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Masuda S, Revaiah PC, Kageyama S, Tsai TY, Miyashita K, Tobe A, Puskas JD, Teichgräber U, Schneider U, Doenst T, Tanaka K, De Mey J, La Meir M, Mushtaq S, Bartorelli AL, Pompilio G, Garg S, Andreini D, Onuma Y, Serruys PW. Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses. J Cardiovasc Comput Tomogr 2024; 18:450-456. [PMID: 38714459 DOI: 10.1016/j.jcct.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUNDS The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. OBJECTIVE This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). METHODS This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opacification within the coronary occlusion, with corresponding ICA. RESULTS Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66-0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. CONCLUSION In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT REGISTRATION NUMBER NCT04142021.
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Affiliation(s)
| | | | | | - Tsung-Ying Tsai
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Akihiro Tobe
- Department of Cardiology, University of Galway, Galway, Ireland
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Kaoru Tanaka
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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Wang C, Leng S, Tan RS, Chai P, Fam JM, Teo LLS, Chin CY, Ong CC, Baskaran L, Keng YJF, Low AFH, Chan MYY, Wong ASL, Chua SJT, Wu Q, Tan SY, Lim ST, Zhong L. Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis. Radiol Cardiothorac Imaging 2023; 5:e230064. [PMID: 38166346 PMCID: PMC11163246 DOI: 10.1148/ryct.230064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 01/04/2024]
Abstract
Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD4, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD4. Diagnostic performance and accuracy of α×LL/MLD4 and LL/MLD4 in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD4 was 54.0 degree/mm3 (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm3 (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (P < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD4 and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD4, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD4, which was significantly greater than the values of 0.84 for LL/MLD4 and 0.63 for diameter stenosis (both P < .001). Conclusion The new morphologic index, α×LL/MLD4, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD4. Keywords: CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.
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Affiliation(s)
| | | | - Ru-San Tan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ping Chai
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Jiang Ming Fam
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lynette Li San Teo
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Chee Yang Chin
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ching Ching Ong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lohendran Baskaran
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Yung Jih Felix Keng
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Adrian Fatt Hoe Low
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Mark Yan-Yee Chan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Aaron Sung Lung Wong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Siang Jin Terrance Chua
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Qinghua Wu
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Swee Yaw Tan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Soo Teik Lim
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Liang Zhong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
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Zhang JM, Han H, Tan RS, Chai P, Fam JM, Teo L, Chin CY, Ong CC, Low R, Chandola G, Leng S, Huang W, Allen JC, Baskaran L, Kassab GS, Low AFH, Chan MYY, Chan KH, Loh PH, Wong ASL, Tan SY, Chua T, Lim ST, Zhong L. Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method. Front Cardiovasc Med 2021; 8:739633. [PMID: 34746257 PMCID: PMC8564016 DOI: 10.3389/fcvm.2021.739633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to evaluate a new analytical method for calculating non-invasive fractional flow reserve (FFRAM) to diagnose ischemic coronary lesions. Patients with suspected or known coronary artery disease (CAD) who underwent computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) with FFR measurements from two sites were prospectively recruited. Obstructive CAD was defined as diameter stenosis (DS) ≥50% on CTCA or ICA. FFRAM was derived from CTCA images and anatomical features using analytical method and was compared with computational fluid dynamics (CFD)-based FFR (FFRB) and invasive ICA-based FFR. FFRAM, FFRB, and invasive FFR ≤ 0.80 defined ischemia. A total of 108 participants (mean age 60, range: 30–83 years, 75% men) with 169 stenosed coronary arteries were analyzed. The per-vessel accuracy, sensitivity, specificity, and positive predictive and negative predictive values were, respectively, 81, 75, 86, 81, and 82% for FFRAM and 87, 88, 86, 83, and 90% for FFRB. The area under the receiver operating characteristics curve for FFRAM (0.89 and 0.87) and FFRB (0.90 and 0.86) were higher than both CTCA- and ICA-derived DS (all p < 0.0001) on per-vessel and per-patient bases for discriminating ischemic lesions. The computational time for FFRAM was much shorter than FFRB (2.2 ± 0.9 min vs. 48 ± 36 min, excluding image acquisition and segmentation). FFRAM calculated from a novel and expeditious non-CFD approach possesses a comparable diagnostic performance to CFD-derived FFRB, with a significantly shorter computational time.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Huan Han
