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Long Y, Guo R, Jin K, An J, Fu P, Lei J, Ma J. Analysis of the perivascular fat attenuation index and quantitative plaque parameters in relation to haemodynamically impaired myocardial ischaemia. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03122-x. [PMID: 38761288 DOI: 10.1007/s10554-024-03122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
To investigate the correlation between quantitative plaque parameters, the perivascular fat attenuation index, and myocardial ischaemia caused by haemodynamic impairment. Patients with stable angina who had invasive flow reserve fraction (FFR) assessment and coronary artery computed tomography (CT) angiography were retrospectively enrolled. A total of 138 patients were included in this study, which were categorized into the FFR < 0.75 group (n = 43), 0.75 ≤ FFR ≤ 0.8 group (n = 37), and FFR > 0.8 group (n = 58), depending on the range of FFR values. The perivascular FAI and CTA-derived parameters, including plaque length (PL), total plaque volume (TPV), minimum lumen area (MLA), and narrowest degree (ND), were recorded for the lesions. An FFR < 0.75 was defined as myocardial-specific ischaemia. The relationships between myocardial ischaemia and parameters such as the PL, TPV, MLA, ND, and FAI were analysed using a logistic regression model and receiver operating characteristic (ROC) curves to compare the diagnostic accuracy of various indicators for myocardial ischaemia. The PL, TPV, ND, and FAI were greater in the FFR < 0.75 group than in the grey area group and the FFR > 0.80 group (all p < 0.05). The MLA in the FFR < 0.75 group was lower than that in the grey area group and the FFR > 0.80 group (both P < 0.05). There were no significant differences in the PL, TPV, or ND between the grey area and the FFR > 0.80 group, but there was a significant difference in the FAI. The coronary artery lesions with FFRs ≤ 0.75 had the greatest FAI values. Multivariate analysis revealed that the perivascular FAI and PL density are significant predictors of myocardial ischaemia. The FAI has some predictive value for myocardial ischaemia (AUC = 0.781). After building a combination model using the FAI and plaque length, the predictive power increased (AUC, 0.781 vs. 0.918), and the change was statistically significant (P < 0.001). The combined model of PL + FAI demonstrated great diagnostic efficacy in identifying myocardial ischaemia caused by haemodynamic impairment; the lower the FFR was, the greater the FAI. Thus, the PL + FAI could be a combined measure to securely rule out myocardial ischaemia.
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Affiliation(s)
- Yangfei Long
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Rui Guo
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Keyu Jin
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - JiaJia An
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Penggang Fu
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Jian Lei
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Jing Ma
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China.
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Sugane H, Asaumi Y, Ogata S, Kimura M, Kanaya T, Hoshi T, Sato A, Miura H, Tomishima Y, Morita Y, Nakao K, Otsuka F, Kataoka Y, Kawasaki T, Nishimura K, Narula J, Yasuda S, Noguchi T. Evaluation of fractional flow reserve and atherosclerotic plaque characteristics on coronary non-contrast T1-weighted magnetic resonance imaging. Atherosclerosis 2024; 392:117530. [PMID: 38583287 DOI: 10.1016/j.atherosclerosis.2024.117530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS The relationship between high-risk coronary plaque characteristics regardless of the severity of lesion stenosis and myocardial ischemia remains unsettled. High-intensity plaques (HIPs) on non-contrast T1-weighted magnetic resonance imaging (T1WI) have been characterized as high-risk coronary plaques. We sought to elucidate whether the presence of coronary HIPs on T1WI influences fractional flow reserve (FFR) in the distal segment of the vessel. METHODS We retrospectively analyzed 281 vessels in 231 patients with chronic coronary syndrome who underwent invasive FFR measurement and coronary T1WI using a multicenter registry. The plaque-to-myocardial signal intensity ratio (PMR) of the most stenotic lesion was evaluated; a coronary plaque with PMR ≥1.4 was defined as a HIP. RESULTS The median PMR of coronary plaques on T1WI in vessels with FFR ≤0.80 was significantly higher than that of plaques with FFR >0.80 (1.17 [interquartile range (IQR): 0.99-1.44] vs. 0.97 [IQR: 0.85-1.09]; p < 0.001). Multivariable analysis showed that an increase in PMR of the most stenotic segment was associated with lower FFR (beta-coefficient, -0.050; p < 0.001). The presence of coronary HIPs was an independent predictor of FFR ≤0.80 (odds ratio (OR), 6.18; 95% confidence interval (CI), 1.93-19.77; p = 0.002). Even after adjusting for plaque composition characteristics based on computed tomography angiography, the presence of coronary HIPs was an independent predictor of FFR ≤0.80 (OR, 4.48; 95% CI, 1.19-16.80; p = 0.026). CONCLUSIONS Coronary plaques with high PMR are associated with low FFR in the corresponding vessel, indicating that plaque morphology might influence myocardial ischemia severity.
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Affiliation(s)
- Hiroki Sugane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiology, Chikamori Hospital, Kochi-city, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michito Kimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Dokkyo Medical Univeristy, Mibu, Japan
| | - Tomoya Hoshi
- Department of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Sato
- Second Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiyuki Tomishima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuku Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Ekmejian A, Howden N, Eipper A, Allahwala U, Ward M, Bhindi R. Association between vessel-specific coronary Aggregated plaque burden, Agatston score and hemodynamic significance of coronary disease (The CAPTivAte study). IJC HEART & VASCULATURE 2024; 51:101384. [PMID: 38496257 PMCID: PMC10940135 DOI: 10.1016/j.ijcha.2024.101384] [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: 11/25/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Background CT coronary angiography (CTCA) is a guideline-endorsed assessment for patients with stable angina and suspected coronary disease. Although associated with excellent negative predictive value in ruling out obstructive coronary disease, there are limitations in the ability of CTCA to predict hemodynamically significant coronary disease. The CAPTivAte study aims to assess the utility of Aggregated Plaque Burden (APB) in predicting ischemia based on Fractional Flow Reserve (FFR). Methods In this retrospective study, patients who had a CTCA and invasive FFR of the LAD were included. The entire length of the LAD was analyzed using semi-automated software which characterized total plaque burden and plaque morphological subtype (including Low Attenuation Plaque (LAP), Non-calcific plaque (NCP) and Calcific Plaque (CP). Aggregated Plaque Burden (APB) was calculated. Univariate and multivariate analysis were performed to assess the association between these CT-derived parameters and invasive FFR. Results There were 145 patients included in this study. 84.8 % of patients were referred with stable angina. There was a significant linear association between APB and FFR in both univariate and multivariate analysis (Adjusted R-squared = 0.0469; p = 0.035). Mean Agatston scores are higher in FFR positive vessels compared to FFR negative vessels (371.6 (±443.8) vs 251.9 (±283.5, p = 0.0493). Conclusion CTCA-derived APB is a reliable predictor of ischemia assessed using invasive FFR and may aid clinicians in rationalizing invasive vs non-invasive management strategies. Vessel-specific Agatston scores are significantly higher in FFR-positive vessels than in FFR-negative vessels. Associations between HU-derived plaque subtype and invasive FFR were inconclusive in this study.
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Affiliation(s)
- Avedis Ekmejian
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Nicklas Howden
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
| | | | - Usaid Allahwala
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Michael Ward
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Ravinay Bhindi
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
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Kumar U, Aslam U, Mancuso DL, Khalpey Z. Anomalous Right Coronary Artery With Interarterial Course: Risk Stratification and Surgical Decision-Making Using Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve. Cureus 2024; 16:e58885. [PMID: 38800194 PMCID: PMC11116748 DOI: 10.7759/cureus.58885] [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] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
An anomalous right coronary artery (RCA) takeoff, a rare congenital condition often characterized by an interarterial RCA course between the pulmonary artery and the ascending aorta, can lead to symptoms of angina pectoris (chest pain) or even sudden cardiac death (SCD) due to compression of the RCA, although most patients remain asymptomatic. In this case report, we highlight the utility of computed tomography angiography (CTA)-derived fractional flow reserve (FFR), a minimally invasive technique used to assess the hemodynamic significance of coronary lesions, in the risk stratification and surgical decision-making process for a 46-year-old female patient presenting with exertional dyspnea and an anomalous RCA takeoff with an interarterial course. The information obtained from this imaging modality was instrumental in determining that surgical repair did not need to be performed urgently and could be scheduled as an elective case in the future.
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Affiliation(s)
- Ujjawal Kumar
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Usman Aslam
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- Department of General Surgery, HonorHealth, Phoenix, USA
| | - David L Mancuso
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
| | - Zain Khalpey
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
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Tsugu T, Tanaka K, Belsack D, Nagatomo Y, Tsugu M, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery. Eur Radiol 2024; 34:1836-1845. [PMID: 37658136 PMCID: PMC10873436 DOI: 10.1007/s00330-023-09972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Computed tomography (CT)-derived fractional flow reserve (FFRCT) decreases continuously from proximal to distal segments of the vessel due to the influence of various factors even in non-obstructive coronary artery disease (NOCAD). It is known that FFRCT is dependent on vessel-length, but the relationship with other vessel morphologies remains to be explained. PURPOSE To investigate morphological aspects of the vessels that influence FFRCT in NOCAD in the right coronary artery (RCA). METHODS A total of 443 patients who underwent both FFRCT and invasive coronary angiography, with < 50% RCA stenosis, were evaluated. Enrolled RCA vessels were classified into two groups according to distal FFRCT: FFRCT ≤ 0.80 (n = 60) and FFRCT > 0.80 (n = 383). Vessel morphology (vessel length, lumen diameter, lumen volume, and plaque volume) and left-ventricular mass were assessed. The ratio of lumen volume and vessel length was defined as V/L ratio. RESULTS Whereas vessel-length was almost the same between FFRCT ≤ 0.80 and > 0.80, lumen volume and V/L ratio were significantly lower in FFRCT ≤ 0.80. Distal FFRCT correlated with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). Among all vessel-related parameters, V/L ratio showed the highest correlation with distal FFRCT (r = 0.61, p < 0.0001). Multivariable analysis showed that calcified plaque volume was the strongest predictor of distal FFRCT, followed by V/L ratio (β-coefficient = 0.48, p = 0.03). V/L ratio was the strongest predictor of a distal FFRCT ≤ 0.80 (cut-off 8.1 mm3/mm, AUC 0.88, sensitivity 90.0%, specificity 76.7%, 95% CI 0.84-0.93, p < 0.0001). CONCLUSIONS Our study suggests that V/L ratio can be a measure to predict subclinical coronary perfusion disturbance. CLINICAL RELEVANCE STATEMENT A novel marker of the ratio of lumen volume to vessel length (V/L ratio) is the strongest predictor of a distal CT-derived fractional flow reserve (FFRCT) and may have the potential to improve the diagnostic accuracy of FFRCT. KEY POINTS • Physiological FFRCT decline depends not only on vessel length but also on the lumen volume in non-obstructive coronary artery disease in the right coronary artery. • FFRCT correlates with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). • Of vessel-related parameters, V/L ratio is the strongest predictor of a distal FFRCT and an optimal cut-off value of 8.1 mm3/mm.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Mayuko Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
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Chen M, Liu B, Li X, Li D, Fan L. Relationship between peri-coronary inflammation and coronary vascular function in patients with suspected coronary artery disease. Front Cardiovasc Med 2024; 11:1303529. [PMID: 38390440 PMCID: PMC10881729 DOI: 10.3389/fcvm.2024.1303529] [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: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background In this study, we aim to investigate the relationship between the attenuation of peri-coronary adipose tissue (PCAT) in patients with suspected coronary artery disease (CAD) and the assessment of coronary vascular functions using coronary flow reserve (CFR). Methods We included 364 patients who underwent 13N-NH3 positron emission tomography/computed tomography and coronary computed tomography angiography (CCTA). We determined the relationship between fat attenuation index (FAI), PCAT volume, and other qualitative CT-derived anatomic parameters with CFR. Results We detected a decrease in CFR (<2.5) in 206 (57%) patients. At the patient level, those with reduced CFR showed a significantly higher prevalence of diffused atherosclerosis (41% vs. 23%; P < 0.001) and higher FAI (-75.5 HU vs. -77.1 HU; P = 0.014). In patients without obstructive CAD, FAI was significantly higher in those with reduced CFR (-75.5 HU vs. -77.7 HU, P = 0.026). On the vessel level, 1,092 vessels were analyzed, and 642 (59%) exhibited reduced CFR. The vessels with reduced CFR presented a significantly higher prevalence of obstructive CAD (37% vs. 26%; P < 0.001), diffused atherosclerosis (22% vs. 11%; P < 0.001), low-attenuation plaque (6% vs. 3%; P = 0.030), and positive remodeling (7% vs. 2%; P = 0.001). FAI was higher in vessels with reduced CFR (-80.8 HU vs. -81.8 HU; P = 0.045) than in normal CFR. In the patient-level analysis, obstructive CAD, diffused atherosclerosis, and FAI were independently linked with CFR. FAI was still associated with global CFR after adjusting for traditional risk factors (age, hypertension, diabetes, hyperlipidemia, and smoking). FAI remained independently associated with reduced CFR in patients without obstructive CAD. Conclusions Coronary perivascular inflammation evaluated by CCTA was independently associated with coronary vascular function. In patients without obstructive CAD, FAI was higher in the presence of reduced CFR. Altogether, FAI can help reveal microcirculatory damage in patients who do not exhibit epicardial artery stenosis.
