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Patel NH, Dave EK, Fatade YA, De Cecco CN, Ko YA, Chen Y, Sharma A, Rashid F, Vatsa N, Samady H, Toleva O, Quyyumi A, Mehta PK, Stillman AE. Epicardial adipose tissue attenuation on computed tomography in women with coronary microvascular dysfunction: A pilot, hypothesis generating study. Atherosclerosis 2024; 395:118520. [PMID: 38944545 DOI: 10.1016/j.atherosclerosis.2024.118520] [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: 02/02/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Patients with myocardial ischemia without obstructive coronary artery disease often have coronary microvascular dysfunction (CMD) and associated increased risk of cardiovascular (CV) events and anginal hospitalizations. Epicardial adipose tissue (EAT) covers much of the myocardium and coronary arteries and when dysfunctional, secretes proinflammatory cytokines and is associated with CV events. While oxidative stress and systemic inflammation are associated with CMD, the relationship between EAT and CMD in women is not well known. METHODS Women diagnosed with CMD (n = 21) who underwent coronary computed tomography with coronary artery calcium (CAC) scoring were compared to a reference group (RG) of women referred for CAC screening for preventive risk assessment (n = 181). EAT attenuation (Hounsfield units (HU)) was measured adjacent to the proximal right coronary artery, along with subcutaneous adipose tissue (SCAT). Two-sample t-tests with unequal variances were utilized. RESULTS Mean age of the CMD group was 56 ± 8 years and body mass index (BMI) was 31.6 ± 6.8 kg/m2. CV risk factors in the CMD group were prevalent: 67 % hypertension, 44 % hyperlipidemia, and 33 % diabetes. Both CMD and RG had similar CAC score (25.86 ± 59.54 vs. 24.17 ± 104.6; p = 0.21. In the CMD group, 67 % had a CAC of 0. Minimal atherosclerosis (CAD-RADS 1) was present in 76 % of women with CMD. The CMD group had lower EAT attenuation than RG (-103.3 ± 6.33 HU vs. -97.9 ± 8.3 HU, p = 0.009, respectively). There were no differences in SCAT attenuation. Hypertension, smoking history, age, BMI, and CAC score did not correlate with EAT in either of the groups. CONCLUSIONS Women with CMD have decreased EAT attenuation compared to RG women. EAT-mediated inflammation and changes in vascular tone may be a mechanistic contributor to abnormal microvascular reactivity. Clinical trials testing therapeutic strategies to decrease EAT may be warranted in the management of CMD.
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Affiliation(s)
- Nidhi H Patel
- J. Willis Hurst Internal Medicine Residency Program, Emory University, USA
| | - Esha K Dave
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, USA
| | - Yetunde A Fatade
- J. Willis Hurst Internal Medicine Residency Program, Emory University, USA
| | - Carlo N De Cecco
- Department of Radiology, Emory University School of Medicine, USA
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, USA
| | - Yunyun Chen
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, USA
| | - Ashish Sharma
- Division of Hospital Medicine, Emory University School of Medicine, USA
| | - Fauzia Rashid
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, USA
| | - Nishant Vatsa
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, USA
| | | | | | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, USA
| | - Puja K Mehta
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, USA; Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, USA.
| | - Arthur E Stillman
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, USA; Department of Radiology, Emory University School of Medicine, USA
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Karady J, Lu MT, Bergström G, Mayrhofer T, Taron J, Foldyna B, Paradis K, McCallum S, Aberg JA, Currier JS, Fitch KV, Fulda ES, Bloomfield GS, Overton ET, Lind L, Östgren CJ, Elvstam O, Söderberg S, Jernberg T, Pepe R, Dubé MP, Mushatt D, Fichtenbaum CJ, Malvestutto C, Zanni MV, Hoffmann U, Ribaudo H, Grinspoon SK, Douglas PS. Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations. JACC. ADVANCES 2024; 3:100968. [PMID: 38938873 PMCID: PMC11198107 DOI: 10.1016/j.jacadv.2024.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 06/29/2024]
Abstract
Background People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification. Objectives The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH. Methods Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence. Results Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; P < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; P < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; P < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, P < 0.001). Conclusions Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.
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Affiliation(s)
- Julia Karady
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Jana Taron
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine, Department of Radiology, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Kayla Paradis
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Sara McCallum
- Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Judith A. Aberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith S. Currier
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lars Lind
- Division of Clinical Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Carl Johan Östgren
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Olof Elvstam
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden
| | - Stefan Söderberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Rosalie Pepe
- Cooper University Hospital, Camden, New Jersey, USA
| | - Michael P. Dubé
- Division of Infectious Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - David Mushatt
- Section of Infectious Disease, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
- Innovative Imaging Consulting LLC, Boston, Massachusetts, USA
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Higueras-Fresnillo S, Herraiz-Adillo Á, Ahlqvist VH, Öberg R, Lenander C, Wennberg P, Wångdahl J, Berglind D, Daka B, Östgren CJ, Rådholm K, Henriksson P. Associations of psychological factors with atherosclerosis and cardiovascular health in middle-age: the population-based Swedish CArdioPulmonary bioImage study (SCAPIS). BMC Public Health 2024; 24:1455. [PMID: 38816713 PMCID: PMC11140911 DOI: 10.1186/s12889-024-18924-w] [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: 09/28/2023] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major global health issue, primarily caused by atherosclerosis. Psychological factors may play a role in the development and progression of CVD. However, the relationship between psychological factors and atherosclerosis is complex and poorly understood. This study, therefore, aimed to examine the association of psychological factors with (i) coronary and carotid atherosclerosis and (ii) cardiovascular health according to Life's Essential 8, in a large Swedish cohort. METHODS This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life's Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life's Essential 8). RESULTS A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC ≥ 1 and the presence of carotid plaques (all odds ratios: 1.10-1.21, 95% CI: 1.02-1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life's Essential 8 score (all standardized β-Coefficient ≤-0.033, p < 0.001). CONCLUSION While there were no strong and consistent associations between psychological factors and atherosclerosis, the consistent associations of psychological factors with cardiovascular health by Life's Essential 8 may have relevance for future CVD risk. However, further studies are needed to elucidate the long-term effects of psychological factors on atherosclerosis development and cardiovascular health.
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Affiliation(s)
- Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Viktor H Ahlqvist
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Robin Öberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Lenander
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Josefin Wångdahl
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel Berglind
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Bledar Daka
- Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Yang W, Wen D, Li S, Zhao H, Xu J, Liu J, Chang Y, Xu J, Zheng M. Prognostic Value of Non-alcoholic Fatty Liver Disease and RCA Pericoronary Adipose Tissue CT Attenuation in Patients with Acute Chest Pain. Acad Radiol 2024; 31:1773-1783. [PMID: 38160090 DOI: 10.1016/j.acra.2023.12.001] [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: 09/24/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
RATIONALE AND OBJECTIVES Pericoronary adipose tissue (PCAT) CT attenuation of right coronary artery (RCA) and non-alcoholic fatty liver disease (NAFLD) have prognostic value for major adverse cardiovascular events (MACE) in patients with coronary artery disease. However, the superior prognostic value between RCA PCAT CT attenuation and NAFLD remains unclear in patients with acute chest pain. This study is to evaluate the prognostic value of NAFLD for MACE, and further assess the incremental prognostic value of NAFLD over PCAT CT attenuation. MATERIALS AND METHODS Between January 2011 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary CT angiography (CCTA) were retrospectively enrolled. MACE included unstable angina requiring hospitalization, coronary revascularization, non-fatal myocardial infarction, and all-cause death. Patients' baseline and CCTA characteristics, RCA PCAT CT attenuation, and the presence of NAFLD were used to evaluate risk factors of MACE using multivariable Cox regression analysis. The prognostic value of NAFLD compared to RCA PCAT CT attenuation was analyzed. RESULTS A total of 514 patients were enrolled (mean age, 58.36 ± 13.05 years; 310 men). During a median follow-up of 31 months, 60 patients (11.67%) experienced MACE. NAFLD (HR = 2.599, 95% CI: 1.207, 5.598, P = 0.015) and RCA PCAT CT attenuation (HR = 1.026, 95% CI: 1.001, 1.051, P = 0.038) were independent predictors of MACE. The global Chi-square analysis showed that NAFLD improved the risk of MACE more than that using clinical risk factors and CCTA metrics (59.51 vs 54.44, P = 0.024) or combined with RCA PCAT CT attenuation (63.75 vs 59.51, P = 0.040). CONCLUSION NAFLD and RCA PCAT CT attenuation were predictors of MACE. NAFLD had an incremental prognostic value beyond RCA PCAT CT attenuation for MACE in patients with acute chest pain. Adding CT-FFR into the risk prediction of patients with acute chest pain is worth considering.
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Affiliation(s)
- Wenxuan Yang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Shuangxin Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Jingji Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Jiali Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Yingjuan Chang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.)
| | - Jian Xu
- Interventional Surgery Center, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (H.Z., J.X., J.L., Y.C., J.X.)
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an, 710032, China (W.Y., D.W., S.L., M.Z.).
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Michaud K, Rotzinger DC, Faouzi M, Grabherr S, Qanadli SD, van der Wal AC, Magnin V. High-risk coronary plaque of sudden cardiac death victims: postmortem CT angiographic features and histopathologic findings. Int J Legal Med 2024:10.1007/s00414-024-03228-w. [PMID: 38594500 DOI: 10.1007/s00414-024-03228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
High-risk coronary plaques (HRP) are characterized in clinical radiological imaging by the presence of low plaque attenuation, a napkin-ring sign (NRS), spotty calcifications (SC) and a positive remodeling index (RI). To evaluate if these signs are detectable in postmortem imaging by a multi-phase postmortem CT angiography (MPMCTA), a retrospective study of a series of autopsy well-documented coronary plaques related to sudden cardiac death (SCD) was performed. Then correlations between histological and radiological findings were described. Fourty SCD cases due to acute coronary syndrome based on clinical history and confirmed at autopsy were selected (28 men and 12 women, age 53.3 ± 10.9). The culprit lesion was mainly situated in the proximal segments of coronary arteries, in the right coronary artery in 23 cases (57.5%), the left anterior descending artery in 13 cases (32.5%), the circumflex artery in 3 cases (7.5%) and in one case in the left main stem. MPMCTA showed a positive RI (≥ 1.1) in 75% of cases with a mean RI 1.39 ± 0.71. RI values were lower in cases with fibrotic plaques. NRS was observed in 40% of cases, low attenuation plaque in 46.3%, and SC in 48.7% of cases. There were significant correlations of the radiological presence of NRS for fibrolipid composition of the plaque (p-value 0.007), severe intraplaque inflammation (p-value 0.017), severe adventitial inflammation (p-value 0.021) and an increased vasa vasorum (p-value 0.012). A significant correlation (p-value 0.002) was observed between the presence of SC at radiological examination and the presence of punctuate/fragmented calcification at histology. In addition, in 58.3% of cases, plaque enhancement was observed, which correlated with plaque inflammation and the fibrolipid composition of the plaque. The coronary artery calcium score was 314 (± 455). There was a poor agreement between stenosis of the lumen at histology versus radiology. Our study shows that the various radiological signs of HRP can be detected in all plaques by MPMCTA, but individually only to a variable extent; plaque enhancement appeared as a new sign of vulnerability. In the postmortem approach, these radiological markers of HRP, should always be applied in combination, which can be useful for developing a predictive model for diagnosing coronary SCD.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland.
