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Iusupova AO, Slepova OA, Pakhtusov NN, Popova LV, Ageev AA, Lishuta AS, Privalova EV, Khabarova NV, Dadashovа GМ, Belenkov YN. Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries. KARDIOLOGIIA 2024; 64:14-21. [PMID: 38742511 DOI: 10.18087/cardio.2024.4.n2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 05/16/2024]
Abstract
AIM To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease. MATERIAL AND METHODS This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis <50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients. RESULTS The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p<0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p<0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p <0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis. CONCLUSION IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.
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Affiliation(s)
- A O Iusupova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O A Slepova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N N Pakhtusov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - L V Popova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Ageev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A S Lishuta
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E V Privalova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N V Khabarova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Yu N Belenkov
- Sechenov First Moscow State Medical University, Moscow, Russia
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2
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Spence JD. Assessment of atherosclerosis: should coronary calcium score and intima-media thickness be replaced by ultrasound measurement of carotid plaque burden and vessel wall volume? Curr Opin Lipidol 2023; 34:126-132. [PMID: 37093105 DOI: 10.1097/mol.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW To describe the uses of vessel wall volume (VWV) and measurement of carotid plaque burden, as total plaque area (TPA) and total plaque volume (TPV), and to contrast them with measurement of carotid intima-media thickness (IMT) and coronary calcium (CAC). RECENT FINDINGS Measurement of carotid plaque burden (CPB) is useful for risk stratification, research into the genetics and biology of atherosclerosis, for measuring effects of new therapies for atherosclerosis, and for treatment of high-risk patients with severe atherosclerosis. It is as predictive of risk as CAC, with important advantages. IMT is only a weak predictor of risk and changes so little over time that it is not useful for assessing effects of therapy. SUMMARY Measurement of CPB and VWV are far superior to measurement of carotid IMT in many ways, and should replace it. Vessel wall volume can be measured in persons with no plaque as an alternative to IMT. There are important advantages of CPB over coronary calcium; CPB should be more widely used in vascular prevention.
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Affiliation(s)
- J David Spence
- Professor Emeritus of Neurology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, London, ON N6G 2V4, Canada
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3
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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4
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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5
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Bansal M, Sharma D, Kasliwal R. Diagnostic accuracy of coronary artery calcium score for excluding obstructive coronary artery disease. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2022. [DOI: 10.4103/jcpc.jcpc_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Pathakota SR, Durgaprasad R, Velam V, Ay L, Kasala L. Correlation of coronary artery calcium score and carotid artery intima-media thickness with severity of coronary artery disease. J Cardiovasc Thorac Res 2020; 12:78-83. [PMID: 32626546 PMCID: PMC7321008 DOI: 10.34172/jcvtr.2020.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Coronary artery calcium score (CACS) and carotid artery intima-media thickness (CIMT) are the markers of atherosclerosis. An association between CACS and CIMT with presence of atherosclerotic coronary artery disease (CAD) is well established. However relationship between severity of CAD with CACS and CIMT is less clear. This study aimed to investigate the correlation between severity of CAD assessed by SYNTAX and Gensini scores with CACS and CIMT. Methods: This prospective study was conducted on 351 patients with CAD between June 2015 to December 2016. CACS was obtained using AGATSTON algorithm with 128 slice multidetector computer tomography (MDCT) before conventional coronary angiography (CCA). CIMT was measured by using Philips IE33 Echo machine. The severity of CAD was assessed by SYNTAX score (SS) and Gensini score on CCA. Correlation between severity of CAD with CACS and CIMT was analysed. Results: Mean CACS was 241.5±463.7, and this was positively correlated with over all SS (r=0.417, P <0.0001) and Gensini score (r=0.405, P<0.0001). Mean CIMT was 0.80±0.18 mm and this was also significantly correlated with SS (r=0.450, P<0.0001) and Gensini score (r=0.459,<0.0001). Multivariate analysis showed that CACS was independently associated with diabetes mellitus (β:0.11, P=0.021), SS (β:0.251, P =0.010) and mean CIMT (β:0.128, P =0.028). Receiver-operating characteristic (ROC) curve analysis revealed a cut off CACS of >493 for SS≥33 (high-SS tertile). Conclusion: Our study confirmed a significant correlation between CACS and CIMT with the severity of CAD assessed by SS and Gensini scores. CACS and CIMT may be considered as important noninvasive diagnostic modalities in the assessment of the severity of CAD.