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Affiliation(s)
- Mengyu Chen
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Bing Liu
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Xu Li
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
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Chen M, Almeida SO, Sayre JW, Karlsberg RP, Packard RRS. Distal-vessel fractional flow reserve by computed tomography to monitor epicardial coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:163-172. [PMID: 37708371 PMCID: PMC11032197 DOI: 10.1093/ehjci/jead229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes. METHODS AND RESULTS Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707). CONCLUSION Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD.
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Affiliation(s)
- Michael Chen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 43-268, Los Angeles, CA 90095, USA
| | - Shone O Almeida
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - James W Sayre
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 43-268, Los Angeles, CA 90095, USA
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, CA, USA
- California NanoSystems Institute, University of California, Los Angeles, CA, USA
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8
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Mol JQ, Volleberg RHJA, Belkacemi A, Hermanides RS, Meuwissen M, Protopopov AV, Laanmets P, Krestyaninov OV, Dennert R, Oemrawsingh RM, van Kuijk JP, Arkenbout K, van der Heijden DJ, Rasoul S, Lipsic E, Rodwell L, Camaro C, Damman P, Roleder T, Kedhi E, van Leeuwen MAH, van Geuns RJM, van Royen N. Fractional Flow Reserve-Negative High-Risk Plaques and Clinical Outcomes After Myocardial Infarction. JAMA Cardiol 2023; 8:1013-1021. [PMID: 37703036 PMCID: PMC10500430 DOI: 10.1001/jamacardio.2023.2910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/11/2023] [Indexed: 09/14/2023]
Abstract
Importance Even after fractional flow reserve (FFR)-guided complete revascularization, patients with myocardial infarction (MI) have high rates of recurrent major adverse cardiovascular events (MACE). These recurrences may be caused by FFR-negative high-risk nonculprit lesions. Objective To assess the association between optical coherence tomography (OCT)-identified high-risk plaques of FFR-negative nonculprit lesions and occurrence of MACE in patients with MI. Design, Setting, and Participants PECTUS-obs (Identification of Risk Factors for Acute Coronary Events by OCT After STEMI [ST-segment elevation MI] and NSTEMI [non-STEMI] in Patients With Residual Non-flow Limiting Lesions) is an international, multicenter, prospective, observational cohort study. In patients presenting with MI, OCT was performed on all FFR-negative (FFR > 0.80) nonculprit lesions. A high-risk plaque was defined containing at least 2 of the following prespecified criteria: (1) a lipid arc at least 90°, (2) a fibrous cap thickness less than 65 μm, and (3) either plaque rupture or thrombus presence. Patients were enrolled from December 14, 2018, to September 15, 2020. Data were analyzed from December 2, 2022, to June 28, 2023. Main Outcome and Measure The primary end point of MACE, a composite of all-cause mortality, nonfatal MI, or unplanned revascularization, at 2-year follow-up was compared in patients with and without a high-risk plaque. Results A total of 438 patients were enrolled, and OCT findings were analyzable in 420. Among included patients, mean (SD) age was 63 (10) years, 340 (81.0) were men, and STEMI and non-STEMI were equally represented (217 [51.7%] and 203 [48.3%]). A mean (SD) of 1.17 (0.42) nonculprit lesions per patient was imaged. Analysis of OCT images revealed at least 1 high-risk plaque in 143 patients (34.0%). The primary end point occurred in 22 patients (15.4%) with a high-risk plaque and 23 of 277 patients (8.3%) without a high-risk plaque (hazard ratio, 1.93 [95% CI, 1.08-3.47]; P = .02), primarily driven by more unplanned revascularizations in patients with a high-risk plaque (14 of 143 [9.8%] vs 12 of 277 [4.3%]; P = .02). Conclusions and Relevance Among patients with MI and FFR-negative nonculprit lesions, the presence of a high-risk plaque is associated with a worse clinical outcome, which is mainly driven by a higher number of unplanned revascularizations. In a population with a high recurrent event rate despite physiology-guided complete revascularization, these results call for research on additional pharmacological or focal treatment strategies in patients harboring high-risk plaques.
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Affiliation(s)
- Jan-Quinten Mol
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | | | | | - Peep Laanmets
- Cardiology Center, North Estonia Medical Center, Tallinn, Estonia
| | | | - Robert Dennert
- Department of Cardiology, Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba
| | - Rohit M. Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Karin Arkenbout
- Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
| | - Dirk J. van der Heijden
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
- Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Saman Rasoul
- Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura Rodwell
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tomasz Roleder
- Department of Cardiology, Regional Specialist Hospital, Wrocław, Poland
| | - Elvin Kedhi
- Department of Cardiology, Erasmus Hospital, Université libre de Bruxelles, Brussels, Belgium
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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9
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Zhang XL, Zhang B, Tang CX, Wang YN, Zhang JY, Yu MM, Hou Y, Zheng MW, Zhang DM, Hu XH, Xu L, Liu H, Sun ZY, Zhang LJ. Machine learning based ischemia-specific stenosis prediction: A Chinese multicenter coronary CT angiography study. Eur J Radiol 2023; 168:111133. [PMID: 37827088 DOI: 10.1016/j.ejrad.2023.111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To evaluate the performance of coronary computed tomography angiography (CCTA) derived characteristics including CT derived fractional flow reserve (CT-FFR) with FFR as a reference standard in identifying the lesion-specific ischemia by machine learning (ML) algorithms. METHODS The retrospective analysis enrolled 596 vessels in 462 patients (mean age, 61 years ± 11 [SD]; 71.4 % men) with suspected coronary artery disease who underwent CCTA and invasive FFR. The data were divided into training cohort, internal validation cohort, external validation cohorts 1 and 2 according to participating centers. All CCTA-derived parameters, which contained 10 qualitative and 33 quantitative plaque parameters, were collected to establish ML model. The Boruta and unsupervised clustering algorithm were implemented to select important and non-redundant parameters. Finally, the eight features with the highest mean importance were included for further ML model establishment and decision tree building. Five models were built to predict lesion-specific ischemia: stenosis degree from CCTA, CT-FFR, ΔCT-FFR, ML model and nested model. RESULTS Low-attenuation plaque, bend and lesion length were the main predictors of ischemia-specific lesions. Of 5 models, the ML model showed favorable discrimination for ischemia-specific lesions in the training and three validation sets (area under the curve [95 % confidence interval], 0.93 [0.90-0.96], 0.86 [0.79-0.94], 0.88 [0.83-0.94], and 0.90 [0.84-0.96], respectively). The nested model which combined the ML model and CT-FFR showed better diagnostic efficacy (AUC [95 %CI], 0.96 [0.94-0.99], 0.92 [0.86-0.99], 0.92 [0.86-0.99] and 0.94 [0.91-0.98], respectively; all P < 0.05), and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were significantly higher than CT-FFR alone. CONCLUSIONS Comprehensive CCTA-derived multiparameter model could better predict the ischemia-specific lesions by ML algorithms compared to stenosis degree from CTA, CT-FFR and ΔCT-FFR. Decision tree can be used to predict myocardial ischemia effectively.
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Affiliation(s)
- Xiao Lei Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Bo Zhang
- Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu 225300, PR China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Jia Yin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Meng Meng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110001, PR China
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi 710032, PR China
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, PR China
| | - Xiu Hua Hu
- Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang 310006, PR China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, PR China
| | - Hui Liu
- Department of Radiology, Guangdong Province People's Hospital, Guangzhou, Guangdong 510000, PR China
| | - Zhi Yuan Sun
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China.
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10
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Jukema RA, de Winter RW, Hopman LHGA, Driessen RS, van Diemen PA, Appelman Y, Twisk JWR, Planken RN, Raijmakers PG, Knaapen P, Danad I. Impact of cardiac history and myocardial scar on increase of myocardial perfusion after revascularization. Eur J Nucl Med Mol Imaging 2023; 50:3897-3909. [PMID: 37561140 PMCID: PMC10611874 DOI: 10.1007/s00259-023-06356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue. METHODS Symptomatic patients underwent [15O]H2O positron emission tomography (PET) and FFR before and after revascularization. Patients with prior CAD, defined as prior MI or PCI, underwent scar quantification by magnetic resonance imaging late gadolinium enhancement. RESULTS Among 137 patients (87% male, age 62.2 ± 9.5 years) 84 (61%) had a prior MI or PCI. The increase in FFR and hyperemic myocardial blood flow (hMBF) was less in patients with prior MI or non-MI PCI compared to those without a cardiac history (FFR: 0.23 ± 0.14 vs. 0.20 ± 0.12 vs. 0.31 ± 0.18, p = 0.02; hMBF: 0.54 ± 0.75 vs. 0.62 ± 0.97 vs. 0.91 ± 0.96 ml/min/g, p = 0.04). Post-revascularization FFR and hMBF were similar across patients without a cardiac history or with prior MI or non-MI PCI. An increase in FFR was strongly associated to hMBF increase in patients without a cardiac history or with prior MI/non-MI PCI (r = 0.60 and r = 0.60, p < 0.01 for both). Similar results were found for coronary flow reserve. In patients with prior MI scar was negatively correlated to hMBF increase and independently predictive of an attenuated CFR increase. CONCLUSIONS Post revascularization FFR and perfusion were similar among patients without a cardiac history, with prior MI or non-MI PCI. In patients with prior MI scar burden was associated to an attenuated perfusion increase.