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
- Center for Primary Care and Public Health, Division of Biostatistics, Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
| | - Salah D Qanadli
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Riviera-Chablais Hospital, Rennaz, 1847, Switzerland
| | - Allard C van der Wal
- Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
- Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
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Liu P, Huang G, Jing J, Bian S, Cheng L, Lu XY, Rao C, Liu Y, Hua Y, Wang Y, He K. An Energy Matching Vessel Segmentation Framework in 3-D Medical Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1476-1488. [PMID: 38048240 DOI: 10.1109/tmi.2023.3339204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Accurate vascular segmentation from High Resolution 3-Dimensional (HR3D) medical scans is crucial for clinicians to visualize complex vasculature and diagnose related vascular diseases. However, a reliable and scalable vessel segmentation framework for HR3D scans remains a challenge. In this work, we propose a High-resolution Energy-matching Segmentation (HrEmS) framework that utilizes deep learning to directly process the entire HR3D scan and segment the vasculature to the finest level. The HrEmS framework introduces two novel components. Firstly, it uses the real-order total variation operator to construct a new loss function that guides the segmentation network to obtain the correct topology structure by matching the energy of the predicted segment to the energy of the manual label. This is different from traditional loss functions such as dice loss, which matches the pixels between predicted segment and manual label. Secondly, a curvature-based weight-correction module is developed, which directs the network to focus on crucial and complex structural parts of the vasculature instead of the easy parts. The proposed HrEmS framework was tested on three in-house multi-center datasets and three public datasets, and demonstrated improved results in comparison with the state-of-the-art methods using both topology-relevant and volumetric-relevant metrics. Furthermore, a double-blind assessment by three experienced radiologists on the critical points of the clinical diagnostic processes provided additional evidence of the superiority of the HrEmS framework.
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Herten VRLM, Hampe N, Takx RAP, Franssen KJ, Wang Y, Sucha D, Henriques JP, Leiner T, Planken RN, Isgum I. Automatic Coronary Artery Plaque Quantification and CAD-RADS Prediction Using Mesh Priors. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1272-1283. [PMID: 37862273 DOI: 10.1109/tmi.2023.3326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Coronary artery disease (CAD) remains the leading cause of death worldwide. Patients with suspected CAD undergo coronary CT angiography (CCTA) to evaluate the risk of cardiovascular events and determine the treatment. Clinical analysis of coronary arteries in CCTA comprises the identification of atherosclerotic plaque, as well as the grading of any coronary artery stenosis typically obtained through the CAD-Reporting and Data System (CAD-RADS). This requires analysis of the coronary lumen and plaque. While voxel-wise segmentation is a commonly used approach in various segmentation tasks, it does not guarantee topologically plausible shapes. To address this, in this work, we propose to directly infer surface meshes for coronary artery lumen and plaque based on a centerline prior and use it in the downstream task of CAD-RADS scoring. The method is developed and evaluated using a total of 2407 CCTA scans. Our method achieved lesion-wise volume intraclass correlation coefficients of 0.98, 0.79, and 0.85 for calcified, non-calcified, and total plaque volume respectively. Patient-level CAD-RADS categorization was evaluated on a representative hold-out test set of 300 scans, for which the achieved linearly weighted kappa ( κ ) was 0.75. CAD-RADS categorization on the set of 658 scans from another hospital and scanner led to a κ of 0.71. The results demonstrate that direct inference of coronary artery meshes for lumen and plaque is feasible, and allows for the automated prediction of routinely performed CAD-RADS categorization.
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8
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Short RT, Lin F, Nair S, Terry JG, Carr JJ, Kandula NR, Lloyd-Jones D, Kanaya AM. Comparing coronary artery cross-sectional area among asymptomatic South Asian, White, and Black participants: the MASALA and CARDIA studies. BMC Cardiovasc Disord 2024; 24:158. [PMID: 38486153 PMCID: PMC10938784 DOI: 10.1186/s12872-024-03811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND South Asian individuals have high risk of atherosclerotic cardiovascular disease (ASCVD). Some investigators suggest smaller coronary artery size may be partially responsible. METHODS We compared the left anterior descending (LAD) artery cross-sectional area (CSA) (lumen and arterial wall) among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study with White and Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, adjusting for BMI, height, and other ASCVD risk factors. We used thin-slice non-contrast cardiac computed tomography to measure LAD CSA. We used linear regression models to determine whether race/ethnicity was associated with LAD CSA after adjusting for demographic factors, BMI, height, coronary artery calcium (CAC), and traditional cardiovascular risk factors. RESULTS Our sample included 3,353 participants: 513 self-identified as South Asian (44.4% women), 1286 as Black (59.6% women), and 1554 as White (53.5% women). After adjusting for age, BMI, height, there was no difference in LAD CSA between South Asian men and women compared to White men and women, respectively. After full adjustment for CVD risk factors, LAD CSA values were: South Asian women (19.9 mm2, 95% CI [18.8 - 20.9]) and men (22.3 mm2, 95% CI [21.4 - 23.2]; White women (20.0 mm2, 95% CI [19.4-20.5]) and men (23.6 mm2, 95% CI [23.0-24.2]); and Black women (21.6 mm2, 95% CI [21.0 - 22.2]) and men (26.0 mm2, 95% CI [25.3 - 26.7]). Height, BMI, hypertension, CAC, and age were positively associated with LAD CSA; current and former cigarette use were inversely associated. CONCLUSIONS South Asian men and women have similar LAD CSA to White men and women, and smaller LAD CSA compared to Black men and women, respectively, after accounting for differences in body size. Future studies should determine whether LAD CSA is associated with future ASCVD events.
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Grants
- R01 HL093009 NHLBI NIH HHS
- UL1 RR024131 NCRR NIH HHS
- K24 HL112827 NHLBI NIH HHS
- P30 DK098722 NIDDK NIH HHS
- P30 DK092924 NIDDK NIH HHS
- 2R01HL093009, UL1TR001872, 5K24HL112827, HHSN268201800005I, HHSN268201800007I, HHSN268201800003I, HHSN268201800006I, HHSN268201800004I, R01-HL098445 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
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Affiliation(s)
- R T Short
- University of California San Francisco, San Francisco, USA.
| | - F Lin
- University of California San Francisco, San Francisco, USA
| | - S Nair
- Vanderbilt University Medical Center, Nashville, USA
| | - J G Terry
- Vanderbilt University Medical Center, Nashville, USA
| | - J J Carr
- Vanderbilt University Medical Center, Nashville, USA
| | | | | | - A M Kanaya
- University of California San Francisco, San Francisco, USA
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9
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Dahl JN, Rasmussen LD, Ding D, Tu S, Westra J, Wijns W, Christiansen EH, Eftekhari A, Li G, Winther S, Bøttcher M. Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2024; 18:162-169. [PMID: 38242777 DOI: 10.1016/j.jcct.2024.01.004] [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: 09/12/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). METHODS Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. RESULTS In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73-86) vs. 77 % (95%CI: 69-83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67-78) vs. 80 % (95%CI: 75-85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). CONCLUSION Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.
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Affiliation(s)
- Jonathan N Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Daixin Ding
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China; Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Jelmer Westra
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - William Wijns
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland.
| | - Evald Høj Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Guanyu Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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10
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Guo W, Zhao S, Xu H, He W, Yin L, Yao Z, Xu Z, Jin H, Wu D, Li C, Yang S, Zeng M. Comparison of machine learning-based CT fractional flow reserve with cardiac MR perfusion mapping for ischemia diagnosis in stable coronary artery disease. Eur Radiol 2024:10.1007/s00330-024-10650-6. [PMID: 38409549 DOI: 10.1007/s00330-024-10650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES To compare the diagnostic performance of machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) and cardiac magnetic resonance (MR) perfusion mapping for functional assessment of coronary stenosis. METHODS Between October 2020 and March 2022, consecutive participants with stable coronary artery disease (CAD) were prospectively enrolled and underwent coronary CTA, cardiac MR, and invasive fractional flow reserve (FFR) within 2 weeks. Cardiac MR perfusion analysis was quantified by stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Hemodynamically significant stenosis was defined as FFR ≤ 0.8 or > 90% stenosis on invasive coronary angiography (ICA). The diagnostic performance of CT-FFR, MBF, and MPR was compared, using invasive FFR as a reference. RESULTS The study protocol was completed in 110 participants (mean age, 62 years ± 8; 73 men), and hemodynamically significant stenosis was detected in 36 (33%). Among the quantitative perfusion indices, MPR had the largest area under receiver operating characteristic curve (AUC) (0.90) for identifying hemodynamically significant stenosis, which is in comparison with ML-based CT-FFR on the vessel level (AUC 0.89, p = 0.71), with comparable sensitivity (89% vs 79%, p = 0.20), specificity (87% vs 84%, p = 0.48), and accuracy (88% vs 83%, p = 0.24). However, MPR outperformed ML-based CT-FFR on the patient level (AUC 0.96 vs 0.86, p = 0.03), with improved specificity (95% vs 82%, p = 0.01) and accuracy (95% vs 81%, p < 0.01). CONCLUSION ML-based CT-FFR and quantitative cardiac MR showed comparable diagnostic performance in detecting vessel-specific hemodynamically significant stenosis, whereas quantitative perfusion mapping had a favorable performance in per-patient analysis. CLINICAL RELEVANCE STATEMENT ML-based CT-FFR and MPR derived from cardiac MR performed well in diagnosing vessel-specific hemodynamically significant stenosis, both of which showed no statistical discrepancy with each other. KEY POINTS • Both machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) and quantitative perfusion cardiac MR performed well in the detection of hemodynamically significant stenosis. • Compared with stress myocardial blood flow (MBF) from quantitative perfusion cardiac MR, myocardial perfusion reserve (MPR) provided higher diagnostic performance for detecting hemodynamically significant coronary artery stenosis. • ML-based CT-FFR and MPR from quantitative cardiac MR perfusion yielded similar diagnostic performance in assessing vessel-specific hemodynamically significant stenosis, whereas MPR had a favorable performance in per-patient analysis.
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Affiliation(s)
- Weifeng Guo
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Haijia Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lekang Yin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Zhifeng Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhihan Xu
- Siemens Healthineers China, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Dong Wu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China.