- National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Ching Ching Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Ris Low
- National Heart Centre Singapore, Singapore, Singapore
| | | | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Lohendran Baskaran
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Adrian Fatt Hoe Low
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Koo Hui Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aaron Sung Lung Wong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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4
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Yang S, Lee JM, Hoshino M, Murai T, Choi KH, Hwang D, Kim KJ, Shin ES, Doh JH, Chang HJ, Nam CW, Zhang J, Wang J, Chen SL, Tanaka N, Matsuo H, Akasaka T, Kakuta T, Koo BK. Prognostic Implications of Comprehensive Whole Vessel Plaque Quantification Using Coronary Computed Tomography Angiography. JACC. ASIA 2021; 1:37-48. [PMID: 36338359 PMCID: PMC9627853 DOI: 10.1016/j.jacasi.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 06/16/2023]
Abstract
Background The prognostic value of whole vessel plaque quantification has not been fully understood. Objectives We aimed to investigate the clinical relevance of whole vessel plaque quantification on coronary computed tomography angiography. Methods In a total of 1,013 vessels with fractional flow reserve (FFR) measurement and available coronary computed tomography angiography, high-risk plaque characteristics (HRPC) included minimum lumen area <4 mm2, plaque burden ≥70%, low attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign; and high-risk vessel characteristics (HRVC) included total plaque volume ≥306.5 mm3, fibrofatty and necrotic core volume ≥4.46 mm3, or percent total atheroma volume ≥32.2% in a target vessel, based on corresponding optimal cutoff values. Survival analysis for vessel-oriented composite outcome (VOCO) (a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization) at 5 years was performed using marginal Cox proportional hazard models. Results Whole vessel plaque quantification had incremental predictability in addition to % diameter stenosis and HRPC (P < 0.001) in predicting FFR ≤0.80. Among 517 deferred vessels based on FFR >0.80, the number of HRVC was significantly associated with the risk of VOCO (HR: 2.54; 95% CI: 1.77-3.64) and enhanced the predictability for VOCO of % diameter stenosis and the number of HRPC (P < 0.001). In a landmark analysis at 2 years, the number of HRVC showed sustained prognostic implications beyond 2 years, but the number of HRPC did not. Conclusions Whole vessel plaque quantification can provide incremental predictability for low FFR and additive prognostic value in deferred vessels with high FFR over anatomical severity and lesion plaque characteristics. (CCTA-FFR Registry for Risk Prediction; NCT04037163).
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Jin Kim
- Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea and Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Jianan Wang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | | | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
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5
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Characteristic findings of microvascular dysfunction on coronary computed tomography angiography in patients with intermediate coronary stenosis. Eur Radiol 2021; 31:9198-9210. [PMID: 34009414 DOI: 10.1007/s00330-021-07909-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We aimed to assess the prevalence of coexistence of coronary microvascular dysfunction (CMD) in patients with intermediate epicardial stenosis and to explore coronary computed tomography angiography (CCTA)-derived lesion-, vessel-, and cardiac fat-related characteristic findings associated with CMD. METHODS A retrospective cross-sectional single-center study included a total of 177 patients with intermediate stenosis in the left anterior descending artery (LAD) who underwent CCTA and invasive physiological measurements. The 320-slice CCTA analysis included qualitative and quantitative assessments of plaque, vessel, epicardial fat volume (ECFV) and epicardial fat attenuation (ECFA), and pericoronary fat attenuation (FAI). CMD was defined by the index of microcirculatory resistance (IMR) ≥ 25. RESULTS In the entire cohort, median fractional flow reserve (FFR) and median IMR values were 0.77 (0.69-0.84) and 19.0 (13.7-27.7), respectively. The prevalence of CMD was 32.8 % (58/177) in the total cohort. The coexistence of CMD and functionally significant stenosis was 34.3 % (37/108), whereas CMD in nonsignificant intermediate stenosis was 30.4 % (21/69). CMD was significantly associated with greater lumen volume (p = 0.031), greater fibrofatty and necrotic component (FFNC) volume (p = 0.030), and greater ECFV (p = 0.030), but not with FAI (p = 0.832) and ECFA (p = 0.445). On multivariable logistic regression analysis, vessel volume, vessel lumen volume, lesion remodeling index, ECFV, and lesion FFNC volume were independent predictors of CMD. CONCLUSIONS The prevalence of CMD was about one-third in patients with intermediate stenosis in LAD regardless of the presence or absence of functional stenosis significance. The integrated CCTA assessment may help in the identification of CMD. KEY POINTS • The coexistence of coronary microvascular dysfunction (CMD) and functionally significant stenosis was 34.3 %, whereas CMD in nonsignificant intermediate stenosis was 30.4 %. • Coronary computed tomography angiography (CCTA)-derived CMD characteristics were vessel volume, vessel lumen volume, remodeling index, epicardial fat volume, and fibrofatty necrotic core volume. • Integrated CCTA assessment may help identify the coexistence of CMD and epicardial stenosis.