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Affiliation(s)
- Sudhakar Reddy Pathakota
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Rajasekhar Durgaprasad
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Vanajakshamma Velam
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Lakshmi Ay
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Latheef Kasala
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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7
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Naguib A, Elsawy N, Aboul-enein F, Hossam N. The relation between serum visfatin levels and cardiovascular involvement in rheumatoid arthritis. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Abir Naguib
- Department of Physical, Medicine Rheumatology and Rehabilitation Faculty of Medicine Alexandria UniversityEgypt
| | - Noha Elsawy
- Department of Physical, Medicine Rheumatology and Rehabilitation Faculty of Medicine Alexandria UniversityEgypt
| | - Fatma Aboul-enein
- Department of Cardiology and Angiology Faculty of Medicine Alexandria University Egypt
| | - Nermin Hossam
- Department of Clinical Pathology Faculty of Medicine Alexandria University Egypt
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8
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Lavenburg P, Cantor G, Agunloye O, Bhagat A, Taub E, Teressa G. Diagnostic and Prognostic Role of the Modified Diamond-Forrester Model in Combination With Coronary Calcium Score in Acute Chest Pain Patients. Crit Pathw Cardiol 2019; 18:32-39. [PMID: 30747763 DOI: 10.1097/hpc.0000000000000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients. METHODS We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Obstructive CAD was defined as luminal narrowing of ≥50% in 1 or more vessels by CCTA. Patients were classified according to PTP as low (<10%), intermediate (10%-90%), or high (>90%). RESULTS The DFM classified 293 (14.7%), 1445 (72.7%), and 250 (12.6%) of patients as low, intermediate, and high risk, respectively, with corresponding 30-day MACE rates of 0.0%, 2.35%, and 14.8%. For patients with intermediate PTP and CCS ≤10, the negative predictive value was 99.2% (95% confidence interval: 98.7-99.8) for 30-day MACE while it was 92.62% (95% confidence interval: 87.9-97.3) for patients with high PTP. Among patients with a high PTP and CCS of zero, the prevalence of 30-day MACE and obstructive CAD remained high (7.07% and 10.1%, respectively). CONCLUSIONS In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP.
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Affiliation(s)
- Philip Lavenburg
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Gregg Cantor
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Olufunmilayo Agunloye
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Aditi Bhagat
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Erin Taub
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Getu Teressa
- From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY
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9
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Gabriel FS, Gonçalves LFG, Melo EVD, Sousa ACS, Pinto IMF, Santana SMM, Matos CJOD, Souto MJS, Conceição FMDS, Oliveira JLM. Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography. Arq Bras Cardiol 2018; 110:420-427. [PMID: 29723329 PMCID: PMC5967134 DOI: 10.5935/abc.20180063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background In view of the high mortality for cardiovascular diseases, it has become
necessary to stratify the main risk factors and to choose the correct
diagnostic modality. Studies have demonstrated that a zero calcium score
(CS) is characteristic of a low risk for cardiovascular events. However, the
prevalence of individuals with coronary atherosclerotic plaques and zero CS
is conflicting in the specialized literature. Objective To evaluate the frequency of patients with coronary atherosclerotic plaques,
their degree of obstruction and associated factors in patients with zero CS
and indication for coronary computed tomography angiography (CCTA). Methods This is a cross-sectional, prospective study with 367 volunteers with zero CS
at CCTA in four diagnostic imaging centers in the period from 2011 to 2016.
A significance level of 5% and 95% confidence interval were adopted. Results The frequency of atherosclerotic plaque in the coronary arteries in 367
patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age
was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant
coronary obstructions (> 50%), with involvement of two or more segments
in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%,
p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was
significantly higher in patients with atherosclerotic plaques, with an odds
ratio of 3.4 for each of this variable. Conclusions The frequency of atherosclerotic plaque with zero CS was relatively high,
indicating that the absence of calcification does not exclude the presence
of plaques, many of which obstructive, especially in non-obese subjects and
alcohol drinkers.
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Affiliation(s)
- Fabíola Santos Gabriel
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Clínica de Medicina Nuclear de Diabetes - CLIMEDI - Aracaju, SE - Brazil
| | - Luiz Flávio Galvão Gonçalves
- Centro de Pesquisas da Fundação São Lucas - Aracaju, SE - Brazil.,Clínica de Medicina Nuclear de Diabetes - CLIMEDI - Aracaju, SE - Brazil
| | - Enaldo Vieira de Melo
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Antônio Carlos Sobral Sousa
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia (ECOLAB) do Hospital e Fundação São Lucas - Aracaju, SE - Brazil
| | | | | | - Carlos José Oliveira de Matos
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Maria Júlia Silveira Souto
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Flávio Mateus do Sacramento Conceição
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Joselina Luzia Menezes Oliveira
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia (ECOLAB) do Hospital e Fundação São Lucas - Aracaju, SE - Brazil.,Instituto Dante Pazzanese de Cardiologia - São Paulo, SP - Brazil.,Centro de Ensino e Pesquisa da Fundação São Lucas - Aracaju, SE - Brazil
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10
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Pochhammer J, Tröster F, Blumenstock G, Closset J, Lang S, Weller MP, Schäffer M. Calcification of the iliac arteries: a marker for leakage risk in rectal anastomosis-a blinded clinical trial. Int J Colorectal Dis 2018; 33:163-170. [PMID: 29273883 DOI: 10.1007/s00384-017-2949-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leakage (AL) is associated with increased morbidity and mortality after colorectal surgery. Calcification of the arteries has been identified as a risk factor for cardiovascular events and can be reliably measured on computed tomography using software assistance. The aim of this prospective study was to prove the value of calcium scoring of the iliac arteries as a predictor of AL after rectal anastomosis. METHODS Consecutive patients who underwent colorectal resection with rectal anastomosis were analyzed. Diagnostic computed tomography images were used to detect calcification of the arteries supplying the rectal anastomosis. Logistic regression analysis was used to determine the relationship between vascular calcification and AL. RESULTS Of 139 included and analyzed patients, AL occurred in 15 (11%). The volume and calcium scores were significantly higher in the infrarenal aorta, the left and right common iliac artery, and the left internal iliac artery. In univariate analysis, calcification of the left internal iliac artery and both internal iliac arteries combined correlated with the occurrence of the primary endpoint. A receiver operating curve analysis led to the cut-off values of 30 and 6 for the volume score and calcium score, respectively. They provide a negative predictive value of 0.97 and a positive predictive value of 0.19. CONCLUSIONS Calcification in the iliac arteries appears to be a good marker for the risk of leakage after rectal anastomosis. The calcification scoring system is easy to calculate after computed tomography and may aid in patient selection to create a protective ileostomy.