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11
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Marinho LL, Rached FH, Morikawa AT, Tavoni TM, Cardoso APT, Torres RVA, Assuncao AN, Serrano CV, Nomura CH, Maranhão RC. Safety and possible anti-inflammatory effect of paclitaxel associated with LDL-like nanoparticles (LDE) in patients with chronic coronary artery disease: a double-blind, placebo-controlled pilot study. Front Cardiovasc Med 2024; 11:1342832. [PMID: 38450375 PMCID: PMC10915057 DOI: 10.3389/fcvm.2024.1342832] [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: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Studies in cholesterol-fed rabbits showed that anti-proliferative chemotherapeutic agents such as paclitaxel associated with solid lipid nanoparticles (LDE) have marked anti-atherosclerotic effects. In addition, association with LDE nearly abolishes paclitaxel toxicity. We investigated whether treatment with LDE-paclitaxel changes plaque progression by coronary CT angiography and is safe in patients with chronic coronary artery disease. Methods We conducted a prospective, randomized, double-blind, placebo-controlled pilot study in patients with multi-vessel chronic coronary artery disease. Patients were randomized to receive IV infusions of LDE-paclitaxel (paclitaxel dose: 175 mg/m2 body surface) or LDE alone (placebo group), administered every 3 weeks for 18 weeks. All participants received guideline-directed medical therapy. Clinical and laboratory safety evaluations were made at baseline and every 3 weeks until the end of the study. Analysis of inflammatory biomarkers and coronary CTA was also performed at baseline and 4 weeks after treatment. Results Forty patients aged 65.6 ± 8 years, 20 in LDE-paclitaxel and 20 in placebo group were enrolled. Among those, 58% had diabetes, 50% had myocardial infarction, and 91% were in use of statin and aspirin. Baseline demographics, risk factors, and laboratory results were not different between groups. In all patients, no clinical or laboratory toxicities were observed. From the baseline to the end of follow-up, there was a non-significant trend toward a decrease in IL-6 levels and hsCRP in the LDE-paclitaxel group (-16% and -28%, respectively), not observed in placebo. Regarding plaque progression analysis, variation in plaque parameter values was wide, and no difference between groups was observed. Conclusion In patients with multivessel chronic coronary artery disease and optimized medical therapy, LDE-paclitaxel was safe and showed clues of potential benefits in reducing inflammatory biomarkers. Clinical Trial Registration https://clinicaltrials.gov/study/NCT04148833, identifier (NCT04148833).
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Affiliation(s)
- Lucas Lage Marinho
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Hanna Rached
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Aleksandra Tiemi Morikawa
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Thauany Martins Tavoni
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | - Carlos Vicente Serrano
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Cesar Higa Nomura
- Department of Radiology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Raul Cavalcante Maranhão
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
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12
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Zeng Y, Wang X, Tang Z, Li T, Jiang X, Ji F, Zhou Y, Ge J, Li Z, Zhao Y, Ma C, Mintz GS, Nie S. Diagnostic accuracy of CT-FFR with a new coarse-to-fine subpixel algorithm in detecting lesion-specific ischemia: a prospective multicenter study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:129-137. [PMID: 37453536 DOI: 10.1016/j.rec.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES A new computed tomography-derived fractional flow reserve (CT-FFR) technique with a "coarse-to-fine subpixel" algorithm has been developed to generate precise lumen contours. The aim of this study was to assess the diagnostic performance of this new CT-FFR algorithm for discriminating lesion-specific ischemia using wire-based FFR ≤ 0.80 as the reference standard in patients with coronary artery disease. METHODS This prospective, multicenter study screened 330 patients undergoing coronary CT angiography (CCTA) and invasive FFR (median interval 2 days) from 6 tertiary hospitals. CT-FFR was evaluated in a blinded fashion with a "coarse-to-fine subpixel" algorithm for lumen contour. RESULTS Between March 2019 and May 2020, we included 316 patients with 324 vessels. There was a good correlation between CT-FFR and invasive FFR (r=0.76, P<.001). The diagnostic sensitivity, specificity, and accuracy on a per-vessel level were 95.3%, 89.8%, and 92.0% for CT-FFR, and 96.4%, 26.4%, and 53.1% for CCTA>50% stenosis, respectively. CT-FFR showed improved discrimination of ischemia compared with CCTA alone overall (AUC, 0.95 vs 0.74, P<.001) and in intermediate (AUC, 0.96 vs 0.62, P<.001) and "gray zone" lesions (AUC, 0.88 vs 0.61, P<.001). The diagnostic specificity, accuracy, and AUC for CT-FFR (71.9%, 82.8%, and 0.84) outperformed CCTA (9.4%, 48.3%, and 0.66) in patients or in vessels with severe calcification (all P<.05). CONCLUSIONS CT-FFR with a new "coarse-to-fine subpixel" algorithm showed high performance in identifying hemodynamically significant stenosis. The diagnostic performance of CT-FFR was superior to that of CCTA in intermediate lesions, "gray zone" lesions, and severely calcified lesions. Clinical Trial Register: NCT04731285.
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Affiliation(s)
- Yaping Zeng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tianchang Li
- Department of Cardiology, Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xuejun Jiang
- Department of Cardiology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhanquan Li
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Yanyan Zhao
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changsheng Ma
- Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, United States
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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13
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van der Bie J, Sharma SP, van Straten M, Hirsch A, Kamila PA, Bos D, Dijkshoorn ML, Booij R, Budde RPJ. Image quality assessment of coronary artery segments using ultra-high resolution dual source photon-counting detector computed tomography. Eur J Radiol 2024; 171:111282. [PMID: 38190778 DOI: 10.1016/j.ejrad.2023.111282] [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: 08/04/2023] [Revised: 11/21/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The study is intended to assess the image quality of ultra-high resolution (UHR) coronary computed tomography angiography (CCTA) performed on dual source photon-counting detector CT (PCD-CT). METHOD Consecutive patients, who underwent clinically indicated CCTA on PCD-CT (UHR 120x 0.2 mm collimation), were included. CCTA images were reconstructed at 0.2 mm slice thickness with Bv40, Bv44, Bv48 and Bv56 kernels and quantum iterative reconstruction level 4. Contrast-to-noise (CNR) and signal-to-noise ratios (SNR) were quantified from contrast-enhanced blood and subcutaneous adipose tissue. All reconstructions were scored per coronary segment (18-segment model) for presence, image quality, motion artefacts, stack artefacts, plaque presence and composition, and stenosis degree. Image quality was scored by two independent observers. RESULTS Sixty patients were included (median age 62 [25th - 75th percentile: 53-67] years, 45% male, median calcium score 62 [0-217]). The mean heart rate during scanning was 71 ± 11 bpm. Median CTDIvol was 19 [16-22]mGy and median DLP 243 [198-327]mGy.cm. The SNR was 9.3 ± 2.3 and the CNR was 11.7 ± 2.6. Of the potential 1080 coronary segments (60 patients x 18 segments), 255/256 (reader1/reader2) segments could not be assessed for being absent or non-evaluable due to size. Both readers scored 85% of the segments as excellent or very good (Intraclass Correlation Coefficient: 0.88 (95% CI: 0.87-0.90). Motion artefacts were present in 45(5%) segments, stack artefacts in 60(7%) segments and metal artefacts in 9(1%) segments. CONCLUSION UHR dual-source PCD-CT CCTA provides excellent or very good image quality in 85% of coronary segments at relatively high heart rates at moderate radiation dose with only limited stack artefacts.
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Affiliation(s)
- Judith van der Bie
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Simran P Sharma
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Alexander Hirsch
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Putri Annisa Kamila
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marcel L Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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14
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Herraiz-Adillo Á, Higueras-Fresnillo S, Ahlqvist VH, Berglind D, Syrjälä MB, Daka B, Lenander C, Sundström J, Ortega FB, Östgren CJ, Rådholm K, Henriksson P. Life's Essential 8 and Life's Simple 7 in Relation to Coronary Atherosclerosis: Results From the Population-Based SCAPIS Project. Mayo Clin Proc 2024; 99:69-80. [PMID: 37843486 DOI: 10.1016/j.mayocp.2023.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To examine the associations between the American Heart Association scores ("Life's Essential 8" [LE8] and "Life's Simple 7" [LS7]) and 2 subclinical coronary atherosclerosis indicators: coronary computed tomographic angiography (CCTA)-stenosis and coronary artery calcium (CAC). PATIENTS AND METHODS We included a population-based sample, aged 50 to 64 years, recruited between 2013 and 2018 from the Swedish Cardiopulmonary Bioimage Study (n=24,819, 50.3% women). CCTA-stenosis was graded as no stenosis, stenosis (1%-49%) or severe stenosis (≥50%), whereas CAC was graded as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. Multinomial logistic regression and receiver operating characteristic (ROC) curves were used to study the associations between cardiovascular health scores and subclinical coronary atherosclerosis. RESULTS Odds ratios (ORs) for CCTA-stenosis and severe CCTA-stenosis between the lowest (<50 points) vs the highest (≥80 points) LE8 group were 4.18 (95% CI, 3.56 to 4.91) and 11.17 (95% CI, 8.36 to 14.93), respectively. For corresponding CAC results, ORs were 3.36 (95% CI, 2.84 to 3.98), 7.72 (95% CI, 6.03 to 9.89), and 14.94 (95% CI, 10.47 to 21.31) for CAC scores of 1 to 99, 100 to 399, and ≥400, respectively. Area under ROC curves for predicting any stenosis were 0.642 (95% CI, 0.635 to 0.649) and 0.631 (95% CI, 0.624 to 0.638, P<.001) for LE8 and LS7, respectively. CONCLUSION Our data indicate that LE8 showed a strong, graded, and inverse association with CCTA-stenosis and CAC score. The capacity to predict CCTA-stenosis was comparable between LE8 and LS7, although LE8 had slightly higher prediction capacity of any stenosis. This study provides novel evidence that the LE8 score may be a useful tool for monitoring cardiovascular health.
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Affiliation(s)
- Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, SE-10431, Stockholm, Sweden
| | - Maria B Syrjälä
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Lenander
- Department for Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
| | - Carl-Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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15
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Mensah GA, Fuster V, Murray CJL, Roth GA. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol 2023; 82:2350-2473. [PMID: 38092509 DOI: 10.1016/j.jacc.2023.11.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Christopher J L Murray
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Gregory A Roth
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, Washington, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
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16
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Park J, Lee H, Jeon Y, Park EJ, Park S, Ann SH, Kim Y, Lee Y, Park G, Choi SH. Depression and Subclinical Coronary Atherosclerosis in Adults Without Clinical Coronary Artery Disease. J Am Heart Assoc 2023; 12:e030315. [PMID: 38063186 PMCID: PMC10863772 DOI: 10.1161/jaha.123.030315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The relationship between depression and subclinical coronary atherosclerosis in asymptomatic individuals is not clear. We evaluated this relationship in a Korean population. METHODS AND RESULTS We analyzed 3920 individuals (mean age 54.7±7.9 years and 2603 men [66.4%]) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography and screening for depression using the Beck Depression Inventory as part of a general health examination. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography, and ≥50% diameter stenosis was defined as significant. Participants were categorized into groups of those with or without depression using the Beck Depression Inventory scores ≥16 as a cutoff value. Of the study participants, 272 (6.9%) had a Beck Depression Inventory score of 16 or higher. After adjustment for cardiovascular risk factors, depression was not significantly associated with any coronary plaque (adjusted odds ratio [OR], 1.05 [95% CI, 0.78-1.41]; P=0.746), calcified plaque (OR, 0.95 [95% CI, 0.71-1.29]; P=0.758), noncalcified plaque (OR, 1.31 [95% CI, 0.79-2.17]; P=0.305), mixed plaque (OR, 1.16 [95% CI, 0.60-2.23]; P=0.659), or significant coronary artery stenosis (OR, 1.22 [95% CI, 0.73-2.03]; P=0.450). In the propensity score-matched population (n=1318) as well, none of the coronary artery disease measures of subclinical coronary atherosclerosis were statistically significantly associated with depression (all P>0.05). CONCLUSIONS In this large cross-sectional study with asymptomatic individuals undergoing coronary computed tomographic angiography and Beck Depression Inventory evaluation, depression was not associated with an increased risk of subclinical coronary atherosclerosis.
