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Osborne-Grinter M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman D, Slomka PJ, Newby DE, Dweck MR, Dey D, Williams MC. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial. Eur Heart J Cardiovasc Imaging 2022; 23:1210-1221. [PMID: 34529050 PMCID: PMC9612790 DOI: 10.1093/ehjci/jeab135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. METHODS AND RESULTS In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1-9 AU), low (10-99 AU), moderate (100-399 AU), high (400-999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS (P < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. CONCLUSION In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque.
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Affiliation(s)
- Maia Osborne-Grinter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Jacek Kwiecinski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- NIHR Leicester Biomedical Research Centre and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Shirjel Alam
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Amanda Hunter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Anoop S V Shah
- Department of non-communicable disease epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tania Pawade
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Chengjia Wang
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | | | - Giles Roditi
- Institute of Cardiovascular & Medical Sciences, Glasgow University, Glasgow, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | | | - Edward D Nicol
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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2
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Koopman MY, Reijnders JJW, Willemsen RTA, van Bruggen R, Doggen CJM, Kietselaer B, Oude Wolcherink MJ, van Ooijen PMA, Gratama JWC, Braam R, Oudkerk M, van der Harst P, Dinant GJ, Vliegenthart R. Coronary calcium scoring as first-line test to detect and exclude coronary artery disease in patients presenting to the general practitioner with stable chest pain: protocol of the cluster-randomised CONCRETE trial. BMJ Open 2022; 12:e055123. [PMID: 35440450 PMCID: PMC9020291 DOI: 10.1136/bmjopen-2021-055123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Identifying and excluding coronary artery disease (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). A diagnostic and prognostic tool could help GPs in determining the likelihood of CAD and guide patient management. Studies in outpatient settings have shown that the CT-based coronary calcium score (CCS) has high accuracy for diagnosis and exclusion of CAD. However, the CT CCS test has not been tested in a primary care setting. In the COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain (CONCRETE) study, the impact of direct access of GPs to CT CCS will be investigated. We hypothesise that this will allow for early diagnosis of CAD and treatment, more efficient referral to the cardiologist and a reduction of healthcare-related costs. METHODS AND ANALYSIS CONCRETE is a pragmatic multicentre trial with a cluster randomised design, in which direct GP access to the CT CCS test is compared with standard of care. In both arms, at least 40 GP offices, and circa 800 patients with atypical AP and non-specific thoracic complaints will be included. To determine the increase in detection and treatment rate of CAD in GP offices, the CVRM registration rate is derived from the GPs electronic registration system. Individual patients' data regarding cardiovascular risk factors, expressed chest pain complaints, quality of life, downstream testing and CAD diagnosis will be collected through questionnaires and the electronic GP dossier. ETHICS AND DISSEMINATION CONCRETE has been approved by the Medical Ethical Committee of the University Medical Center of Groningen. TRIAL REGISTRATION NUMBER NTR 7475; Pre-results.
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Affiliation(s)
- Moniek Y Koopman
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorn J W Reijnders
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Robert T A Willemsen
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rykel van Bruggen
- Multicenter General Practitioners Organisation 'HuisartsenOrganisatie Oost-Gelderland', Apeldoorn, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Martijn J Oude Wolcherink
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Peter M A van Ooijen
- Department of Data Science Center in Health, University of Groniningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Richard Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Matthijs Oudkerk
- Department of Medical Science, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Koopman MY, Willemsen RTA, van der Harst P, van Bruggen R, Gratama JWC, Braam R, van Ooijen PMA, Doggen CJM, Dinant GJ, Kietselaer B, Vliegenthart R. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. ROFO-FORTSCHR RONTG 2022; 194:257-265. [PMID: 35081649 PMCID: PMC8837467 DOI: 10.1055/a-1662-5711] [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] [Indexed: 11/07/2022]
Abstract
Background
Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints.
Method
PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n = 38 137 patients) focused on diagnostic value and 23 articles (n = 44 683 patients) on prognostic value of CCS. Of these, 10 articles (n = 21 208 patients) focused on both the diagnostic and prognostic value of CCS.
Results
Between 22 and 10 037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43 % and 51 % patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD (OCAD, defined as a luminal stenosis of ≥ 50 % in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4 % (n = 703/16 074) with a range of 0–26 % in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0 % to 2.1 % during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98 % and 100 % in CCS 0 patients. At increasing CCS, the OCAD probability and MACE risk increased. OCAD was present in 58.3 % (n = 617/1058) of CCS > 400 patients with percentages ranging from 20 % to 94 % and MACE occurred in 16.7 % (n = 175/1048) of these patients with percentages ranging from 6.9 % to 50 %.
Conclusion
Accumulating evidence shows that OCAD is unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCAD and risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting.