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Affiliation(s)
- Julius Pochhammer
- Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany
| | - Fridolin Tröster
- Department of Diagnostic and Interventional Radiology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Julienne Closset
- Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany
| | - Stefanie Lang
- Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany
| | - Marie-Pascale Weller
- Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany
| | - Michael Schäffer
- Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany.
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11
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Engbers EM, Timmer JR, Ottervanger JP. Coronary artery calcium score as a gatekeeper in the non-invasive evaluation of suspected coronary artery disease in symptomatic patients. J Nucl Cardiol 2017; 24:826-831. [PMID: 28150157 DOI: 10.1007/s12350-017-0792-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Elsemiek M Engbers
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - Jorik R Timmer
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Jan Paul Ottervanger
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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12
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Ruckel SM, Gulati M. Coronary Calcium Scoring as the Gate Keeper for Stress Myocardial Perfusion Imaging: Antagonist. J Nucl Cardiol 2017; 24:832-834. [PMID: 28144907 DOI: 10.1007/s12350-017-0793-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Shane M Ruckel
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona-Phoenix, 1111 East McDowell Road, Suite 200, Phoenix, AZ, 85008, USA.
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13
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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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14
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Hinzpeter R, Higashigaito K, Morsbach F, Benz D, Manka R, Seifert B, Keller DI, Alkadhi H. Coronary artery calcium scoring for ruling-out acute coronary syndrome in chest pain CT. Am J Emerg Med 2017; 35:1565-1567. [PMID: 28390834 DOI: 10.1016/j.ajem.2017.03.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - David Benz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland; Department of Cardiology, University Heart Center Zurich, University of Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
| | - Burkhardt Seifert
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
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Nicoll R, Henein M. Arterial calcification: A new perspective? Int J Cardiol 2017; 228:11-22. [DOI: 10.1016/j.ijcard.2016.11.099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
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16
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Urabe Y, Yamamoto H, Kitagawa T, Utsunomiya H, Tsushima H, Tatsugami F, Awai K, Kihara Y. Identifying Small Coronary Calcification in Non-Contrast 0.5-mm Slice Reconstruction to Diagnose Coronary Artery Disease in Patients with a Conventional Zero Coronary Artery Calcium Score. J Atheroscler Thromb 2016; 23:1324-1333. [PMID: 27397477 PMCID: PMC5221495 DOI: 10.5551/jat.35808] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: In a new-generation computed tomography (CT) scanner, coronary artery calcium (CAC) scores were measured using 3.0-mm slice reconstruction images originally acquired with 0.5 mm thickness scans in a single beat. This study investigated the usefulness of thin-slice (0.5 mm) reconstruction for identifying small calcifications in coronary arteries and evaluated the association with coronary plaques and stenosis compared to conventional 3.0-mm reconstruction images. Methods: We evaluated 132 patients with zero CAC scores in conventional 3.0-mm Agatston method using a 320-slice CT. Then, 0.5-mm slice reconstruction was performed to identify small calcifications. The presence of stenosis and coronary plaques was assessed using coronary CT angiography. Results: In total, 22 small calcifications were identified in 18 patients. There were 28 (21%) patients with any (≥ 25%) stenosis (34 lesions). Forty-seven coronary plaques were found in 33 patients (25%), including 7 calcified plaques in 7 patients (5%), 34 noncalcified plaques in 27 patients (20%), and 6 partially calcified plaques in 5 patients (4%). Patients with small calcifications had a significantly higher prevalence of noncalcified or partially calcified plaques (83% vs 14%; p < 0.001) and obstructive stenosis (33% vs 5.2%; p < 0.001) compared to those without small calcifications. The addition of small calcifications to the coronary risk factors when diagnosing stenosis significantly improved the diagnostic value. Conclusion: Small calcifications detected by thin-slice 0.5-mm reconstruction are useful for distinguishing coronary atherosclerotic lesions in patients with zero CAC scores from conventional CT reconstruction.
