 had a multivariable-adjusted hazard ratio of 3.1 compared to CAC = 0 (95%CI: 1.9-4.9). CAC differentiated risk similarly in patients with and without obstructive CAD. Overall, the 5-year estimated number needed to treat to prevent one event with icosapent ethyl was 45 and ranged from 87 in those with CAC = 0 to 17 in those with CAC ≥300. Some patients with non-obstructive CAD had lower estimated NNT than patients with obstructive CAD when their plaque burden was higher. CONCLUSION Atherosclerotic plaque burden as assessed by CAC can identify REDUCE-IT eligible patients who are expected to derive most, and least, absolute benefit from treatment with icosapent ethyl regardless of obstructive versus nonobstructive CAD status.
Collapse
Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
| | | |
Collapse
|
205
|
Weir-McCall JR, Sarnak MJ, Nørgaard BL. The challenge of cardiovascular risk assessment in Chronic Kidney Disease; is there a role for CTA and FFRCT? J Cardiovasc Comput Tomogr 2022; 16:452-453. [DOI: 10.1016/j.jcct.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/08/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
|
206
|
Won KB, Lee BK, Heo R, Park HB, Lin FY, Hadamitzky M, Kim YJ, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, de Araújo Gonçalves P, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Bax JJ, Min JK, Chang HJ. Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels. JACC: ASIA 2022; 2:311-319. [PMID: 36338409 PMCID: PMC9627907 DOI: 10.1016/j.jacasi.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
Background Despite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited. Objectives The authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA). Methods A total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm3/year) was defined as total PVC divided by the interscan period. Results Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P = 0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β = −0.114) in overall participants (P < 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β = −2.401; P = 0.004). Conclusions Serial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411)
Collapse
Affiliation(s)
- Ki-Bum Won
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Address for correspondence: Dr Byoung Kwon Lee, Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06237, South Korea.
| | - Ran Heo
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyung-Bok Park
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Department of Cardiology, Catholic Kwandong University International St. Mary’s Hospital, Incheon, South Korea
| | - Fay Y. Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
| | | | | | | | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Jonathon A. Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sang-Eun Lee
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | - Habib Samady
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Daniel S. Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York, USA
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - James K. Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Hyuk-Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
| |
Collapse
|
207
|
Hollenberg EJ, Lin F, Blaha MJ, Budoff MJ, van den Hoogen IJ, Gianni U, Lu Y, Bax AM, van Rosendael AR, Tantawy SW, Andreini D, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, de Araújo Gonçalves P, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Gimelli A, Lee SE, Bax JJ, Berman DS, Sellers SL, Leipsic JA, Blankstein R, Narula J, Chang HJ, Shaw LJ. Relationship Between Coronary Artery Calcium and Atherosclerosis Progression Among Patients With Suspected Coronary Artery Disease. JACC Cardiovasc Imaging 2022; 15:1063-1074. [PMID: 35680215 DOI: 10.1016/j.jcmg.2021.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among symptomatic patients, it remains unclear whether a coronary artery calcium (CAC) score alone is sufficient or misses a sizeable burden and progressive risk associated with obstructive and nonobstructive atherosclerotic plaque. OBJECTIVES Among patients with low to high CAC scores, our aims were to quantify co-occurring obstructive and nonobstructive noncalcified plaque and serial progression of atherosclerotic plaque volume. METHODS A total of 698 symptomatic patients with suspected coronary artery disease (CAD) underwent serial coronary computed tomographic angiography (CTA) performed 3.5 to 4.0 years apart. Atherosclerotic plaque was quantified, including by compositional subgroups. Obstructive CAD was defined as ≥50% stenosis. Multivariate linear regression models were used to measure atherosclerotic plaque progression by CAC scores. Cox proportional hazard models estimated CAD event risk (median of 10.7 years of follow-up). RESULTS Across baseline CAC scores from 0 to ≥400, total plaque volume ranged from 30.4 to 522.4 mm3 (P < 0.001) and the prevalence of obstructive CAD increased from 1.4% to 49.1% (P < 0.001). Of those with a 0 CAC score, 97.9% of total plaque was noncalcified. Among patients with baseline CAC <100, nonobstructive CAD was prevalent (40% and 89% in CAC scores of 0 and 1-99), with plaque largely being noncalcified. On the follow-up coronary CTA, volumetric plaque growth (P < 0.001) and the development of new or worsening stenosis (P < 0.001) occurred more among patients with baseline CAC ≥100. Progression varied compositionally by baseline CAC scores. Patients with no CAC had disproportionate growth in noncalcified plaque, and for every 1 mm3 increase in calcified plaque, there was a 5.5 mm3 increase in noncalcified plaque volume. By comparison, patients with CAC scores of ≥400 exhibited disproportionate growth in calcified plaque with a volumetric increase 15.7-fold that of noncalcified plaque. There was a graded increase in CAD event risk by the CAC with rates from 3.3% for no CAC to 21.9% for CAC ≥400 (P < 0.001). CONCLUSIONS CAC imperfectly characterizes atherosclerotic disease burden, but its subgroups exhibit pathogenic patterns of early to advanced disease progression and stratify long-term prognostic risk.
Collapse
Affiliation(s)
- Emma J Hollenberg
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA; Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fay Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Inge J van den Hoogen
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Umberto Gianni
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, USA
| | - A Maxim Bax
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Alexander R van Rosendael
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sara W Tantawy
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | | | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | | | | | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul South Korea
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Sang-Eun Lee
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie L Sellers
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul South Korea
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York, USA.
| |
Collapse
|
208
|
Allmendinger T, Nowak T, Flohr T, Klotz E, Hagenauer J, Alkadhi H, Schmidt B. Photon-Counting Detector CT-Based Vascular Calcium Removal Algorithm: Assessment Using a Cardiac Motion Phantom. Invest Radiol 2022; 57:399-405. [PMID: 35025834 PMCID: PMC9071027 DOI: 10.1097/rli.0000000000000853] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The diagnostic performance of coronary computed tomography angiography is known to be negatively affected by the presence of severely calcified plaques in the coronary arteries. In this article, the performance of a novel image reconstruction algorithm (PureLumen) based on spectral CT data of a first-generation dual-source photon-counting detector computed tomography (PCD-CT) system was assessed in a phantom study. PureLumen tries to remove only the calcified contributions from the image while leaving the rest unmodified. MATERIALS AND METHODS The study uses 2 iodine contrast filled vessel phantoms (diameter 4 mm) filled with different concentrations of iodine and equipped with calcified stenosis inserts. Each phantom features 2 separate calcified lesions of 25% and 50% percentage diameter stenosis (PDS) size. The vessel phantoms were mounted inside an anthropomorphic thorax phantom attached to an artificial motion device, simulating realistic cardiac motion at heart rates between 50 beats per minute and 100 beats per minute. Acquisitions were performed using a prospectively electrocardiogram triggered dual-source sequence mode on a PCD-CT system (NAEOTOM Alpha, Siemens Healthineers). Images were reconstructed at 80% of the RR interval with virtual monoenergetic images (Mono) and with additional calcium-removal (PureLumen), both at 65 keV. PureLumen is based on a spectral base material decomposition into iodine and calcium, which aims to reconstruct images without calcium contributions, while leaving all other material contribution unchanged. Stenosis grade was assessed individually for each vessel insert in all reconstructed image series by 2 readers. RESULTS The measured median PDS values for the 50% lesion were 56.0% (52.0%, 57.0%) for the Mono case and 50.0% (48.5%, 51.0%) for PureLumen. The 25% lesion median PDS values were 36.0% (29.5%, 39.5%) for Mono and 31.5% (30.5%, 34.0%) for PureLumen. Both lesion sizes demonstrate a significant difference between Mono and PureLumen in their result (P < 0.05) with PureLumen median values being closer to the actual true stenosis size for the 50% and 25% lesion. A visual assessment of the image quality depending on the heart rate yielded good image quality up to a heart rate of 80 beats per minute in the PureLumen case. CONCLUSIONS This phantom study shows that a novel calcium-removal image reconstruction algorithm (PureLumen) using a first-generation dual-source PCD-CT effectively decreases blooming artifacts caused by heavily calcified plaques and improves image interpretability. It also shows that PureLumen retains its performance in the presence of motion with simulated heart rates up to 80 beats per minute. Future in vivo clinical studies are needed to confirm the benefits of this type of reconstruction in terms of coronary computed tomography angiography quality and accuracy.