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6
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Hoshino M, Zhang J, Sugiyama T, Yang S, Kanaji Y, Hamaya R, Yamaguchi M, Hada M, Misawa T, Usui E, Murai T, Yonetsu T, Lee JM, Koo BK, Sasano T, Kakuta T. Prognostic value of pericoronary inflammation and unsupervised machine-learning-defined phenotypic clustering of CT angiographic findings. Int J Cardiol 2021; 333:226-232. [PMID: 33741428 DOI: 10.1016/j.ijcard.2021.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pericoronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects pericoronary inflammation and is associated with cardiac mortality. OBJECTIVE The aim of this study was to define the sub-phenotypes of coronary CCTA-defined plaque and whole vessel quantification by unsupervised machine learning (ML) and its prognostic impact when combined with pericoronary inflammation. METHODS A total of 220 left anterior descending arteries (LAD) with intermediate stenosis who underwent fractional flow reserve (FFR) measurement and CCTA were studied. After removal of outcome and FAI data, the phenotype heterogeneity of CCTA-defined plaque and whole vessel quantification was investigated by unsupervised hierarchical clustering analysis based on Ward's method. Detailed features of CCTA findings were assessed according to the clusters (CS1 and CS2). Major adverse cardiac events (MACE)-free survivals were assessed according to the stratifications by FAI and the clusters. RESULTS Compared with CS2 (n = 119), CS1 (n = 101) were characterized by greater vessel size, increased plaque volume, and high-risk plaque features. FAI was significantly higher in CS1. ROC analyses revealed that best cut-off value of FAI to predict MACE was -73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥ -73.1 had a significantly higher risk of MACE. Multivariate Cox proportional hazards regression analysis revealed that age, FAI ≥ -73.1, and the clusters were independent predictors of MACE. CONCLUSION Unsupervised hierarchical clustering analysis revealed two distinct CCTA-defined subgroups and discriminated by high-risk plaque features and increased FAI. The risk of MACE differs significantly according to the increased FAI and ML-defined clusters.
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Affiliation(s)
- Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - 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.
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7
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Shaw LJ, Blankstein R, Bax JJ, Ferencik M, Bittencourt MS, Min JK, Berman DS, Leipsic J, Villines TC, Dey D, Al'Aref S, Williams MC, Lin F, Baskaran L, Litt H, Litmanovich D, Cury R, Gianni U, van den Hoogen I, R van Rosendael A, Budoff M, Chang HJ, E Hecht H, Feuchtner G, Ahmadi A, Ghoshajra BB, Newby D, Chandrashekhar YS, Narula J. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. J Cardiovasc Comput Tomogr 2021; 15:93-109. [PMID: 33303383 DOI: 10.1016/j.jcct.2020.11.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
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Affiliation(s)
- Leslee J Shaw
- Weill Cornell School of Medicine, New York, NY, USA.