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Affiliation(s)
- Yoji Urabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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17
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McKavanagh P, Walls G, McCune C, Malloy J, Harbinson MT, Ball PA, Donnelly PM. The Essentials of Cardiac Computerized Tomography. Cardiol Ther 2015; 4:117-29. [PMID: 26536882 PMCID: PMC4675750 DOI: 10.1007/s40119-015-0052-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Indexed: 10/25/2022] Open
Abstract
Cardiac computerized tomography (CT) has evolved from a research tool to an important diagnostic investigation in cardiology, and is now recommended in European, US, and UK guidelines. This review is designed to give the reader an overview of the current state of cardiac CT. The role of cardiac CT is multifaceted, and includes risk stratification, disease detection, coronary plaque quantification, defining congenital heart disease, planning for structural intervention, and, more recently, assessment of ischemia. This paper addresses basic principles as well as newer evidence.
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Karády J, Drobni ZD, Kolossváry M, Maurovich-Horvat P. Non-invasive Assessment of Coronary Plaque Morphology. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Relationship between serum IgG4 concentrations and atherosclerotic coronary plaques assessed by computed tomographic angiography. J Cardiol 2015; 67:254-61. [PMID: 26164687 DOI: 10.1016/j.jjcc.2015.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Immunoglobulin G4 (IgG4)-related immuno-inflammation has been suggested to affect the development of coronary artery atherosclerosis. The aim of this study was to analyze the association of serum IgG4 concentrations with calcified and non-calcified coronary plaques. METHODS Serum IgG4 concentrations were measured in 263 patients who underwent 320-slice coronary computed tomographic (CT) angiography. Vulnerable coronary plaques were evaluated for CT plaque characteristics, including low-density plaque (LDP), positive remodeling, and spotty calcification. RESULTS Serum concentrations of IgG4 were significantly higher in patients with non-calcified plaque (NCP) than in those without (32.2mg/dL vs. 23.7mg/dL, p=0.029). By contrast, the median serum IgG4 concentrations in patients with and without calcified plaque were 31.2mg/dL and 26.2mg/dL, respectively (p=0.107). Serum IgG4 concentrations were significantly elevated in patients with LDP (33.5mg/dL vs. 26.9mg/dL, p=0.002) and in those with positive remodeling (31.4mg/dL vs. 28.4mg/dL, p=0.039) than in those without. Patients with spotty calcification also had significantly higher serum IgG4 concentrations than those without (32.1mg/dL vs. 24.9mg/dL, p=0.049). In age- and gender-adjusted logistic regression analysis, the highest IgG4 quartile (≥56.7mg/dL) was significantly associated with LDP with an odds ratio of 2.49 (95% CI, 1.15-5.36, p=0.020). CONCLUSIONS Serum IgG4 concentrations were significantly associated with NCP, especially with LDP, suggesting that IgG4-related immuno-inflammation may play a role in coronary plaque vulnerability.
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CT attenuation features of individual calcified coronary plaque: differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups. PLoS One 2015; 10:e0131254. [PMID: 26106881 PMCID: PMC4481104 DOI: 10.1371/journal.pone.0131254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
Background Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups. Methods In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2. Results Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001). Conclusions Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.
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Tsushima H, Yamamoto H, Kitagawa T, Urabe Y, Tatsugami F, Awai K, Kihara Y. Association of epicardial and abdominal visceral adipose tissue with coronary atherosclerosis in patients with a coronary artery calcium score of zero. Circ J 2015; 79:1084-91. [PMID: 25739955 DOI: 10.1253/circj.cj-14-1169] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We sought to examine whether epicardial and abdominal visceral adipose tissue distribution is associated with coronary atherosclerosis in patients with a coronary artery calcium (CAC) score of zero, assessed by coronary computed tomography angiography (CCTA). METHODS AND RESULTS We studied 352 patients with suspected coronary artery disease (mean age 61±11 years, 57% male) with a CAC score of zero who had undergone CCTA. Non-calcified coronary plaques (NCPs) were detected in 102 patients (29%); those causing ≥50% stenosis were found in 15 patients (4%). Patients were divided into 4 groups on the basis of CT-based epicardial adipose tissue (EAT) volume and abdominal visceral adipose tissue (VAT) area using the sex-specific median value. Multivariate analysis showed that the adjusted odds ratios for the presence of NCPs in the high VAT area/low EAT volume group, and the high VAT area/high EAT volume group were 2.80 (95% confidence interval [95% CI]: 1.25-6.35, P=0.01) and 2.68 (95% CI: 1.36-5.45, P=0.004), respectively. Interestingly, the low VAT area/high EAT volume group showed an equivalent adjusted odds ratio of 3.02 (95% CI: 1.33-6.90, P=0.008). CONCLUSIONS EAT volume is eligible as a marker to be evaluated in addition to VAT area in patients with a CAC score of zero.