Key Points:
Citation Format
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Affiliation(s)
| | | | - Pim van der Harst
- Cardiology, University Medical Centre Utrecht Department of Cardiology, Utrecht, Netherlands.,Division Heart and Lungs, University Medical Centre Groningen, Netherlands
| | - Rykel van Bruggen
- Primary Health Care, Multicenter General Practitioners Organisation "HuisartsenOrganisatie Oost-Gelderland", Apeldoorn, Netherlands
| | | | | | - Peter M A van Ooijen
- Data Science Center in Health, University Medical Centre Groningen, Netherlands.,Radiation Oncology, University Medical Centre Groningen, Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, Netherlands
| | | | - Bas Kietselaer
- Cardiology, Zuyderland Medical Centre Sittard-Geleen, Netherlands
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Garg K, Patel TR, Kanwal A, Villines TC, Aggarwal NR, Nasir K, Blumenthal RS, Blaha MJ, Douglas PS, Shaw LJ, Sharma G. The evolving role of coronary computed tomography in understanding sex differences in coronary atherosclerosis. J Cardiovasc Comput Tomogr 2021; 16:138-149. [PMID: 34654676 DOI: 10.1016/j.jcct.2021.09.004] [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: 06/24/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Our understanding of sex differences in subclinical atherosclerosis and plaque composition and characteristics have greatly improved with the use of coronary computed tomography (CCTA) over the past years. CCTA has emerged as an important frontline diagnostic test for women, especially as we continue to understand the impact of non-obstructive atherosclerosis as well as diffuse, high risk plaque as precursors of acute cardiac events in women. Based on its ability to identify complex plaque morphology such as low attenuation plaque, high risk non calcified plaque, positive remodeling, fibrous cap, CCTA can be used to assess plaque characteristics. CCTA can avoid false positive of other imaging studies, if included earlier in assessment of ischemic symptoms. In the contemporary clinical setting, CCTA will prove useful in further understanding and managing cardiovascular disease in women and those without traditional obstructive coronary disease.
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Affiliation(s)
- Keva Garg
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Toral R Patel
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Arjun Kanwal
- Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Todd C Villines
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Khurram Nasir
- Center for Outcomes Research, Division of Cardiology, Houston Methodist, Houston, TX, USA
| | - Roger S Blumenthal
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslee J Shaw
- Department of Population Health Science, Blavatnik Women's Health Research Institute, Mount Sinai School of Medicine, NY, USA
| | - Garima Sharma
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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5
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Yamamoto H, Kihara Y, Fujimoto S, Daida H, Kobuke K, Iwanaga Y, Miyazaki S, Kawasaki T, Fujii T, Kuribayashi S. Predictive value of the coronary artery calcium score and advanced plaque characteristics: Post hoc analysis of the PREDICT registry. J Cardiovasc Comput Tomogr 2020; 15:148-153. [PMID: 32826204 DOI: 10.1016/j.jcct.2020.06.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whether coronary plaque characteristics assessed in coronary computed tomography angiography (CCTA) in association with the coronary artery calcium score (CACS) have predictive value for coronary events is unclear. We aimed to examine the predictive value of the CACS and plaque characteristics for the occurrence of coronary events. METHODS Among 2802 patients who were analyzed in the PREDICT registry, 2083 with suspected coronary artery disease (CAD) were studied using post hoc analysis. High-risk plaques were defined as having ≥2 adverse characteristics, such as low computed tomographic attenuation, positive remodeling, spotty calcification, and napkin-ring sign. An adjudicative composite of coronary events (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization ≥3 months after indexed CCTA) were analyzed. RESULTS Seventy-three (3.5%) patients had coronary events and 313 (15.0%) had high-risk plaques. Multivariate Cox proportional hazard analysis showed that high-risk plaques remained an independent predictor of coronary events (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.13-3.34, P = 0.0154), as well as the log-transformed CACS (adjusted HR 1.24, 95% CI 1.11-1.39, P = 0.0002) and the presence of obstructive stenosis (adjusted HR 5.63, 95% CI 3.22-10.12, P 0.0001). In subgroup analyses, high-risk plaques were independently predictive only in the low CACS class (<100). CONCLUSION This study shows that assessment of adverse features by coronary plaque imaging independently predicts coronary events in patients with suspected CAD and a low CACS. Our findings suggest that the clinical value of high-risk plaques to CACS and stenosis assessment appears marginal.
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Affiliation(s)
- Hideya Yamamoto
- Laboratory of Physiology and Morphology, School of Pharmacy, Yasuda Women's University, 6-13-1 Yasu-higashi, Asa-Minami-ku, Hiroshima, 731-0153, Japan.