Collapse
Affiliation(s)
| | | | - Thomas Flohr
- From Siemens Healthcare GmbH, Forchheim
- University Tübingen, Tübingen
| | | | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard Schmidt
- From Siemens Healthcare GmbH, Forchheim
- University Erlangen, Erlangen, Germany
| |
Collapse
|
209
|
Mickley H, Veien KT, Gerke O, Lambrechtsen J, Rohold A, Steffensen FH, Husic M, Akkan D, Busk M, Jessen LB, Jensen LO, Diederichsen A, Øvrehus KA. Diagnostic and Clinical Value of FFR CT in Stable Chest Pain Patients With Extensive Coronary Calcification: The FACC Study. JACC Cardiovasc Imaging 2022; 15:1046-1058. [PMID: 35680213 DOI: 10.1016/j.jcmg.2021.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The influence of extensive coronary calcifications on the diagnostic and prognostic value of coronary computed tomography angiography-derived fractional flow reserve (FFRCT) has been scantily investigated. OBJECTIVES The purpose of this study was to investigate the diagnostic and short-term role of FFRCT in chest pain patients with Agatston score (AS) >399. METHODS This was a prospective multicenter study of 260 stable patients with suspected coronary artery disease (CAD) and AS >399. FFRCT was measured blinded by an independent core laboratory. All patients underwent invasive coronary angiography (ICA) and FFR if indicated. The agreement of FFRCT ≤0.80 with hemodynamically significant CAD on ICA/FFR (≥50% left main or ≥70% epicardial artery stenosis and/or FFR ≤0.80) was assessed. Patients undergoing FFR had colocation FFRCT measured, and the lowest per-patient FFRCT was registered in all patients. The association among per-patient FFRCT, coronary revascularization, and major clinical events (all-cause mortality, myocardial infarction, or unstable angina hospitalization) at 90-day follow-up was evaluated. RESULTS Median age and AS were 68.5 years (IQR: 63-74 years) and 895 (IQR: 587-1,513), respectively. FFRCT was ≤0.80 in 204 patients (78%). Colocation FFRCT (n = 112) showed diagnostic accuracy, sensitivity, and specificity to identify hemodynamically significant CAD of 71%, 87%, and 54%. The area under the receiver-operating characteristics curve (AUC) was 0.75. When using the lowest FFRCT (n = 260), per-patient accuracy, sensitivity, and specificity were 57%, 95%, and 32%, respectively. The AUC was 0.84. A total of 85 patients underwent revascularization, and FFRCT was ≤0.80 in 96% of these. During follow-up, major clinical events occurred in 3 patients (1.2%), all with FFRCT ≤0.80. CONCLUSIONS Most patients with AS >399 had FFRCT ≤0.80. Using ICA/FFR as the reference revealed a moderate diagnostic accuracy of colocation FFRCT. Compared with the lowest per-patient FFRCT, colocation FFRCT measurement improved diagnostic accuracy and specificity. The 90-day follow-up was favorable with few coronary revascularizations and no major clinical events occurring in patients with FFRCT >0.80. (Use of FFR-CT in Stable Intermediate Chest Pain Patients With Severe Coronary Calcium Score [FACC]; NCT03548753).
Collapse
Affiliation(s)
- Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Karsten T Veien
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Allan Rohold
- Department of Cardiology, Esbjerg Hospital, Esbjerg, Denmark
| | | | - Mirza Husic
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | - Dilek Akkan
- Department of Cardiology, Esbjerg Hospital, Esbjerg, Denmark
| | - Martin Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - Louise B Jessen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
210
|
Mendoza-Pinto C, Munguía-Realpzo P, García-Carrasco M, Godinez-Bolaños K, Rojas-Villarraga A, Morales-Etchegaray I, Ayón-Aguilar J, Méndez-Martínez S, Cervera R. Asymptomatic coronary artery disease assessed by coronary computed tomography in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Eur J Intern Med 2022; 100:102-109. [PMID: 35410814 DOI: 10.1016/j.ejim.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) assessed by coronary computed tomography (CT) in patients with systemic lupus erythematosus (SLE) has been investigated in several studies, but with conflicting results. The aim of this systematic review and meta-analysis of the literature was synthesize the evidence on this topic. METHODS The relevant literature was identified and evaluated from inception until January 2021 in PubMed, Embase, Web of Science and Cochrane library. Studies reporting coronary artery calcification (CAC), and its prevalence and extent using the coronary calcium score (CCS) were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI) and weighted mean differences (WMD) with 95%CI. RESULTS Twenty-four studies were eligible for inclusion. For the CAC prevalence, 11 studies were included (918 SLE patients and 3952 controls) and the pooled prevalence for the random effect was 29.8% (95%CI 25.7-32.9%) for SLE patients and 11.8% (95%CI 16.2-20.4%) in controls (RR 2.22, 95%CI 1.42 to 3.48; p= 0.0005) and no significant increase in the WMD for CCS (MD= 0.32, 95%CI -5.55 to 6.20, p= 0.91) compared with controls in seven studies. Greater organ damage and glucocorticoid use has been associated with a higher CCS. According to two studies, the coronary CT angiography calcified and non-calcified plaque burden were increased in SLE patients compared with controls. CONCLUSIONS In SLE, asymptomatic CAD by CAC is more prevalent and there is more multivessel disease compared with controls without lupus. However, the extent of CAC was not increased in SLE patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021228710.
Collapse
Affiliation(s)
- Claudia Mendoza-Pinto
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico; Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE, Mexican Social Security Institute, Puebla, México.
| | - Pamela Munguía-Realpzo
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Karla Godinez-Bolaños
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | | | - Ivet Morales-Etchegaray
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Jorge Ayón-Aguilar
- Research in Health Coordination, Mexican Social Security Institute, Puebla, México.
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
| |
Collapse
|
211
|
Lee SE, Sung JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Shin S, Kitslaar PH, Reiber JH, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Association Between Changes in Perivascular Adipose Tissue Density and Plaque Progression. JACC Cardiovasc Imaging 2022; 15:1760-1767. [DOI: 10.1016/j.jcmg.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
|
212
|
Alnabelsi T, Ahmed AI, Han Y, Al Rifai M, Nabi F, Cainzos-Achirica M, Al-Mallah MH. Added Prognostic Value of Plaque Burden to Computed Tomography Angiography and Myocardial Perfusion Imaging in Patients with Diabetes. Am J Med 2022; 135:761-768.e7. [PMID: 35081387 DOI: 10.1016/j.amjmed.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to compare the added prognostic value of plaque burden to cardiac computed tomographic angiography (CCTA) anatomic assessment and single-photon emission computed tomography (SPECT) physiologic assessment in patients with diabetes undergoing both tests. METHODS Consecutive patients with diabetes who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected coronary artery disease were included. Stenosis severity and segment involvement score (SIS) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed from date of imaging for major adverse cardiovascular events (MACE). RESULTS A total of 778 patients were included (mean age 60.6 ± 14.4 years, 55% males). After a median follow-up of 31 months, 87 (11%) patients experienced a MACE. In multivariable Cox regression models, SIS significantly predicted outcomes in models including obstructive stenosis and ischemia (hazard ratio 1.17, 95% confidence interval 1.10-1.24, P < .001; hazard ratio 1.16, 95% confidence interval 1.10-1.23, P < .001, respectively), and improved discrimination (Harrel's C 0.75, P = .006; 0.76, P = .006 in models with CCTA obstructive stenosis and SPECT ischemia, respectively). Results were consistent using subgroups of summed scores by composition of plaque (calcified vs noncalcified) and alternate definitions of obstructive stenosis. CONCLUSION Our results suggest that in high-risk patients with diabetes and suspected coronary disease, SIS has incremental prognostic value over ischemia by SPECT or stenosis by CCTA in predicting incident cardiovascular outcomes.
Collapse
Affiliation(s)
| | | | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
| | | | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
| | | | | |
Collapse
|
213
|
Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, Dyke CK, Ferencik M, Heitner JF, Henry TD, Hung J, Knuuti J, Lindner JR, Phillips LM, Raman SV, Rao SV, Rybicki FJ, Saraste A, Stainback RF, Thompson RC, Williamson E, Nieman K, Tremmel JA, Woodard PK, Di Carli MF, Chandrashekhar YS. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging 2022; 15:912-926. [PMID: 35512960 DOI: 10.1016/j.jcmg.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jeroen Bax
- Heart Center, Turku University Hospital, Turku, Finland; Leiden University Medical Centre, Leiden, the Netherlands
| | - Dennis A Calnon
- Ohio Health Heart & Vascular Physicians, Columbus, Ohio, USA
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Subha V Raman
- Indiana University CV Institute and Krannert CV Research Center, Indianapolis, Indiana, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frank J Rybicki
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Raymond F Stainback
- Texas Heart Institute and Baylor College of Medicine, Division of Cardiology, Houston, Texas, USA
| | - Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Koen Nieman
- Stanford University, Palo Alto, California, USA
| | | | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
214
|
Coronary Atherosclerosis, Cardiac Troponin, and Interleukin-6 in Patients With Chest Pain. JACC: CARDIOVASCULAR IMAGING 2022; 15:1427-1438. [PMID: 35926901 PMCID: PMC9353061 DOI: 10.1016/j.jcmg.2022.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased inflammation and myocardial injury can be observed in the absence of myocardial infarction or obstructive coronary artery disease (CAD). OBJECTIVES The authors determined whether biomarkers of inflammation and myocardial injury-interleukin (IL)-6 and high-sensitivity cardiac troponin (hs-cTn)-were associated with the presence and extent of CAD and were independent predictors of major adverse cardiovascular events (MACEs) in stable chest pain. METHODS Using participants from the PROMISE trial, the authors measured hs-cTn I and IL-6 concentrations and analyzed computed tomography angiography (CTA) images in the core laboratory for CAD characteristics: significant stenosis (≥70%), high-risk plaque (HRP), Coronary Artery Disease Reporting and Data System (CAD-RADS) categories, segment involvement score (SIS), and coronary artery calcium (CAC) score. The primary endpoint was a composite MACE (death, myocardial infarction, or unstable angina). RESULTS The authors included 1,796 participants (age 60.2 ± 8.0 years; 47.5% men, median follow-up 25 months). In multivariable linear regression adjusted for atherosclerotic cardiovascular disease (ASCVD) risk, hs-cTn was associated with HRP, stenosis, CAD-RADS, and SIS. IL-6 was only associated with stenosis and CAD-RADS. hs-cTn above median (1.5 ng/L) was associated with MACEs in univariable analysis (HR: 2.1 [95% CI: 1.3-3.6]; P = 0.006), but not in multivariable analysis adjusted for ASCVD and CAD. IL-6 above median (1.8 ng/L) was associated with MACEs in multivariable analysis adjusted for ASCVD and HRP (HR: 1.9 [95% CI: 1.1-3.3]; P = 0.03), CAC (HR: 1.9 [95% CI: 1.0-3.4]; P = 0.04), and SIS (HR: 1.8 [95% CI: 1.0-3.2]; P = 0.04), but not for stenosis or CAD-RADS. In participants with nonobstructive CAD (stenosis 1%-69%), the presence of both hs-cTn and IL-6 above median was strongly associated with MACEs (HR: 2.5-2.7 after adjustment for CAD characteristics). CONCLUSIONS Concentrations of hs-cTn and IL-6 were associated with CAD characteristics and MACEs, indicating that myocardial injury and inflammation may each contribute to pathways in CAD pathophysiology. This association was most pronounced among participants with nonobstructive CAD representing an opportunity to tailor treatment in this at-risk group. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
Collapse
|
215
|
Fischer AM, Decker JA, Schoepf J, Varga-Szemes A, Flohr T, Schmidt B, Gutjahr R, Sahbaee P, Giovagnoli DA, Emrich T, Martinez JD, Lari KB, Bayer RR, Martin SS. Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm. Br J Radiol 2022; 95:20201456. [PMID: 35084228 PMCID: PMC10993975 DOI: 10.1259/bjr.20201456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.