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Affiliation(s)
- Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yolande Appelman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R Nils Planken
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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11
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Lee SH, Hong D, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Joh HS, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Jeong MH, Gwon HC, Hahn JY, Lee JM. QFR Assessment and Prognosis After Nonculprit PCI in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2023; 16:2365-2379. [PMID: 37821181 DOI: 10.1016/j.jcin.2023.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Complete revascularization using either angiography-guided or fractional flow reserve (FFR)-guided strategy can improve clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in un-necessary PCI of the non-infarct-related artery (non-IRA), and its long-term prognosis is still unclear. OBJECTIVES This study sought to evaluate clinical outcomes after non-IRA PCI according to the quantitative flow ratio (QFR). METHODS We performed post hoc QFR analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease) trial, which randomly allocated 562 patients into either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR ≤0.80 and QFR >0.80 groups. The primary outcome was a major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (n = 60) underwent non-IRA PCI despite having QFR >0.80 in the non-IRA. Conversely, only 2.7% (n = 4) among 209 patients in the FFR-guided PCI group had QFR >0.80 in the non-IRA. At a median follow-up of 3.5 years, the rate of MACEs was significantly higher among patients with non-IRA PCI despite QFR >0.80 than in patients with deferred PCI for non-IRA lesions (12.9% vs 3.1%; HR: 4.13; 95% CI: 1.10-15.57; P = 0.036). Non-IRA PCI despite QFR >0.80 was associated with a higher risk of non-IRA MACEs than patients with deferred PCI for non-IRA lesions (12.9% vs 2.1%; HR: 5.44; 95% CI: 1.13-26.19; P = 0.035). CONCLUSIONS In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions. (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease [FRAME-AMI] ClinicalTrials.gov number; NCT02715518).
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyun Sung Joh
- Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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12
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Lee JM, Shin D, Lee SH, Choi KH, Kim SM, Chun EJ, Lee KY, Hwang D, Ahn SG, Brown AJ, Mejía-Rentería H, Lefieux A, Molony D, Chang K, Kakuta T, Escaned J, Samady H. Differential predictability for high-risk plaque characteristics between fractional flow reserve and instantaneous wave-free ratio. Sci Rep 2023; 13:16005. [PMID: 37749337 PMCID: PMC10520044 DOI: 10.1038/s41598-023-43352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
To evaluate the differential associations of high-risk plaque characteristics (HRPC) with resting or hyperemic physiologic indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve [FFR]), a total of 214 vessels from 127 patients with stable angina or acute coronary syndrome who underwent coronary computed tomography angiography (CCTA) and invasive physiologic assessment were investigated. HPRC were classified into quantitative (minimal luminal area < 4 mm2 or plaque burden ≥ 70%) and qualitative features (low attenuation plaque, positive remodeling, napkin ring sign, or spotty calcification). Vessels with FFR ≤ 0.80 or iFR ≤ 0.89 had significantly higher proportions of HRPC than those with FFR > 0.80 or iFR > 0.89, respectively. FFR was independently associated with both quantitative and qualitative HRPC, but iFR was only associated with quantitative HRPC. Both FFR and iFR were significantly associated with the presence of ≥ 3 HRPC, and FFR demonstrated higher discrimination ability than iFR (AUC 0.703 vs. 0.648, P = 0.045), which was predominantly driven by greater discriminating ability of FFR for quantitative HRPC (AUC 0.832 vs. 0.744, P = 0.005). In conclusion, both FFR and iFR were significantly associated with CCTA-derived HRPC. Compared with iFR, however, FFR was independently associated with the presence of qualitative HRPC and showed a higher predictive ability for the presence of ≥ 3 HRPC.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Doosup Shin
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | | | | | - David Molony
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Heart and Vascular Institute, Northeast Georgia Health System, 200 South Enota Drive, Suite 430, Gainesville, GA, 30501, USA
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
- Georgia Heart and Vascular Institute, Northeast Georgia Health System, 200 South Enota Drive, Suite 430, Gainesville, GA, 30501, USA.
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13
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Yang S, Koo BK. Coronary Physiology-Based Approaches for Plaque Vulnerability: Implications for Risk Prediction and Treatment Strategies. Korean Circ J 2023; 53:581-593. [PMID: 37653694 PMCID: PMC10475684 DOI: 10.4070/kcj.2023.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 09/02/2023] Open
Abstract
In the catheterization laboratory, the measurement of physiological indexes can help identify functionally significant lesions and has become one of the standard methods to guide treatment decision-making. Plaque vulnerability refers to a coronary plaque susceptible to rupture, enabling risk prediction before coronary events, and it can be detected by defining a certain type of plaque morphology on coronary imaging modalities. Although coronary physiology and plaque vulnerability have been considered different attributes of coronary artery disease, the underlying pathophysiological basis and clinical data indicate a strong correlation between coronary hemodynamic properties and vulnerable plaque. In prediction of coronary events, emerging data have suggested independent and additional implications of a physiology-based approach to a plaque-based approach. This review covers the fundamental interplay between coronary physiology and plaque morphology during disease progression with clinical data supporting this relationship and examines the clinical relevance of physiological indexes in prediction of clinical outcomes and therapeutic decision-making along with plaque vulnerability.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, Korea.
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14
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Csecs I, Feher A. The fat and the flow: multiparametric imaging assessment of pericoronary adipose tissue and myocardial blood flow. J Nucl Cardiol 2023; 30:1570-1573. [PMID: 36929294 DOI: 10.1007/s12350-023-03247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Ibolya Csecs
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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15
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Kuronuma K, van Diemen PA, Han D, Lin A, Grodecki K, Kwiecinski J, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial. J Nucl Cardiol 2023; 30:1558-1569. [PMID: 36645580 DOI: 10.1007/s12350-022-03194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/02/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Positron emission tomography (PET) is the clinical gold standard for quantifying myocardial blood flow (MBF). Pericoronary adipose tissue (PCAT) attenuation may detect vascular inflammation indirectly. We examined the relationship between MBF by PET and plaque burden and PCAT on coronary CT angiography (CCTA). METHODS This post hoc analysis of the PACIFIC trial included 208 patients with suspected coronary artery disease (CAD) who underwent [15O]H2O PET and CCTA. Low-attenuation plaque (LAP, < 30HU), non-calcified plaque (NCP), and PCAT attenuation were measured by CCTA. RESULTS In 582 vessels, 211 (36.3%) had impaired per-vessel hyperemic MBF (≤ 2.30 mL/min/g). In multivariable analysis, LAP burden was independently and consistently associated with impaired hyperemic MBF (P = 0.016); over NCP burden (P = 0.997). Addition of LAP burden improved predictive performance for impaired hyperemic MBF from a model with CAD severity and calcified plaque burden (P < 0.001). There was no correlation between PCAT attenuation and hyperemic MBF (r = - 0.11), and PCAT attenuation was not associated with impaired hyperemic MBF in univariable or multivariable analysis of all vessels (P > 0.1). CONCLUSION In patients with stable CAD, LAP burden was independently associated with impaired hyperemic MBF and a stronger predictor of impaired hyperemic MBF than NCP burden. There was no association between PCAT attenuation and hyperemic MBF.
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Affiliation(s)
- Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | | | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Guadalupe Flores Tomasino
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
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16
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Han D, van Diemen P, Kuronuma K, Lin A, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Sex differences in computed tomography angiography-derived coronary plaque burden in relation to invasive fractional flow reserve. J Cardiovasc Comput Tomogr 2023; 17:112-119. [PMID: 36670043 PMCID: PMC10148895 DOI: 10.1016/j.jcct.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Distinct sex-related differences exist in coronary artery plaque burden and distribution. We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography (CCTA) in relation to ischemia by invasive fractional flow reserve (FFR). METHODS This post-hoc analysis of the PACIFIC trial included 581 vessels in 203 patients (mean age 58.1 ± 8.7 years, 63.5% male) who underwent CCTA and per-vessel invasive FFR. Quantitative assessment of total, calcified, non-calcified, and low-density non-calcified plaque burden were performed using semiautomated software. Significant ischemia was defined as invasive FFR ≤0.8. RESULTS The per-vessel frequency of ischemia was higher in men than women (33.5% vs. 7.5%, p < 0.001). Women had a smaller burden of all plaque subtypes (all p < 0.01). There was no sex difference on total, calcified, or non-calcified plaque burdens in vessels with ischemia; only low-density non-calcified plaque burden was significantly lower in women (beta: -0.183, p = 0.035). The burdens of all plaque subtypes were independently associated with ischemia in both men and women (For total plaque burden (5% increase): Men, OR: 1.15, 95%CI: 1.06-1.24, p = 0.001; Women, OR: 1.96, 95%CI: 1.11-3.46, p = 0.02). No significant interaction existed between sex and total plaque burden for predicting ischemia (interaction p = 0.108). The addition of quantitative plaque burdens to stenosis severity and adverse plaque characteristics improved the discrimination of ischemia in both men and women. CONCLUSIONS In symptomatic patients with suspected CAD, women have a lower CCTA-derived burden of all plaque subtypes compared to men. Quantitative plaque burden provides independent and incremental predictive value for ischemia, irrespective of sex.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Pepijn van Diemen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cardiovascular Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Artificial Interlligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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17
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Takagi H, Ihdayhid AR, Leipsic JA. Integration of fractional flow reserve derived from CT into clinical practice. J Cardiol 2023; 81:577-585. [PMID: 36805489 DOI: 10.1016/j.jjcc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/21/2023]
Abstract
Fractional flow reserve (FFR) is currently considered as the gold standard for revascularization decision-making in patients with stable coronary artery disease (CAD). The application of computational fluid dynamics to coronary computed tomography (CT) angiography (CCTA) enables calculation of FFR without additional testing, radiation exposure, contrast medium injection, and hyperemia (FFRCT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFRCT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFRCT computation, and there are numerous factors impacting on FFRCT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFRCT need to recognize in interpretation of FFRCT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFRCT computation and interpretation to refine the FFRCT strategy in patients with stable CAD.
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Affiliation(s)
- Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Huang Z, Cheng XQ, Liu YN, Bi XJ, Deng YB. Value of Intraplaque Neovascularization on Contrast-Enhanced Ultrasonography in Predicting Ischemic Stroke Recurrence in Patients With Carotid Atherosclerotic Plaque. Korean J Radiol 2023; 24:338-348. [PMID: 36907591 PMCID: PMC10067694 DOI: 10.3348/kjr.2022.0977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Patients with a history of ischemic stroke are at risk for a second ischemic stroke. This study aimed to investigate the relationship between carotid plaque enhancement on perfluorobutane microbubble contrast-enhanced ultrasonography (CEUS) and future recurrent stroke, and to determine whether plaque enhancement can contribute to risk assessment for recurrent stroke compared with the Essen Stroke Risk Score (ESRS). MATERIALS AND METHODS This prospective study screened 151 patients with recent ischemic stroke and carotid atherosclerotic plaques at our hospital between August 2020 and December 2020. A total of 149 eligible patients underwent carotid CEUS, and 130 patients who were followed up for 15-27 months or until stroke recurrence were analyzed. Plaque enhancement on CEUS was investigated as a possible risk factor for stroke recurrence and as a possible adjunct to ESRS. RESULTS During follow-up, 25 patients (19.2%) experienced recurrent stroke. Patients with plaque enhancement on CEUS had an increased risk of stroke recurrence events (22/73, 30.1%) compared to those without plaque enhancement (3/57, 5.3%), with an adjusted hazard ratio (HR) of 38.264 (95% confidence interval [CI]:14.975-97.767; P < 0.001) according to a multivariable Cox proportional hazards model analysis, indicating that the presence of carotid plaque enhancement was a significant independent predictor of recurrent stroke. When plaque enhancement was added to the ESRS, the HR for stroke recurrence in the high-risk group compared to that in the low-risk group (2.188; 95% CI, 0.025-3.388) was greater than that of the ESRS alone (1.706; 95% CI, 0.810-9.014). A net of 32.0% of the recurrence group was reclassified upward appropriately by the addition of plaque enhancement to the ESRS. CONCLUSION Carotid plaque enhancement was a significant and independent predictor of stroke recurrence in patients with ischemic stroke. Furthermore, the addition of plaque enhancement improved the risk stratification capability of the ESRS.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Qing Cheng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Jun Bi
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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19
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Nicol ED. Machine Learning Assessment of CAD: A Giant Leap or a Small Step for Coronary CTA? JACC Cardiovasc Imaging 2023; 16:206-208. [PMID: 36754477 DOI: 10.1016/j.jcmg.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Edward D Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.