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhiro Kobuke
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Shunichi Miyazaki
- Saiseikai-Tondabayashi Hospital, 1-3-36, Koyodai, Tondabayashi, Osaka, 584-0082, Japan
| | - Tomohiro Kawasaki
- Cardiovascular Center, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, 830-8577, Japan
| | - Takashi Fujii
- Division of Cardiology, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, 738-8503, Japan
| | - Sachio Kuribayashi
- Center of Diagnostic Radiology, HIMEDIC Yamanakako, 562-12 Hirano, Yamanakako Village, 401-0502, Japan
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6
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Williams MC, Kwiecinski J, Doris M, McElhinney P, D’Souza MS, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah AS, Mills NL, Pawade T, Wang C, Weir McCall J, Bonnici-Mallia M, Murrills C, Roditi G, van Beek EJ, Shaw LJ, Nicol ED, Berman DS, Slomka PJ, Newby DE, Dweck MR, Dey D. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Circulation 2020; 141:1452-1462. [PMID: 32174130 PMCID: PMC7195857 DOI: 10.1161/circulationaha.119.044720] [Citation(s) in RCA: 353] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The future risk of myocardial infarction is commonly assessed using cardiovascular risk scores, coronary artery calcium score, or coronary artery stenosis severity. We assessed whether noncalcified low-attenuation plaque burden on coronary CT angiography (CCTA) might be a better predictor of the future risk of myocardial infarction. METHODS In a post hoc analysis of a multicenter randomized controlled trial of CCTA in patients with stable chest pain, we investigated the association between the future risk of fatal or nonfatal myocardial infarction and low-attenuation plaque burden (% plaque to vessel volume), cardiovascular risk score, coronary artery calcium score or obstructive coronary artery stenoses. RESULTS In 1769 patients (56% male; 58±10 years) followed up for a median 4.7 (interquartile interval, 4.0-5.7) years, low-attenuation plaque burden correlated weakly with cardiovascular risk score (r=0.34; P<0.001), strongly with coronary artery calcium score (r=0.62; P<0.001), and very strongly with the severity of luminal coronary stenosis (area stenosis, r=0.83; P<0.001). Low-attenuation plaque burden (7.5% [4.8-9.2] versus 4.1% [0-6.8]; P<0.001), coronary artery calcium score (336 [62-1064] versus 19 [0-217] Agatston units; P<0.001), and the presence of obstructive coronary artery disease (54% versus 25%; P<0.001) were all higher in the 41 patients who had fatal or nonfatal myocardial infarction. Low-attenuation plaque burden was the strongest predictor of myocardial infarction (adjusted hazard ratio, 1.60 (95% CI, 1.10-2.34) per doubling; P=0.014), irrespective of cardiovascular risk score, coronary artery calcium score, or coronary artery area stenosis. Patients with low-attenuation plaque burden greater than 4% were nearly 5 times more likely to have subsequent myocardial infarction (hazard ratio, 4.65; 95% CI, 2.06-10.5; P<0.001). CONCLUSIONS In patients presenting with stable chest pain, low-attenuation plaque burden is the strongest predictor of fatal or nonfatal myocardial infarction. These findings challenge the current perception of the supremacy of current classical risk predictors for myocardial infarction, including stenosis severity. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01149590.
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Affiliation(s)
- Michelle C. Williams
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Jacek Kwiecinski
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)
| | - Mhairi Doris
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | - Michelle S. D’Souza
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Sebastien Cadet
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - Philip D. Adamson
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A)
| | - Alastair J. Moss
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Shirjel Alam
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Amanda Hunter
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Anoop S.V. Shah
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Nicholas L. Mills
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Tania Pawade
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Chengjia Wang
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | | | - Christopher Murrills
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom (M.B-M., C.M.)
| | - Giles Roditi
- Institute of Clinical Sciences, University of Glasgow, United Kingdom (G.R.)
| | - Edwin J.R. van Beek
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | - Edward D. Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology; and the National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom (E.D.N.)
| | - Daniel S. Berman
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - Piotr J. Slomka
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - David E. Newby
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D’S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
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Ong P, Safdar B, Seitz A, Hubert A, Beltrame JF, Prescott E. Diagnosis of coronary microvascular dysfunction in the clinic. Cardiovasc Res 2020; 116:841-855. [DOI: 10.1093/cvr/cvz339] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
The coronary microcirculation plays a pivotal role in the regulation of coronary blood flow and cardiac metabolism. It can adapt to acute and chronic pathologic conditions such as coronary thrombosis or long-standing hypertension. Due to the fact that the coronary microcirculation cannot be visualized in human beings in vivo, its assessment remains challenging. Thus, the clinical importance of the coronary microcirculation is still often underestimated or even neglected. Depending on the clinical condition of the respective patient, several non-invasive (e.g. transthoracic Doppler-echocardiography assessing coronary flow velocity reserve, cardiac magnetic resonance imaging, positron emission tomography) and invasive methods (e.g. assessment of coronary flow reserve (CFR) and microvascular resistance (MVR) using adenosine, microvascular coronary spasm with acetylcholine) have been established for the assessment of coronary microvascular function. Individual patient characteristics, but certainly also local availability, methodical expertise and costs will influence which methods are being used for the diagnostic work-up (non-invasive and/or invasive assessment) in a patient with recurrent symptoms and suspected coronary microvascular dysfunction. Recently, the combined invasive assessment of coronary vasoconstrictor as well as vasodilator abnormalities has been titled interventional diagnostic procedure (IDP). It involves intracoronary acetylcholine testing for the detection of coronary spasm as well as CFR and MVR assessment in response to adenosine using a dedicated wire. Currently, the IDP represents the most comprehensive coronary vasomotor assessment. Studies using the IDP to better characterize the endotypes observed will hopefully facilitate development of tailored and effective treatments.