Collapse
Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- University Department of Geriatric Medicine FELIX PLATTER and
University of Basel, Basel,
Switzerland
| | - Josua A. Decker
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg,
Augsburg, Germany
| | - Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | | | | | | | | | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Medical Center, Mainz,
Germany
- German Center for Cardiovascular Research (DZHK), Partner Site
Rhine Main, Mainz,
Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Kia B Lari
- University of South Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
| | - Robert R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, South
Carolina, USA
| | - Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Frankfurt,
Frankfurt, Germany
| |
Collapse
|
216
|
Pezel T, Hovasse T, Lefèvre T, Sanguineti F, Unterseeh T, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Prognostic Value of Stress CMR in Symptomatic Patients With Coronary Stenosis on CCTA. JACC Cardiovasc Imaging 2022; 15:1408-1422. [DOI: 10.1016/j.jcmg.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
|
217
|
van Rosendael AR, van den Hoogen IJ, Lin FY, Gianni U, Lu Y, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJ, Conte E, Cury RC, Feuchtner G, de Araújo Gonçalves P, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Raff GL, Villines TC, Lee SE, Al’Aref SJ, Baskaran L, Cho I, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Min JK, Narula J, Berman DS, Chang HJ, Shaw LJ, Bax JJ. Age related compositional plaque burden by CT in patients with future ACS. J Cardiovasc Comput Tomogr 2022; 16:491-497. [DOI: 10.1016/j.jcct.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
|
218
|
Achenbach S. [Cardiac computed tomography - Current diagnostic role in cardiology]. Dtsch Med Wochenschr 2022; 147:549-556. [PMID: 35468636 DOI: 10.1055/a-1554-8450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Computed tomography (CT) imaging of the heart requires specific equipment and protocols in order to synchronize image generation with the electrocardiogram (ECG), usually achieved via ECG-gated reconstruction or ECG-triggered acquisition. The main application of cardiac CT is coronary artery imaging. Contrast-enhanced coronary artery CT allows the identification and rule-out of stenoses and is a diagnostic approach to patients with suspected chronic coronary artery disease or acute chest pain, provided that patient characteristics are associated with a high likelihood of fully diagnostic image quality. In addition, CT has the potential to visualize coronary atherosclerotic plaque, even if non-obstructive, and data suggest that this may be a valuable guide towards more intensive risk modification strategy such as statin therapy. In recent years, the use of CT imaging to guide structural heart interventions has become another important application, and many interventions, such as transcatheter aortic valve implantation, substantially depend on CT imaging to plan the procedure, minimize risks, and optimize outcome.
Collapse
|
219
|
Rottländer D, Saal M, Ögütcü A, Degen H, Haude M. Anatomy and Topography of Coronary Sinus and Mitral Valve Annulus in Functional Mitral Regurgitation. Front Cardiovasc Med 2022; 9:868562. [PMID: 35528836 PMCID: PMC9072628 DOI: 10.3389/fcvm.2022.868562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background We aimed to investigate the anatomical relationship of the coronary sinus (CS) and the mitral valve annulus (MVA) in patients with or without functional mitral regurgitation (FMR) using a multislice CT (MSCT) software to determine (a) the distance and angle of both CS and MVA plane and (b) the mitral annulus geometry. Methods A total of 215 patients with MSCT and CS to MVA topography evaluation were enrolled in this retrospective study. Results This patient cohort included 145 patients without FMR (67.4%, FMR ≤ 1+) and 70 patients (32.6%) with clinically relevant FMR (FMR ≥ 2+). Distance and angulation of CS to MVA planes were highly variable. In all groups, no significant correlation was documented between the distance or angle of CS to MVA planes and left ventricular ejection fraction, left ventricular end-diastolic diameter, or left atrial volume. A significant increase in total CS length could be found in patients with FMR ≥ 2+ compared to the FMR ≤ 1+ group. MVA diameter, area, and perimeter were significantly increased in FMR ≥ 2+ compared to FMR ≤ 1+. In the FMR ≥ 2+ cohort 61% showed a distance of CS to MVA plane <7.8 mm and 58% revealed an angle of CS to MVA plane <14.2°. Conclusion Distance and angulation of CS to MVA topography using an MSCT approach are similar between patients with or without FMR, while CS length, MVA area, MVA perimeter, anterior-posterior diameter, and intercommissural diameter are significantly increased in all FMR subgroups. However, ~60% of FMR ≥ 2+ patients showed favorable CS to MVA topography for indirect mitral annuloplasty.
Collapse
Affiliation(s)
- Dennis Rottländer
- Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany
- Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
- Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Martin Saal
- Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany
| | - Alev Ögütcü
- Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany
| | - Hubertus Degen
- Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany
| | - Michael Haude
- Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany
- *Correspondence: Michael Haude
| |
Collapse
|
220
|
Coronary CTA With AI-QCT Interpretation: Comparison With Myocardial Perfusion Imaging for Detection of Obstructive Stenosis UsingInvasive Angiography as Reference Standard. AJR Am J Roentgenol 2022; 219:407-419. [PMID: 35441530 DOI: 10.2214/ajr.21.27289] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Deep learning frameworks have been applied to interpretation of coronary CTA performed for coronary artery disease (CAD) evaluation. Objective: To compare the diagnostic performance of myocardial perfusion imaging (MPI) and coronary CTA with artificial intelligence-quantitative CT (AI-QCT) interpretation for detection of obstructive CAD on invasive angiography, and to assess downstream impact of including coronary CTA with AI-QCT in diagnostic algorithms. Methods: This study entailed a retrospective post-hoc analysis of the derivation cohort of the prospective 23-center CREDENENCE trial. The study included 301 patients [mean age 64.4±10.2 years; 88 female, 213 male] recruited from 2014 to 2017 with stable symptoms of myocardial ischemia referred for nonemergent invasive angiography. Patients underwent coronary CTA and MPI before angiography with quantitative coronary angiography (QCA) measurements and fractional flow reserve (FFR). CTA examinations were analyzed using an FDA-cleared cloud-based software that performs AI-QCT for stenosis determination. Diagnostic performance was evaluated. Diagnostic algorithms were compared. Results: Among 102 patients with no ischemia on MPI, AI-QCT identified obstructive (≥50%) stenosis in 54%, including severe (≥70%) stenosis in 20%. Among 199 patients with ischemia on MPI, AI-QCT identified non-obstructive (1-49%) stenosis in 23%. AI-QCT had significantly higher AUC (all p<.001) than MPI for predicting ≥50% stenosis by QCA (0.88 vs 0.66), ≥70% stenosis by QCA (0.92 vs 0.81), and FFR <0.80 (0.90 vs 0.71). AI-QCT ≥50% and ischemia on stress MPI had sensitivity of 95% versus 74% and specificity of 63% versus 43% for detecting ≥50% stenosis by QCA measurement. Compared with performing MPI in all patients and those showing ischemia undergoing invasive angiography, a scenario of performing coronary CTA with AI-QCT in all patients and those showing ≥70% stenosis undergoing invasive angiography would reduce invasive angiography utilization by 39%; a scenario of performing MPI in all patients and those showing ischemia undergoing coronary CTA with AI-QCT and those with ≥70% stenosis on AI-QCT undergoing invasive angiography would reduce invasive angiography utilization by 49%. Conclusion: Coronary CTA with AI-QCT had higher diagnostic performance than MPI for detecting obstructive CAD. Clinical impact: A diagnostic algorithm incorporating AI-QCT could substantially reduce unnecessary downstream invasive testing. Trial Registration: ClinicalTrials.gov NCT02173275.
Collapse
|
221
|
Bularga A, Hung J, Daghem M, Stewart S, Taggart C, Wereski R, Singh T, Meah MN, Fujisawa T, Ferry AV, Chiong J, Jenkins WS, Strachan FE, Semple S, van Beek EJ, Williams M, Dey D, Tuck C, Baker AH, Newby DE, Dweck MR, Mills NL, Chapman AR. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study. Circulation 2022; 145:1188-1200. [PMID: 35341327 PMCID: PMC9010024 DOI: 10.1161/circulationaha.121.058542] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Type 2 myocardial infarction is caused by myocardial oxygen supply-demand imbalance, and its diagnosis is increasingly common with the advent of high-sensitivity cardiac troponin assays. Although this diagnosis is associated with poor outcomes, widespread uncertainty and confusion remain among clinicians as to how to investigate and manage this heterogeneous group of patients with type 2 myocardial infarction. METHODS In a prospective cohort study, 8064 consecutive patients with increased cardiac troponin concentrations were screened to identify patients with type 2 myocardial infarction. We excluded patients with frailty or renal or hepatic failure. All study participants underwent coronary (invasive or computed tomography angiography) and cardiac (magnetic resonance or echocardiography) imaging, and the underlying causes of infarction were independently adjudicated. The primary outcome was the prevalence of coronary artery disease. RESULTS In 100 patients with a provisional diagnosis of type 2 myocardial infarction (median age, 65 years [interquartile range, 55-74 years]; 43% women), coronary and cardiac imaging reclassified the diagnosis in 7 patients: type 1 or 4b myocardial infarction in 5 and acute myocardial injury in 2 patients. In those with type 2 myocardial infarction, median cardiac troponin I concentrations were 195 ng/L (interquartile range, 62-760 ng/L) at presentation and 1165 ng/L (interquartile range, 277-3782 ng/L) on repeat testing. The prevalence of coronary artery disease was 68% (63 of 93), which was obstructive in 30% (28 of 93). Infarct-pattern late gadolinium enhancement or regional wall motion abnormalities were observed in 42% (39 of 93), and left ventricular systolic dysfunction was seen in 34% (32 of 93). Only 10 patients had both normal coronary and normal cardiac imaging. Coronary artery disease and left ventricular systolic dysfunction were previously unrecognized in 60% (38 of 63) and 84% (27 of 32), respectively, with only 33% (21 of 63) and 19% (6 of 32) on evidence-based treatments. CONCLUSIONS Systematic coronary and cardiac imaging of patients with type 2 myocardial infarction identified coronary artery disease in two-thirds and left ventricular systolic dysfunction in one-third of patients. Unrecognized and untreated coronary or cardiac disease is seen in most patients with type 2 myocardial infarction, presenting opportunities for initiation of evidence-based treatments with major potential to improve clinical outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03338504.