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20
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Cho SG, Lee JE, Kim HY, Song HC, Kim YH. Association between myocardial ischemia and plaque characteristics in chronic total occlusion. J Nucl Cardiol 2023; 30:388-398. [PMID: 35836093 DOI: 10.1007/s12350-022-03020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Myocardial ischemia varies in chronic total occlusion (CTO) despite the occluded artery. We analyzed whether it is associated with the plaque characteristics of the occluded segment. METHODS We retrospectively enrolled 100 patients with CTO who underwent myocardial perfusion single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) within 2 months. CTO-related ischemia was classified as moderate to severe (summed difference score [SDS] of the CTO territory ≥ 5) or mild or none (SDS < 5) on SPECT. Using CCTA, the atherosclerotic plaques of the occluded segment were subdivided into low-density (- 100-30 HU), intermediate-density (31-350 HU), and high-density (351-1000 HU) plaques. The plaque composition was compared according to the severity of CTO-related ischemia. RESULTS Moderate-to-severe CTO-related ischemia (n = 23) showed significantly higher proportion of intermediate-density plaques (72.4% vs. 64.0%), intermediate/low-density (7.10 vs. 3.65) and intermediate-to-high/low-density (7.78 vs. 3.80) plaque ratios, frequent shorter occlusion (30% vs. 6%), and lower volume (26.5 mm3 vs. 58.8 mm3) and proportion (11.4% vs. 20.8%) of low-density plaques. Multivariable analysis revealed significant associations between higher proportion of intermediate-density plaques and moderate-to-severe CTO-related ischemia, independent of occlusion length. CONCLUSION Higher proportion of intermediate-density plaques in the occluded segment was associated with the moderate-to-severe CTO-related ischemia.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea
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21
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Yang S, Hoshino M, Yonetsu T, Zhang J, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen S, Tanaka N, Matsuo H, Kubo T, Chang HJ, Kakuta T, Koo BK. Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography. EUROINTERVENTION 2023; 18:1011-1021. [PMID: 36222756 PMCID: PMC9853032 DOI: 10.4244/eij-d-22-00562] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/16/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The integrative implications of quantitative and qualitative plaque characteristics on clinical outcomes and therapeutic guidance have not been fully investigated. AIMS We aimed to investigate the combined prognostic value of quantitative and qualitative plaque measures and their interactions with treatment modalities and physiological lesion severity. METHODS Among 697 vessels from 458 patients who underwent fractional flow reserve (FFR)-guided treatment, quantitative high-risk plaque (qn-HRP; plaque burden ≥70% and minimum lumen area <3.3 mm2) and qualitative HRP (ql-HRP; low-attenuation plaque or positive remodelling) were defined on coronary computed tomography angiography (CCTA). The primary endpoint was the vessel-oriented composite outcome (VOCO; a composite of cardiac death, myocardial infarction, or revascularisation). RESULTS The mean baseline FFR was 0.85±0.12, and 25.8% underwent percutaneous coronary intervention (PCI) during the index procedure. In medically treated lesions, both qn-HRP and ql-HRP were associated with an increased risk of VOCO (p<0.05). Relative to the lesions with qn-HRP(-)/ql-HRP(-),those with qn-HRP(+)/ql-HRP(+) showed a higher risk of VOCO (hazard ratio [HR] 8.36, 95% confidence interval [CI]: 2.86-24.44). The PCI group showed a lower risk for VOCO than the medical treatment group (HR 0.31, 95% CI: 0.11-0.91) in lesions with qn-HRP(+)/ql-HRP(+). This difference was consistent in lesions with an FFR of 0.81-0.90 (HR 0.19, 95 CI: 0.04-0.90), but not in those with an FFR of>0.90. CONCLUSIONS In non-ischaemic lesions, ql-HRP and qn-HRP showed a synergistic impact on risk assessment and had prognostic interactions with FFR and treatment modalities. Therefore, they need to be integrated into risk stratification and the optimisation of a treatment strategy. CLINICALTRIALS gov: NCT04037163.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea and Division of Cardiology, Ulsan Hospital, Ulsan, Republic of Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jianan Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | | | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University, Seoul, Republic of Korea
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22
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Smit JM, El Mahdiui M, de Graaf MA, Montero-Cabezas JM, Reiber JHC, Jukema JW, Scholte AJ, Knuuti J, Wijns W, Narula J, Bax JJ. Relation Between Coronary Plaque Composition Assessed by Intravascular Ultrasound Virtual Histology and Myocardial Ischemia Assessed by Quantitative Flow Ratio. Am J Cardiol 2023; 186:228-235. [PMID: 36333150 DOI: 10.1016/j.amjcard.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/10/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Coronary plaque composition may play an important role in the induction of myocardial ischemia. Our objective was to further clarify the relation between coronary plaque composition and myocardial ischemia in patients with chest pain symptoms. The study population consisted of 103 patients who presented to the outpatient clinic or emergency department with chest pain symptoms and were referred for diagnostic invasive coronary angiography. Intravascular ultrasound virtual histology was used for the assessment of coronary plaque composition. A noncalcified plaque was defined as a combination of necrotic core and fibrofatty tissue. Quantitative flow ratio (QFR), which is a coronary angiography-based technique used to calculate fractional flow reserve without the need for hyperemia induction or for a pressure wire, was used as the reference standard for the evaluation of myocardial ischemia. Coronary artery plaques with QFR of ≤0.80 were considered abnormal-that is, ischemia-generating. In total, 149 coronary plaques were analyzed, 21 of which (14%) were considered abnormal according to QFR. The percentage of noncalcified tissue was significantly higher in plaques with abnormal QFR (38.2 ± 6.5% vs 33.1 ± 9.0%, p = 0.014). After univariable analysis, both plaque load (odds ratio [OR] per 1% increase 1.081, p <0.001) and the percentage of noncalcified tissue (OR per 1% increase 1.070, p = 0.020) were significantly associated with reduced QFR. However, after multivariable analysis, only plaque load remained significantly associated with abnormal QFR (OR per 1% increase 1.072, p <0.001). In conclusion, the noncalcified plaque area was significantly higher in hemodynamically significant coronary lesions than in nonsignificant lesions. Although an increase in the noncalcified plaque area was significantly associated with a reduced QFR, this association lost significance after adjustment for localized plaque load.
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Affiliation(s)
- Jeff M Smit
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johan H C Reiber
- Medis Medical Imaging, Leiden, The Netherlands; Departments of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J Scholte
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - William Wijns
- Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeroen J Bax
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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23
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Clinical and Coronary Plaque Predictors of Atherosclerotic Nonresponse to Statin Therapy. JACC. CARDIOVASCULAR IMAGING 2022; 16:495-504. [PMID: 36648046 DOI: 10.1016/j.jcmg.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Statins reduce the incidence of major cardiovascular events, but residual risk remains. The study examined the determinants of atherosclerotic statin nonresponse. OBJECTIVES This study aimed to investigate factors associated with statin nonresponse-defined atherosclerosis progression in patients treated with statins. METHODS The multicenter PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) registry included patients who underwent serial coronary computed tomography angiography ≥2 years apart, with whole-heart coronary tree quantification of vessel, lumen, and plaque, and matching of baseline and follow-up coronary segments and lesions. Patients with statin use at baseline and follow-up coronary computed tomography angiography were included. Atherosclerotic statin nonresponse was defined as an absolute increase in percent atheroma volume (PAV) of 1.0% or more per year. Furthermore, a secondary endpoint was defined by the additional requirement of progression of low-attenuation plaque or fibro-fatty plaque. RESULTS We included 649 patients (age 62.0 ± 9.0 years, 63.5% male) on statin therapy and 205 (31.5%) experienced atherosclerotic statin nonresponse. Age, diabetes, hypertension, and all atherosclerotic plaque features measured at baseline scan (high-risk plaque [HRP] features, calcified and noncalcified PAV, and lumen volume) were significantly different between patients with and without atherosclerotic statin nonresponse, whereas only diabetes, number of HRP features, and noncalcified and calcified PAV were independently associated with atherosclerotic statin nonresponse (odds ratio [OR]: 1.41 [95% CI: 0.95-2.11], OR: 1.15 [95% CI: 1.09-1.21], OR: 1.06 [95% CI: 1.02-1.10], OR: 1.07 [95% CI: 1.03-1.12], respectively). For the secondary endpoint (N = 125, 19.2%), only noncalcified PAV and number of HRP features were the independent determinants (OR: 1.08 [95% CI: 1.03-1.13] and OR: 1.21 [95% CI: 1.06-1.21], respectively). CONCLUSIONS In patients treated with statins, baseline plaque characterization by plaque burden and HRP is associated with atherosclerotic statin nonresponse. Patients with the highest plaque burden including HRP were at highest risk for plaque progression, despite statin therapy. These patients may need additional therapies for further risk reduction.
