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Howden N, Branch K, Douglas P, Gray M, Budoff M, Dewey M, Newby DE, Nicholls SJ, Blankstein R, Fathieh S, Grieve SM, Figtree GA. Computed tomographic angiography measures of coronary plaque in clinical trials: opportunities and considerations to accelerate drug translation. Front Cardiovasc Med 2024; 11:1359500. [PMID: 38500753 PMCID: PMC10945423 DOI: 10.3389/fcvm.2024.1359500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
Atherosclerotic coronary artery disease (CAD) is the causal pathological process driving most major adverse cardiovascular events (MACE) worldwide. The complex development of atherosclerosis manifests as intimal plaque which occurs in the presence or absence of traditional risk factors. There are numerous effective medications for modifying CAD but new pharmacologic therapies require increasingly large and expensive cardiovascular outcome trials to assess their potential impact on MACE and to obtain regulatory approval. For many disease areas, nearly a half of drugs are approved by the U.S. Food & Drug Administration based on beneficial effects on surrogate endpoints. For cardiovascular disease, only low-density lipoprotein cholesterol and blood pressure are approved as surrogates for cardiovascular disease. Valid surrogates of CAD are urgently needed to facilitate robust evaluation of novel, beneficial treatments and inspire investment. Fortunately, advances in non-invasive imaging offer new opportunity for accelerating CAD drug development. Coronary computed tomography angiography (CCTA) is the most advanced candidate, with the ability to measure accurately and reproducibly characterize the underlying causal disease itself. Indeed, favourable changes in plaque burden have been shown to be associated with improved outcomes, and CCTA may have a unique role as an effective surrogate endpoint for therapies that are designed to improve CAD outcomes. CCTA also has the potential to de-risk clinical endpoint-based trials both financially and by enrichment of participants at higher likelihood of MACE. Furthermore, total non-calcified, and high-risk plaque volume, and their change over time, provide a causally linked measure of coronary artery disease which is inextricably linked to MACE, and represents a robust surrogate imaging biomarker with potential to be endorsed by regulatory authorities. Global consensus on specific imaging endpoints and protocols for optimal clinical trial design is essential as we work towards a rigorous, sustainable and staged pathway for new CAD therapies.
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Affiliation(s)
- N. Howden
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia
| | - K. Branch
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - P. Douglas
- Duke Department of Medicine, The Duke University Medical Center, Durham, NC, United States
| | - M. Gray
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - M. Budoff
- Department of Cardiology, Lundquist Institute, Torrance, CA, United States
| | - M. Dewey
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Campus Mitte, Charitéplatz 1, Berlin, Germany
| | - D. E. Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - S. J. Nicholls
- Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - R. Blankstein
- Departments of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - S. Fathieh
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - S. M. Grieve
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - G. A. Figtree
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Ajimu Y, Shiga Y, Hirata T, Tashiro K, Higashi S, Kawahira Y, Suematsu Y, Kato Y, Kuwano T, Sugihara M, Miura SI. Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry. J Clin Med 2023; 12:5987. [PMID: 37762928 PMCID: PMC10532007 DOI: 10.3390/jcm12185987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The liver fibrosis score reflects the degree of hepatic scarring and has been reported to be associated with cardiovascular disease. Using a coronary artery computed tomography angiography registry at the Fukuoka University Hospital (FU-CCTA registry), we investigated the association between major adverse cardiovascular events (MACEs) and the liver fibrosis score (fibrosis-4 index (FIB-4I)) in 612 patients who underwent CCTA to screen for coronary artery disease and performed a prognosis survey for up to 5 years. The primary endpoint was MACEs (all-cause mortality, acute myocardial infarction, ischemic stroke, coronary revascularization). FIB-4I in all patients and in patients with hypertension (HTN) was significantly higher in the MACE group than in the non-MACE group. The event-free survival rate of MACEs targeting only patients with HTN was significantly lower in patients with a high risk of liver fibrosis (FIB-4I values of 2.67 or higher) than in those with a low or intermediate risk (less than 2.67). However, no significant difference was observed in all patients or in patients without HTN. Finally, FIB-4I and body mass index were independent factors associated with MACEs in patients with HTN. In conclusion, the liver fibrosis score may be an independent predictor of MACEs in hypertensive patients undergoing CCTA.
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Affiliation(s)
- Yusuke Ajimu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Tetsuo Hirata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Sara Higashi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0133, Japan; (Y.A.); (Y.S.); (T.H.); (K.T.); (S.H.); (Y.K.); (Y.S.); (Y.K.); (T.K.); (M.S.)