Collapse
Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - John Hung
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Stacey Stewart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Caelan Taggart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Trisha Singh
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Mohammed N. Meah
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Amy V. Ferry
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Justin Chiong
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - William S. Jenkins
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Fiona E. Strachan
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Scott Semple
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Edwin J.R. van Beek
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Michelle Williams
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Chris Tuck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Andrew H. Baker
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | | | - Andrew R. Chapman
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| |
Collapse
|
222
|
Baskaran L, Neo YP, Lee JK, Yoon YE, Jiang Y, Al'Aref SJ, van Rosendael AR, Han D, Lin FY, Nakanishi R, Maurovich Horvat P, Tan SY, Villines TC, Bittencourt MS, Shaw LJ. Evaluating the Coronary Artery Disease Consortium Model and the Coronary Artery Calcium Score in Predicting Obstructive Coronary Artery Disease in a Symptomatic Mixed Asian Cohort. J Am Heart Assoc 2022; 11:e022697. [PMID: 35411790 PMCID: PMC9238474 DOI: 10.1161/jaha.121.022697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The utility of a given pretest probability score in predicting obstructive coronary artery disease (CAD) is population dependent. Previous studies investigating the additive value of coronary artery calcium (CAC) on pretest probability scores were predominantly limited to Western populations. This retrospective study seeks to evaluate the CAD Consortium (CAD2) model in a mixed Asian cohort within Singapore with stable chest pain and to evaluate the incremental value of CAC in predicting obstructive CAD. Methods and Results Patients who underwent cardiac computed tomography and had chest pain were included. The CAD2 clinical model comprised of age, sex, symptom typicality, diabetes, hypertension, hyperlipidemia, and smoking status and was compared with the CAD2 extended model that added CAC to assess the incremental value of CAC scoring, as well as to the corresponding locally calibrated local assessment of the heart models. A total of 522 patients were analyzed (mean age 54±11 years, 43.1% female). The CAD2 clinical model obtained an area under the curve of 0.718 (95% CI, 0.668–0.767). The inclusion of CAC score improved the area under the curve to 0.896 (95% CI, 0.867–0.925) in the CAD2 models and from 0.767 (95% CI, 0.721–0.814) to 0.926 (95% CI, 0.900–0.951) in the local assessment of the heart models. The locally calibrated local assessment of the heart models showed better discriminative performance than the corresponding CAD2 models (P<0.05 for all). Conclusions The CAD2 model was validated in a symptomatic mixed Asian cohort and local calibration further improved performance. CAC scoring provided significant incremental value in predicting obstructive CAD.
Collapse
Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Yu Pei Neo
- Duke-National University of Singapore Singapore
| | | | | | - Yilin Jiang
- Department of Cardiology National Heart Centre Singapore
| | - Subhi J Al'Aref
- Division of Cardiology Department of Medicine University of Arkansas for Medical Sciences Little Rock AR
| | | | - Donghee Han
- Department of Imaging Cedars-Sinai Medical Center Los Angeles CA
| | - Fay Y Lin
- Department of Radiology New York-Presbyterian Hospital and Weill Cornell Medicine New York NY
| | - Rine Nakanishi
- Department of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo Japan
| | | | - Swee Yaw Tan
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Todd C Villines
- Division of Cardiovascular Medicine University of Virginia Health System Charlottesville VA
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research University Hospital University of Sao Paulo School of Medicine Sao Paulo Brazil
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute Mount Sinai School of Medicine New York NY
| |
Collapse
|
223
|
Welch T, Rampersad F, Motilal S, Seecheran NA. Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study. Open Heart 2022; 9:openhrt-2021-001922. [PMID: 35354659 PMCID: PMC8968509 DOI: 10.1136/openhrt-2021-001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. Methods Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. Results One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). Conclusions Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. Trial registration number NCT04774861.
Collapse
Affiliation(s)
- Tonya Welch
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Fidel Rampersad
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| |
Collapse
|
224
|
Karout L, Salman R, Ershaid F, Sawaya F, Abi-Ghanem AS. Imaging Modalities Employed in the TAVR Procedure With a Focus on CTA: What the Radiologist Needs to Know. Acad Radiol 2022; 29 Suppl 4:S69-S81. [PMID: 34551883 DOI: 10.1016/j.acra.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic stenosis (AS) is one of the most common valvular heart disease. Symptomatic AS is associated with a high mortality rate which prompts fast intervention. The introduction of transcatheter aortic valve replacement (TAVR) has drastically improved the outcome of high surgical risk for mortality patients with severe AS. However, this procedure requires the employment of multimodality imaging in the pre-procedural planning, intra-procedural optimization, and post-procedural follow-up stages. This also requires an accurate understanding of the indications, measurements, strength, and limitations of each imaging modality during the different TAVR stages. CONCLUSION In this review, we aim to outline to radiologists the evidence-based approach and indications of different imaging modalities through the pre, peri, and post TAVR stages.
Collapse
|
225
|
Incremental prognostic value of spect over CCTA. Int J Cardiol 2022; 358:120-127. [DOI: 10.1016/j.ijcard.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022]
|
226
|
Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J, Pieszko K, Razipour A, Grodecki K, Park C, Otaki Y, Doris M, Kwan AC, Han D, Kuronuma K, Flores Tomasino G, Tzolos E, Shanbhag A, Goeller M, Marwan M, Gransar H, Tamarappoo BK, Cadet S, Achenbach S, Nicholls SJ, Wong DT, Berman DS, Dweck M, Newby DE, Williams MC, Slomka PJ, Dey D. Deep learning-enabled coronary CT angiography for plaque and stenosis quantification and cardiac risk prediction: an international multicentre study. Lancet Digit Health 2022; 4:e256-e265. [PMID: 35337643 PMCID: PMC9047317 DOI: 10.1016/s2589-7500(22)00022-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atherosclerotic plaque quantification from coronary CT angiography (CCTA) enables accurate assessment of coronary artery disease burden and prognosis. We sought to develop and validate a deep learning system for CCTA-derived measures of plaque volume and stenosis severity. METHODS This international, multicentre study included nine cohorts of patients undergoing CCTA at 11 sites, who were assigned into training and test sets. Data were retrospectively collected on patients with a wide range of clinical presentations of coronary artery disease who underwent CCTA between Nov 18, 2010, and Jan 25, 2019. A novel deep learning convolutional neural network was trained to segment coronary plaque in 921 patients (5045 lesions). The deep learning network was then applied to an independent test set, which included an external validation cohort of 175 patients (1081 lesions) and 50 patients (84 lesions) assessed by intravascular ultrasound within 1 month of CCTA. We evaluated the prognostic value of deep learning-based plaque measurements for fatal or non-fatal myocardial infarction (our primary outcome) in 1611 patients from the prospective SCOT-HEART trial, assessed as dichotomous variables using multivariable Cox regression analysis, with adjustment for the ASSIGN clinical risk score. FINDINGS In the overall test set, there was excellent or good agreement, respectively, between deep learning and expert reader measurements of total plaque volume (intraclass correlation coefficient [ICC] 0·964) and percent diameter stenosis (ICC 0·879; both p<0·0001). When compared with intravascular ultrasound, there was excellent agreement for deep learning total plaque volume (ICC 0·949) and minimal luminal area (ICC 0·904). The mean per-patient deep learning plaque analysis time was 5·65 s (SD 1·87) versus 25·66 min (6·79) taken by experts. Over a median follow-up of 4·7 years (IQR 4·0-5·7), myocardial infarction occurred in 41 (2·5%) of 1611 patients from the SCOT-HEART trial. A deep learning-based total plaque volume of 238·5 mm3 or higher was associated with an increased risk of myocardial infarction (hazard ratio [HR] 5·36, 95% CI 1·70-16·86; p=0·0042) after adjustment for the presence of deep learning-based obstructive stenosis (HR 2·49, 1·07-5·50; p=0·0089) and the ASSIGN clinical risk score (HR 1·01, 0·99-1·04; p=0·35). INTERPRETATION Our novel, externally validated deep learning system provides rapid measurements of plaque volume and stenosis severity from CCTA that agree closely with expert readers and intravascular ultrasound, and could have prognostic value for future myocardial infarction. FUNDING National Heart, Lung, and Blood Institute and the Miriam & Sheldon G Adelson Medical Research Foundation.