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24
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Lin A, van Diemen PA, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen RS, Berman DS, Nørgaard BL, Slomka PJ, Knaapen P, Dey D. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Fractional Flow Reserve-Defined Ischemia and Impaired Myocardial Blood Flow. Circ Cardiovasc Imaging 2022; 15:e014369. [PMID: 36252116 PMCID: PMC10085569 DOI: 10.1161/circimaging.122.014369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A pathophysiological interplay exists between plaque morphology and coronary physiology. Machine learning (ML) is increasingly being applied to coronary computed tomography angiography (CCTA) for cardiovascular risk stratification. We sought to assess the performance of a ML score integrating CCTA-based quantitative plaque features for predicting vessel-specific ischemia by invasive fractional flow reserve (FFR) and impaired myocardial blood flow (MBF) by positron emission tomography (PET). METHODS This post-hoc analysis of the PACIFIC trial (Prospective Comparison of Cardiac Positron Emission Tomography/Computed Tomography [CT]' Single Photon Emission Computed Tomography/CT Perfusion Imaging and CT Coronary Angiography with Invasive Coronary Angiography) included 208 patients with suspected coronary artery disease who prospectively underwent CCTA' [15O]H2O PET, and invasive FFR. Plaque quantification from CCTA was performed using semiautomated software. An ML algorithm trained on the prospective NXT trial (484 vessels) was used to develop a ML score for the prediction of ischemia (FFR≤0.80), which was then evaluated in 581 vessels from the PACIFIC trial. Thereafter, the ML score was applied for predicting impaired hyperemic MBF (≤2.30 mL/min per g) from corresponding PET scans. The performance of the ML score was compared with CCTA reads and noninvasive FFR derived from CCTA (FFRCT). RESULTS One hundred thirty-nine (23.9%) vessels had FFR-defined ischemia, and 195 (33.6%) vessels had impaired hyperemic MBF. For the prediction of FFR-defined ischemia, the ML score yielded an area under the receiver-operating characteristic curve of 0.92, which was significantly higher than that of visual stenosis grade (0.84; P<0.001) and comparable with that of FFRCT (0.93; P=0.34). Quantitative percent diameter stenosis and low-density noncalcified plaque volume had the greatest ML feature importance for predicting FFR-defined ischemia. When applied for impaired MBF prediction, the ML score exhibited an area under the receiver-operating characteristic curve of 0.80; significantly higher than visual stenosis grade (area under the receiver-operating characteristic curve 0.74; P=0.02) and comparable with FFRCT (area under the receiver-operating characteristic curve 0.77; P=0.16). CONCLUSIONS An externally validated ML score integrating CCTA-based quantitative plaque features accurately predicts FFR-defined ischemia and impaired MBF by PET, performing superiorly to standard CCTA stenosis evaluation and comparably to FFRCT.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pepijn A. van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Rios
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S. Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Daniel S. Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bjarne L. Nørgaard
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Piotr J. Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Vattay B, Borzsák S, Boussoussou M, Vecsey-Nagy M, Jermendy ÁL, Suhai FI, Maurovich-Horvat P, Merkely B, Kolossváry M, Szilveszter B. Association between coronary plaque volume and myocardial ischemia detected by dynamic perfusion CT imaging. Front Cardiovasc Med 2022; 9:974805. [PMID: 36158821 PMCID: PMC9498180 DOI: 10.3389/fcvm.2022.974805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction We aimed to evaluate the relationship between quantitative plaque metrics derived from coronary CT angiography (CTA) and segmental myocardial ischemia using dynamic perfusion CT (DPCT). Methods In a prospective single-center study, patients with > 30% stenosis on rest CTA underwent regadenoson stress DPCT. 480 myocardium segments of 30 patients were analyzed. Quantitative plaque assessment included total plaque volume (PV), area stenosis, and remodeling index (RI). High-risk plaque (HRP) was defined as low-attenuation plaque burden > 4% or RI > 1.1. Absolute myocardial blood flow (MBF) and relative MBF (MBFi: MBF/75th percentile of all MBF values) were quantified. Linear and logistic mixed models correcting for intra-patient clustering and clinical factors were used to evaluate the association between total PV, area stenosis, HRP and MBF or myocardial ischemia (MBF < 101 ml/100 g/min). Results Median MBF and MBFi were 111 ml/100 g/min and 0.94, respectively. The number of ischemic segments were 164/480 (34.2%). Total PV of all feeding vessels of a given myocardial territory differed significantly between ischemic and non-ischemic myocardial segments (p = 0.001). Area stenosis and HRP features were not linked to MBF or MBFi (all p > 0.05). Increase in PV led to reduced MBF and MBFi after adjusting for risk factors including hypertension, diabetes, and statin use (per 10 mm3; β = −0.035, p < 0.01 for MBF; β = −0.0002, p < 0.01 for MBFi). Similarly, using multivariate logistic regression total PV was associated with ischemia (OR = 1.01, p = 0.033; per 10 mm3) after adjustments for clinical risk factors, area stenosis and HRP. Conclusion Total PV was independently associated with myocardial ischemia based on MBF, while area stenosis and HRP were not.
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Affiliation(s)
- Borbála Vattay
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sarolta Borzsák
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ádám L. Jermendy
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc I. Suhai
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: Bálint Szilveszter,
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26
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Zeng D, Zeng C, Zeng Z, Li S, Deng Z, Chen S, Bian Z, Ma J. Basis and current state of computed tomography perfusion imaging: a review. Phys Med Biol 2022; 67. [PMID: 35926503 DOI: 10.1088/1361-6560/ac8717] [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: 11/17/2021] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
Computed tomography perfusion (CTP) is a functional imaging that allows for providing capillary-level hemodynamics information of the desired tissue in clinics. In this paper, we aim to offer insight into CTP imaging which covers the basics and current state of CTP imaging, then summarize the technical applications in the CTP imaging as well as the future technological potential. At first, we focus on the fundamentals of CTP imaging including systematically summarized CTP image acquisition and hemodynamic parameter map estimation techniques. A short assessment is presented to outline the clinical applications with CTP imaging, and then a review of radiation dose effect of the CTP imaging on the different applications is presented. We present a categorized methodology review on known and potential solvable challenges of radiation dose reduction in CTP imaging. To evaluate the quality of CTP images, we list various standardized performance metrics. Moreover, we present a review on the determination of infarct and penumbra. Finally, we reveal the popularity and future trend of CTP imaging.
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Affiliation(s)
- Dong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Cuidie Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhixiong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Sui Li
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhen Deng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Sijin Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhaoying Bian
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
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27
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Wang X, van den Hoogen IJ, Butcher SC, Kuneman JH, de Graaf MA, Kamperidis V, Boukes M, Maaniitty T, Schultz J, van Rosendael AR, Saraste A, Knuuti J, Bax JJ. Importance of plaque volume and composition for the prediction of myocardial ischaemia using sequential coronary computed tomography angiography/positron emission tomography imaging. Eur Heart J Cardiovasc Imaging 2022; 24:776-784. [PMID: 36047438 PMCID: PMC10229289 DOI: 10.1093/ehjci/jeac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Coronary atherosclerosis with a large necrotic core has been postulated to reduce the vasodilatory capacity of vascular tissue. In the present analysis, we explored whether total plaque volume and necrotic core volume on coronary computed tomography angiography (CCTA) are independently associated with myocardial ischaemia on positron emission tomography (PET). METHODS AND RESULTS From a registry of symptomatic patients with suspected coronary artery disease and clinically indicated CCTA with sequential [15O]H2O PET myocardial perfusion imaging, we quantitatively measured diameter stenosis, total and compositional plaque volumes on CCTA. Primary endpoint was myocardial ischaemia on PET, defined as an absolute stress myocardial blood flow ≤2.4 mL/g/min in ≥1 segment. Multivariable prediction models for myocardial ischaemia were consecutively created using logistic regression analysis (stenosis model: diameter stenosis ≥50%; plaque volume model: +total plaque volume; plaque composition model: +necrotic core volume). A total of 493 patients (mean age 63 ± 8 years, 54% men) underwent sequential CCTA/PET imaging. In 153 (31%) patients, myocardial ischaemia was detected on PET. Diameter stenosis ≥50% (P < 0.001) and necrotic core volume (P = 0.029) were independently associated with myocardial ischaemia, while total plaque volume showed borderline significance (P = 0.052). The plaque composition model (χ2 = 169) provided incremental value for the prediction of ischaemia when compared with the stenosis model (χ2 = 138, P < 0.001) and plaque volume model (χ2 = 164, P = 0.021). CONCLUSION The volume of necrotic core on CCTA independently and incrementally predicts myocardial ischaemia on PET, beyond diameter stenosis alone.
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Affiliation(s)
- Xu Wang
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | | | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark Boukes
- Department of Communication Science at the Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Schultz
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Yang S, Hoshino M, Koo BK, Yonetsu T, Zhang J, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen S, Tanaka N, Matsuo H, Kubo T, Chang HJ, Kakuta T, Narula J. Relationship of Plaque Features at Coronary CT to Coronary Hemodynamics and Cardiovascular Events. Radiology 2022; 305:578-587. [PMID: 35972355 DOI: 10.1148/radiol.213271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Plaque assessments with coronary CT angiography (CCTA) and coronary flow indexes have prognostic implications. Purpose To investigate the association and additive prognostic value of plaque burden and characteristics at CCTA with coronary pressure and flow. Materials and Methods Data of patients with coronary artery disease who underwent CCTA within 90 days before physiologic assessments at tertiary cardiovascular centers between January 2011 and December 2018 were retrospectively analyzed, which included fractional flow reserve (FFR), resting distal coronary artery pressure (Pd)-to-aortic pressure (Pa) ratio (hereafter, Pd/Pa), coronary flow reserve (CFR), hyperemic flow (1/hyperemic mean transit time [Tmn]), resting flow (1/resting Tmn), and index of microcirculatory resistance (IMR). Four high-risk plaque (HRP) attributes at CCTA defined high disease burden (plaque burden, ≥70%; minimum lumen area, <4 mm2) and adverse plaque (low-attenuation plaque, positive remodeling). Their lesion-specific relationships with coronary hemodynamic parameters and major adverse cardiovascular events (MACE) were investigated using a generalized estimating equation and marginal Cox model. Results Among 406 lesions from 335 patients (mean age, 67 years ± 10 [SD]; 259 men), high disease burden is predicted by FFR (odds ratio [OR], 0.55; P < .001), resting Pd/Pa (OR, 0.47; P < .001), CFR (OR, 0.85; P = .004), and hyperemic flow (OR, 0.91; P = .03), and adverse plaque by FFR (OR, 0.67; P < .001), resting Pd/Pa (OR, 0.69; P = .001), hyperemic flow (OR, 0.76; P = .006), resting flow (OR, 0.54; P = .001), and IMR (OR, 1.27; P = .008). High disease burden (hazard ratio [HR], 4.0; P = .004) and adverse plaque (HR, 2.7; P = .02) were associated with a higher risk of MACE (n = 27) over median 2.9-year follow-up. In six lesion subsets with normal flow or pressure, at least three HRP attributes predicted a higher MACE rate (HR range, 2.6-6.3). Conclusion High-risk plaque features and plaque burden at coronary CT angiography were associated with cardiovascular events independent of coronary hemodynamic parameters. Clinical trial registration no. NCT04037163 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leipsic and Tzimas in this issue.