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Affiliation(s)
- Hiroshi Tsushima
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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Garcia MJ. Computed Tomographic Angiography (CTA) of the Coronary, Aorta, Visceral, and Lower Extremity Arteries. PANVASCULAR MEDICINE 2015:1225-1248. [DOI: 10.1007/978-3-642-37078-6_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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23
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Okada K, Ohshima S, Isobe S, Harada K, Hirashiki A, Funahashi H, Arai K, Hayashi D, Hayashi M, Ishii H, Murohara T. Epicardial fat volume correlates with severity of coronary artery disease in nonobese patients. J Cardiovasc Med (Hagerstown) 2014; 15:384-90. [PMID: 23549277 DOI: 10.2459/jcm.0b013e32836094da] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE It has been reported that epicardial adipose tissue could locally modulate the coronary artery functions through secretion of proinflammatory and anti-inflammatory cytokines. Epicardial fat tissue is further implicated in the pathogenesis of coronary artery disease (CAD) because of its proximity to the adventitia of the major epicardial coronary arteries. We investigated the relationship between epicardial fat volume (EFV) and severity of CAD in nonobese patients using 64-slice multidetector computed tomography (MDCT). METHODS One hundred and forty nonobese patients (BMI <25 kg/m2) were enrolled. EFV and visceral fat area were measured by MDCT. Patients were classified according to the plaque components (noncalcified, mixed and calcified) and severity of CAD. Inflammatory biomarkers were also measured, and compared with each CT parameter. RESULTS EFV was significantly correlated with the extent or severity of CAD. Patients with noncalcified or mixed plaque had a greater EFV than those with calcified plaque. Log-transferred high sensitivity C-reactive protein (CRP) was significantly correlated with EFV (r = 0.24, P = 0.04). Adiponectin level was significantly inversely correlated with visceral fat area (r = 0.38, P = 0.0001). CONCLUSION Increased EFV is associated with more severe CAD and noncalcified or mixed coronary plaques in nonobese patients.
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Affiliation(s)
- Koji Okada
- aDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya bDepartment of Cardiology, Handa City Hospital, Handa cDepartment of Cardiology, Tsushima City Hospital, Tsushima, Japan
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Palacio D, Betancourt S, Gladish GW. Screening for coronary heart disease in asymptomatic patients using multidetector computed tomography: calcium scoring and coronary computed tomography angiography. Semin Roentgenol 2014; 50:111-7. [PMID: 25770341 DOI: 10.1053/j.ro.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Palacio
- Department of Radiology, University of Arizona, College of Medicine, Tucson, AZ.
| | - Sonia Betancourt
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory W Gladish
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Cho I, Chang HJ, Ó Hartaigh B, Shin S, Sung JM, Lin FY, Achenbach S, Heo R, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Dunning AM, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Leipsic J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Min JK. Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study. Eur Heart J 2014; 36:501-8. [PMID: 25205531 DOI: 10.1093/eurheartj/ehu358] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. METHODS AND RESULTS From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. CONCLUSION Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.
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Affiliation(s)
- Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea
| | - Bríain Ó Hartaigh
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Sanghoon Shin
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea
| | - Fay Y Lin
- Department of Medicine, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | | | - Ran Heo
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | | | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA
| | - Filippo Cademartiri
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, DC, USA
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Erica Maffei
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
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Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy. Int J Cardiol 2014; 177:385-91. [PMID: 25281436 DOI: 10.1016/j.ijcard.2014.08.130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS). METHODS Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories. RESULTS From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting ≥ 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P=0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 ± 449 in suspected ACS and 435 ± 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients. CONCLUSIONS The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.
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Raff GL, Chinnaiyan KM, Cury RC, Garcia MT, Hecht HS, Hollander JE, O'Neil B, Taylor AJ, Hoffmann U. SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: A Report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8:254-71. [DOI: 10.1016/j.jcct.2014.06.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 02/06/2023]
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Kalra DK, Heo R, Valenti V, Nakazato R, Min JK. Role of computed tomography for diagnosis and risk stratification of patients with suspected or known coronary artery disease. Arterioscler Thromb Vasc Biol 2014; 34:1144-54. [PMID: 24723554 PMCID: PMC4120118 DOI: 10.1161/atvbaha.113.302074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiac computed tomographic angiography (CCTA) has emerged as a powerful imaging modality for the detection and prognostication of individuals with suspected coronary artery disease. Because calcification of coronary plaque occurs in proportion to the total atheroma volume, the initial diagnostic potential of CCTA focused on the identification and quantification of coronary calcium in low- to intermediate-risk individuals, a finding that tracks precisely with the risk of incident adverse clinical events. Beyond noncontrast detection of coronary calcium, CCTA using iodinated contrast yields incremental information about the degree and distribution of coronary plaques and stenosis, as well as vessel wall morphology and atherosclerotic plaque features. This additive information offers the promise of CCTA to provide a more comprehensive view of total atherosclerotic burden because it relates to myocardial ischemia and future adverse clinical events. Furthermore, emerging data suggest the prognostic and diagnostic importance of stenosis severity detection and atherosclerotic plaque features described by CCTA including positive remodeling, low-attenuation plaque, and spotty calcification, which have been associated with the vulnerability of plaque. We report a summary of the evidence supporting the role of CCTA in the detection of subclinical and clinical coronary artery disease in both asymptomatic and symptomatic patients and discuss the potential of CCTA to augment the identification of at-risk individuals. CCTA and coronary artery calcium scoring offer the ability to improve risk stratification, discrimination, and reclassification of the risk in patients with suspected coronary artery disease and to noninvasively determine the measures of stenosis severity and atherosclerotic plaque features.