Collapse
Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aditya Killekar
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Jacek Kwiecinski
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Pieszko
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology, Collegium Medicum, University of Zielona Góra, Poland
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alan C Kwan
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guadalupe Flores Tomasino
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Aakash Shanbhag
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus Goeller
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji K Tamarappoo
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Dennis T Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marc Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Piotr J Slomka
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
227
|
Yan H, Zhao N, Geng W, Hou Z, Gao Y, Lu B. Pericoronary fat attenuation index and coronary plaque quantified from coronary computed tomography angiography identify ischemia-causing lesions. Int J Cardiol 2022; 357:8-13. [PMID: 35306030 DOI: 10.1016/j.ijcard.2022.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between pericoronary fat attenuation index (FAI), plaque characteristics, and lesion-specific ischemia identified by fractional flow reserve (FFR) remains unclear. METHODS Coronary computed tomography angiography (CCTA) stenosis, FAI, plaque characteristics, FFR derived from computed tomography (FFRCT) and FFR were assessed in 280 vessels of 247 patients. Stenosis ≥50% was considered obstructive. Optimal thresholds of FAI and plaque variables were defined by the area under the receiver-operating characteristics curve (AUC) analysis. Ischemia was defined by FFR ≤ 0.80. RESULTS FAI ≥ -71.9 HU, low-attenuation plaque (LAP) ≥ 49.62 mm3 and aggregate plaque volume (APV) ≥ 28.91% predicted ischemia independent of other plaque characteristics. The addition of FAI ≥ -71.9 HU improved discrimination (AUC, 0.720 vs. 0.674, P = 0.035) and reclassification abilities (category-free net reclassification index [NRI], 0.470, P < 0.001; relative integrated discrimination improvement [IDI], 0.047, P < 0.001) of ischemia compared with stenosis evaluation alone, with further discrimination (AUC, 0.772 vs. 0.720, P = 0.028) and reclassification abilities (NRI, 0.385, P = 0.001; relative IDI, 0.077, P < 0.001) of ischemia by adding information regarding LAP ≥49.62 mm3 + APV ≥ 28.91%. And the diagnostic performance of combination approach was comparable to that of FFRCT alone (AUC, 0.772 vs. 0.762, P = 0.771). CONCLUSIONS Stenosis severity, FAI, plaque characteristics predicted lesion-specific ischemia. The combination of FAI and plaque assessment improved the discrimination of ischemia compared with stenosis assessment alone.
Collapse
Affiliation(s)
- Hankun Yan
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Na Zhao
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenlei Geng
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhihui Hou
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Gao
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| |
Collapse
|
228
|
Ming Wang TK, Chan N, Khayata M, Flanagan P, Grimm RA, Griffin BP, Husni ME, Littlejohn E, Xu B. Cardiovascular Manifestations, Imaging, and Outcomes in Systemic Lupus Erythematosus: An Eight-Year Single Center Experience in the United States. Angiology 2022; 73:877-886. [PMID: 35238664 DOI: 10.1177/00033197221078056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a challenging autoimmune and multi-system condition. With advances in cardiovascular screening and therapies for SLE patients, we evaluated the cardiovascular characteristics, multi-modality imaging, and outcomes of SLE at our tertiary referral center over an 8 year period. Consecutive patients from our SLE registry from April 2012 to March 2020 were retrospectively analyzed. Data pertaining to cardiovascular manifestations, investigations, management, and outcomes were assessed. We studied 258 SLE patients (mean age 42.2 ± 14.7 years); 233 (90.3%) were female. The main cardiac manifestations at index SLE clinic were pericardial disease in 33.3%, valve disease in 18%, cardiomyopathy in 9.6%, and stroke in 7.4%. During a mean follow-up of 3.0 ± 2.2 years after index SLE clinic, there were 5 (1.9%) deaths, 24 (9.3%) cardiovascular events, and 44 (17.1%) SLE-related hospitalizations. A history of stroke and hypertension were independently associated with cardiovascular events, hazard ratio (HR) (95% confidence intervals (CI)) of 5.38 (1.41-20.6) and 3.31 (1.02-10.7), respectively, while younger age and lower albumin predicted SLE-related hospitalizations. Cardiovascular manifestations are prevalent in SLE, especially for pericardial, valvular, and atherosclerotic diseases. With contemporary SLE and cardiovascular management, subsequent adverse cardiovascular events were infrequent in this study.
Collapse
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas Chan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Khayata
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 2569Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiovascular Sciences, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Patrick Flanagan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Littlejohn
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
229
|
Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
|
230
|
Soschynski M, Hagar MT, Taron J, Krauss T, Ruile P, Hein M, Nührenberg T, Russe MF, Bamberg F, Schlett CL. Update for the Performance of CT Coronary Angiography. ROFO-FORTSCHR RONTG 2022; 194:613-624. [PMID: 35231938 DOI: 10.1055/a-1747-3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure. METHOD The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience. RESULTS AND CONCLUSION According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI). KEY POINTS · CCTA is a valid method to exclude coronary artery disease in patients with a low to intermediate clinical likelihood.. · Even with the latest generation CT scanners, premedication with beta blockers and nitrates can improve image quality at low radiation exposure.. · Current CT scanners usually provide retrospective ECG gating and prospective ECG triggering. Dual-source scanners additionally provide a "high pitch" scan mode to scan the whole heart during one heartbeat, which may also be achieved using single-source scanners with broad detectors in some cases.. · Besides the available scanner technology, the choice of scan mode primarily depends on heart rate and heart rate variability (e. g., arrhythmia).. CITATION FORMAT · Soschynski M, Hagar MT, Taron J et al. Update for the Performance of CT Coronary Angiography. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1747-3554.
Collapse
Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany.,Cardiac MR PET CT Program, Massachusetts General-Hospital, Harvard Medical School, Boston, United States
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Thomas Nührenberg
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| |
Collapse
|
231
|
Hoshika M, Nakaura T, Oda S, Kidoh M, Nagayama Y, Sakabe D, Hirai T, Funama Y. Comparison of the effects of varying tube voltage and iodinated concentration on increasing the iodinated radiation dose in computed tomography. Phys Med 2022; 95:57-63. [DOI: 10.1016/j.ejmp.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/09/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
|
232
|
Min JK, Chang HJ, Andreini D, Pontone G, Guglielmo M, Bax JJ, Knaapen P, Raman SV, Chazal RA, Freeman AM, Crabtree T, Earls JP. Coronary CTA Plaque Volume Severity Stages According to Invasive Coronary Angiography and FFR. J Cardiovasc Comput Tomogr 2022; 16:415-422. [DOI: 10.1016/j.jcct.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
|
233
|
Budoff MJ, Lakshmanan S, Toth PP, Hecht HS, Shaw LJ, Maron DJ, Michos ED, Williams KA, Nasir K, Choi AD, Chinnaiyan K, Min J, Blaha M. Cardiac CT angiography in current practice: An American society for preventive cardiology clinical practice statement ✰. Am J Prev Cardiol 2022; 9:100318. [PMID: 35146468 PMCID: PMC8802838 DOI: 10.1016/j.ajpc.2022.100318] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
In this clinical practice statement, we represent a summary of the current evidence and clinical applications of cardiac computed tomography (CT) in evaluation of coronary artery disease (CAD), from an expert panel organized by the American Society for Preventive Cardiology (ASPC), and appraises the current use and indications of cardiac CT in clinical practice. Cardiac CT is emerging as a front line non-invasive diagnostic test for CAD, with evidence supporting the clinical utility of cardiac CT in diagnosis and prevention. CCTA offers several advantages beyond other testing modalities, due to its ability to identify and characterize coronary stenosis severity and pathophysiological changes in coronary atherosclerosis and stenosis, aiding in early diagnosis, prognosis and management of CAD. This document further explores the emerging applications of CCTA based on functional assessment using CT derived fractional flow reserve, peri‑coronary inflammation and artificial intelligence (AI) that can provide personalized risk assessment and guide targeted treatment. We sought to provide an expert consensus based on the latest evidence and best available clinical practice guidelines regarding the role of CCTA as an essential tool in cardiovascular prevention - applicable to risk assessment and early diagnosis and management, noting potential areas for future investigation.
Collapse
Affiliation(s)
- Matthew J. Budoff
- Division of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance CA, USA
| | - Suvasini Lakshmanan
- Division of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance CA, USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harvey S. Hecht
- Department of Medicine, Mount Sinai Medical Center, New York, NY
| | - Leslee J. Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J. Maron
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kim A. Williams
- Division of Cardiology, Rush University Medical Center, Chicago IL
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Andrew D. Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Kavitha Chinnaiyan
- Division of Cardiology, Department of Medicine, Beaumont Hospital, Royal Oak, MI
| | - James Min
- Chief Executive Officer Cleerly Inc., New York, NY
| | - Michael Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
234
|
Williams MC, Earls JP, Hecht H. Quantitative assessment of atherosclerotic plaque, recent progress and current limitations. J Cardiovasc Comput Tomogr 2022; 16:124-137. [PMID: 34326003 DOI: 10.1016/j.jcct.2021.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.
Collapse
Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - James P Earls
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
235
|
Shui X, Chen Z, Wen Z, Tang L, Tang W, Liao Y, Wu Z, Chen L. Association of Atherogenic Index of Plasma With Angiographic Progression in Patients With Suspected Coronary Artery Disease. Angiology 2022; 73:927-935. [PMID: 35229661 DOI: 10.1177/00033197221080911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present study aimed to explore the correlation of atherogenic index of plasma (AIP) with angiographic progression of coronary artery disease (CAD). AIP was defined as the base 10 logarithm of the ratio of the triglyceride to high-density lipoprotein cholesterol concentration. The extent of coronary lesion was assessed by the Gensini Score (GS) system and angiographic progression was defined as the GS rate of change per year >1 point. A total of 896 patients with suspected CAD who underwent coronary computed tomography angiography twice at intervals of >6 months were included. Baseline AIP was positively correlated with remnant cholesterol (r = .644, P < .001). When patients were assigned into four groups according to baseline AIP quartiles, the incidence of CAD progression significantly increased across the quartiles of AIP (Q1 [lowest]: 23.7 vs Q2: 29.9 vs Q3: 33.9 vs Q4 [highest]: 34.8%; P = .042). After multivariate adjustment, the odds ratio for CAD progression was 1.89 when comparing the highest to the lowest quartile of AIP (95% confidence interval: 1.18-3.02; P = .008). Therefore, AIP was independently correlated with angiographic progression of CAD beyond conventional risk factors, suggesting that AIP may play a role in early risk stratification as a simple surrogate of residual risk.