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Affiliation(s)
- Jangho Park
- Department of PsychiatryUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Hyeji Lee
- Department of Emergency MedicineUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Young‐Jee Jeon
- Department of Family MedicineUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Eun Ji Park
- Big Data CenterUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Sangwoo Park
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Soe Hee Ann
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Yong‐Giun Kim
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Yongjik Lee
- Department of Thoracic and Cardiovascular SurgeryUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Gyung‐Min Park
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
| | - Seong Hoon Choi
- Department of RadiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanRepublic of Korea
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17
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Juarez-Orozco LE, Niemi M, Yeung MW, Benjamins JW, Maaniitty T, Teuho J, Saraste A, Knuuti J, van der Harst P, Klén R. Hybridizing machine learning in survival analysis of cardiac PET/CT imaging. J Nucl Cardiol 2023; 30:2750-2759. [PMID: 37656345 PMCID: PMC10682215 DOI: 10.1007/s12350-023-03359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Machine Learning (ML) allows integration of the numerous variables delivered by cardiac PET/CT, while traditional survival analysis can provide explainable prognostic estimates from a restricted number of input variables. We implemented a hybrid ML-and-survival analysis of multimodal PET/CT data to identify patients who developed myocardial infarction (MI) or death in long-term follow up. METHODS Data from 739 intermediate risk patients who underwent coronary CT and selectively stress 15O-water-PET perfusion were analyzed for the occurrence of MI and all-cause mortality. Images were evaluated segmentally for atherosclerosis and absolute myocardial perfusion through 75 variables that were integrated through ML into an ML-CCTA and an ML-PET score. These scores were then modeled along with clinical variables through Cox regression. This hybridized model was compared against an expert interpretation-based and a calcium score-based model. RESULTS Compared with expert- and calcium score-based models, the hybridized ML-survival model showed the highest performance (CI .81 vs .71 and .64). The strongest predictor for outcomes was the ML-CCTA score. CONCLUSION Prognostic modeling of PET/CT data for the long-term occurrence of adverse events may be improved through ML imaging score integration and subsequent traditional survival analysis with clinical variables. This hybridization of methods offers an alternative to traditional survival modeling of conventional expert image scoring and interpretation.
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Affiliation(s)
- Luis Eduardo Juarez-Orozco
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Mikael Niemi
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Ming Wai Yeung
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Walter Benjamins
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Pim van der Harst
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riku Klén
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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18
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Kitagawa T, Sasaki K, Fujii Y, Ikegami Y, Tatsugami F, Awai K, Hirokawa Y, Nakano Y. 18F-sodium fluoride positron emission tomography following coronary computed tomography angiography in predicting long-term coronary events: a 5-year follow-up study. J Nucl Cardiol 2023; 30:2365-2378. [PMID: 37127726 DOI: 10.1007/s12350-023-03277-5] [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: 01/12/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The predictive value of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) in combination with coronary computed tomography (CT) angiography (CCTA) for future coronary events has attracted interest. We evaluated the potential of 18F-NaF PET/CT following CCTA to predict major coronary events (MACE) during a 5-year follow-up period. METHODS Forty patients with coronary atherosclerotic lesions detected on CCTA underwent 18F-NaF PET/CT examination. Each lesion was evaluated for luminal stenosis and high-risk plaque (HRP) with < 30 Hounsfield units and a > 1.1 remodeling index on CCTA. Focal 18F-NaF uptake in each lesion was quantified using the maximum tissue-to-background ratio (TBRmax), and the maximum TBRmax per patient (M-TBRmax) was determined. We followed MACE (cardiac death, acute coronary syndrome, and/or coronary revascularization > 6 months after 18F-NaF PET/CT) for 5 years. RESULTS In total, 142 coronary lesions were analyzed. Eleven patients experienced any MACE. Patients with MACE showed a higher M-TBRmax than those without (1.40 ± .19 vs. 1.18 ± .18, P = .0011), and the optimal M-TBRmax cutoff to predict MACE was 1.29. Patients with M-TBRmax of ≥ 1.29 had a higher risk of MACE than those with lower values (P = .012, log-rank test), whereas patients with obstructive stenosis and those with HRP did not. Multivariate Cox proportional analysis adjusted for age, sex, coronary risk factors, and CCTA findings showed that M-TBRmax of ≥ 1.29 remained an independent predictor of 5-year MACE (hazard ratio, 5.4; 95% confidence interval, 1.1-25.4; P = .034). CONCLUSION 18F-NaF PET/CT following CCTA provides useful strategies to predict 5-year MACE.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuki Ikegami
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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19
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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20
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Zhang Y, Luo G, Wang W, Cao S, Dong S, Yu D, Wang X, Wang K. TTN: Topological Transformer Network for Automated Coronary Artery Branch Labeling in Cardiac CT Angiography. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:129-139. [PMID: 38074924 PMCID: PMC10706468 DOI: 10.1109/jtehm.2023.3329031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Existing methods for automated coronary artery branch labeling in cardiac CT angiography face two limitations: 1) inability to model overall correlation of branches, since differences between branches cannot be captured directly. 2) a serious class imbalance between main and side branches. METHODS AND PROCEDURES Inspired by the application of Transformer in sequence data, we propose a topological Transformer network (TTN), which solves the vessel branch labeling from a novel perspective of sequence labeling learning. TTN detects differences between branches by establishing their overall correlation. A topological encoding that represents the positions of vessel segments in the artery tree, is proposed to assist the model in classifying branches. Also, a segment-depth loss is introduced to solve the class imbalance between main and side branches. RESULTS On a dataset with 325 CCTA, our method obtains the best overall result on all branches, the best result on side branches, and a competitive result on main branches. CONCLUSION TTN solves two limitations in existing methods perfectly, thus achieving the best result in coronary artery branch labeling task. It is the first Transformer based vessel branch labeling method and is notably different from previous methods. CLINICAL IMPACT This Pre-Clinical Research can be integrated into a computer-aided diagnosis system to generate cardiovascular disease diagnosis report, assisting clinicians in locating the atherosclerotic plaques.
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Affiliation(s)
- Yuyang Zhang
- Faculty of ComputingHarbin Institute of TechnologyHarbin150001China
| | - Gongning Luo
- Faculty of ComputingHarbin Institute of TechnologyHarbin150001China
| | - Wei Wang
- Faculty of ComputingHarbin Institute of TechnologyHarbin150001China
- School of Computer Science and TechnologyHarbin Institute of TechnologyShenzhen518000China
| | - Shaodong Cao
- Department of RadiologyThe Fourth Hospital of Harbin Medical UniversityHarbin150001China
| | - Suyu Dong
- College of Computer and Control EngineeringNortheast Forestry UniversityHarbin150040China
| | - Daren Yu
- Department of CardiologyThe Fourth Hospital of Harbin Medical UniversityHarbin150001China
| | - Xiaoyun Wang
- Department of CardiologyThe Fourth Hospital of Harbin Medical UniversityHarbin150001China
| | - Kuanquan Wang
- Faculty of ComputingHarbin Institute of TechnologyHarbin150001China
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21
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Williams C, Han D, Takagi H, Fordyce CB, Sellers S, Blanke P, Lin FY, Shaw LJ, Lee SE, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Bax JJ, Leipsic JA, Chang HJ. Effects of renin-angiotensin-aldosterone-system inhibitors on coronary atherosclerotic plaques: The PARADIGM registry. Atherosclerosis 2023; 383:117301. [PMID: 37769454 DOI: 10.1016/j.atherosclerosis.2023.117301] [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: 02/24/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIMS Inhibition of Renin-Angiotensin-Aldosterone-System (RAAS) has been hypothesized to improve endothelial function and reduce plaque inflammation, however, their impact on the progression of coronary atherosclerosis is unclear. We aim to study the effects of RAAS inhibitor on plaque progression and composition assessed by serial coronary CT angiography (CCTA). METHODS We performed a prospective, multinational study consisting of a registry of patients without history of CAD, who underwent serial CCTAs. Patients using RAAS inhibitors were propensity matched to RAAS inhibitor naïve patients based on clinical and CCTA characteristics at baseline. Atherosclerotic plaques in CCTAs were quantitatively analyzed for percent atheroma volume (PAV) according to plaque composition. Interactions between RAAS inhibitor use and baseline PAV on plaque progression were assessed in the unmatched cohort using a multivariate linear regression model. RESULTS Of 1248 patients from the registry, 299 RAAS inhibitor taking patients were matched to 299 RAAS inhibitor naïve patients. Over a mean interval of 3.9 years, there was no significant difference in annual progression of total PAV between RAAS inhibitor naïve vs taking patients (0.75 vs 0.79%/year, p = 0.66). With interaction testing in the unmatched cohort, however, RAAS inhibitor use was significantly associated with lower non-calcified plaque progression (Beta coefficient -0.100, adjusted p = 0.038) with higher levels of baseline PAV. CONCLUSIONS The use of RAAS inhibitors over a period of nearly 4 years did not significantly impact on total atherosclerotic plaque progression or various plaque components. However, interaction testing to assess the differential effect of RAAS inhibition based on baseline PAV suggested a significant decrease in progression of non-calcified plaque in patients with a higher burden of baseline atherosclerosis, which should be considered hypothesis generating.
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Affiliation(s)
- Curtis Williams
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenobu Takagi
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eun Ju Chun
- 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, New York, NY, USA
| | - Ji Min Sung
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Georgia Heart Institute, Gainesville, USA
| | - Peter H Stone
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jagat Narula
- 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, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Hyuk-Jae Chang
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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22
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Xue R, Ren Z, Zhao H, Xu J, Li S, Lin S, Li J, Wen D, Zheng M. Prognostic value of coronary CT angiography and CT myocardial perfusion imaging among patients with and without Diabetes. Eur J Radiol 2023; 167:111063. [PMID: 37660486 DOI: 10.1016/j.ejrad.2023.111063] [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: 03/03/2023] [Revised: 06/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Whether stress CT myocardial perfusion imaging (CT-MPI) improves risk assessment in patients with diabetes mellitus (DM) remains unexplored. We aimed to evaluate the prognostic value of coronary CT angiography (CCTA) and stress CT-MPI in suspected coronary artery disease (CAD) patients with and without DM. METHODS A total of 334 patients with suspected CAD who underwent CCTA and stress CT-MPI from May 2020 to July 2021 were retrospectively analyzed. The endpoint was major adverse cardiovascular events (MACEs). Multivariable Cox regression analysis was used to evaluate the risk factors for MACEs, including clinical risk factors, CCTA characteristics and CT-MPI characteristics. RESULTS After a median follow-up of 21 months,15 patients of the DM group and 16 patients of the non-DM group experienced MACEs. Multivariate Cox stepwise regression analysis showed that abnormal perfusion myocardial segments ratio was associated with MACEs after adjusting for clinical risk factors and CCTA characteristics in all patients (HR:1.023, p < 0.001), DM group (HR:1.024, p = 0.008) and non-DM group (HR:1.028, p = 0.003). By adding CT-MPI characteristics to CCTA characteristics and clinical risk factors, the global chi-square for predicting MACEs increased from 62.24 to 78.84 in all patients (p < 0.001), from 19.18 to 27.30 in DM group (p = 0.004) and from 39.51 to 48.65 in non-DM group (p = 0.003); the increment of C-index in all patients, DM group and non-DM group were 0.018, 0.054 and 0.019, respectively. CONCLUSION In all patients and those with and without DM, CT-MPI has incremental prognostic value over clinical risk factors alone or combined with CCTA characteristics in predicting MACEs.