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Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Astrid Hubert
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - John F Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, Australia
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study. J Am Coll Cardiol 2019; 73:291-301. [PMID: 30678759 PMCID: PMC6342893 DOI: 10.1016/j.jacc.2018.10.066] [Citation(s) in RCA: 354] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/31/2022]
Abstract
Background Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque. Objectives The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease. Methods In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years. Results Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden. Conclusions Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)
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9
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Robinson C, Deshpande A, Rutty G, Morgan B. Post-mortem CT: is coronary angiography required in the presence of a high coronary artery calcium score? Clin Radiol 2019; 74:926-932. [PMID: 31526540 DOI: 10.1016/j.crad.2019.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
AIM To test whether a high coronary artery score predicts that the subsequent post-mortem computed tomography (PMCT) with angiography (PMCTA) will diagnose significant coronary artery disease (CAD); to test the diagnostic impact of assuming there is significant CAD based on a high coronary artery calcium (CAC) score alone; and (3) to test whether the clinical CAC score threshold (400) is the most accurate to make this prediction. MATERIALS AND METHODS CAC scoring and PMCTA were performed in cases of adult sudden natural death. Angiography was reviewed to determine if there was sufficient CAD to give as the cause of death. Data were analysed to test whether high calcium score predicts significant CAD. RESULTS PMCTA with CAC score was successful in 100/104 PMCT examinations and in 87/100 angiography examinations (87%). Forty-six cases (46%) had a CAC score of >400, the clinical level of severe disease. CAD was given as the cause of death in 31 (67%) of these cases. Angiography was successful in 39 of these cases (84.7%) and showed severe CAD in all but one (97%). Twenty-five (25%) cases were diagnosed with a CAD death without a high CAC score. CONCLUSION Although CAC score can neither diagnose nor exclude death due to CAD, the addition of angiography adds little diagnostic information to a high CAC score. If PMCT investigation is to exclude trauma and provide a medical cause of death on the "balance of probabilities", angiography is not required when the calcium score >400. This could reduce the number of patients requiring angiography by almost 50%.
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Affiliation(s)
- C Robinson
- Imaging Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
| | - A Deshpande
- Imaging Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - G Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK
| | - B Morgan
- University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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10
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Cademartiri F, Maffei E. Anatomy and physiology in coronary artery disease imaging. J Nucl Cardiol 2019; 26:569-573. [PMID: 28815422 DOI: 10.1007/s12350-017-1033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Filippo Cademartiri
- Cardiovascular Imaging Center - IRCCS SDN, Naples, Italy.
- Cardiovascular Imaging Center - Affidea, Padua, Italy.
- Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands.
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
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11
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Chamsi-Pasha MA, Kurrelmeyer KM. Noninvasive Evaluation of Symptomatic Women with Suspected Coronary Artery Disease. Methodist Debakey Cardiovasc J 2018; 13:193-200. [PMID: 29744011 DOI: 10.14797/mdcj-13-4-193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, yet several factors make it challenging to diagnose in women. Although women have more frequent chest pain than men, atypical symptoms such as nausea, dyspnea, and fatigue make it difficult to determine their risk of coronary artery disease (CAD) before testing. Current guidelines recommend exercise electrocardiography (ex-ECG) as the initial test in symptomatic women with intermediate pretest probability who can exercise and have a normal resting ECG; however, treadmill ex-ECG testing has a significantly lower positive predictive value in women. In addition, women often have nonobstructive CAD in conjunction with microvascular dysfunction and other cardiovascular abnormalities that can decrease the accuracy of all noninvasive tests. The following provides an overview of exercise ECG, echocardiography, SPECT imaging, and various other available modalities and examines their effectiveness in diagnosing and managing symptomatic women with suspected CAD.
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Affiliation(s)
| | - Karla M Kurrelmeyer
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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12
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Affiliation(s)
- Mouaz H Al-Mallah
- Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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13
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Affiliation(s)
- Ying Wang
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael T Osborne
- Department of Radiology, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian Tung
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ming Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yaming Li
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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14
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Chavent B, Maillard N, Boutet C, Albertini JN, Duprey A, Favre JP. Prognostic Value of Aortoiliac Calcification Score in Kidney Transplantation Recipients. Ann Vasc Surg 2017; 44:245-252. [PMID: 28479451 DOI: 10.1016/j.avsg.2017.03.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kidney recipients are increasingly older with arterial disease and extended arterial calcifications. In a kidney transplantation population, the prognosis value of aortic and iliac calcifications remains poorly explored. We aimed to assess the impact of pretransplantation aortoiliac vascular calcifications on patients, grafts survival, and cardiovascular events. METHODS This retrospective study included kidney transplantation patients from 2006 to 2012 for whom we had available presurgery abdominal computed tomography results (n = 100). We designed a score to quantify aortoiliac calcifications. Primary end points were patient and graft survival. Secondary end points were renal function and cardiovascular morbidity. Predictive performances of calcification score were assessed using area under receiver-operating characteristic curves. Patients were classified in quartiles depending on global calcium score value. RESULTS The cumulated rate of death and graft loss was 13% with no significant differences for survival between quartiles. No significant difference was observed in renal function (P = 0.4). Seventeen cardiovascular events were registered with a significant correlation between calcium score elevation and need of cardiovascular surgery during the follow-up (P = 0.01). Global calcium score had a predictive value of 74.5% (95% confidence interval 0.62-0.87) with 71% sensitivity and 73% specificity. CONCLUSIONS Aortoiliac calcifications do not decrease patient and graft survival. High calcium score predict cardiovascular events and procedures during the follow-up.