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Affiliation(s)
- Seokhun Yang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Masahiro Hoshino
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Bon-Kwon Koo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Taishi Yonetsu
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jinlong Zhang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Doyeon Hwang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Eun-Seok Shin
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Joon-Hyung Doh
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Chang-Wook Nam
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jianan Wang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Shaoliang Chen
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Nobuhiro Tanaka
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Hitoshi Matsuo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Takashi Kubo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Hyuk-Jae Chang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Tsunekazu Kakuta
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jagat Narula
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 2022; 16:362-383. [PMID: 35729014 DOI: 10.1016/j.jcct.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant Anna Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila Euroecolab, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania
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30
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Lee SH, Hong D, Dai N, Shin D, Choi KH, Kim SM, Kim HK, Jeon KH, Ha SJ, Lee KY, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Choe YH, Gwon HC, Ge J, Lee JM. Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events. Front Cardiovasc Med 2022; 9:871450. [PMID: 35677691 PMCID: PMC9167998 DOI: 10.3389/fcvm.2022.871450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWhile coronary computed tomography angiography (CCTA) enables the evaluation of anatomic and hemodynamic plaque characteristics of coronary artery disease (CAD), the clinical roles of these characteristics are not clear. We sought to evaluate the prognostic implications of CCTA-derived anatomic and hemodynamic plaque characteristics in the prediction of subsequent coronary events.MethodsThe study cohort consisted of 158 patients who underwent CCTA with suspected CAD within 6–36 months before percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) or unstable angina and age-/sex-matched 62 patients without PCI as the control group. Preexisting high-risk plaque characteristics (HRPCs: low attenuation plaque, positive remodeling, napkin-ring sign, spotty calcification, minimal luminal area <4 mm2, or plaque burden ≥70%) and hemodynamic parameters (per-vessel fractional flow reserve [FFRCT], per-lesion ΔFFRCT, and percent ischemic myocardial mass) were analyzed from prior CCTA. The primary outcome was a subsequent coronary event, which was defined as a composite of vessel-specific MI or revascularization for unstable angina. The prognostic impact of clinical risk factors, HRPCs, and hemodynamic parameters were compared between vessels with (160 vessels) and without subsequent coronary events (329 vessels).ResultsVessels with a subsequent coronary event had higher number of HRPCs (2.6 ± 1.4 vs. 2.3 ± 1.4, P = 0.012), lower FFRCT (0.76 ± 0.13 vs. 0.82 ± 0.11, P < 0.001), higher ΔFFRCT (0.14 ± 0.12 vs. 0.09 ± 0.08, P < 0.001), and higher percent ischemic myocardial mass (29.0 ± 18.5 vs. 26.0 ± 18.4, P = 0.022) than those without a subsequent coronary event. Compared with clinical risk factors, HRPCs and hemodynamic parameters showed higher discriminant abilities for subsequent coronary events with ΔFFRCT being the most powerful predictor. HRPCs showed additive discriminant ability to clinical risk factors (c-index 0.620 vs. 0.558, P = 0.027), and hemodynamic parameters further increased discriminant ability (c-index 0.698 vs. 0.620, P = 0.001) and reclassification abilities (NRI 0.460, IDI 0.061, P < 0.001 for all) for subsequent coronary events. Among vessels with negative FFRCT (>0.80), adding HRPCs into clinical risk factors significantly increased discriminant and reclassification abilities for subsequent coronary events (c-index 0.687 vs. 0.576, P = 0.005; NRI 0.412, P = 0.002; IDI 0.064, P = 0.001) but not for vessels with positive FFRCT (≤0.80).ConclusionIn predicting subsequent coronary events, both HRPCs and hemodynamic parameters by CCTA allow better prediction of subsequent coronary events than clinical risk factors. HRPCs provide more incremental predictability than clinical risk factors alone among vessels with negative FFRCT but not among vessels with positive FFRCT.Clinical Trial RegistrationPreDiction and Validation of Clinical CoursE of Coronary Artery DiSease With CT-Derived Non-INvasive HemodYnamic Phenotyping and Plaque Characterization (DESTINY Study), NCT04794868.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Neng Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea
| | - Ki-Hyun Jeon
- Division of Cardiovascular Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Joo Myung Lee ;
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31
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Kim CH, Yang S, Zhang J, Lee JM, Hoshino M, Murai T, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen SL, Tanaka N, Matsuo H, Akasaka T, Kakuta T, Koo BK. Differences in Plaque Characteristics and Myocardial Mass. JACC: ASIA 2022; 2:157-167. [PMID: 36339124 PMCID: PMC9627886 DOI: 10.1016/j.jacasi.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022]
Abstract
Background The mechanism of the fractional flow reserve (FFR) difference according to sex has not been clearly understood. Objectives This study sought to evaluate sex differences in coronary stenosis, plaque characteristics, and left ventricular (LV) mass and their implications for physiological significance. Methods This was a post hoc analysis of a pooled population of multicenter, international prospective cohorts. Patients (166 women and 489 men) underwent coronary computed tomography angiography (CCTA) within 90 days before invasive FFR measurements were included. The minimal lumen area, percent of plaque burden, whole vessel plaque volume by composition, high-risk plaque characteristics, and LV mass were analyzed from CCTA images. Results Among 1,188 vessels analyzed, the FFR value was higher in women than that in men (0.85 ± 0.13 vs 0.82 ± 0.14; P = 0.001) despite a similar percentage of diameter stenosis between the sexes (45.9% ± 18.9% vs 46.1% ± 17.7%; P = 0.920). The composition of fibrofatty plaque + necrotic core (13.1% ± 16.9% vs 21.2% ± 19.9%; P < 0.001) and frequencies of low attenuation plaque (12.7% vs 24.5%; P < 0.001) and positive remodeling (33.8% vs 45.5%; P = 0.001) were lower in women than in men. Vessel, plaque, and lumen volumes were significantly smaller in women than that in men (all P < 0.001); however, no sex difference was observed in any of these parameters after adjustment for LV mass (all P > 0.10). Sex was not an independent predictor of the FFR value after adjustment for stenosis severity, plaque characteristics, and LV mass. Conclusions Higher FFR values for the same stenosis severity in women can be explained by fewer high-risk plaque characteristics and smaller myocardial mass in women than that in men. (CCTA-FFR Registry for Risk Prediction; NCT04037163)
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Yamamoto A, Nagao M, Ando K, Nakao R, Sakai A, Watanabe E, Momose M, Sato K, Fukushima K, Sakai S, Hagiwara N. Myocardial Flow Reserve in Coronary Artery Disease with Low Attenuation Plaque: Coronary CTA and 13N-ammonia PET Assessments. Acad Radiol 2022; 29 Suppl 4:S17-S24. [PMID: 33281040 DOI: 10.1016/j.acra.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Physiological measurements from coronary angiography show that coronary stenosis with necrotic core plaque reduces coronary flow reserve (CFR). Myocardial flow reserve (MFR) estimated by 13N-ammonia PET (NH3-PET) is a different index from CFR. Low attenuation plaque (LAP) on coronary CTA (CCTA) contains necrotic core, but the link between LAP and MFR has not been elucidated. We aimed to investigate the influence of LAP on MFR in coronary artery disease (CAD). MATERIALS AND METHODS The study included 105 consecutive patients who underwent NH3-PET and CCTA within 3 months. Nonevaluable coronary arteries due to severe calcification and stent implants were excluded. Finally, 290 major vessels were retrospectively analyzed. Coronary arteries were divided into mild (1%-49%), moderate (50%-69% stenosis), and severe (≥70% stenosis) groups. Coronary plaques were classified either LAP (including soft tissue CT value <30 HU) or completely classified plaques. MFR for the major vessels were calculated and MFR <2.0 was considered a significant decrease. Comparison of MFR between territories with and without LAP, and the effect of plaque characteristics on MFR was analyzed. RESULTS MFR was significantly lower for territories with LAP than with calcified plaques or no plaque (2.1 ± 0.7, 2.4 ± 0.7, and 2.3 ± 0.7; p < 0.05). There was no difference between calcified plaque and no plaque territories (p = 0.79). Multivariate logistic analysis for plaque characteristics and stenosis severity revealed that LAP and severe stenosis were independent predictors for territories with MFR <2.0 with odds ratios of 3.1 (95% confidence interval, 1.2-8.1) and 3.0 (95% confidence interval, 1.7-5.3). CONCLUSION LAP reduced MFR compared with calcified plaque or no plaque in CAD. LAP is an independent predictor of the territory with MFR <2.0.
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2022; 35:329-354. [PMID: 35379446 DOI: 10.1016/j.echo.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant'Anna - Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Gao Y, Zhao N, Song L, Hu H, Jiang T, Chen W, Zhang F, Dou K, Mu C, Yang W, Fu G, Xu L, Li D, Fan L, An Y, Wang Y, Li W, Xu B, Lu B. Diagnostic Performance of CT FFR With a New Parameter Optimized Computational Fluid Dynamics Algorithm From the CT-FFR-CHINA Trial: Characteristic Analysis of Gray Zone Lesions and Misdiagnosed Lesions. Front Cardiovasc Med 2022; 9:819460. [PMID: 35391840 PMCID: PMC8980684 DOI: 10.3389/fcvm.2022.819460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
To assess the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (CT-FFR) obtained by a new computational fluid dynamics (CFD) algorithm to detect ischemia, using FFR as a reference, and analyze the characteristics of “gray zone” and misdiagnosed lesions. This prospective multicenter clinical trial (NCT03692936, https://clinicaltrials.gov/) analyzed 317 patients with coronary stenosis between 30 and 90% in 366 vessels from five centers undergoing CTA and FFR between November 2018 and March 2020. CT-FFR were obtained from a CFD algorithm (Heartcentury Co., Ltd., Beijing, China). Diagnostic performance of CT-FFR and CTA in detecting ischemia was assessed. Coronary atherosclerosis characteristics of gray zone and misdiagnosed lesions were analyzed. Per-vessel sensitivity, specificity and accuracy for CT-FFR and CTA were 89.9, 87.8, 88.8% and 89.3, 35.5, 60.4%, respectively. Accuracy of CT-FFR was 80.0% in gray zone lesions. In gray zone lesions, lumen area and diameter were significantly larger than lesions with FFR < 0.76 (both p < 0.001), lesion length, non-calcified and calcified plaque volume were all significantly higher than non-ischemic lesions (all p < 0.05). In gray zone lesions, Agatston score (OR = 1.009, p = 0.044) was the risk factor of false negative results of CT-FFR. In non-ischemia lesions, coronary stenosis >50% (OR = 2.684, p = 0.03) was the risk factor of false positive results. Lumen area (OR = 0.567, p = 0.02) and diameter (OR = 0.296, p = 0.03) had a significant negative effect on the risk of false positive results of CT-FFR. In conclusion, CT-FFR based on the new parameter-optimized CFD model provides better diagnostic performance for lesion-specific ischemia than CTA. For gray zone lesions, stenosis degree was less than those with FFR < 0.76, and plaque load was heavier than non-ischemic lesions.
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Affiliation(s)
- Yang Gao
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Na Zhao
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Jiang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenqiang Chen
- Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China
| | - Feng Zhang
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chaowei Mu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Xu
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dumin Li
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Yunqiang An
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Bin Lu,
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35
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The relation of RAAS activity and endothelin-1 levels to coronary atherosclerotic burden and microvascular dysfunction in chest pain patients. Atherosclerosis 2022; 347:47-54. [DOI: 10.1016/j.atherosclerosis.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
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36
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Affiliation(s)
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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37
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Yang S, Zhang J, Hwang D, Lee JM, Nam CW, Shin ES, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Koo BK. Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation. Front Cardiovasc Med 2021; 8:696756. [PMID: 34950710 PMCID: PMC8688402 DOI: 10.3389/fcvm.2021.696756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
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Yang S, Koo BK, Narula J. Interactions Between Morphological Plaque Characteristics and Coronary Physiology: From Pathophysiological Basis to Clinical Implications. JACC Cardiovasc Imaging 2021; 15:1139-1151. [PMID: 34922863 DOI: 10.1016/j.jcmg.2021.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
High-risk coronary plaque refers to a distinct set of plaque characteristics prone to future coronary events. Coronary physiology represents a group of indexes reflective of the local physiological environment and hemodynamic changes in the macrovascular and microvascular system. Although a large body of evidence has supported the clinical relevance of these 2 factors, currently, identifying plaque morphology cannot reliably capture the lesion subset that causes hard events. Also, the guideline-directed approach based on physiological indexes cannot fully predict and prevent clinical events. In parallel, there is accumulating evidence that these 2 aspects of coronary artery disease influence each other with significant clinical implications, despite traditionally being considered to have separate effects on significances, treatments, and outcomes. In this state-of-the-art review, we explore the clinical evidence of pathophysiological interplay of physiological indexes related to local hemodynamics, epicardial stenosis, and microvascular dysfunction with plaque morphological characteristics that provide a better understanding of the nature of coronary events. Furthermore, we examine the emerging data on the complementary role between plaque morphology and coronary physiology in prognostication and how to apply this concept to overcome the limitations of individual assessment alone. Finally, we propose the potential benefit of integrative assessment of coronary anatomy, plaque quantity and quality, and physiological aspects of a target lesion and vessels for personalized risk profiling and optimized treatment strategy.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea.