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Affiliation(s)
- Ruijia Xue
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Zilong Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Jingji Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Shuangxin Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | | | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
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23
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Li JL, Zhou JR, Tan P, Chen J. Dynamic assessment of coronary artery during different cardiac cycle in patients with coronary artery disease using coronary CT angiography. Perfusion 2023; 38:1453-1460. [PMID: 35817556 DOI: 10.1177/02676591221114951] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To evaluate the effect of the cardiac cycle for the coronary artery opening and coronary stenosis at the plaque to determine the phase of measuring maximum diameters required for coronary artery disease (CAD). METHODS This retrospective study assessed data for 208 consecutive patients who underwent coronary computed tomography angiography (CTA). The cross-sectional area and diameters of the opening of the left main coronary artery (LM), left anterior descending branch (LAD), left circumflex branch (LCX) and right coronary artery (RCA), the stenosis rate of involved vessels were measured in 10 cardiac cycles. And all their dynamic changes were estimated by the linear mixed model. The relationship between stenosis rate and opening orifice were analyzed by monofactorial variance. RESULTS The opening parameters and stenosis rate of the four main coronary arteries varied within the cardiac cycle (p < .05). The maximum opening area occurred at the 45%-55% phase; The range of stenosis rate varied approximately 11%-14% and the maximum stenosis rate was at the 65% phase. The degree of vascular stenosis for LM, LAD and LCX were not associated with their corresponding opening diameters, but were positively intercorrelation with each other. CONCLUSION For patients with CAD, the maximum coronary artery stenosis rate were at 65% phase and the maximum value of coronary artery opening were at 45%-55% phase, which were chosen for the appropriate measurement and evaluation by CTA.
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Affiliation(s)
- Jia-Li Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jin-Rong Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Pan Tan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jing Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
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24
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Östgren CJ, Otten J, Festin K, Angerås O, Bergström G, Cederlund K, Engström G, Eriksson MJ, Eriksson M, Fall T, Gummesson A, Hagström E, Hellman U, James SK, Jernberg T, Kihlberg J, Kylhammar D, Markstad H, Nilsson P, Persson A, Persson M, Pirazzi C, Renklint R, Rosengren A, Söderberg S, Sundström J. Prevalence of atherosclerosis in individuals with prediabetes and diabetes compared to normoglycaemic individuals-a Swedish population-based study. Cardiovasc Diabetol 2023; 22:261. [PMID: 37759237 PMCID: PMC10537533 DOI: 10.1186/s12933-023-01982-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes have an increased risk of death and cardiovascular events and people with diabetes or prediabetes have been found to have increased atherosclerotic burden in the coronary and carotid arteries. This study will estimate the cross-sectional prevalence of atherosclerosis in the coronary and carotid arteries in individuals with prediabetes and diabetes, compared with normoglycaemic individuals in a large population-based cohort. METHODS The 30,154 study participants, 50-64 years, were categorized according to their fasting glycaemic status or self-reported data as normoglycaemic, prediabetes, and previously undetected or known diabetes. Prevalence of affected coronary artery segments, severity of stenosis and coronary artery calcium score (CACS) were determined by coronary computed tomography angiography. Total atherosclerotic burden was assessed in the 11 clinically most relevant segments using the Segment Involvement Score and as the presence of any coronary atherosclerosis. The presence of atherosclerotic plaque in the carotid arteries was determined by ultrasound examination. RESULTS Study participants with prediabetes (n = 4804, 16.0%) or diabetes (n = 2282, 7.6%) had greater coronary artery plaque burden, more coronary stenosis and higher CACS than normoglycaemic participants (all, p < 0.01). Among male participants with diabetes 35.3% had CACS ≥ 100 compared to 16.1% among normoglycaemic participants. For women, the corresponding figures were 8.9% vs 6.1%. The prevalence of atherosclerosis in the coronary arteries was higher in participants with previously undetected diabetes than prediabetes, but lower than in patients with known diabetes. The prevalence of any plaque in the carotid arteries was higher in participants with prediabetes or diabetes than in normoglycaemic participants. CONCLUSIONS In this large population-based cohort of currently asymptomatic people, the atherosclerotic burden in the coronary and carotid arteries increased with increasing degree of dysglycaemia. The finding that the atherosclerotic burden in the coronary arteries in the undetected diabetes category was midway between the prediabetes category and patients with known diabetes may have implications for screening strategies and tailored prevention interventions for people with dysglycaemia in the future.
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Affiliation(s)
- Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Karin Festin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Eriksson
- Medicine Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
- Unit of Endocrinology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Anders Gummesson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Urban Hellman
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Johan Kihlberg
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - David Kylhammar
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Hanna Markstad
- Center for Medical Imaging and Physiology, Skåne University Hospital and Lund University, Lund, Sweden
- Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anders Persson
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rebecka Renklint
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Park HW, Jo S, Park KS, Lee H, Jeon YJ, Park S, Ann SH, Kim YG, Choi SH, Kwon WJ, Cho YR, Suh J, Park GM. Differential Impact of Degree of Hypertension on Subclinical Coronary Atherosclerosis in Asymptomatic Subjects With and Without Diabetes Mellitus. Am J Cardiol 2023; 203:343-351. [PMID: 37517130 DOI: 10.1016/j.amjcard.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/02/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
This study sought to evaluate the association between the degree of hypertension and subclinical coronary atherosclerosis in asymptomatic subjects with and without diabetes mellitus (DM). We retrospectively analyzed 7,352 asymptomatic subjects (mean age 52.8 ± 7.8 years; 4,689 [63.8%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomography angiography as part of a general health examination. The classification of hypertension was adapted from the American College of Cardiology and American Heart Association 2017 guideline. Subclinical coronary atherosclerosis was defined as the presence of coronary plaque by coronary computed tomography angiography. In subjects without DM (n = 6,598), after the adjustment for cardiovascular risk factors, subclinical coronary atherosclerosis was significantly associated with both stage 1 hypertension (adjusted odds ratio [aOR] 1.356; 95% confidence interval [CI], 1.167 to 1.575; p <0.001) and stage 2 hypertension (aOR, 1.614; 95% CI, 1.329 to 1.961; p <0.001) groups compared with the normal group. In contrast, in subjects with DM (n = 754), there was no statistical difference in the aOR of the stage 1 hypertension group for the presence of coronary plaque (aOR, 1.449; 95% CI, 0.982 to 2.136; p = 0.061). However, the stage 2 hypertension group had a significant association with subclinical coronary atherosclerosis (aOR, 2.067; 95% CI, 1.287 to 3.322; p = 0.003). In subjects without DM, both stages 1 and 2 hypertension were associated with subclinical coronary atherosclerosis. However, in subjects with DM, stage 2 hypertension was only associated with an increased risk of subclinical coronary atherosclerosis.
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Affiliation(s)
- Hyun Woo Park
- Department of Cardiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Sangyong Jo
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Kyung Sun Park
- Department of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyeji Lee
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seong Hoon Choi
- Department of Diagnostic Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woon Jung Kwon
- Department of Diagnostic Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Jon Suh
- Department of Cardiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; Basic-Clinic Translational Research Center, University of Ulsan, Ulsan, Republic of Korea.
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26
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Qin C, Li C, Luo Y, Li Z, Cao H. Construction and validation of a clinical prediction model for asymptomatic obstructive coronary stenosis in patients with carotid stenosis. Front Cardiovasc Med 2023; 10:1096020. [PMID: 37745123 PMCID: PMC10512547 DOI: 10.3389/fcvm.2023.1096020] [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: 11/11/2022] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Background Coronary artery stenosis occurs frequently in patients with carotid artery stenosis. We developed a clinical predictive model to investigate the clinical risk of asymptomatic obstructive coronary artery stenosis in patients with carotid artery stenosis ≥ 50%. Methods From January 2018 to January 2022, carotid stenosis patients hospitalized at the First Affiliated Hospital of Zhengzhou University's Department of Endovascular Surgery were subjected to a retrospective analysis of their clinical information and imaging results. Excluded criteria were patients with lacking data, symptomatic coronary stenosis, prior coronary artery bypass grafting, and coronary stent implantation. Patients were separated into case and control groups according to whether or not they had obstructive coronary stenosis. Independent predictors were screened using univariate and multivariate logistic regression, and their accuracy was confirmed using least absolute shrinkage and selection operator (LASSO) regression. A Nomogram prediction model was developed using the aforementioned filtered factors. The model's discrimination and specificity were evaluated using the receiver operating characteristic curve (ROC) and Hosmer-Lemeshow goodness-of-fit test. Internal validation employed the Bootstrap procedure. The clinical decision curve analysis (DCA) of the prediction model was developed to assess the clinical applicability of the model. Results The investigation included a total of 227 patients, of whom 132 (58.1%) had coronary artery stenosis. Hypertension, Grade I plaque, HbA1c ≥ 7.0%, MPV ≥ 9.2fl, and Fib ≥ 3.0 g/L were independent predictors, with OR values of (2.506, 0.219, 0.457, 1.876, 2.005), according to multivariate logistic regression. Risk factor screening and validation using lasso regression. The predictors chosen based on the optimal λ value are consistent with the predictors identified by multiple regression. The area under the ROC curve (AUC) of the model based on the above predictors was 0.701 (0.633-0.770), indicating that the model discriminated well. The calibration curve of the model closely matched the actual curve, and P > 0.05 in the Hosmer-Lemeshow goodness-of-fit test indicated the model's accuracy. The results of the DCA curve demonstrate the clinical applicability of the prediction model. Conclusion Hypertension, grade I plaque, HbA1c ≥ 7.0%, MPV ≥ 9.2 fl, and Fib ≥ 3.0 g/L are predictors of asymptomatic coronary stenosis in patients with carotid stenosis ≥50%. The diagnostic model is clinically applicable and useful for identifying patients at high risk.
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Affiliation(s)
| | | | | | | | - Hui Cao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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27
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Hyun J, Lee PH, Lee J, Yang Y, Kim JH, Kim TO, Kang SJ, Kim JK, Lee JS, Lee SW. Ten-year prognostic value of coronary CT angiography in asymptomatic patients with type 2 diabetes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:700-707. [PMID: 36716990 DOI: 10.1016/j.rec.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/04/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES The United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes. METHODS We evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA. RESULTS The incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome. CONCLUSIONS In asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.
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Affiliation(s)
- Junho Hyun
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. https://twitter.com/@jhhyun0609
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Junghoon Lee
- Department of Internal Medicine, Division of Cardiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yujin Yang
- Department of Cardiology, Daejeon Veterans Hospital, Daejeon, Korea
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Korea
| | - Tae Oh Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Ki Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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28
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Lima TP, Assuncao AN, Bittencourt MS, Liberato G, Arbab-Zadeh A, Lima JAC, Rochitte CE. Coronary computed tomography plaque-based scores predict long-term cardiovascular events. Eur Radiol 2023; 33:5436-5445. [PMID: 36806566 DOI: 10.1007/s00330-023-09408-3] [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: 02/11/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD. METHODS The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3-9.1) years, and 73 patients met the composite endpoints of MACE. RESULTS Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001). CONCLUSIONS Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD. KEY POINTS • Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
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Affiliation(s)
- Thais Pinheiro Lima
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Antonildes N Assuncao
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Gabriela Liberato
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Carlos Eduardo Rochitte
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil.