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Affiliation(s)
- Bertrand Chavent
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Nicolas Maillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Noël Albertini
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Ambroise Duprey
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Pierre Favre
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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16
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Wang R, Liu X, Wang C, Ye X, Xu X, Yang C. Higher coronary artery calcification score is associated with adverse prognosis in patients with stable angina pectoris. J Thorac Dis 2017; 9:582-589. [PMID: 28449466 DOI: 10.21037/jtd.2017.02.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary artery calcification (CAC) indicates the presence of atherosclerotic lesions and serves as a marker of prognosis in patients with coronary artery disease (CAD). This study evaluated the value of the CAC score for determining the prognosis of patients with stable angina pectoris (SAP). METHODS A total of 106 consecutive patients with SAP were enrolled in this study from January 2011 to June 2014; from these patients, 640 multi-slice computer tomography (MSCT) samples were used to obtain CAC scores. The CAC scores were calculated according to the standard Agatston calcium scoring algorithm. All subjects were divided into a lower CAC score group (CAC score, ≤300) and a higher CAC score group (CAC score, >300). Major adverse cardiac events (MACE) were followed-up, and the non-event survival time was recorded. The relationships between the CAC score and both clinical characteristics and MACE were then analysed. RESULTS The CAC positively correlated with age and the creatinine (Cr) level. Compared with patients who received lower CAC scores, the rates of percutaneous coronary intervention (PCI), MACE and multi-vessel disease were significantly higher in patients who received higher CAC scores. The Cox regression analysis results showed that the CAC score [pre-standard deviation (SD)] was a risk factor for the no-event survival time [hazard ratio (HR), 3.06; 95% confidence interval (CI), 1.47-6.38; P<0.05 for all]. However, the Kaplan-Meier analysis suggested that the rates of MACE did not differ between patients who were treated with PCI plus medical therapy and those who were treated with optimal medical therapy alone in both the higher and lower CAC score groups. CONCLUSIONS The CAC scores (per-SD) and MACE strongly and positively correlated in patients with SAP, and PCI was not related to the clinical prognosis of patients with SAP in either group.
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Affiliation(s)
- Renrong Wang
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Xiaoxiao Liu
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Chunxia Wang
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Xinhe Ye
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Xin Xu
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Chengjian Yang
- Department of Cardiology, Wuxi No. 2 Hospital, Nanjing Medical University, Wuxi 214002, China
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Harrington J, Mody P, Blankstein R, Nasir K, Blaha MJ, Joshi PH. Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Shalaeva EV, Saner H, Janabaev BB, Shalaeva AV. Coronary artery calcium score and coronary computed tomographic angiography for major perioperative cardiovascular complications in symptomatic diabetic patients undergoing trans-femoral amputation. Int J Cardiol 2016; 221:806-11. [DOI: 10.1016/j.ijcard.2016.06.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Baldassarre LA, Raman SV, Min JK, Mieres JH, Gulati M, Wenger NK, Marwick TH, Bucciarelli-Ducci C, Bairey Merz CN, Itchhaporia D, Ferdinand KC, Pepine CJ, Walsh MN, Narula J, Shaw LJ. Noninvasive Imaging to Evaluate Women With Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2016; 9:421-35. [PMID: 27056162 PMCID: PMC5486953 DOI: 10.1016/j.jcmg.2016.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
Declines in cardiovascular deaths have been dramatic for men but occur significantly less in women. Among patients with symptomatic ischemic heart disease (IHD), women experience relatively worse outcomes compared with their male counterparts. Evidence to date has failed to adequately explore unique female imaging targets and their correlative signs and symptoms of IHD as major determinants of IHD risk. We highlight sex-specific anatomic and functional differences in contemporary imaging and introduce imaging approaches that leverage refined targets that may improve IHD risk prediction and identify potential therapeutic strategies for symptomatic women.