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Affiliation(s)
- Dan K Kalra
- From the Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (D.K.K., R.H., V.V., J.K.M.); and Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (R.N.)
| | - Ran Heo
- From the Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (D.K.K., R.H., V.V., J.K.M.); and Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (R.N.)
| | - Valentina Valenti
- From the Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (D.K.K., R.H., V.V., J.K.M.); and Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (R.N.)
| | - Ryo Nakazato
- From the Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (D.K.K., R.H., V.V., J.K.M.); and Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (R.N.)
| | - James K Min
- From the Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (D.K.K., R.H., V.V., J.K.M.); and Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan (R.N.).
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von Ziegler F, Greif M, Tittus J, Schenzle J, Becker C, Becker A. Distribution of coronary calcifications in patients with suspected coronary heart disease. Am Heart J 2014; 167:568-75. [PMID: 24655707 DOI: 10.1016/j.ahj.2013.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 12/27/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary calcifications are a marker of coronary atherosclerosis. The role of coronary calcium scoring (CS) as part of the initial evaluation of patients with suspected coronary heart disease (CHD) is controversially discussed. The primary goal of this study was to characterize the coronary calcium distribution in this particular patient population. In a second step, we aimed to establish a possible clinical implication using CS for the diagnosis of CHD. METHODS Calcium scoring procedure was performed by either using a multidetector or a dual-source computed tomographic scanner. All patients underwent invasive coronary angiography (ICA) as the current criterion standard for CHD detection. A total of 4,137 (2,780 men, mean age 60.5 ± 12.4 years) consecutive patients were included. RESULTS Mean CS was 288 ± 446 (range 0-5,252). Overall coronary artery calcifications significantly increased with patients' age. In 2,048 patients (mean CS 101 ± 239, range 0-5252), significant CHD (≥50% stenosis) was excluded by ICA (1,939 patients without calcifications). In remaining 2,089 patients (51%, mean CS 607 ± 821, range 0-5,252), significant CHD was documented leading to intervention in 732 patients. A threshold of zero calcifications (existence of calcified tissue) had the best overall sensitivity and negative predictive value with 99%. Overall specificity with 34% and overall positive predictive value with 24% were rather low. CONCLUSION Coronary calcium scoring is able to exclude significant CHD in patients with suspected CHD with a high negative predictive value and, therefore, possibly reduce the number of invasive diagnostic examinations. Because of the low specificity and positive predictive value, CS cannot be used to indicate ICA.
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Walther S, Schueler S, Tackmann R, Schuetz GM, Schlattmann P, Dewey M. Compliance with STARD Checklist among Studies of Coronary CT Angiography: Systematic Review. Radiology 2014; 271:74-86. [DOI: 10.1148/radiol.13121720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yerramasu A, Lahiri A, Venuraju S, Dumo A, Lipkin D, Underwood SR, Rakhit RD, Patel DJ. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging 2014; 15:886-92. [PMID: 24513880 DOI: 10.1093/ehjci/jeu011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT) is recommended as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood (10-29%) of underlying obstructive coronary artery disease (CAD) after clinical assessment. The recommendation has not previously been tested prospectively in a rapid access chest pain clinic (RACPC). METHODS We recruited 300 consecutive patients presenting with stable chest pain to the RACPC of three hospitals. All patients underwent CAC imaging, followed by invasive coronary angiography (ICA) in patients with CAC ≥ 1000 Agatston units (Au) and CT coronary angiography (CTCA) in those with CAC <1000. Patients with 50-70% stenosis on CTCA underwent myocardial perfusion scintigraphy (MPS) while those with ≥ 70% stenosis underwent ICA. Obstructive CAD was defined as ≥ 70% stenosis on ICA or the presence of inducible ischaemia on MPS. Patients were followed up clinically for a mean of 17 (SD 6) months. RESULTS The mean patient age was 60.6 (SD 9.6) years and 48% were males. Obstructive CAD was found in 56 (19%) patients, of whom 42 (14%) underwent revascularization. CAC was zero in 131 (44%) patients, of whom two (1.5%) had obstructive CAD and one (0.8%) underwent revascularization. The sensitivity, specificity, negative predictive value, and positive predictive value of CAC ≥ 1 for detection of obstructive CAD were 96, 53, 32, and 98%, respectively. None of the 57 patients with low pre-test probability of CAD and zero CAC had obstructive CAD or suffered a cardiovascular event during the follow-up. CONCLUSION Patients with stable chest pain symptoms but a low likelihood of CAD can safely be diagnosed as not having obstructive CAD in the absence of detectable coronary calcification by unenhanced CT. Patients with CAC >400 Au have a high prevalence of obstructive CAD and further investigation with ICA or functional imaging may be warranted rather than CTCA. These findings support NICE guidance for the investigation of stable chest pain. ClinicalTrials gov identifier: NCT01464203.