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - James K Min
- Weill Cornell School of Medicine; Cleerly, Inc. (started in 2020), New York, NY, USA
| | - Daniel S Berman
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Fay Lin
- Weill Cornell School of Medicine, New York, NY, USA
| | | | - Harold Litt
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Litmanovich
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, FL, USA
| | | | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | - Amir Ahmadi
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - David Newby
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, NY, USA
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8
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Merkulova IN, Shariya MA, Mironov VM, Shabanova MS, Veselova TN, Gaman SA, Barysheva NA, Shakhnovich RM, Zhukova NI, Sukhinina TS, Staroverov II, Ternovoy SK. [Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound]. ACTA ACUST UNITED AC 2021; 60:64-75. [PMID: 33522469 DOI: 10.18087/cardio.2020.12.n1304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
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Affiliation(s)
- I N Merkulova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M A Shariya
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - V M Mironov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M S Shabanova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T N Veselova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S A Gaman
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N A Barysheva
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - R M Shakhnovich
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N I Zhukova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T S Sukhinina
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I I Staroverov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S K Ternovoy
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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9
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Hoshino M, Yang S, Sugiyama T, Zhang J, Kanaji Y, Yamaguchi M, Hada M, Sumino Y, Horie T, Nogami K, Ueno H, Misawa T, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Peri-coronary inflammation is associated with findings on coronary computed tomography angiography and fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 14:483-489. [DOI: 10.1016/j.jcct.2020.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 01/11/2023]
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10
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Zhang JM, Chandola G, Tan RS, Chai P, Teo LLS, Low R, Allen JC, Huang W, Fam JM, Chin CY, Wong ASL, Low AF, Kassab GS, Chua T, Tan SY, Lim ST, Zhong L. Quantification of effects of mean blood pressure and left ventricular mass on noninvasive fast fractional flow reserve. Am J Physiol Heart Circ Physiol 2020; 319:H360-H369. [DOI: 10.1152/ajpheart.00135.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ping Chai
- National University Hospital, Singapore
| | | | - Ris Low
- National Heart Centre Singapore, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore
| | | | | | - Aaron Sung Lung Wong
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | | | - Terrance Chua
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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11
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Ramasamy A, Safi H, Moon J, Andiapen M, Rathod K, Maurovich-Horvat P, Bajaj R, Serruys P, Mathur A, Baumbach A, Pugliese F, Torii R, Bourantas C. Evaluation of the Efficacy of Computed Tomographic Coronary Angiography in Assessing Coronary Artery Morphology and Physiology: Rationale and Study Design. Cardiology 2020; 145:285-293. [DOI: 10.1159/000506537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022]
Abstract
Computed tomographic coronary angiography (CTCA) is a non-invasive imaging modality, which allows plaque burden and composition assessment and detection of plaque characteristics associated with increased vulnerability. In addition, CTCA-based coronary artery reconstruction enables local haemodynamic forces assessment, which regulate plaque formation and vascular inflammation and prediction of lesions that are prone to progress and cause events. However, the use of CTCA for vulnerable plaque detection in the clinical arena remains limited. To unlock the full potential of CTCA and enable its broad use, further work is needed to develop user-friendly processing tools that will allow fast and accurate analysis of CTCA, computational fluid dynamic modelling, and evaluation of the local haemodynamic forces. The present study aims to develop a seamless platform that will overcome the limitations of CTCA and enable fast and accurate evaluation of plaque morphology and physiology. We will analyse imaging data from 70 patients with coronary artery disease who will undergo state-of-the-art CTCA and near-infrared spectroscopy-intravascular ultrasound imaging and develop and train algorithms that will take advantage of the intravascular imaging data to optimise vessel segmentation and plaque characterisation. Furthermore, we will design an advanced module that will enable reconstruction of coronary artery anatomy from CTCA, blood flow simulation, shear stress estimation, and comprehensive visualisation of vessel pathophysiology. These advances are expected to facilitate the broad use of CTCA, not only for risk stratification but also for the evaluation of the effect of emerging therapies on plaque evolution.