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Affiliation(s)
| | - Subha V Raman
- The Ohio State University College of Medicine, Columbus, Ohio
| | - James K Min
- Weill Cornell Medical College, New York, New York
| | | | - Martha Gulati
- The University of Arizona College of Medicine, Tucson, Arizona
| | | | | | | | | | - Dipti Itchhaporia
- Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, California
| | | | - Carl J Pepine
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
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Rodriguez-Granillo GA, Carrascosa P, Bruining N, Waksman R, Garcia-Garcia HM. Defining the non-vulnerable and vulnerable patients with computed tomography coronary angiography: evaluation of atherosclerotic plaque burden and composition. Eur Heart J Cardiovasc Imaging 2016; 17:481-91. [PMID: 26903599 DOI: 10.1093/ehjci/jew012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/13/2016] [Indexed: 12/11/2022] Open
Abstract
The shift from coronary plaque stability to plaque instability remains poorly understood despite enormous efforts and expenditures have been assigned to the study of the subject. On the other hand, there have been serious advances in imaging helping us to characterizenon-vulnerable patients The latter has much more value in the clinical decision-making process since it provides high certainty that the patient's probability of a future acute event is low and treatment decisions should be made accordingly. Although coronary plaque rupture is still recognized as the main source of acute thrombotic events, numerous studies have shown that the prediction of events on an individual basis is far more complex and demands a more open approach aimed at characterizing patient risk rather than assessing the risk of thrombosis of a single plaque. Computed tomography coronary angiography (CTCA) has the ability to evaluate non-invasively the extent, burden, severity, and characteristics of coronary artery disease (CAD) and has a close relationship to intravascular ultrasound. On the basis of an excellent negative predictive value with an annualized event rate of ∼0.20% assessed over more than 6000 patients, thus providing a 5-year warranty period, CTCA has been identified as the finest non-invasive tool to exclude CAD. This means that CTCA is able to reliably characterize the non-vulnerable patient. Conversely, in the past few years, several studies have attempted to establish CTCA-derived predictors of acute coronary syndromes, both from a lesion level and a patient level basis with very low positive predictive value, thus questioning the vulnerable patient/plaque concept.
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Affiliation(s)
- Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
| | - Nico Bruining
- Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ron Waksman
- MedStar Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC 20010, USA
| | - Hector M Garcia-Garcia
- MedStar Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC 20010, USA
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Wang Z, Li L, Du R, Yan J, Liu N, Yuan W, Jiang Y, Xu S, Ye F, Yuan G, Zhang B, Liu P. CML/RAGE signal induces calcification cascade in diabetes. Diabetol Metab Syndr 2016; 8:83. [PMID: 28035243 PMCID: PMC5192585 DOI: 10.1186/s13098-016-0196-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Vascular calcification is a significant predictor of coronary heart disease events, stroke, and lower-limb amputation. Advanced glycation end-products (AGEs) play a key role in the development of vascular calcification. However, the role of Nε-carboxymethyl-lysine (CML), a major active ingredient of heterogeneous AGEs, in the development of atherosclerotic calcification in diabetic patients and the underlying mechanism remain unclear. Hence, the role and the mechanism of CML in the transmission pathway of diabetic calcification cascade were investigated in the present study. METHODS In vivo and in vitro investigations were performed. In study I, 45 diabetic patients hospitalized for above-knee amputation in the Department of Orthopedics, Affiliated Hospital of Jiangsu University were recruited from February 2010 to June 2015. The patients were categorized based on the severity of anterior tibial artery stenosis, which was assessed by color Doppler ultrasound, into mild stenosis (0% < stenosis < 50%, n = 15), moderate stenosis (50 ≤ stenosis < 70%, n = 15), and severe stenosis/occlusion groups (70 ≤ stenosis ≤ 100%, n = 15). In study II, the specific mechanism of CML in the transmission pathway of the diabetic calcification cascade signal was investigated in A7r5 aortic smooth muscle cells under high-lipid, apoptosis-coexisting conditions. ELISA (for serum CML concentration of patients), ultrasound (for plaque size, calcification, blood flow filling, vascular stenosis etc.), H&E staining (for plaque morphology), vonKossa staining (for qualitative analysis of calcification), calcium content assay (for quantitative analysis of calcification), and Western blot analyses of CML, receptor for advanced glycation end products (RAGE), NADPH oxidase 4, phosphorylated p38, core-binding factor α1 (cbfα1), alkaline phosphatase (ALP) and β-actin were then performed. RESULTS Morphological analysis revealed extensive calcification lesions in the intima and media of the anterior tibial artery. The extent and area of calcium deposition in the intima significantly increased with disease progression. Interestingly, spotty calcification was predominant in the atherosclerotic plaques of diabetic patients with amputation, and macrocalcification was almost invisible. Pearson correlation analysis revealed that serum CML level exhibited a significant positive correlation with calcium content in the arterial wall (R2 = 0.6141, P < 0.0001). Semi-quantitative Western blot analysis suggested that the intensity of CML/RAGE signal increased with progression of atherosclerotic calcification in diabetic patients. In subsequent in vitro study, the related pathway was blocked by anti-RAGE antibody, NADPH oxidase inhibitor DPI, p38MAPK inhibitor SB203580, and anti-cbfa1 antibody in a step-wise manner to observe changes in calcium deposition and molecular signals. Results suggested that CML may play a key role in atherosclerotic calcification mainly through the CML/RAGE- reactive oxygen species (ROS)-p38MAPK-cbfα1-ALP pathway. CONCLUSION Spotty calcification was predominant in the atherosclerotic plaques of amputated diabetic patients. CML/RAGE signal may induce the calcification cascade in diabetes via ROS-p38MAPK.