- Department of Internal Medicine, Fukuoka University Nishijin Hospital, Fukuoka 814-0005, Japan
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Kawahira Y, Shiga Y, Inoue H, Suematsu Y, Tashiro K, Kato Y, Fujimi K, Takamiya Y, Kuwano T, Sugihara M, Miura SI. Association between high-density lipoprotein cholesterol levels and major adverse cardiovascular events in patients who underwent coronary computed tomography angiography: FU-CCTA registry. Heart Vessels 2021; 36:1457-1465. [PMID: 33744994 DOI: 10.1007/s00380-021-01831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
It is unclear whether higher levels of serum high-density lipoprotein cholesterol (HDL-C) prevent major adverse cardiovascular events (MACE). We prospectively evaluated 501 patients who had undergone coronary computed tomography angiography at Fukuoka University Hospital and either were clinically suspected of having coronary artery disease (CAD) or had at least one cardiovascular risk factor with a follow-up of up to 5 years. The primary endpoint was MACE (cardiovascular death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into tertiles according to the HDL-C level: 47 mg/dl ≥ HDL-C level [n = 167, lower HDL-C level (L-HDL)], 58 mg/dl ≥ HDL-C level ≥ 48 mg/dl [n = 167, middle HDL-C level (M-HDL)] and HDL-C level ≥ 59 mg/dl [n = 167, higher HDL-C level (H-HDL)] groups. There were significant differences in %CAD among the L-HDL, M-HDL and H-HDL groups. Unexpectedly, there was no difference in %MACE between M-HDL and H-HDL, although %MACE in M-HDL was significantly lower than that in L-HDL (p < 0.05). By a multivariate logistic regression analysis, MACE in H-HDL-C was independently associated with diabetes mellitus (DM) (p = 0.03). A Kaplan-Meier curve according to the HDL subgroup indicated that M-HDL, not H-HDL, enjoyed the greatest freedom from MACE among the 3 groups (log-rank test p = 0.047). Finally, the results of a Cox regression model indicated that L-HDL and H-HDL had significantly higher risk of MACE than M-HDL. In conclusions, patients with middle HDL-C levels, not higher HDL-C levels, showed the greatest freedom from MACE. Patients with higher HDL-C levels need to be strictly managed for DM to prevent MACE.
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Affiliation(s)
- Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroko Inoue
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Cardiac Rehabilitation Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Yosuke Takamiya
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. .,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan. .,Cardiac Rehabilitation Center, Fukuoka University Hospital, Fukuoka, Japan.
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Higashi S, Shiga Y, Yano M, Imaizumi T, Tashiro K, Idemoto Y, Kato Y, Kuwano T, Sugihara M, Miura SI. Associations between smoking habits and major adverse cardiovascular events in patients who underwent coronary computed tomography angiography as screening for coronary artery disease. Heart Vessels 2020; 36:483-491. [PMID: 33245490 DOI: 10.1007/s00380-020-01727-5] [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: 05/07/2020] [Accepted: 11/06/2020] [Indexed: 12/01/2022]
Abstract
We analyzed whether smoking was associated with major adverse cardiovascular events (MACE) and the progression of coronary atherosclerosis as assessed by coronary computed tomography angiography (CCTA) as screening for coronary artery disease (CAD). We enrolled 443 patients who had all undergone CCTA and either were clinically suspected of having CAD or had at least one cardiovascular risk factor. We divided the patients into smoking (past and current smoker) and non-smoking groups and into males and females, and evaluated the presence of CAD, severity of coronary atherosclerosis and MACE (cardiovascular death, ischemic stroke, acute myocardial infarction and coronary revascularization) with a follow-up of up to 5 years. %CAD and the severity of coronary atherosclerosis in the smoking group were significantly higher than those in the non-smoking group. %MACE in males and smokers were significantly higher than those in females and non-smokers, respectively. Interestingly, Kaplan-Meier curves also showed that female non-smokers enjoyed significantly greater freedom from MACE than female smokers (p = 0.007), whereas there was no significant difference in freedom from MACE between male non-smokers and male smokers (p = 0.984). Although there were no significant predictors of MACE in all patients according to a multiple logistic regression analysis, smoking was useful for predicting MACE in females, but not males. In conclusion, smoking was significantly associated with MACE in females, but not males, who underwent CCTA as screening for CAD.
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Affiliation(s)
- Sara Higashi
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Masaya Yano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tomoki Imaizumi
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiaki Idemoto
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. .,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
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Sajjadieh Khajouei A, Adibi A, Maghsodi Z, Nejati M, Behjati M. Prognostic value of normal and non-obstructive coronary artery disease based on CT angiography findings. A 12 month follow up study. J Cardiovasc Thorac Res 2019; 11:318-321. [PMID: 31824615 PMCID: PMC6891042 DOI: 10.15171/jcvtr.2019.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings.
Methods: This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined.
Results: After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57).
Conclusion: A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.
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Affiliation(s)
| | - Atoosa Adibi
- Al-Zahra hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Maghsodi
- Al-Zahra hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Nejati
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohaddeseh Behjati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Combined use of exercise electrocardiography, coronary calcium score and cardiac CT angiography for the prediction of major cardiovascular events in patients presenting with stable chest pain. Int J Cardiol 2013; 167:121-5. [DOI: 10.1016/j.ijcard.2011.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 12/02/2011] [Accepted: 12/03/2011] [Indexed: 01/19/2023]
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