Collapse
Affiliation(s)
- Xing Shui
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Zefeng Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Zheqi Wen
- Department of Cardiac Care Unit, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Leile Tang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Wenyu Tang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Yixuan Liao
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Zhen Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, 144991Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
236
|
Han Y, Ahmed AI, Schwemmer C, Cocker M, Alnabelsi TS, Saad JM, Ramirez Giraldo JC, Al-Mallah MH. Interoperator reliability of an on-site machine learning-based prototype to estimate CT angiography-derived fractional flow reserve. Open Heart 2022; 9:openhrt-2021-001951. [PMID: 35314508 PMCID: PMC8938695 DOI: 10.1136/openhrt-2021-001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Advances in CT and machine learning have enabled on-site non-invasive assessment of fractional flow reserve (FFRCT). PURPOSE To assess the interoperator and intraoperator variability of coronary CT angiography-derived FFRCT using a machine learning-based postprocessing prototype. MATERIALS AND METHODS We included 60 symptomatic patients who underwent coronary CT angiography. FFRCT was calculated by two independent operators after training using a machine learning-based on-site prototype. FFRCT was measured 1 cm distal to the coronary plaque or in the middle of the segments if no coronary lesions were present. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate interoperator variability effect in FFRCT estimates. Sensitivity analysis was done by cardiac risk factors, degree of stenosis and image quality. RESULTS A total of 535 coronary segments in 60 patients were assessed. The overall ICC was 0.986 per patient (95% CI 0.977 to 0.992) and 0.972 per segment (95% CI 0.967 to 0.977). The absolute mean difference in FFRCT estimates was 0.012 per patient (95% CI for limits of agreement: -0.035 to 0.039) and 0.02 per segment (95% CI for limits of agreement: -0.077 to 0.080). Tight limits of agreement were seen on Bland-Altman analysis. Distal segments had greater variability compared with proximal/mid segments (absolute mean difference 0.011 vs 0.025, p<0.001). Results were similar on sensitivity analysis. CONCLUSION A high degree of interoperator and intraoperator reproducibility can be achieved by on-site machine learning-based FFRCT assessment. Future research is required to evaluate the physiological relevance and prognostic value of FFRCT.
Collapse
Affiliation(s)
- Yushui Han
- Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Ahmed Ibrahim Ahmed
- Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Chris Schwemmer
- Computed Tomography-Research & Development, Siemens Healthcare GmbH, Erlangen, Bayern, Germany
| | - Myra Cocker
- Computed Tomography-Research Collaborations, Siemens Healthcare USA, Malvern, Pennsylvania, USA
| | - Talal S Alnabelsi
- Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Jean Michel Saad
- Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Juan C Ramirez Giraldo
- Computed Tomography-Research Collaborations, Siemens Healthcare USA, Malvern, Pennsylvania, USA
| | - Mouaz H Al-Mallah
- Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
237
|
Nanna MG, Vemulapalli S, Fordyce CB, Mark DB, Patel MR, Al-Khalidi HR, Kelsey M, Martinez B, Yow E, Mullen S, Stone GW, Ben-Yehuda O, Udelson JE, Rogers C, Douglas PS. The prospective randomized trial of the optimal evaluation of cardiac symptoms and revascularization: Rationale and design of the PRECISE trial. Am Heart J 2022; 245:136-148. [PMID: 34953768 PMCID: PMC8979644 DOI: 10.1016/j.ahj.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinicians vary widely in their preferred diagnostic approach to patients with non-acute chest pain. Such variation exposes patients to potentially avoidable risks, as well as inefficient care with increased costs and unresolved patient concerns. METHODS The Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization (PRECISE) trial (NCT03702244) compares an investigational "precision" diagnostic strategy to a usual care diagnostic strategy in participants with stable chest pain and suspected coronary artery disease (CAD). RESULTS PRECISE randomized 2103 participants with stable chest pain and a clinical recommendation for testing for suspected CAD at 68 outpatient international sites. The investigational precision evaluation strategy started with a pre-test risk assessment using the PROMISE Minimal Risk Tool. Those at lowest risk were assigned to deferred testing (no immediate testing), and the remainder received coronary computed tomographic angiography (cCTA) with selective fractional flow reserve (FFRCT) for any stenosis meeting a threshold of ≥30% and <90%. For participants randomized to usual care, the clinical care team selected the initial noninvasive or invasive test (diagnostic angiography) according to customary practice. The use of cCTA as the initial diagnostic strategy was proscribed by protocol for the usual care strategy. The primary endpoint is time to a composite of major adverse cardiac events (MACE: all-cause death or non-fatal myocardial infarction) or invasive cardiac catheterization without obstructive CAD at 1 year. Secondary endpoints include health care costs and quality of life. CONCLUSIONS PRECISE will determine whether a precision approach comprising a strategically deployed combination of risk-based deferred testing and cCTA with selective FFRCT improves the clinical outcomes and efficiency of the diagnostic evaluation of stable chest pain over usual care.
Collapse
Affiliation(s)
- Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | | | - Christopher B. Fordyce
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Michelle Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart and the Cardiovascular Research Foundation, New York, NY
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, NY, NY and the University of California, San Diego
| | - James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| |
Collapse
|
238
|
Logan JK, Ayers MP. Noninvasive Imaging for the Asymptomatic Patient: How to Use Imaging to Guide Treatment Goals? Med Clin North Am 2022; 106:377-388. [PMID: 35227437 DOI: 10.1016/j.mcna.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Imaging subclinical atherosclerosis identifies individuals at higher risk of cardiovascular disease through direct visualization before events occur so that preventative measures can be taken. Coronary artery calcium (CAC) scans are the most widely used and studied to identify subclinical atherosclerosis and are most useful in men older than 40 years and women older than 50 years. Coronary computed tomography angiography has high prognostic value and might be the best modality for assessing subclinical atherosclerosis with incremental increase in predictive value over CAC. Ankle-brachial indexes are specific markers for cardiovascular risk but are a less sensitive tool for risk assessment.
Collapse
Affiliation(s)
- Juliette Kathleen Logan
- Division of Cardiovascular Medicine, University of Virginia, Heart and Vascular Center Fontaine, 500 Ray C. Hunt Drive, Charlottesville, VA 22903, USA.
| | - Michael Parker Ayers
- Division of Cardiovascular Medicine, University of Virginia, Heart and Vascular Center Fontaine, 500 Ray C. Hunt Drive, Charlottesville, VA 22903, USA.
| |
Collapse
|
239
|
Sun T, Wang Y, Wang X, Hu W, Li A, Li S, Xu X, Cao R, Fan L, Cao F. Effect of long-term intensive cholesterol control on the plaque progression in elderly based on CTA cohort study. Eur Radiol 2022; 32:4374-4383. [PMID: 35226154 DOI: 10.1007/s00330-022-08594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the long-term effects of intensive LDL cholesterol-lowering treatments on lumen stenosis severity, plaque calcification, spotty calcifications, percent calcified plaque volume (PCPV), and Agatston coronary artery calcium score (CACS) based on coronary computed tomography angiography (CCTA) in elderly patients. METHODS A total of 240 patients over 60 years old (comprising 754 lesions) who underwent serial CCTA were retrospectively enrolled in this 5-year cohort study. Patients were divided into three groups: an intensive lipid-lowering group, a lipid-lowering group, and a control group. The stenosis severity, plaque volume (PV), plaque composition, PCPV, and high-risk plaque (HRP) presence were quantitatively analyzed. The CACS was calculated at baseline and follow-up. RESULTS All patients were male with an average age of 66.8 ± 5.8 years old. Over time, increases in the percentages of obstructive coronary lesions (p < 0.001) were observed. Compared with those at baseline, the percentage of obstructive lesions remained unchanged (p = 0.077), and the percentage of spotty calcifications significantly decreased (p < 0.05) at the follow-up CCTA scan in the intensive lipid-lowering group. Patients in the intensive lipid-lowering group demonstrated a higher progression in calcified PV, CACS, and PCPV (all p < 0.05), and a significantly greater attenuation in fibrous-fatty and lipid-rich PV (all p < 0.05) than patients in other groups. CONCLUSIONS The PV and contents increased gradually with time in all groups. Intensive LDL-C lowering was associated with slower progression of stenosis severity and reduction of high-risk plaque features, with increased plaque calcification and higher progression in PCPV. Comprehensive serial plaque evaluations by CCTAs may contribute to further refinement of risk stratification and reasonable lipid-lowering treatment in elderly patients. KEY POINTS • Intensive LDL-C lowering increased coronary calcification and percent calcified plaque volume progression. • Comprehensive serial plaque evaluations by serial CCTAs may help to refine risk stratification.
Collapse
Affiliation(s)
- Ting Sun
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yabin Wang
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xinjiang Wang
- Department of Radiology, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenchao Hu
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Ang Li
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Sulei Li
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xian Xu
- Department of Radiology, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Ruihua Cao
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Fan
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Feng Cao
- Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
240
|
Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part I. Eur Heart J Cardiovasc Imaging 2022; 23:299-314. [PMID: 35076061 PMCID: PMC8863074 DOI: 10.1093/ehjci/jeab293] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiac computed tomography (CT) was introduced in the late 1990's. Since then, an increasing body of evidence on its clinical applications has rapidly emerged. From an initial emphasis on its technical efficiency and diagnostic accuracy, research around cardiac CT has now evolved towards outcomes-based studies that provide information on prognosis, safety, and cost. Thanks to the strong and compelling data generated by large, randomized control trials, the scientific societies have endorsed cardiac CT as pivotal diagnostic test for the management of appropriately selected patients with acute and chronic coronary syndrome. This consensus document endorsed by the European Association of Cardiovascular Imaging is divided into two parts and aims to provide a summary of the current evidence and to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. This first part focuses on the most established applications of cardiac CT from primary prevention in asymptomatic patients, to the evaluation of patients with chronic coronary syndrome, acute chest pain, and previous coronary revascularization.