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Affiliation(s)
- Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001 China
| | - Rui Du
- Department of Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001 China
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Naifeng Liu
- Department and Institute of Cardiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao, Nanjing, 210009 China
| | - Wei Yuan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Yicheng Jiang
- Department of Cardiology, Huaian No.1 People’s Hospital, Huaian, 223300 China
| | - Suining Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Fei Ye
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Guoyue Yuan
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001 China
| | - Baohai Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
| | - Peijing Liu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, 438 Jiefang, Zhenjiang, 212001 China
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22
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Park HE, Jeon J, Hwang IC, Sung J, Lee SP, Kim HK, Cho GY, Sohn DW, Kim YJ. Effect of Dipeptidyl Peptidase-4 Inhibitor on All-Cause Mortality and Coronary Revascularization in Diabetic Patients. J Cardiovasc Ultrasound 2015; 23:233-43. [PMID: 26755932 PMCID: PMC4707309 DOI: 10.4250/jcu.2015.23.4.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/03/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anti-atherosclerotic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors has been suggested from previous studies, and yet, its association with cardiovascular outcome has not been demonstrated. We aimed to evaluate the effect of DPP-4 inhibitors in reducing mortality and coronary revascularization, in association with baseline coronary computed tomography (CT). METHODS The current study was performed as a multi-center, retrospective observational cohort study. All subjects with diabetes mellitus who had diagnostic CT during 2007-2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users were compared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularization therapy after 90 days of CT in addition to all-cause mortality. RESULTS DPP-4 inhibitors users had significantly less adverse events [0.8% vs. 4.4% in users vs. non-users, adjusted hazard ratios (HR) 0.220, 95% confidence interval (CI) 0.102-0.474, p = 0.0001 for primary outcome, 4.1% vs. 7.6% in users vs. non-users, HR 0.517, 95% CI 0.363-0.735, p = 0.0002 for secondary outcome, adjusted variables were age, sex, presence of hypertension, high sensitivity C-reactive protein, glycated hemoglobin, statin use, coronary artery calcium score and degree of stenosis]. Interestingly, DPP-4 inhibitor seemed to be beneficial only in subjects without significant stenosis (adjusted HR 0.148, p = 0.0013 and adjusted HR 0.525, p = 0.0081 for primary and secondary outcome). CONCLUSION DPP-4 inhibitor is associated with reduced all-cause mortality and coronary revascularization in diabetic patients. Such beneficial effect was significant only in those without significant coronary stenosis, which implies that DPP-4 inhibitor may have beneficial effect in earlier stage of atherosclerosis.
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Affiliation(s)
- Hyo Eun Park
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jooyeong Jeon
- Master in Statistics, Department of Statistics, Sungkyunkwan University, Seoul, Korea
| | - In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dae-Won Sohn
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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23
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Buscombe JR. Exploring the nature of atheroma and cardiovascular inflammation in vivo using positron emission tomography (PET). Br J Radiol 2015; 88:20140648. [PMID: 26110339 DOI: 10.1259/bjr.20140648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Positron emission tomography (PET) has become widely established in oncology. Subsequently, a whole new “toolbox” of tracers have become available to look at different aspects of cancer cell function and dysfunction, including cell protein production, DNA synthesis, hypoxia and angiogenesis. In the past 5 years, these tools have been used increasingly to look at the other great killer of the developed world: cardiovascular disease. For example, inflammation of the unstable plaque can be imaged with 18-fludeoxyglucose (18F-FDG), and this uptake can be quantified to show the effect that statins have in reducing inflammation and explains how these drugs can reduce the risk of stroke. 18F-FDG has also become established in diagnosing and monitoring large-vessel vasculitis and has now entered routine practice. Other agents such as gallium-68 (68Ga) octreotide have been shown to identify vascular inflammation possibly more specifically than 18FFDG.Hypoxia within the plaque can be imaged with 18F-fluoromisonidazole and resulting angiogenesis with 18F-RGD peptides. Active calcification such as that found in unstable atheromatous plaques can be imaged with 18F-NaF. PET imaging enables us to understand the mechanisms by which cardiovascular disease, including atheroma, leads tomorbidity and death and thus increases the chance of finding new and effective treatments.
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24
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Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, Duvernoy C, Walsh MN, Bairey Merz CN. Emergence of Nonobstructive Coronary Artery Disease: A Woman's Problem and Need for Change in Definition on Angiography. J Am Coll Cardiol 2015; 66:1918-33. [PMID: 26493665 PMCID: PMC4618799 DOI: 10.1016/j.jacc.2015.08.876] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 01/12/2023]
Abstract
Recognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.
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Affiliation(s)
- Carl J Pepine
- Division of Cardiology, University of Florida, Gainesville, Florida.
| | | | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Rashmee U Shah
- Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Martha Gulati
- The College of Medicine and The College of Clinical Public Health, The Ohio State University, Columbus, Ohio
| | - Claire Duvernoy
- Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
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25
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AlJaroudi WA, Hage FG. Review of cardiovascular imaging in The Journal of Nuclear Cardiology in 2014: Part 1 of 2: Positron emission tomography, computed tomography, and neuronal imaging. J Nucl Cardiol 2015; 22:507-12. [PMID: 25523416 DOI: 10.1007/s12350-014-0045-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
The year 2014 has been an exciting year for the cardiovascular imaging community with significant advances in the realm of nuclear and multimodality cardiac imaging. In this new feature of the Journal of Nuclear Cardiology, we will summarize some of the breakthroughs that were published in the Journal in 2014 in 2 sister articles. This first article will concentrate on publications dealing with cardiac positron emission tomography (PET), computed tomography (CT), and neuronal imaging.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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26
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Chaikriangkrai K, Velankar P, Schutt R, Alchalabi S, Nabi F, Mahmarian J, Chang SM. Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease. Am J Cardiol 2015; 115:738-44. [PMID: 25604930 DOI: 10.1016/j.amjcard.2014.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 11/19/2022]
Abstract
The objective of this study was to examine the additive prognostic performance of coronary artery calcium score (CACS) over coronary computed tomography angiography (CCTA) stenosis assessment in symptomatic patients suspected for coronary artery disease (CAD) undergoing CCTA. A total of 805 symptomatic patients without known history of CAD who underwent coronary evaluation by multidetector cardiac CT were analyzed. Mean age of the cohort was 58 ± 13 years. A total of 44% (354 of 805) of the patients had a 0 CACS, 27% (215 of 805) had CACS 1 to 100, 14% (111 of 805) had CACS 101 to 400, and 15% (125 of 805) had CACS >400. CCTA showed normal coronary arteries in 43% (349 of 805) of patients, ≤50% stenosis in 42% (333 of 805), and >50% stenosis in 15% (123 of 805). Patients were followed for 2.3 ± 0.9 years. Major adverse cardiac event (MACE) was defined as cardiac death, nonfatal myocardial infarction, and late coronary revascularization. Overall incidence of MACE was 1.4% per year. Both CACS and CCTA stenosis were independently associated with increased MACE (p <0.05 for both). Addition of CACS into the model with clinical risk factors and CCTA stenosis significantly improved predictive performance for MACE from the model with clinical risk factors and CCTA stenosis only (global chi-square score 108 vs 70; p = 0.019). In conclusion; in symptomatic patients without known CAD, both CACS and CCTA stenosis were independently associated with increased cardiac events, and performing non-contrast-enhanced CACS evaluation in addition to contrast-enhanced CCTA improved predictive ability for future cardiac events compared to CCTA stenosis assessment alone.
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Affiliation(s)
| | - Pradnya Velankar
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Robert Schutt
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Sama Alchalabi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Faisal Nabi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - John Mahmarian
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Su Min Chang
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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27
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Uehara M, Funabashi N, Takaoka H, Ozawa K, Kobayashi Y. The CHADS2 score is a useful predictor of coronary arteriosclerosis on 320 slice CT and may correlate with prognosis in subjects with atrial fibrillation. Int J Cardiol 2015; 179:84-9. [DOI: 10.1016/j.ijcard.2014.10.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/29/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
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28
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Shah N, Soon K, Wong C, Kelly AM. Screening for asymptomatic coronary heart disease in the young 'at risk' population: Who and how? IJC HEART & VASCULATURE 2014; 6:60-65. [PMID: 28785628 PMCID: PMC5497146 DOI: 10.1016/j.ijcha.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/20/2014] [Indexed: 01/13/2023]
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
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29
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Kong YG, Kang JW, Kim YK, Seo H, Lim TH, Hwang S, Hwang GS, Lee SG. Preoperative coronary calcium score is predictive of early postoperative cardiovascular complications in liver transplant recipients. Br J Anaesth 2014; 114:437-43. [PMID: 25416273 DOI: 10.1093/bja/aeu384] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Coronary computed tomographic angiography (coronary CT) is a non-invasive test for diagnosis of cardiac function. Coronary calcium scores determined by coronary CT are associated with cardiovascular risk factors. However, no studies have investigated the association between coronary calcium scores and cardiovascular complications after liver transplantation (LT). We therefore evaluated the utility of preoperative coronary calcium scores for predicting early postoperative cardiovascular complications in LT recipients. METHODS Between 2010 and 2012, 443 LT recipients were analysed retrospectively. Preoperative cardiovascular assessments, including coronary CT, were performed. A coronary calcium score >400 was defined as a positive finding. Predictive factors of early postoperative cardiovascular complications were evaluated by univariate and multivariate analyses. Major cardiovascular complications occurring during a period of 1 month after LT were noted. RESULTS Of the 443 patients, 38 (8.6%) experienced one or more cardiovascular complications. Positive coronary CT findings were seen in 11 (2.5%) patients. In the multivariate analysis, a coronary calcium score >400 {odds ratio (OR)=4.62 [95% confidence interval (CI): 1.14-18.72], P=0.032} and female sex [OR=2.76 (1.37-5.57), P=0.005] were predictive of cardiovascular complications. CONCLUSIONS A preoperative coronary calcium score of >400 predicted cardiovascular complications occurring 1 month after LT, suggesting that preoperative evaluation of coronary calcium scores could help predict early postoperative cardiovascular complications in LT recipients.
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Affiliation(s)
- Y-G Kong
- Department of Anesthesiology and Pain Medicine
| | | | - Y-K Kim
- Department of Anesthesiology and Pain Medicine,
| | - H Seo
- Department of Anesthesiology and Pain Medicine
| | | | - S Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G-S Hwang
- Department of Anesthesiology and Pain Medicine
| | - S-G Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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