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12
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Foldyna B, Sandri M, Luecke C, Garbade J, Gohmann R, Hahn J, Fischer J, Gutberlet M, Lehmkuhl L. Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy. Eur Radiol 2020; 30:4317-4326. [PMID: 32179995 PMCID: PMC7338811 DOI: 10.1007/s00330-019-06653-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/20/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
Abstract
Objectives To associate coronary wall volume and composition, derived from coronary computed tomography angiography (CTA), with cardiac allograft vasculopathy (CAV) detected on invasive coronary angiography (ICA) in heart-transplanted (HTX) patients. Methods We included consecutive adults who received ICA and coronary CTA for evaluation of CAV ≥ 10 months after HTX. In all coronary segments, we assessed lumen and wall volumes and segmental length, calculated volume-length ratio (VLR) (volumes indexed by segmental length; mm3/mm), wall burden (WB) (wall/wall + lumen volumes; %), and assessed proportions of calcified, fibrotic, fibro-fatty, and low-attenuation tissue (%) in coronary wall. We rendered independent CTA measures associated with CAV by ICA, tested their discriminatory capacity, and assessed concordance between CTA and ICA. Results Among 50 patients (84% men; 53.6 ± 11.9 years), we analyzed 632 coronary segments. Mean interval between HTX and CTA was 6.7 ± 4.7 years and between ICA and CTA 1 (0–1) day. Segmental VLR, WB, and proportion of fibrotic tissue were independently associated with CAV (OR = 1.06–1.27; p ≤ 0.002), reaching a high discriminatory capacity (combination of all three: AUC = 0.84; 95%CI, 0.75–0.90). Concordance between CTA and ICA was higher in advanced CAV (88%) compared with that in none (37%) and mild (19%) CAV. Discordance was primarily driven by a large number of segments with coronary wall changes on CTA but without luminal stenoses on ICA (177/591; 25%). Conclusion CTA-derived coronary wall VLR, WB, and the proportion of fibrotic tissue are independent markers of CAV. Combination of these three parameters may aid the detection of early CAV not detected by ICA, the current standard of care. Key Points • Coronary CTA detects CAV in HTX patients. • Coronary wall volume-length ratio, wall burden, and proportion of fibrotic tissue are independently associated with CAV. • In contrast to ICA, coronary CTA may identify the early stages of CAV. Electronic supplementary material The online version of this article (10.1007/s00330-019-06653-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Borek Foldyna
- Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany. .,Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA. .,Clinic for Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany.
| | - Marcus Sandri
- Department of Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Christian Luecke
- Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Robin Gohmann
- Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Jochen Hahn
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Julia Fischer
- Department of Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Lukas Lehmkuhl
- Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany.,Clinic for Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
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Munnur RK, Andrews J, Kataoka Y, Nerlekar N, Psaltis PJ, Nicholls SJ, Malaiapan Y, Cameron JD, Meredith IT, Seneviratne S, Wong DTL. Quantitative and Qualitative Coronary Plaque Assessment Using Computed Tomography Coronary Angiography: A Comparison With Intravascular Ultrasound. Heart Lung Circ 2019; 29:883-893. [PMID: 31564511 DOI: 10.1016/j.hlc.2019.06.719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/12/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare computed tomography coronary angiography (CTCA) with intravascular ultrasound (IVUS) in quantitative and qualitative plaque assessment. METHODS Patients who underwent IVUS and CTCA within 3 months for suspected coronary artery disease were retrospectively studied. Plaque volumes on CTCA were quantified manually and with automated-software and were compared to IVUS. High-risk plaque features were compared between CTCA and IVUS. RESULTS There were 769 slices in 32 vessels (27 patients). Manual plaque quantification on CTCA was comparable to IVUS per slice (mean difference of 0.06±0.07, p=0.44; Bland-Altman 95% limits of agreement -2.19-2.08 mm3, bias of -0.06mm3) and per vessel (3.1mm3 ± -2.85mm3, p=0.92). In contrast, there was significant difference between automated-software and IVUS per slice (2.3±0.09mm3, p<0.001; 95% LoA -6.78 to 2.25mm3, bias of -2.2mm3) and per vessel (33.04±10.3 mm3, p<0.01). The sensitivity, specificity, positive and negative predictive value of CTCA to detect plaques that had features of echo-attenuation on IVUS was 93.3%, 99.6%, 93.3% and 99.6% respectively. The association of ≥2 high-risk plaque features on CTCA with echo attenuation (EA) plaque features on IVUS was excellent (86.7%, 99.6%, 92.9% and 99.2%). In comparison, the association of high-risk plaque features on CTCA and plaques with echo-lucency on IVUS was only modest. CONCLUSION Plaque volume quantification by manual CTCA method is accurate when compared to IVUS. The presence of at least two high-risk plaque features on CTCA is associated with plaque features of echo attenuation on IVUS.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia.