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Affiliation(s)
- Ajay Yerramasu
- Clinical Imaging and Research Centre, Wellington Hospital, London, UK
| | - Avijit Lahiri
- Clinical Imaging and Research Centre, Wellington Hospital, London, UK University of Middlesex, London, UK
| | | | - Alain Dumo
- Clinical Imaging and Research Centre, Wellington Hospital, London, UK
| | - David Lipkin
- Clinical Imaging and Research Centre, Wellington Hospital, London, UK
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton Hospital, Sydney St, London SW3 6NP, UK
| | | | - Deven J Patel
- Barnet and Chase Farm Hospitals NHS Trust, London, UK
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Yoon YE, Lim TH. Current roles and future applications of cardiac CT: risk stratification of coronary artery disease. Korean J Radiol 2014; 15:4-11. [PMID: 24497786 PMCID: PMC3909860 DOI: 10.3348/kjr.2014.15.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/02/2013] [Indexed: 12/25/2022] Open
Abstract
Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.
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Affiliation(s)
- Yeonyee Elizabeth Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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Garcia MJ. Computed Tomography Angiography: Peripheral and Visceral Vascular System. PANVASCULAR MEDICINE 2014:1-28. [DOI: 10.1007/978-3-642-37393-0_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 09/02/2023]
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Ibrahimi P, Jashari F, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: how useful is the imaging? Atherosclerosis 2013; 231:323-33. [PMID: 24267246 DOI: 10.1016/j.atherosclerosis.2013.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/13/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023]
Abstract
The recent advancement of imaging modalities has made possible visualization of atherosclerosis disease in all phases of its development. Markers of subclinical atherosclerosis or even the most advanced plaque features are acquired by invasive (IVUS, OCT) and non-invasive imaging modalities (US, MRI, CTA). Determining plaques prone to rupture (vulnerable plaques) might help to identify patients at risk for myocardial infarction or stroke. The most accepted features of plaque vulnerability include: thin cap fibroatheroma, large lipid core, intimal spotty calcification, positive remodeling and intraplaque neovascularizations. Today, research is focusing on finding imaging techniques that are less invasive, less radiation and can detect most of the vulnerable plaque features. While, carotid atherosclerosis can be visualized using noninvasive imaging, such as US, MRI and CT, imaging plaque feature in coronary arteries needs invasive imaging modalities. However, atherosclerosis is a systemic disease with plaque development simultaneously in different arteries and data acquisition in carotid arteries can add useful information for prediction of coronary events.
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Affiliation(s)
- Pranvera Ibrahimi
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Relationship Between Carotid Disease on Ultrasound and Coronary Disease on CT Angiography. JACC Cardiovasc Imaging 2013; 6:1160-7. [DOI: 10.1016/j.jcmg.2013.06.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/31/2013] [Accepted: 06/28/2013] [Indexed: 11/23/2022]
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Mouden M, Timmer JR, Reiffers S, Oostdijk AH, Knollema S, Ottervanger JP, Jager PL. Coronary Artery Calcium Scoring to Exclude Flow-Limiting Coronary Artery Disease in Symptomatic Stable Patients at Low or Intermediate Risk. Radiology 2013; 269:77-83. [DOI: 10.1148/radiol.13122529] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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The natural history of coronary calcification: A meta-analysis from St Francis and EBEAT trials. Int J Cardiol 2013; 168:3944-8. [DOI: 10.1016/j.ijcard.2013.06.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 04/14/2013] [Accepted: 06/29/2013] [Indexed: 11/22/2022]
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Bengrid T, Nicoll R, Zhao Y, Schmermund A, Henein MY. Coronary calcium score is superior to exercise tolerance testing in predicting significant coronary artery stenosis. Int J Cardiol 2013; 168:1697-9. [DOI: 10.1016/j.ijcard.2013.03.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/23/2013] [Indexed: 11/24/2022]
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Karpouzas GA, Malpeso J, Choi TY, Li D, Munoz S, Budoff MJ. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann Rheum Dis 2013; 73:1797-804. [DOI: 10.1136/annrheumdis-2013-203617] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arterial calcification: Friend or foe? Int J Cardiol 2013; 167:322-7. [PMID: 22809537 DOI: 10.1016/j.ijcard.2012.06.110] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/13/2012] [Accepted: 06/24/2012] [Indexed: 01/28/2023]
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Kim J, Bravo PE, Gholamrezanezhad A, Sohn S, Rafique A, Travis A, Machac J. Coronary artery and thoracic aorta calcification is inversely related to coronary flow reserve as measured by ⁸²Rb PET/CT in intermediate risk patients. J Nucl Cardiol 2013; 20:375-84. [PMID: 23468383 PMCID: PMC3653061 DOI: 10.1007/s12350-013-9675-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/11/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The strength and nature of the relationship between myocardial perfusion imaging (MPI), coronary flow reserve (CFR), and coronary artery calcium (CAC) and thoracic aorta calcium (TAC) remain to be clarified. METHODS Dynamic rest-pharmacological stress (82)Rb positron emission tomography/computed tomography MPI with CFR, CAC, and TAC was performed in 75 patients (59 ± 13 years; F/M = 38/37) with intermediate risk of coronary artery disease. RESULTS A total of 29 (39%) patients had ischemic and 46 (61%) had normal MPI. CAC was correlated with TAC (ρ = 0.7; P < .001), and CFR was inversely related with CAC and TAC (ρ = -0.6 and -0.5; P < .001, respectively). By gender-specific univariate analysis, age (P = .001), CAC (P = .004), and CFR (P = .008) in males, but CFR (P = .0001), age (P = .002), and TAC (P = .01) in females were significant predictors of ischemic MPI. By multiple regression, the most potent predictor was CFR [odds ratio (OR) = 0.17, P = .01), followed by age (OR = 1.07, P = .02), gender (OR = 4.01, P = .03), and CAC (OR = 1.002, P = .9). CONCLUSIONS Combination of MPI, CFR, CAC, and TAC has complementary roles in intermediate risk patients.