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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39
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Ma S, Chen X, Ma Y, Liu H, Zhang J, Xu L, Wang Y, Liu T, Wang K, Yang J, Hou Y. Lesion-Specific Peri-Coronary Fat Attenuation Index Is Associated With Functional Myocardial Ischemia Defined by Abnormal Fractional Flow Reserve. Front Cardiovasc Med 2021; 8:755295. [PMID: 34805310 PMCID: PMC8595266 DOI: 10.3389/fcvm.2021.755295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear. Method: Data of patients who underwent coronary computed tomography angiography (CTA) and subsequent invasive coronary angiography (ICA) and FFR measurement within 1 week were retrospectively included. Lesion-specific FAI (FAIlesion), lesion-free FAI (FAInormal), epicardial adipose tissue (EAT) volume and attenuation was collected, along with stenosis severity and plaque characteristics. Lesions with FFR <0.8 were considered functionally significant. The association between FFR and each parameter was analyzed by logistic regression or receiver operating characteristic curve. Result: A total of 227 patients from seven centers were included. EAT volume or attenuation, traditional risk factors, and FAInormal (with vs. without ischemia: −82 ± 11 HU vs. −81 ± 11 HU, p = 0.65) were not significantly different in patients with or without abnormal FFR. In contrast, lesions causing functional ischemia presented more severe stenosis, greater plaque volume, and higher FAIlesion (with vs. without ischemia: −71 ± 8 HU vs. −76 ± 9 HU, p < 0.01). Additionally, the CTA-assessed stenosis severity (OR 1.06, 95%CI 1.04–1.08, p < 0.01) and FAIlesion (OR 1.08, 95%CI 1.04–1.12, p < 0.01) were determined to be independent factors that could predict ischemia. The combination model of these two CTA parameters exhibited a diagnostic value similar to the invasive coronary angiography (ICA)-assessed stenosis severity (AUC: 0.820 vs. 0.839, p = 0.39). Conclusion: It was FAIlesion, not general EAT parameters, that was independently associated with abnormal FFR and the diagnostic performance of CTA-assessed stenosis severity for functional ischemia was significantly improved in combination with FAIlesion.
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Affiliation(s)
- Shaowei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xujiao Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Kunhua Wang
- Department of Radiology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Jinzhu Yang
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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40
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-invasive Imaging in Coronary Syndromes - Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. Eur Heart J Cardiovasc Imaging 2021; 23:e6-e33. [PMID: 34751391 DOI: 10.1093/ehjci/jeab244] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact.(1) Non-invasive imaging modalities play a fundamental role in the evaluation and management of patients with known or suspected CAD. Imaging end-points have served as surrogate markers in many observational studies and randomized clinical trials that evaluated the benefits of specific therapies for CAD.(2) A number of guidelines and recommendations have been published about coronary syndromes by cardiology societies and associations, but have not focused on the excellent opportunities with cardiac imaging. The recent European Society of Cardiology (ESC) 2019 guideline on chronic coronary syndromes (CCS) and 2020 guideline on acute coronary syndromes in patients presenting with non-ST-segment elevation (NSTE-ACS) highlight the importance of non-invasive imaging in the diagnosis, treatment, and risk assessment of the disease.(3)(4) The purpose of the current recommendations is to present the significant role of non-invasive imaging in coronary syndromes in more detail. These recommendations have been developed by the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), in collaboration with the American Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance, all of which have approved the final document.
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Affiliation(s)
- Thor Edvardsen
- Dept of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway, and University of Oslo, Norway
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, DC, . USA
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University; VA Portland Health Care System, Portland, OR, USA
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, 2300RC, Leiden, The Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, USA
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, 111 East 210th Street, Bronx, New York, 10467, USA
| | - Otto Kamp
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danilo Neglia
- Department of Cardiology, Fondazione Toscana G. Monastrerio, Pisa, Italy
| | - Aleksandar N Neskovic
- Dept of Cardiology, Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, California, ., USA
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa and Milan, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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41
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Computed Tomography Coronary Plaque Characteristics Predict Ischemia Detected by Invasive Fractional Flow Reserve. J Thorac Imaging 2021; 36:360-366. [PMID: 32701769 DOI: 10.1097/rti.0000000000000543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Coronary computed tomography angiography (CCTA) plaque quantification has been proposed to be of incremental value in the prediction of ischemia, although prior studies have shown conflicting results. We aimed to determine whether CCTA plaque features assessed on a commercial vendor platform predict invasive fractional flow reserve (FFR)/instantaneous wave-free ratio (IFR). METHODS Consecutive patients who underwent CCTA for evaluation of suspected stable coronary artery disease followed by invasive coronary physiology testing within 60 days at a single academic center were identified retrospectively. Semiautomated plaque quantification of the vessel proximal to the location of FFR/IFR measurement was carried out in TeraRecon, along with simple visual assessment for high-risk plaque features of positive remodeling, spotty calcification, low-attenuation plaque (LAP), and lesion length. Ischemia was defined by FFR ≤0.80 or IFR ≤0.89. RESULTS A total of 134 patients (62% male, mean age 62±10 y) were included in this study. On univariate logistic regression, the following visual plaque analysis parameters were predictive of ischemia: positive remodeling (odds ratio [OR] with 95% confidence interval [CI]: 4.96; 2.25-10.95; P<0.001), lesion length (OR for every 1 mm with 95% CI: 1.24; 1.14-1.34; P<0.001), spotty calcification (OR with 95% CI: 6.67; 1.67-26.64; P=0.007), and LAP (OR with 95% CI: 30; 3.78-246; P=0.001). None of the semiautomated plaque quantification parameters, such as noncalcified plaque volume or LAP volume, were predictive of ischemia. On stepwise multivariable logistic regression, lesion length (OR with 95% CI: 1.25; 1.14-1.37; P<0.0001) and LAP (OR with 95% CI: 43; 4.4-438; P=0.001) were significant predictors of ischemia, improving the area under the curve of CCTA from 0.53 to 0.87. CONCLUSIONS Simple visual plaque assessment for high-risk plaque features improved the performance of CCTA to predict ischemia. Semiautomated plaque quantification performed on a commercial vendor platform was not predictive of ischemia.
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42
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Liu H, Wingert A, Wang X, Zhang J, Sun J, Chen F, Khalid SG, Gong Y, Xia L, Jiang J, Wang J, Zheng D. Consistency in Geometry Among Coronary Atherosclerotic Plaques Extracted From Computed Tomography Angiography. Front Physiol 2021; 12:715265. [PMID: 34712147 PMCID: PMC8546263 DOI: 10.3389/fphys.2021.715265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The three-dimensional (3D) geometry of coronary atherosclerotic plaques is associated with plaque growth and the occurrence of coronary artery disease. However, there is a lack of studies on the 3D geometric properties of coronary plaques. We aim to investigate if coronary plaques of different sizes are consistent in geometric properties. Methods: Nineteen cases with symptomatic stenosis caused by atherosclerotic plaques in the left coronary artery were included. Based on attenuation values on computed tomography angiography images, coronary atherosclerotic plaques and calcifications were identified, 3D reconstructed, and manually revised. Multidimensional geometric parameters were measured on the 3D models of plaques and calcifications. Linear and non-linear (i.e., power function) fittings were used to investigate the relationship between multidimensional geometric parameters (length, surface area, volume, etc.). Pearson correlation coefficient (r), R-squared, and p-values were used to evaluate the significance of the relationship. The analysis was performed based on cases and plaques, respectively. Significant linear relationship was defined as R-squared > 0.25 and p < 0.05. Results: In total, 49 atherosclerotic plaques and 56 calcifications were extracted. In the case-based analysis, significant linear relationships were found between number of plaques and number of calcifications (r = 0.650, p = 0.003) as well as total volume of plaques (r = 0.538, p = 0.018), between number of calcifications and total volume of plaques (r = 0.703, p = 0.001) as well as total volume of calcification (r = 0.646, p = 0.003), and between the total volumes of plaques and calcifications (r = 0.872, p < 0.001). In plaque-based analysis, the power function showed higher R-squared values than the linear function in fitting the relationships of multidimensional geometric parameters. Two presumptions of plaque geometry in different growth stages were proposed with simplified geometric models developed. In the proposed models, the exponents in the power functions of geometric parameters were in accordance with the fitted values. Conclusion: In patients with coronary artery disease, coronary plaques and calcifications are positively related in number and volume. Different coronary plaques are consistent in the relationship between geometry parameters in different dimensions.
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Affiliation(s)
- Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.,Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Aleksandra Wingert
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Xinhong Wang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jucheng Zhang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianzhong Sun
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Syed Ghufran Khalid
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.,Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Yinglan Gong
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
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Zhang J, Hwang D, Yang S, Kim CH, Lee JM, Nam CW, Shin ES, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Koo BK. Differential Prognostic Implications of Pre- and Post-Stent Fractional Flow Reserve in Patients Undergoing Percutaneous Coronary Intervention. Korean Circ J 2021; 52:47-59. [PMID: 34877828 PMCID: PMC8738713 DOI: 10.4070/kcj.2021.0128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
The current study showed that pre-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) was associated with target vessel failure (TVF) after PCI. When the prognostic value of post-PCI FFR was evaluated according to pre-PCI FFR value, the risk of TVF significantly decreased along with the increase of post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Our study results suggest that patient prognosis can be varied according to the level of physiologic indices, both before and after PCI, and the integration of both information can provide better risk stratification after PCI. Background and Objectives The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR. Trial Registration ClinicalTrials.gov Identifier: NCT04012281
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Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Chee Hae Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea.
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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Eskerud I, Gerdts E, Larsen TH, Simon J, Maurovich-Horvat P, Lønnebakken MT. Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease. IJC HEART & VASCULATURE 2021; 35:100831. [PMID: 34258383 PMCID: PMC8255815 DOI: 10.1016/j.ijcha.2021.100831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
AIM Whether the total coronary atherosclerotic plaque burden is independently associated with myocardial ischemia in non-obstructive coronary artery disease (CAD) is not well established. We aimed to test the association of total plaque burden quantified by coronary computed tomography angiography (CCTA) with myocardial ischemia in patients with chronic coronary syndrome and non-obstructive CAD. METHODS We included 125 patients (age 62 ± 9 years, 58% women) with chronic coronary syndrome and non-obstructive CAD (stenosis < 50%) by CCTA, who were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. Total plaque burden was quantified by CCTA as the total plaque volume in the main coronary arteries, and positive remodelling was defined as remodelling index > 1.10. RESULTS Patients with myocardial ischemia (n = 66) had higher total plaque burden (847 ± 245 mm3 vs. 758 ± 251 mm3, p = 0.049) and higher left ventricular (LV) mass index (42.1 ± 9.9 g/m2.7 vs. 37.3 ± 8.0 g/m2.7, p = 0.004), while age, sex, prevalence of hypertension, diabetes, calcium score and positive remodelling did not differ between the groups (all p > 0.05). In multivariable regression analysis, total plaque burden remained associated with presence of myocardial ischemia (OR 1.02, 95% CI 1.00-1.04, p = 0.045) independent of age, sex, hypertension, diabetes, LV mass index, coronary calcium score and positive remodelling. CONCLUSION Total coronary artery plaque burden by CCTA was independently associated with myocardial ischemia in patients with non-obstructive CAD. Whether plaque quantification is useful for clinical management of patients with non-obstructive CAD should be tested in prospective studies.ClinicalTrials.gov: Identifier NCT01853527.