- Cardiovascular Magnetic Resonance and Computed Tomography Department, Heart Institute, InCor, University of Sao Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
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Cederström S, Lundman P, Alfredsson J, Hagström E, Ravn-Fischer A, Söderberg S, Yndigegn T, Tornvall P, Jernberg T. Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Sci Rep 2023; 13:12171. [PMID: 37500663 PMCID: PMC10374905 DOI: 10.1038/s41598-023-39051-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Despite abundant knowledge about the relationship between inflammation and coronary atherosclerosis, it is still unknown whether systemic inflammation measured as high-sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in a general population. This study aimed to examine the association between hsCRP and coronary computed tomography angiography (CCTA)-detected coronary atherosclerosis in a population-based cohort. Out of 30,154 randomly invited men and women aged 50 to 64 years in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), 25,408 had a technically acceptable CCTA and analysed hsCRP. Coronary atherosclerosis was defined as presence of plaque of any degree in any of 18 coronary segments. HsCRP values were categorised in four groups. Compared with hsCRP below the detection limit, elevated hsCRP (≥ 2.3 mg/L) was weakly associated with any coronary atherosclerosis (OR 1.15, 95% CI 1.07-1.24), coronary diameter stenosis ≥ 50% (OR 1.27, 95% CI 1.09-1.47), ≥ 4 segments involved (OR 1.13, 95% CI 1.01-1.26 ) and severe atherosclerosis (OR 1.33, 95% CI 1.05-1.69) after adjustment for age, sex and traditional risk factors. The associations were attenuated after further adjustment for body mass index (BMI), although elevated hsCRP still associated with noncalcified plaques (OR 1.16, 95% CI 1.02-1.32), proposed to be more vulnerable. In conclusion, the additional value of hsCRP to traditional risk factors in detection of coronary atherosclerosis is low. The association to high-risk noncalcified plaques, although unlikely through a causal pathway, could explain the relationship between hsCRP and clinical coronary events in numerous studies.
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Affiliation(s)
- Sofia Cederström
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Lundman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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30
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Dong Z, Si G, Zhu X, Li C, Hua R, Teng J, Zhang W, Xu L, Qian W, Liu B, Wang J, Wang T, Tang Y, Zhao Y, Gong X, Tao Z, Xu Z, Li Y, Chen B, Kong X, Xu Y, Gu N, Li C. Diagnostic Performance and Safety of a Novel Ferumoxytol-Enhanced Coronary Magnetic Resonance Angiography. Circ Cardiovasc Imaging 2023; 16:580-590. [PMID: 37463240 DOI: 10.1161/circimaging.123.015404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Currently, noninvasive arteriography for the diagnosis of coronary artery disease is clinically limited to the computed tomography scanning, where patients have to be exposed to the radiation and risks associated with iodinated contrast. We aimed to investigate the diagnostic performance and safety of a novel ferumoxytol-enhanced coronary magnetic resonance angiography (CMRA) in patients with suspected coronary artery disease. METHODS Thirty patients, 19 males, with a median age of 63 years old, and 17 with renal insufficiency, who were scheduled for invasive coronary angiography, were enrolled. Ferumoxytol was administered intravenously with a dose of 3 mg/kg during CMRA. Images were acquired with an ECG-triggered, navigator-gated, inversion recovery-prepared 3D fast low-angle shot sequence, and the image quality was assessed by a 4-point scale. Eighteen-segment coronary artery model was adopted to evaluate the visibility of the coronary arteries, and the image quality and stenosis were evaluated in nine segments. The diagnostic performance of CMRA is described as sensitivity, specificity, positive and negative predictive values, and accuracy with the invasive coronary angiography results as reference. The patients' vital signs were monitored during CMRA, and their hepatic and renal functions were followed up for 3 months to evaluate the safety of ferumoxytol. RESULTS Two hundred fifty-two of the 270 study segments were identified by CMRA, and their quality score reached 3.6±0.7. Referring to the invasive coronary angiography results, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ferumoxytol-enhanced CMRA reached 100.0%, 66.7%, 92.3%, 100.0%, and 93.3% respectively in patient-based analysis; 91.4%, 90.9%, 86.5%, 94.3%, and 91.1%, respectively in vessel-based analysis; and 92.3%, 96.7%, 83.7%, 98.6%, and 96.0%, respectively in segment-based analysis. No ferumoxytol-related adverse event was observed during the 3-month follow-up. CONCLUSIONS Ferumoxytol-enhanced CMRA demonstrated good diagnostic performance and excellent safety in the diagnosis of significant coronary stenosis, providing an alternative to coronary computed tomography angiography for the diagnosis of coronary artery disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT05032937.
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Affiliation(s)
- Zhou Dong
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Guangxiang Si
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing, China (G.S., N.G.)
| | - Xiaomei Zhu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Chen Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Rui Hua
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Jianzhen Teng
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Wenhao Zhang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Lulu Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Wen Qian
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Bo Liu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Jun Wang
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Tong Wang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Yingdan Tang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, China (Y.T., Y.Z.)
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, China (Y.T., Y.Z.)
| | - Xiaoxuan Gong
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Zhiwen Tao
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Zhihui Xu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Yong Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Bo Chen
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Xiangqing Kong
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
| | - Yi Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (X.Z., L.X., W.Q., B.L., J.W., Y.X.)
| | - Ning Gu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
- Medical School, Nanjing University, Nanjing, Jiangsu, China (N.G.)
| | - Chunjian Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (Z.D., C.L., R.H., J.T., W.Z., T.W., X.G., Z.T., Z.X., Y.L., B.C., X.K., C.L.)
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Winther S, Dupont Rasmussen L, Westra J, Abdulzahra SRK, Dahl JN, Gormsen LC, Christiansen EH, Brix GS, Mortensen J, Ejlersen JA, Søndergaard HM, Hansson NCL, Holm NR, Knudsen LL, Eftekhari A, Møller PL, Rohde PD, Nyegaard M, Böttcher M. Danish study of Non-Invasive Testing in Coronary Artery Disease 3 (Dan-NICAD 3): study design of a controlled study on optimal diagnostic strategy. Open Heart 2023; 10:e002328. [PMID: 37487656 PMCID: PMC10373750 DOI: 10.1136/openhrt-2023-002328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Current guideline recommend functional imaging for myocardial ischaemia if coronary CT angiography (CTA) has shown coronary artery disease (CAD) of uncertain functional significance. However, diagnostic accuracy of selective myocardial perfusion imaging after coronary CTA is currently unclear. The Danish study of Non-Invasive testing in Coronary Artery Disease 3 trial is designed to evaluate head to head the diagnostic accuracy of myocardial perfusion imaging with positron emission tomography (PET) using the tracers 82Rubidium (82Rb-PET) compared with oxygen-15 labelled water PET (15O-water-PET) in patients with symptoms of obstructive CAD and a coronary CT scan with suspected obstructive CAD. METHODS AND ANALYSIS This prospective, multicentre, cross-sectional study will include approximately 1000 symptomatic patients without previous CAD. Patients are included after referral to coronary CTA. All patients undergo a structured interview and blood is sampled for genetic and proteomic analysis and a coronary CTA. Patients with possible obstructive CAD at coronary CTA are examined with both 82Rb-PET, 15O-water-PET and invasive coronary angiography with three-vessel fractional flow reserve and thermodilution measurements of coronary flow reserve. After enrolment, patients are followed with Seattle Angina Questionnaires and follow-up PET scans in patients with an initially abnormal PET scan and for cardiovascular events in 10 years. ETHICS AND DISSEMINATION Ethical approval was obtained from Danish regional committee on health research ethics. Written informed consent will be provided by all study participants. Results of this study will be disseminated via articles in international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04707859.
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Affiliation(s)
- Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | | | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | - Jesper Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - June Anita Ejlersen
- Department of Nuclear Medicine, Regional Hospital Central Jutland, Viborg, Denmark
| | | | | | | | | | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter L Møller
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Palle Duun Rohde
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Nyegaard
- Health Science and Technology, Aalborg Universitet, Gistrup, Denmark
| | - Morten Böttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
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Kitagawa T, Sasaki K, Fujii Y, Tatsugami F, Awai K, Hirokawa Y, Nakano Y. A longitudinal pilot study to assess temporal changes in coronary arterial 18F-sodium fluoride uptake. J Nucl Cardiol 2023; 30:1158-1165. [PMID: 35488027 DOI: 10.1007/s12350-022-02975-w] [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: 01/18/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE How coronary arterial 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography changes over the long term and what clinical factors impact the changes remain unclear. We sought to investigate the topics in this study. METHODS We retrospectively studied 15 patients with ≥1 coronary atherosclerotic lesion/s detected on cardiac computed tomography who underwent baseline and follow-up (interval of >3 years) 18F-NaF positron emission tomography/computed tomography scans. Focal 18F-NaF uptake in each lesion was quantified using maximum tissue-to-background ratio (TBRmax). The temporal change in TBRmax was assessed using a ratio of follow-up to baseline TBRmax (R-TBRmax). RESULTS A total of 51 lesions were analyzed. Mean R-TBRmax was 0.96 ± 0.21. CT-based lesion features (location, obstructive stenosis, plaque types, features of high-risk plaque) did not correlate with an increase in R-TBRmax. In multivariate analysis, baseline TBRmax significantly correlated with higher follow-up TBRmax (β = 0.57, P < 0.0001), and the presence of diabetes mellitus significantly correlated with both higher follow-up TBRmax (β = 0.34, P = 0.001) and elevated R-TBRmax (β = 0.40, P = 0.003). CONCLUSION Higher coronary arterial 18F-NaF uptake is likely to remain continuously high. Diabetes mellitus affects the long-term increase in coronary arterial 18F-NaF uptake.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Park S, Jeon YJ, Ann SH, Kim YG, Lee Y, Choi SH, Han S, Park GM. Comprehensive Prediction of Subclinical Coronary Atherosclerosis in Subjects Without Traditional Cardiovascular Risk Factors. Am J Cardiol 2023; 198:64-71. [PMID: 37201233 DOI: 10.1016/j.amjcard.2023.04.011] [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: 01/29/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
It is not uncommon for asymptomatic individuals without identified cardiovascular risk factors to present with atherosclerosis-related adverse events. We aimed to evaluate the predictors of subclinical coronary atherosclerosis in individuals without traditional cardiovascular risk factors. We analyzed 2,061 individuals without identified cardiovascular risk factors who voluntarily underwent coronary computed tomography angiography as part of a general health examination. Subclinical atherosclerosis was defined as the presence of any coronary plaque. Of 2,061 individuals, subclinical atherosclerosis was observed in 337 individuals (16.4%). Clinical variables, such as age, gender, body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were significantly associated with subclinical coronary atherosclerosis. The participants were randomly split into train and validation data sets. In the train set, a prediction model using 6 variables with optimal cutoffs (age >53 years for men and >55 years for women, gender, BMI >22 kg/m2, SBP >120 mm Hg, HDL-C <55 mg/100 ml, and LDL-C >130 mg/100 ml) was derived (area under the curve 0.780, 95% confidence interval 0.751 to 0.809, goodness-of-fit p = 0.693). In the validation set, this model performed well (area under the curve 0.792, 95% confidence interval 0.726 to 0.858, goodness-of-fit p = 0.073). In conclusion, together with nonmodifiable risk factors, such as age and gender, modifiable variables, such as BMI, SBP, LDL-C, and HDL-C, were shown to be associated with subclinical coronary atherosclerosis, even at currently acceptable levels. These results suggest that stricter control of BMI, blood pressure, and cholesterol might be helpful in the primary prevention of future coronary events.