Collapse
Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
| |
Collapse
|
241
|
Qiao HY, Tang CX, Schoepf UJ, Bayer RR, Tesche C, Di Jiang M, Yin CQ, Zhou CS, Zhou F, Lu MJ, Jiang JW, Lu GM, Ni QQ, Zhang LJ. One-year outcomes of CCTA alone versus machine learning-based FFR CT for coronary artery disease: a single-center, prospective study. Eur Radiol 2022; 32:5179-5188. [PMID: 35175380 DOI: 10.1007/s00330-022-08604-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/25/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore downstream management and outcomes of machine learning (ML)-based CT derived fractional flow reserve (FFRCT) strategy compared with an anatomical coronary computed tomography angiography (CCTA) alone assessment in participants with intermediate coronary artery stenosis. METHODS In this prospective study conducted from April 2018 to March 2019, participants were assigned to either the CCTA or FFRCT group. The primary endpoint was the rate of invasive coronary angiography (ICA) that demonstrated non-obstructive disease at 90 days. Secondary endpoints included coronary revascularization and major adverse cardiovascular events (MACE) at 1-year follow-up. RESULTS In total, 567 participants were allocated to the CCTA group and 566 to the FFRCT group. At 90 days, the rate of ICA without obstructive disease was higher in the CCTA group (33.3%, 39/117) than that (19.8%, 19/96) in the FFRCT group (risk difference [RD] = 13.5%, 95% confidence interval [CI]: 8.4%, 18.6%; p = 0.03). The ICA referral rate was higher in the CCTA group (27.5%, 156/567) than in the FFRCT group (20.3%, 115/566) (RD = 7.2%, 95% CI: 2.3%, 12.1%; p = 0.003). The revascularization-to-ICA ratio was lower in the CCTA group than that in the FFRCT group (RD = 19.8%, 95% CI: 14.1%, 25.5%, p = 0.002). MACE was more common in the CCTA group than that in the FFRCT group at 1 year (HR: 1.73; 95% CI: 1.01, 2.95; p = 0.04). CONCLUSION In patients with intermediate stenosis, the FFRCT strategy appears to be associated with a lower rate of referral for ICA, ICA without obstructive disease, and 1-year MACE when compared to the anatomical CCTA alone strategy. KEY POINTS • In stable patients with intermediate stenosis, ML-based FFRCT strategy was associated with a lower referral ICA rate, a lower normalcy rate of ICA, and higher revascularization-to-ICA ratio than the CCTA strategy. • Compared with the CCTA strategy, ML-based FFRCTshows superior outcome prediction value which appears to be associated with a lower rate of 1-year MACE. • ML-based FFRCT strategy as a non-invasive "one-stop-shop" modality may be the potential to change diagnostic workflows in patients with suspected coronary artery disease.
Collapse
Affiliation(s)
- Hong Yan Qiao
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.,Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, 214041, Jiangsu, China
| | - Chun Xiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.,Department of Internal Medicine, St. Johannes-Hospital, Dortmund, Germany
| | - Meng Di Jiang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Qing Yin
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Meng Jie Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jian Wei Jiang
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, 214041, Jiangsu, China
| | - Guang Ming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Qian Qian Ni
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| |
Collapse
|
242
|
Si-Mohamed SA, Boccalini S, Lacombe H, Diaw A, Varasteh M, Rodesch PA, Dessouky R, Villien M, Tatard-Leitman V, Bochaton T, Coulon P, Yagil Y, Lahoud E, Erhard K, Riche B, Bonnefoy E, Rioufol G, Finet G, Bergerot C, Boussel L, Greffier J, Douek PC. Coronary CT Angiography with Photon-counting CT: First-In-Human Results. Radiology 2022; 303:303-313. [PMID: 35166583 DOI: 10.1148/radiol.211780] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Spatial resolution, soft-tissue contrast, and dose-efficient capabilities of photon-counting CT (PCCT) potentially allow a better quality and diagnostic confidence of coronary CT angiography (CCTA) in comparison to conventional CT. Purpose To compare the quality of CCTA scans obtained with a clinical prototype PCCT system and an energy-integrating detector (EID) dual-layer CT (DLCT) system. Materials and Methods In this prospective board-approved study with informed consent, participants with coronary artery disease underwent retrospective electrocardiographically gated CCTA with both systems after injection of 65-75 mL of 400 mg/mL iodinated contrast agent at 5 mL/sec. A prior phantom task-based quality assessment of the detectability index of coronary lesions was performed. Ultra-high-resolution parameters were used for PCCT (1024 matrix, 0.25-mm section thickness) and EID DLCT (512 matrix, 0.67-mm section thickness). Three cardiac radiologists independently performed a blinded analysis using a five-point quality score (1 = insufficient, 5 = excellent) for overall image quality, diagnostic confidence, and diagnostic quality of calcifications, stents, and noncalcified plaques. A logistic regression model, adjusted for radiologists, was used to evaluate the proportion of improvement in scores with the best method. Results Fourteen consecutive participants (12 men; mean age, 61 years ± 17) were enrolled. Scores of overall quality and diagnostic confidence were higher with PCCT images with a median of 5 (interquartile range [IQR], 2) and 5 (IQR, 1) versus 4 (IQR, 1) and 4 (IQR, 3) with EID DLCT images, using a mean tube current of 255 mAs ± 0 versus 349 mAs ± 111 for EID DLCT images (P < .01). Proportions of improvement with PCCT images for quality of calcification, stent, and noncalcified plaque were 100%, 92% (95% CI: 71, 98), and 45% (95% CI: 28, 63), respectively. In the phantom study, detectability indexes were 2.3-fold higher for lumen and 2.9-fold higher for noncalcified plaques with PCCT images. Conclusion Coronary CT angiography with a photon-counting CT system demonstrated in humans an improved image quality and diagnostic confidence compared with an energy-integrating dual-layer CT. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Sandfort and Bluemke in this issue.
Collapse
Affiliation(s)
- Salim A Si-Mohamed
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Sara Boccalini
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Hugo Lacombe
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Adja Diaw
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Mohammad Varasteh
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Pierre-Antoine Rodesch
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Riham Dessouky
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Marjorie Villien
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Valérie Tatard-Leitman
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Thomas Bochaton
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Philippe Coulon
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Yoad Yagil
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Elias Lahoud
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Klaus Erhard
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Benjamin Riche
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Eric Bonnefoy
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Gilles Rioufol
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Gerard Finet
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Cyrille Bergerot
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Loic Boussel
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Joel Greffier
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Philippe C Douek
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| |
Collapse
|
243
|
Tiwari N, Nagraj S, Tzoumas A, Arfaras-Melainis A, Katamreddy A, Sohal S, Palaiodimos L. Diagnostic accuracy of coronary computed tomography angiography in ischemic workup of heart failure: a meta-analysis. Future Cardiol 2022; 18:325-335. [PMID: 35118872 DOI: 10.2217/fca-2021-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: The role of coronary computed tomography angiography (CCTA) in evaluating the etiology of heart failure with reduced ejection fraction (HFrEF) is unclear. This is a meta-analysis assessing the pooled diagnostic accuracy of CCTA in diagnosing significant coronary artery disease in HFrEF. Materials & methods: Electronic databases were searched for studies comparing CCTA with invasive coronary angiography in HFrEF. A random-effects model meta-analysis was conducted. Results: Five studies comprising 269 patients were included. On patient-based analysis, pooled sensitivity and specificity of CCTA were 0.99 (95% CI: 0.94-1.00) and 0.94 (95% CI: 0.90-0.97), respectively. On segment-based analysis, pooled sensitivity and specificity were 0.74 (95% CI: 0.67-0.80) and 0.99 (95% CI: 0.98-0.99), respectively. Conclusion: CCTA has excellent diagnostic accuracy in diagnosing significant coronary artery disease in newly diagnosed HFrEF.
Collapse
Affiliation(s)
- Nidhish Tiwari
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Andreas Tzoumas
- Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 541 24, Greece
| | - Angelos Arfaras-Melainis
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Adarsh Katamreddy
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sumit Sohal
- Department of Cardiology, RWJBH-Newark Beth Israel Medical Center, Newark, NJ 07112, USA
| | - Leonidas Palaiodimos
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| |
Collapse
|
244
|
Wu PW, Tsay PK, Sun Z, Peng SJ, Lee CY, Hsu MY, Ko YS, Hsieh IC, Wen MS, Wan YL. Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques. Diagnostics (Basel) 2022; 12:diagnostics12020390. [PMID: 35204481 PMCID: PMC8871267 DOI: 10.3390/diagnostics12020390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries.
Collapse
Affiliation(s)
- Patricia Wanping Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan;
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Bentley, WA 6102, Australia;
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan;
| | - Chia-Yen Lee
- Department of Electrical Engineering, National United University, Miaoli 360302, Taiwan;
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
| | - Yu-Shien Ko
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - I-Chang Hsieh
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - Ming-Shien Wen
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 2575)
| |
Collapse
|
245
|
Rampidis GP, Kampaktsis PΝ, Kouskouras K, Samaras A, Benetos G, Giannopoulos AΑ, Karamitsos T, Kallifatidis A, Samaras A, Vogiatzis I, Hadjimiltiades S, Ziakas A, Buechel RR, Gebhard C, Smilowitz NR, Toutouzas K, Tsioufis K, Prassopoulos P, Karvounis H, Reynolds H, Giannakoulas G. Role of cardiac CT in the diagnostic evaluation and risk stratification of patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): rationale and design of the MINOCA-GR study. BMJ Open 2022; 12:e054698. [PMID: 35110321 PMCID: PMC8811605 DOI: 10.1136/bmjopen-2021-054698] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 5%-15% of all patients with acute myocardial infarction. Cardiac MR (CMR) and optical coherence tomography have been used to identify the underlying pathophysiological mechanism in MINOCA. The role of cardiac CT angiography (CCTA) in patients with MINOCA, however, has not been well studied so far. CCTA can be used to assess atherosclerotic plaque volume, vulnerable plaque characteristics as well as pericoronary fat tissue attenuation, which has not been yet studied in MINOCA. METHODS AND ANALYSIS MINOCA-GR is a prospective, multicentre, observational cohort study based on a national registry that will use CCTA in combination with CMR and invasive coronary angiography (ICA) to evaluate the extent and characteristics of coronary atherosclerosis and its correlation with pericoronary fat attenuation in patients with MINOCA. A total of 60 consecutive adult patients across 4 participating study sites are expected to be enrolled. Following ICA and CMR, patients will undergo CCTA during index hospitalisation. The primary endpoints are quantification of extent and severity of coronary atherosclerosis, description of high-risk plaque features and attenuation profiling of pericoronary fat tissue around all three major epicardial coronary arteries in relation to CMR. Follow-up CCTA for the evaluation of changes in pericoronary fat attenuation will also be performed. MINOCA-GR aims to be the first study to explore the role of CCTA in combination with CMR and ICA in the underlying pathophysiological mechanisms and assisting in diagnostic evaluation and prognosis of patients with MINOCA. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board/independent ethics committee at each site prior to study commencement. All patients will provide written informed consent. Results will be disseminated at national meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT4186676.