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Affiliation(s)
- Jongho Kim
- Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574 USA
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 300, Baltimore, MD 21205 USA
| | - Paco E. Bravo
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 300, Baltimore, MD 21205 USA
| | - Ali Gholamrezanezhad
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 300, Baltimore, MD 21205 USA
| | - Seil Sohn
- Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574 USA
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Ash Rafique
- Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574 USA
| | - Arlene Travis
- Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574 USA
| | - Josef Machac
- Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574 USA
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Hou ZH, Lu B, Gao Y, Jiang SL, Wang Y, Li W, Budoff MJ. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging 2013; 5:990-9. [PMID: 23058065 DOI: 10.1016/j.jcmg.2012.06.006] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/04/2012] [Accepted: 06/14/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE). BACKGROUND The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA. METHODS We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. RESULTS Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001). CONCLUSIONS The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value.
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Affiliation(s)
- Zhi-hui Hou
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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McBride CB, Cheezum MK, Gore RS, Pathirana IN, Slim AM, Villines TC. Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:211-220. [PMID: 23795234 PMCID: PMC3683145 DOI: 10.1007/s12410-013-9198-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The detection and quantification of coronary artery calcification (CAC) significantly improves cardiovascular risk prediction in asymptomatic patients. Many have advocated for expanded CAC testing in symptomatic patients based on data demonstrating that the absence of quantifiable CAC in patients with possible angina makes obstructive coronary artery disease (CAD) and subsequent adverse events highly unlikely. However, the widespread use of CAC testing in symptomatic patients may be limited by the high background prevalence of CAC and its low specificity for obstructive CAD, necessitating additional testing ('test layering') in a large percentage of eligible patients. Further, adequately powered prospective studies validating the comparative effectiveness of a 'CAC first' approach with regards to cost, safety, accuracy and clinical outcomes are lacking. Due to marked reductions in patient radiation exposure and higher comparative accuracy and prognostic value make coronary computed tomographic angiography the preferred CT-based test for appropriately selected symptomatic patients.
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Affiliation(s)
- Chad B McBride
- Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue., Bethesda, MD 20850 USA
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Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity. Eur Radiol 2013; 23:1603-22. [PMID: 23322410 DOI: 10.1007/s00330-012-2763-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/29/2012] [Accepted: 12/10/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool. METHODS Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy. RESULTS The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item ("Uninterpretable Results") showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with "no fulfilment" increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy. CONCLUSIONS The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies. KEY POINTS • Good methodological quality is a basic requirement in diagnostic accuracy studies. • Most coronary CT angiography studies have only been of moderate design quality. • Weak methodological quality will affect the sensitivity and specificity. • No improvement in methodological quality was observed over time. • Authors should consider the QUADAS checklist when undertaking accuracy studies.
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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47
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Schuetz GM, Schlattmann P, Dewey M. Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies. BMJ 2012; 345:e6717. [PMID: 23097549 PMCID: PMC3480336 DOI: 10.1136/bmj.e6717] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether a 3 × 2 table, using an intention to diagnose approach, is better than the "classic" 2 × 2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. DESIGN Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3 × 2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. DATA SOURCES Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. ELIGIBILITY CRITERIA Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. RESULTS 120 studies (10,287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2 × 2 tables and 3 × 2 tables. Using a bivariate random effects model, we compared the 2 × 2 table with the 3 × 2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P<0.05)). CONCLUSION Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3 × 2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.
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Affiliation(s)
- Georg M Schuetz
- Department of Radiology, The Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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van der Wall EE. Ablation for atrial fibrillation: CT overlay or standard electroanatomical mapping? Neth Heart J 2012; 20:299-301. [PMID: 22767412 PMCID: PMC3402569 DOI: 10.1007/s12471-012-0301-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- E E van der Wall
- Interuniversity Cardiology Institute of the Netherlands (ICIN)-Netherlands Heart Institute (NHI), Utrecht, the Netherlands,
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Jensen JK, Medina HM, Nørgaard BL, Øvrehus KA, Jensen JM, Nielsen LH, Maurovich-Horvat P, Engel LC, Januzzi JL, Hoffmann U, Truong QA. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. Int J Cardiol 2012; 160:171-4. [DOI: 10.1016/j.ijcard.2011.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/11/2011] [Accepted: 04/14/2011] [Indexed: 11/25/2022]
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