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Affiliation(s)
| | | | | | | | | | - Seong Hoon Choi
- Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.
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Liu M, Li R, Bai C, Chen Q, Yin Y, Chen Y, Zhou X, Zhao X. Predictive value of DEEPVESSEL-fractional flow reserve and quantitative plaque analysis based on coronary CT angiography for major adverse cardiac events. Clin Radiol 2023:S0009-9260(23)00179-4. [PMID: 37258332 DOI: 10.1016/j.crad.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
AIM To investigate the predictive value of the combination of DEEPVESSEL-fractional flow reserve (DVFFR) and quantitative plaque analysis using coronary computed tomographic angiography (CCTA) for major adverse cardiac events (MACE). METHOD In this retrospective study, data from 69 vessels from 58 consecutive patients were collected. These patients who underwent coronary angiography (CAG) with DVFFR were divided into MACE-positive and MACE-negative groups. DVFFR measurements were obtained from CCTA images acquired before CAG, and an FFR or DVFFR value ≤ 0.80 was considered haemodynamically significant. CCTA images were analysed quantitatively using automated software to obtain the following indices: total plaque volume (TPV) and burden (TPB), calcified plaque volume (CPV) and burden (CPB), non-calcified plaque volume (NCPV) and burden (NCPB), low-attenuation plaque (LAP), minimum lumen area (MLA), stenosis grade (SG) and lesion length (LL). Univariate and multivariate logistic regression, correlation, and receiver operating characteristic (ROC) analyses were used for statistical analysis. RESULTS DVFFR was highly correlated with invasive FFR (R=0.728), and the Bland-Altman plot showed good agreement between DVFFR and FFR (95% CI: -0.109-0.087) on a per-vessel level. DVFFR showed a high diagnostic performance in identifying abnormal haemodynamic vessels, with an area under the ROC curve (AUC) of 0.984. In multivariate analysis, the following biomarkers were predictors of MACE: DVFFR ≤ 0.8, SG, TPB, NCPB, and LL values. The combination of the above independent risk factors yielded the most valuable prediction for MACE (AUC:0.888). CONCLUSIONS DVFFR was highly correlated with FFR with satisfactory diagnostic accuracy. DVFFR, together with plaque analysis indices, yielded valuable predictions for MACE.
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Affiliation(s)
- M Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - R Li
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C Bai
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Q Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Y Yin
- Keya Medical, Shenzhen, China
| | - Y Chen
- Keya Medical, Shenzhen, China
| | - X Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Meah MN, Wereski R, Bularga A, van Beek EJR, Dweck MR, Mills NL, Newby DE, Dey D, Williams MC, Lee KK. Coronary low-attenuation plaque and high-sensitivity cardiac troponin. Heart 2023; 109:702-709. [PMID: 36631142 PMCID: PMC10357930 DOI: 10.1136/heartjnl-2022-321867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE In patients with acute chest pain who have had myocardial infarction excluded, plasma cardiac troponin I concentrations ≥5 ng/L are associated with risk of future adverse cardiovascular events. We aim to evaluate the association between cardiac troponin and coronary plaque composition in such patients. METHODS In a prespecified secondary analysis of a prospective cohort study, blinded quantitative plaque analysis was performed on 242 CT coronary angiograms of patients with acute chest pain in whom myocardial infarction was excluded. Patients were stratified by peak plasma cardiac troponin I concentration ≥5 ng/L or <5 ng/L. Associations were assessed using univariable and multivariable logistic regression analyses. RESULTS The cohort was predominantly middle-aged (62±12 years) men (69%). Patients with plasma cardiac troponin I concentration ≥5 ng/L (n=161) had a higher total (median 33% (IQR 0-47) vs 0% (IQR 0-33)), non-calcified (27% (IQR 0-37) vs 0% (IQR 0-28)), calcified (2% (IQR 0-8) vs 0% (IQR 0-3)) and low-attenuation (1% (IQR 0-3) vs 0% (IQR 0-1)) coronary plaque burden compared with those with concentrations <5 ng/L (n=81; p≤0.001 for all). Low-attenuation plaque burden was independently associated with plasma cardiac troponin I concentration ≥5 ng/L after adjustment for clinical characteristics (adjusted OR per doubling 1.62 (95% CI 1.17 to 2.32), p=0.005) or presence of any visible coronary artery disease (adjusted OR per doubling 1.57 (95% CI 1.07 to 2.37), p=0.026). CONCLUSION In patients with acute chest pain but without myocardial infarction, plasma cardiac troponin I concentrations ≥5 ng/L are associated with greater burden of low-attenuation coronary plaque.
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Affiliation(s)
- Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Ryan Wereski
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
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Effectiveness of clinical scores in predicting coronary artery disease in familial hypercholesterolemia: a coronary computed tomography angiography study. LA RADIOLOGIA MEDICA 2023; 128:445-455. [PMID: 36877423 PMCID: PMC10119045 DOI: 10.1007/s11547-023-01610-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE One of the major challenges in the management of familial hypercholesterolemia (FH) is the stratification of cardiovascular risk in asymptomatic subjects. Our purpose is to investigate the performance of clinical scoring systems, Montreal-FH-score (MFHS), SAFEHEART risk (SAFEHEART-RE) and FH risk score (FHRS) equations and Dutch Lipid Clinic Network (DLCN) diagnostic score, in predicting extent and severity of CAD at coronary computed tomography angiography (CCTA) in asymptomatic FH. MATERIAL AND METHODS One-hundred and thirty-nine asymptomatic FH subjects were prospectively enrolled to perform CCTA. MFHS, FHRS, SAFEHEART-RE and DLCN were assessed for each patient. Atherosclerotic burden scores at CCTA (Agatston score [AS], segment stenosis score [SSS]) and CAD-RADS score were calculated and compared to clinical indices. RESULTS Non-obstructive CAD was found in 109 patients, while 30 patients had a CAD-RADS ≥ 3. Classifying the two groups according to AS, values varied significantly for MFHS (p < 0.001), FHRS (p < 0.001) and SAFEHEART-RE (p = 0.047), while according to SSS only MFHS and FHRS showed significant differences (p < 0.001). MFHS, FHRS and SAFEHEART-RE, but not DLCN, showed significant differences between the two CAD-RADS groups (p < .001). MFHS proved to have the best discriminatory power (AUC = 0.819; 0.703-0.937, p < 0.001) at ROC analysis, followed by FHRS (AUC = 0.795; 0.715-0.875, p < .0001) and SAFEHEART-RE (AUC = .725; .61-.843, p < .001). CONCLUSIONS Greater values of MFHS, FHRS and SAFEHEART-RE are associated to higher risk of obstructive CAD and might help to select asymptomatic patients that should be referred to CCTA for secondary prevention.
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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Hennessey B, Pareek N, Macaya F, Yeoh J, Shlofmitz E, Gonzalo N, Hill J, Escaned J. Contemporary percutaneous management of coronary calcification: current status and future directions. Open Heart 2023; 10:openhrt-2022-002182. [PMID: 36796870 PMCID: PMC9936324 DOI: 10.1136/openhrt-2022-002182] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Severe coronary artery calcification is one of the greatest challenges in attaining success in percutaneous coronary intervention, limiting acute and long-term results. In many cases, plaque preparation is a critical prerequisite for delivery of devices across calcific stenoses and also to achieve adequate luminal dimensions. Recent advances in intracoronary imaging and adjunctive technologies now allow the operator to select the most appropriate strategy in each individual case. In this review, we will revisit the distinct advantages of a complete assessment of coronary artery calcification with imaging and application of appropriate and contemporary plaque modification technologies in achieving durable results in this complex lesion subset.
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK .,School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Fernando Macaya
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain.,King's College Hospital NHS Foundation Trust, London, UK
| | - Julian Yeoh
- King's College Hospital NHS Foundation Trust, London, UK.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nieves Gonzalo
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Jonathan Hill
- King's College Hospital NHS Foundation Trust, London, UK.,Royal Brompton Hospital, London, UK
| | - Javier Escaned
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
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39
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Lee J, Shaikh K, Nakanishi R, Gransar H, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Rubinshtein R, Villines TC, Lu Y, Peña JM, Lin FY, Min JK, Shaw LJ, Budoff MJ. Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry. Heart Lung Circ 2023; 32:175-183. [PMID: 36336615 DOI: 10.1016/j.hlc.2022.09.014] [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: 05/14/2022] [Revised: 08/21/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known. METHODS We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry. Cumulative long-term incidence of all-cause mortality (ACM) was assessed between DM and non-DM patients by normal or non-obstructive LM disease (1-49% stenosis). RESULTS The mean age of the study population was 57.6±12.6 years. Of the 27,252 patients, 4,434 (16%) patients had DM. A total of 899 (3%) deaths occurred during the follow-up of 3.6±1.9. years. Compared to patients with normal LM, those with non-obstructive LM had more pronounced overall coronary atherosclerosis and more cardiovascular risk factors. After clinical risk factors, segment involvement score, and stenosis severity adjustment, compared to patients without DM and normal LM, patients with DM were associated with increased ACM regardless of normal (HR 1.48, 95% CI 1.22-1.78, p<0.001) or non-obstructive LM (HR 1.46, 95% CI 1.04-2.04, p=0.029), while nonobstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85, 95% CI 0.67-1.07, p=0.165) and there was no significant interaction between DM and LM status (HR 1.03, 95% CI 0.69-1.54, p=0.879). CONCLUSION From the CONFIRM registry, we demonstrated that DM was associated with increased ACM. However, the presence of non-obstructive LM was not an independent risk marker of ACM, and there was no significant interaction between DM and non-obstructive LM disease for ACM.