| | - Jordan Andrews
- South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Peter J Psaltis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Stephen J Nicholls
- South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia; South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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Zhang JM, Shuang D, Baskaran L, Wu W, Teo SK, Huang W, Gobeawan L, Allen JC, Tan RS, Su X, Ismail NB, Wan M, Su B, Zou H, Low R, Zhao X, Chi Y, Zhou J, Su Y, Lomarda AM, Chin CY, Fam JM, Keng FYJ, Wong ASL, Tan JWC, Yeo KK, Wong PEH, Chin CT, Ho KW, Yap J, Kassab GS, Chua T, Koh TH, Tan SY, Lim ST, Zhong L. Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions. Int J Cardiol 2018; 267:208-214. [DOI: 10.1016/j.ijcard.2018.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/16/2018] [Accepted: 04/05/2018] [Indexed: 12/21/2022]
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15
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Kim U, Leipsic JA, Sellers SL, Shao M, Blanke P, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Shin S, Choi JH, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study. JACC Cardiovasc Imaging 2018; 11:1461-1471. [PMID: 29778853 DOI: 10.1016/j.jcmg.2018.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). BACKGROUND The natural history of coronary PP in patients with DM is not well established. METHODS A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. RESULTS DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. CONCLUSIONS People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.
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Affiliation(s)
- Ung Kim
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Yeungnam University Medical Center, Daegu, South Korea
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Stephanie L Sellers
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michael Shao
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany; Seoul National University Hospital, Seoul, South Korea
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, South Korea
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy
| | | | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | | | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, New York
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
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Wang C, Liao Y, Chen H, Zhen X, Li J, Xu Y, Zhou L. Influence of tube potential on quantitative coronary plaque analyses by low radiation dose computed tomography: a phantom study. Int J Cardiovasc Imaging 2018; 34:1315-1322. [PMID: 29582238 DOI: 10.1007/s10554-018-1344-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/22/2018] [Indexed: 12/18/2022]
Abstract
Previous studies have shown that employing the low dose computed tomography (CT) technique based on low tube potential reduces the radiation dose required for the coronary artery examination protocol. However, low tube potential may adversely influence the CT number of plaque composition. Therefore, we aimed to determine whether quantitative atherosclerotic plaque analysis by a multi-slice, low radiation dose CT protocol using 80 kilovolts (kV) yields results comparable to those of the standard 120 kV protocol. Artificial plaque samples (n = 17) composed of three kinds of plaque were scanned at 120 and 80 kV. Relative low-density and medium-density plaque component volumes obtained by three protocols (80 kV, 60 Hounsfield units [HU] threshold; 120 kV, 60 HU threshold; and 80 kV, 82 HU threshold) were compared. Using the 60 HU threshold, relative volume of the low-density plaque component obtained at 80 kV was lower than that obtained at 120 kV (27 ± 3% vs. 51 ± 5%, P < 0.001), whereas relative volume of the medium-density plaque component obtained at 80 kV was higher than that obtained at 120 kV (73 ± 3% vs. 48 ± 5%, P < 0.001). By contrast, no significant difference in relative volume obtained at 80 kV (82 HU threshold) versus 120 kV (60 HU threshold) was observed for either low-density (52 ± 5% vs. 51 ± 5%) or medium-density (48 ± 5% vs. 48 ± 5%) plaque component. Low tube potential may affect the accuracy of quantitative atherosclerotic plaque analysis. For our phantom test, 82 HU was the optimal threshold for scanning at 80 kV.
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Affiliation(s)
- Chunhong Wang
- Department of Radiology, Xinyang Central Hospital, Xinyang, 464002, Henan, China
| | - Yuliang Liao
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Haibin Chen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xin Zhen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jianhong Li
- Department of Radiology, Xinyang Central Hospital, Xinyang, 464002, Henan, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China.
| | - Linghong Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Dwivedi A, Al'Aref SJ, Lin FY, Min JK. Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging. Korean Circ J 2018; 48:124-133. [PMID: 29441745 PMCID: PMC5861003 DOI: 10.4070/kcj.2017.0392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.
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Affiliation(s)
- Aeshita Dwivedi
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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Kim J, Kwag HJ, Yoo SM, Yoo JY, Chae IH, Choi DJ, Park MJ, Vembar M, Chun EJ. Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events. Eur Radiol 2017; 28:1356-1364. [DOI: 10.1007/s00330-017-5095-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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