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Affiliation(s)
- Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway
- Department of Biomedicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, 18 Hataror ut, 1122, Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway
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Kalykakis GE, Antonopoulos AS, Pitsargiotis T, Siogkas P, Exarchos T, Kafouris P, Sakelarios A, Liga R, Tzifa A, Giannopoulos A, Scholte AJHA, Kaufmann PA, Parodi O, Knuuti J, Fotiadis DI, Neglia D, Anagnostopoulos CD. Relationship of Endothelial Shear Stress with Plaque Features with Coronary CT Angiography and Vasodilating Capability with PET. Radiology 2021; 300:549-556. [PMID: 34184936 DOI: 10.1148/radiol.2021204381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Advances in three-dimensional reconstruction techniques and computational fluid dynamics of coronary CT angiography (CCTA) data sets make feasible evaluation of endothelial shear stress (ESS) in the vessel wall. Purpose To investigate the relationship between CCTA-derived computational fluid dynamics metrics, anatomic and morphologic characteristics of coronary lesions, and their comparative performance in predicting impaired coronary vasodilating capability assessed by using PET myocardial perfusion imaging (MPI). Materials and Methods In this retrospective study, conducted between October 2019 and September 2020, coronary vessels in patients with stable chest pain and with intermediate probability of coronary artery disease who underwent both CCTA and PET MPI with oxygen 15-labeled water or nitrogen 13 ammonia and quantification of myocardial blood flow were analyzed. CCTA images were used in assessing stenosis severity, lesion-specific total plaque volume (PV), noncalcified PV, calcified PV, and plaque phenotype. PET MPI was used in assessing significant coronary stenosis. The predictive performance of the CCTA-derived parameters was evaluated by using area under the receiver operating characteristic curve (AUC) analysis. Results There were 92 coronary vessels evaluated in 53 patients (mean age, 65 years ± 7; 31 men). ESS was higher in lesions with greater than 50% stenosis versus those without significant stenosis (mean, 15.1 Pa ± 30 vs 4.6 Pa ± 4 vs 3.3 Pa ± 3; P = .004). ESS was higher in functionally significant versus nonsignificant lesions (median, 7 Pa [interquartile range, 5-23 Pa] vs 2.6 Pa [interquartile range, 1.8-5 Pa], respectively; P ≤ .001). Adding ESS to stenosis severity improved prediction (change in AUC, 0.10; 95% CI: 0.04, 0.17; P = .002) for functionally significant lesions. Conclusion The combination of endothelial shear stress with coronary CT angiography (CCTA) stenosis severity improved prediction of an abnormal PET myocardial perfusion imaging result versus CCTA stenosis severity alone. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Kusmirek and Wieben in this issue.
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Affiliation(s)
- Georgios-Eleftherios Kalykakis
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Alexios S Antonopoulos
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Thomas Pitsargiotis
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Panagiotis Siogkas
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Themistoklis Exarchos
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Pavlos Kafouris
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Antonis Sakelarios
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Riccardo Liga
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Aphrodite Tzifa
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Andreas Giannopoulos
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Arthur J H A Scholte
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Philipp A Kaufmann
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Oberdan Parodi
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Juhani Knuuti
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Dimitrios I Fotiadis
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Danilo Neglia
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
| | - Constantinos D Anagnostopoulos
- From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.)
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46
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Kumamaru KK, Fujimoto S, Otsuka Y, Kawasaki T, Kawaguchi Y, Kato E, Takamura K, Aoshima C, Kamo Y, Kogure Y, Inage H, Daida H, Aoki S. Diagnostic accuracy of 3D deep-learning-based fully automated estimation of patient-level minimum fractional flow reserve from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 21:437-445. [PMID: 31230076 DOI: 10.1093/ehjci/jez160] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/15/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS Although deep-learning algorithms have been used to compute fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA), no study has achieved 'fully automated' (i.e. free from human input) FFR calculation using deep-learning algorithms. The purpose of the study was to evaluate the accuracy of a fully automated 3D deep-learning model for estimating minimum FFR from CCTA data, with invasive FFR as the reference standard. METHODS AND RESULTS This retrospective study of 1052 patients included 131 patients whose CCTA studies showed 30-90% stenosis and underwent invasive FFR (abnormal FFR observed in 72/131, 55%), and 921 patients who underwent clinically indicated CCTA without invasive FFR. We designed a fully automated 3D deep-learning model that inputs CCTA data and outputs minimum FFR without requiring human input. The model comprised a series of deep-learning algorithms: a conditional generative adversarial network, a 3D convolutional ladder network, and two independent neural networks with integrated virtual adversarial training. We used Monte Carlo cross-validation to evaluate the accuracy of the model for estimating FFR, with invasive FFR as the reference standard. The deep-learning FFR achieved area under the receiver-operating characteristic curve of 0.78 for detection of abnormal FFR; and was significantly higher than for visually determined CCTA >50% stenosis (area under the curve = 0.56). The deep-learning FFR model achieved 76% accuracy for detecting abnormal FFR, with sensitivity of 85% (79-89%) and specificity of 63% (54-70%). CONCLUSION The 3D deep-learning model, which performs fully automatic estimation of minimum FFR from cardiac CT data, achieved 76% accuracy in detecting abnormal FFR.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yujiro Otsuka
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.,Milliman, Inc., Urbannet Kojimachi Bldg. 8F, 1-6-2 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Etsuro Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yosuke Kogure
- Department of Radiological Technology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hidekazu Inage
- Department of Radiological Technology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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47
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Driessen RS, Bom MJ, van Diemen PA, Schumacher SP, Leonora RM, Everaars H, van Rossum AC, Raijmakers PG, van de Ven PM, van Kuijk CC, Lammertsma AA, Knuuti J, Ahmadi A, Min JK, Leipsic JA, Narula J, Danad I, Knaapen P. Incremental prognostic value of hybrid [15O]H2O positron emission tomography-computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology. Eur Heart J Cardiovasc Imaging 2021; 21:1105-1113. [PMID: 32959061 PMCID: PMC7971168 DOI: 10.1093/ehjci/jeaa192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/25/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
Aims This study sought to determine the prognostic value of combined functional testing using positron emission tomography (PET) perfusion imaging and anatomical testing using coronary computed tomography angiography (CCTA)-derived stenosis severity and plaque morphology in patients with suspected coronary artery disease (CAD). Methods and results In this retrospective study, 539 patients referred for hybrid [15O]H2O PET-CT imaging because of suspected CAD were investigated. PET was used to determine myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenoses and high-risk plaque (HRP) morphology. Patients were followed up for the occurrence of all-cause death and non-fatal myocardial infarction (MI). During a median follow-up of 6.8 (interquartile range 4.8–7.8) years, 42 (7.8%) patients experienced events, including 23 (4.3%) deaths, and 19 (3.5%) MIs. Annualized event rates for normal vs. abnormal results of PET MBF, CCTA-derived stenosis, and HRP morphology were 0.6 vs. 2.1%, 0.4 vs. 2.1%, and 0.8 vs. 2.8%, respectively (P < 0.001 for all). Cox regression analysis demonstrated prognostic values of PET perfusion imaging [hazard ratio (HR) 3.75 (1.84–7.63), P < 0.001], CCTA-derived stenosis [HR 5.61 (2.36–13.34), P < 0.001], and HRPs [HR 3.37 (1.83–6.18), P < 0.001] for the occurrence of death or MI. However, only stenosis severity [HR 3.01 (1.06–8.54), P = 0.039] and HRPs [HR 1.93 (1.00–3.71), P = 0.049] remained independently associated. Conclusion PET-derived MBF, CCTA-derived stenosis severity, and HRP morphology were univariably associated with death and MI, whereas only stenosis severity and HRP morphology provided independent prognostic value.
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Affiliation(s)
- Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Remi M Leonora
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis C van Kuijk
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Amir Ahmadi
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 E 69th Street, Suite 108, New York, NY 10021, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, 2775 Laurel St. Vancouver, BC V5Z 1M9, Canada
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Boussoussou M, Vattay B, Szilveszter B, Kolossváry M, Simon J, Vecsey-Nagy M, Merkely B, Maurovich-Horvat P. Functional assessment of coronary plaques using CT based hemodynamic simulations: Current status, technical principles and clinical value. IMAGING 2021. [DOI: 10.1556/1647.2020.00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractIn recent years, coronary computed tomography angiography (CCTA) has emerged as an accurate and safe non-invasive imaging modality in terms of detecting and excluding coronary artery disease (CAD). In the latest European Society of Cardiology Guidelines CCTA received Class I recommendation for the evaluation of patients with stable chest pain with low to intermediate clinical likelihood of CAD. Despite its high negative predictive value, the diagnostic performance of CCTA is limited by the relatively low specificity, especially in patients with heavily calcified lesions. The discrepancy between the degree of stenosis and ischemia is well established based on both invasive and non-invasive tests. The rapid evolution of computational flow dynamics has allowed the simulation of CCTA derived fractional flow reserve (FFR-CT), which improves specificity by combining anatomic and functional information regarding coronary atherosclerosis. FFR-CT has been extensively validated against invasively measured FFR as the reference standard. Due to recent technological advancements FFR-CT values can also be calculated locally, without offsite processing. Wall shear stress (WSS) and axial plaque stress (APS) are additional key hemodynamic elements of atherosclerotic plaque characteristics, which can also be measured using CCTA images. Current evidence suggests that WSS and APS are important hemodynamic features of adverse coronary plaques. CCTA based hemodynamic calculations could therefore improve prognostication and the management of patients with stable CAD.
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Affiliation(s)
- Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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49
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Risk stratification in coronary artery disease using NH 3-PET myocardial flow reserve and CAD-RADS on coronary CT angiography. Int J Cardiovasc Imaging 2021; 37:3335-3342. [PMID: 34117587 DOI: 10.1007/s10554-021-02312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Myocardial flow reserve (MFR) derived from 13N-ammonia positron emission tomography (NH3-PET) can predict the prognosis of patients with various heart diseases. Coronary computed tomography angiography (CCTA) is a non-invasive investigation for ischemic heart disease. The coronary artery disease reporting and data system (CAD-RADS) was established to standardize and facilitate the reporting of CCTA data regarding CAD. This study aimed to investigate the prognostic value of CAD-RADS and MFR. A total of 133 patients who underwent NH3-PET and CCTA within 3 months were enrolled. Patients were divided into groups with CAD-RADS 0-2 and ≥ 3 and into groups with MFR ≥ 2.0 and < 2.0. The endpoint was major adverse cardiac events (MACE) comprising all-cause death, acute coronary syndrome, hospitalization due to heart failure, and cerebrovascular disease. The ability of CAD-RADS and MFR to predict MACE was analyzed using Kaplan-Meier analysis. There was no significant difference in MFR between patients with CAD-RADS 0-2 and ≥ 3 (2.3 ± 0.9 vs. 2.2 ± 0.7, p = 0.50). The MACE rate for patients with CAD-RADS 0-2 and ≥ 3 was equivalent (log-rank test, p = 0.64). Patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.017). In patients with CAD-RADS ≥ 3, patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.034). CAD-RADS did not contribute to MACE prediction. Conversely, MFR was useful in predicting MACE, allowing for further risk stratification in addition to CAD-RADS.
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50
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Benjamin MM, Rabbat MG. Machine learning-based advances in coronary computed tomography angiography. Quant Imaging Med Surg 2021; 11:2208-2213. [PMID: 34079695 DOI: 10.21037/qims-21-99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mina M Benjamin
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Rabbat
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
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