Collapse
Affiliation(s)
- Georgios P Rampidis
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
- Cardiac Imaging Unit, Diagnostic Center "PANAGIA", Veroia, Greece
| | | | - Konstantinos Kouskouras
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Athanasios Samaras
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Georgios Benetos
- First Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Andreas Α Giannopoulos
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | - Theodoros Karamitsos
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - Antonios Samaras
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Ioannis Vogiatzis
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Stavros Hadjimiltiades
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ronny R Buechel
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Panagiotis Prassopoulos
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Harmony Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - George Giannakoulas
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| |
Collapse
|
246
|
Coronary volume to left ventricular mass ratio in patients with diabetes mellitus. J Cardiovasc Comput Tomogr 2022; 16:319-326. [DOI: 10.1016/j.jcct.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
|
247
|
Atlas-ISTN: Joint Segmentation, Registration and Atlas Construction with Image-and-Spatial Transformer Networks. Med Image Anal 2022; 78:102383. [DOI: 10.1016/j.media.2022.102383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/24/2021] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
|
248
|
Matsuda K, Hoshino M, Kanaji Y, Sugiyama T, Misawa T, Hada M, Nagamine T, Nogami K, Sayama K, Teng Y, Ueno H, Yonetsu T, Sasano T, Kakuta T. Coronary Computed Tomography Angiographic Predictors of Non-culprit Territory Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance in Non-ST-elevation Acute Coronary Syndrome. Front Cardiovasc Med 2022; 8:825523. [PMID: 35174226 PMCID: PMC8841688 DOI: 10.3389/fcvm.2021.825523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/24/2021] [Indexed: 01/07/2023] Open
Abstract
Objectives This study sought to assess the predictors of coronary computed tomography angiographic findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with a first episode of non-ST-elevation acute coronary syndrome (NSTE-ACS). Background UMI detected by cardiac magnetic resonance imaging (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and coronary computed tomography angiographic (CCTA) findings remains unknown. Methods We investigated 158 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA and uncomplicated urgent percutaneous coronary intervention (PCI) within 48 h of admission. In these patients, post-PCI CMR was performed within 30 days from urgent PCI and before non-IR lesion staged PCI. UMI was assessed using late gadolinium enhancement (LGE)-CMR by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI). CCTA analysis included qualitative and quantitative assessments of the culprit segment, Agatston score, mean peri-coronary fat attenuation index (FAI), epicardial fat volume (EFV) and epicardial fat attenuation (EFA). Results Non-IR UMI was detected in 30 vessel territories (9.7%, 30/308 vessels) of 28 patients (17.7%, 28/158 patients). The presence of low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling was not significantly different between vessels with and without subtended non-IR UMI. Agatston score >30.0 (OR: 8.39, 95% confidence interval (CI): 2.17 to 32.45, p = 0.002), mean FAI >-64.3 (OR: 3.23, 95% CI: 1.34 to 7.81, p = 0.009), and stenosis severity (OR: 1.04, 95% CI: 1.02 to 1.06, p < 0.001) were independently associated with non-IR UMI. Neither EFV (p = 0.340) nor EFA (p = 0.700) was associated with non-IR UMI. Conclusion The prevalence of non-IR UMI was 17.7 % in patients with first NSTE-ACS presentation. Agatston score, mean FAI, and coronary stenosis severity were independent CCTA predictors of the presence of non-IR UMI. The integrated CCTA assessment may help identify the presence of non-IR UMI before urgent PCI.
Collapse
Affiliation(s)
- Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yun Teng
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
- *Correspondence: Tsunekazu Kakuta
| |
Collapse
|
249
|
Vernon ST, Kott KA, Hansen T, Finemore M, Baumgart KW, Bhindi R, Yang J, Hansen PS, Nicholls SJ, Celermajer DS, Ward MR, van Nunen SA, Grieve SM, Figtree GA. Immunoglobulin E Sensitization to Mammalian Oligosaccharide Galactose-α-1,3 (α-Gal) Is Associated With Noncalcified Plaque, Obstructive Coronary Artery Disease, and ST-Segment-Elevated Myocardial Infarction. Arterioscler Thromb Vasc Biol 2022; 42:352-361. [PMID: 35045730 DOI: 10.1161/atvbaha.121.316878] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treating known risk factors for coronary artery disease (CAD) has substantially reduced CAD morbidity and mortality. However, a significant burden of CAD remains unexplained. Immunoglobulin E sensitization to mammalian oligosaccharide galactose-α-1,3-galactose (α-Gal) was recently associated with CAD in a small observational study. We sought to confirm that α-Gal sensitization is associated with CAD burden, in particular noncalcified plaque. Additionally, we sort to assess whether that α-Gal sensitization is associated with ST-segment-elevated myocardial infarction (STEMI) Methods: We performed a cross-sectional analysis of participants enrolled in the BioHEART cohort study. We measured α-Gal specific-immunoglobulin E antibodies in serum of 1056 patients referred for CT coronary angiography for suspected CAD and 100 selected patients presenting with STEMI, enriched for patients without standard modifiable risk factors. CT coronary angiograms were assessed using coronary artery calcium scores and segmental plaque scores. RESULTS α-Gal sensitization was associated with presence of noncalcified plaque (odds ratio, 1.62 [95% CI, 1.04-2.53], P=0.03) and obstructive CAD (odds ratio, 2.05 [95% CI, 1.29-3.25], P=0.002), independent of age, sex, and traditional risk factors. The α-Gal sensitization rate was 12.8-fold higher in patients with STEMI compared with matched healthy controls and 2.2-fold higher in the patients with STEMI compared with matched stable CAD patients (17% versus 1.3%, P=0.01 and 20% versus 9%, P=0.03, respectively). CONCLUSIONS α-Gal sensitization is independently associated with noncalcified plaque burden and obstructive CAD and occurs at higher frequency in patients with STEMI than those with stable or no CAD. These findings may have implications for individuals exposed to ticks, as well as public health policy. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12618001322224.
Collapse
Affiliation(s)
- Stephen T Vernon
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Katharine A Kott
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Thomas Hansen
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Meghan Finemore
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia
| | | | - Ravinay Bhindi
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Jean Yang
- Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,School of Mathematics and Statistics (J.Y.) University of Sydney, Australia
| | - Peter S Hansen
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Australia (S.J.N.)
| | - David S Celermajer
- Sydney Medical School (D.S.C.) University of Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (D.S.C.)
| | - Michael R Ward
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Sheryl A van Nunen
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Northern Beaches Hospital, Sydney, Australia (S.A.v.N.)
| | - Stuart M Grieve
- Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health (S.M.G.), University of Sydney, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia (S.M.G.)
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| |
Collapse
|
250
|
Yan H, Gao Y, Zhao N, Geng W, Hou Z, An Y, Zhang J, Lu B. Change in Computed Tomography-Derived Fractional Flow Reserve Across the Lesion Improve the Diagnostic Performance of Functional Coronary Stenosis. Front Cardiovasc Med 2022; 8:788703. [PMID: 35097009 PMCID: PMC8792740 DOI: 10.3389/fcvm.2021.788703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study sought to evaluate the diagnostic performance of change in computed tomography-derived fractional flow reserve (CT-FFR) across the lesion (ΔCT-FFR) for identifying ischemia lesions with FFR as the reference standard.Methods: Patients who underwent coronary CT angiography (CCTA) and FFR measurement within 1 week from December 2018 to December 2019 were retrospectively enrolled. CT-FFR within 2 cm distal to the lesion, ΔCT-FFR and plaque characteristics were analyzed. The diagnostic accuracy of CCTA (coronary stenosis ≥ 50%), CT-FFR ≤ 0.80, and ΔCT-FFR ≥ 0.15 (based on the largest Youden index) were assessed with FFR as the reference standard. The relationship between plaque characteristics and ΔCT-FFR was analyzed.Results: The specificity of ΔCT-FFR and CT-FFR were 70.8 and 67.4%, respectively, which were both higher than CCTA (39.3%) (both P < 0.001), while there were no statistical significance in sensitivity among the three (84.5, 77.4, 88.1%, respectively; P = 0.08). The area under the curves (AUCs) of ΔCT-FFR and CT-FFR were 0.803 and 0.743, respectively, which were both higher than that of CCTA (0.637) (both P < 0.05), and the AUC of ΔCT-FFR was higher than that of CT-FFR (P < 0.001). Multivariable analysis showed that low-attenuation plaque (LAP) volume (odds ratio [OR], 1.006) and plaque length (OR, 1.021) were independently correlated with ΔCT-FFR (both P < 0.05).Conclusions: CT-FFR and ΔCT-FFR and here especially the ΔCT-FFR could improve the diagnostic performance of ischemia compared with CCTA alone. LAP volume and plaque length were the independent risk factors of ΔCT-FFR.
Collapse
|