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Affiliation(s)
- Juhwan Lee
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Medicine, CHA University GUMI CHA Hospital, Gyeongsangbuk-do, South Korea
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Rine Nakanishi
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Erlangen, Germany
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Zurich, Switzerland
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | | | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
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40
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Herczeg S, Simon J, Szegedi N, Karády J, Kolossváry M, Szilveszter B, Balogi B, Nagy VK, Merkely B, Széplaki G, Maurovich-Horvat P, Gellér L. High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation. Coron Artery Dis 2023; 34:18-23. [PMID: 36484216 PMCID: PMC9742003 DOI: 10.1097/mca.0000000000001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is often performed before catheter ablation of atrial fibrillation to map atrial and pulmonary anatomy. Incident coronary artery disease (CAD) may also be diagnosed during cardiac CT angiography (CTA). Our aim was to assess whether coronary CTA might be able to identify a significant proportion of patients with obstructive CAD prior to their catheter ablation procedure event, even in asymptomatic patients. METHODS Consecutive patients undergoing pre-ablation coronary CTA for atrial fibrillation between 2013 and 2020 were retrospectively selected. Patients with previously diagnosed CAD were excluded. Obstructive CAD was defined as ≥50% luminal stenosis. We analyzed the relationship between obstructive CAD, any chest pain, and traditional risk factors. RESULTS Overall, 2321 patients [median age 63.0 (54.4-69.2), 1052/2321 (45.3%) female] underwent coronary CTA and 488/2321 (21.0%) were diagnosed with obstructive CAD. There was no difference regarding the rate of obstructive CAD in patients with any chest pain compared to patients without any chest pain [91/404 (22.5%) vs. 397/1917 (20.7%), P = 0.416, respectively). The following parameters were associated with obstructive CAD: age > 65 years [odds ratio (OR) = 2.51; 95% confidence interval (CI), 2.02-3.13; P < 0.001), male sex (OR = 1.59; 95% CI, 1.28-1.98; P < 0.001), hypertension (OR = 1.40; 95% CI, 1.08-1.81; P = 0.012), diabetes (OR = 1.50; 95% CI, 1.13-1.99; P = 0.006), dyslipidaemia (OR = 1.33; 95% CI, 1.07-1.66; P = 0.011) and history of smoking (OR = 1.34; 95% CI, 1.07-1.68; P = 0.011). CONCLUSIONS The high prevalence of obstructive CAD even in patients without chest pain highlights the importance of additional coronary artery diagnostics in patients undergoing left atrial CTA awaiting catheter ablation for atrial fibrillation. These patients regardless of chest pain thus may require further risk modification to decrease their potential ischemic and thromboembolic risk.
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Affiliation(s)
- Szilvia Herczeg
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Bernadett Balogi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Vivien K Nagy
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
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41
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Pedersen ER, Hovland S, Karaji I, Berge C, Mohamed Ali A, Lekven OC, Kuiper KJ, Rotevatn S, Larsen TH. Coronary calcium score in the initial evaluation of suspected coronary artery disease. Heart 2022; 109:695-701. [PMID: 36549683 DOI: 10.1136/heartjnl-2022-321682] [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: 07/24/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We evaluated coronary artery calcium (CAC) scoring as an initial diagnostic tool in outpatients and in patients presenting at the emergency department due to suspected coronary artery disease (CAD). METHODS 10 857 patients underwent CAC scoring and coronary CT angiography (CCTA) at Haukeland University Hospital in Norway during 2013-2020. Based on CCTA, obstructive CAD was defined as at least one coronary stenosis ≥50%. High-risk CAD included obstructive stenoses of the left main stem, the proximal left ascending artery or affecting all three major vascular territories with at least one proximal segment involved. RESULTS Median age was 58 years and 49.5% were women. The overall prevalence of CAC=0 was 45.0%. Among those with CAC=0, 1.8% had obstructive CAD and 0.6% had high-risk CAD on CCTA. Overall, the sensitivity, specificity, positive predictive value and negative predictive value (NPV) of CAC=0 for obstructive CAD were 95.3%, 53.4%, 30.0% and 98.2%, respectively. However, among patients <45 years of age, although the NPV was high at 98.9%, the sensitivity of CAC=0 for obstructive CAD was only 82.3%. CONCLUSIONS In symptomatic patients, CAC=0 correctly ruled out obstructive CAD and high-risk CAD in 98.2% and 99.4% of cases. This large registry-based cross-sectional study supports the incorporation of CAC testing in the early triage of patients with chest pain and as a gatekeeper to further cardiac testing. However, a full CCTA may be needed for safely ruling out obstructive CAD in the youngest patients (<45 years of age).
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Affiliation(s)
- Eva Ringdal Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway .,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Siren Hovland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Iman Karaji
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Christ Berge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Kier Jan Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Terje Hjalmar Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
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42
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Garzelli L, Nuzzo A, Hamon A, Ben Abdallah I, Gregory J, Raynaud L, Paulatto L, Dioguardi Burgio M, Castier Y, Panis Y, Vilgrain V, Corcos O, Ronot M. Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome. Insights Imaging 2022; 13:194. [PMID: 36512135 PMCID: PMC9748024 DOI: 10.1186/s13244-022-01339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. METHODS Patients with AAMI who underwent endovascular revascularization (2016-2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. RESULTS Fifty patients (23 men, median 72-yrs [IQR 60-77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22-48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). CONCLUSION RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.
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Affiliation(s)
- Lorenzo Garzelli
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Alexandre Nuzzo
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Annick Hamon
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Iannis Ben Abdallah
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Jules Gregory
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Lucas Raynaud
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Luisa Paulatto
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Marco Dioguardi Burgio
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Yves Castier
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Yves Panis
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Digestive, Hôpital Bichat, APHP.Nord, Paris, France
| | - Valérie Vilgrain
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Olivier Corcos
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Maxime Ronot
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
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Meah MN, Tzolos E, Wang KL, Bularga A, Dweck MR, Curzen N, Kardos A, Keating L, Storey RF, Mills NL, Slomka PJ, Dey D, Newby DE, Gray A, Williams MC, Roobottom C. Plaque Burden and 1-Year Outcomes in Acute Chest Pain: Results From the Multicenter RAPID-CTCA Trial. JACC Cardiovasc Imaging 2022; 15:1916-1925. [PMID: 36357133 DOI: 10.1016/j.jcmg.2022.04.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In patients with stable chest pain, computed tomography (CT) plaque burden is an independent predictor of future coronary events. OBJECTIVES The purpose of this study was to determine whether plaque burden and characteristics can predict subsequent death or myocardial infarction in patients with acute chest pain. METHODS In a post hoc analysis of a multicenter trial of early coronary CT angiography, the authors performed quantitative plaque analysis to assess the association between primary endpoint of 1-year all-cause death or nonfatal myocardial infarction and the GRACE (Global Registry of Acute Coronary Events) score, presence of obstructive coronary artery disease, and plaque burden in 404 patients with suspected acute coronary syndrome. RESULTS Following the index event, 25 patients had a primary event that was associated with a higher GRACE score (134 ± 44 vs 113 ± 35; P = 0.012), larger burdens of total (46% [IQR: 43%-50%] vs 36% [IQR: 21%-46%]; P < 0.001), noncalcified (41% [IQR: 37%-%47] vs 33% [IQR: 20%-41%]; P < 0.001), and low-attenuation plaque (4.22% [IQR: 3.3%-5.68%] vs 2.14% [IQR: 0.5%-4.88%]; P < 0.001), but not obstructive coronary artery disease (P = 0.065). Total, noncalcified, and low-attenuation plaque burden were the strongest predictors of future events independent of GRACE score and obstructive coronary artery disease (P ≤ 0.002 for all). Patients with a low-attenuation burden above the median had nearly an 8-fold increased risk of the primary endpoint (HR: 7.80 [95% CI: 2.33-26.0]; P < 0.001), outperforming either a GRACE score of >140 (HR: 3.80 [95% CI :1.45-6.98]; P = 0.004) or obstructive coronary artery disease (HR: 2.07 [95% CI: 0.94-4.53]; P = 0.07). CONCLUSIONS In patients with suspected acute coronary syndrome, low-attenuation plaque burden is a major predictor of 1-year death or recurrent myocardial infarction. (Rapid Assessment of Potential Ischaemic Heart Disease With CTCA [RAPID-CTCA]; NCT02284191).
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Affiliation(s)
- Mohammed N Meah
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Evangelos Tzolos
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kang-Ling Wang
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anda Bularga
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; University Hospital Southampton, Southampton, United Kingdom
| | - Attila Kardos
- Department of Cardiology Milton Keynes University Hospital, School of Sciences and Medicine, University of Buckingham, Buckingham, United Kingdom
| | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Nicholas L Mills
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David E Newby
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom
| | - Alasdair Gray
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom
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Wendell D, Jenista E, Kim HW, Chen EL, Azevedo CF, Kaolawanich Y, Alenezi F, Rehwald W, Darty S, Parker M, Kim RJ. Assessment of Papillary Muscle Infarction with Dark-Blood Delayed Enhancement Cardiac MRI in Canines and Humans. Radiology 2022; 305:329-338. [PMID: 35880980 PMCID: PMC9619201 DOI: 10.1148/radiol.220251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
Background The relationship between papillary muscle infarction (papMI) and the culprit coronary lesion has not been fully investigated. Delayed enhancement cardiac MRI may detect papMI, yet its accuracy is unknown. Flow-independent dark-blood delayed enhancement (FIDDLE) cardiac MRI has been shown to improve the detection of myocardial infarction adjacent to blood pool. Purpose To assess the diagnostic performance of delayed enhancement and FIDDLE cardiac MRI for the detection of papMI, and to investigate the prevalence of papMI and its relationship to the location of the culprit coronary lesion. Materials and Methods A prospective canine study was used to determine the accuracy of conventional delayed enhancement imaging and FIDDLE imaging for detection of papMI, with pathology-based findings as the reference standard. Participants with first-time myocardial infarction with a clear culprit lesion at coronary angiography were prospectively enrolled at a single hospital from 2015 to 2018 and compared against control participants with low Framingham risk scores. In canines, diagnostic accuracy was calculated for delayed enhancement and FIDDLE imaging. Results In canines (n = 27), FIDDLE imaging was more sensitive (100% [23 of 23] vs 57% [13 of 23], P < .001) and accurate (100% [54 of 54] vs 80% [43 of 54], P = .01) than delayed enhancement imaging for detection of papMI. In 43 participants with myocardial infarction (mean age, 56 years ± 16 [SD]; 28 men), the infarct-related artery was the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery in 47% (20 of 43), 26% (11 of 43), and 28% (12 of 43), respectively. The prevalence of anterior papMI was lower than posterior papMI (37% [16 of 43 participants] vs 44% [19 of 43 participants]) despite more LAD culprit lesions. Culprits leading to papMI were restricted to a smaller "at-risk" portion of the coronary tree for anterior papMI (subtended first diagonal branch of the LAD or first marginal branch of the LCX) compared with posterior (subtended posterior descending artery or third obtuse marginal branch of the LCX). Culprits within these at-risk portions were predictive of papMI at a similar rate (anterior, 83% [15 of 18 participants] vs posterior, 86% [18 of 21 participants]). Conclusion Flow-independent dark-blood delayed enhancement cardiac MRI, unlike conventional delayed enhancement cardiac MRI, was highly accurate in the detection of papillary muscle infarction (papMI). Anterior papMI was less prevalent than posterior papMI, most likely due to culprit lesions being restricted to a smaller portion of the coronary tree rather than because of redundant, dual vascular supply. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kawel-Boehm and Bremerich in this issue.
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Affiliation(s)
- David Wendell
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Elizabeth Jenista
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Han W. Kim
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Enn-Ling Chen
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Clerio F. Azevedo
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | | | - Fawaz Alenezi
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Wolfgang Rehwald
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Stephen Darty
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Michele Parker
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Raymond J. Kim
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
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Dahal S, Budoff MJ, Roy SK. Coronary Computed Tomography Angiography for Evaluation of Chest Pain in the Emergency Department. Tex Heart Inst J 2022; 49:e217550. [PMID: 36511943 PMCID: PMC9809099 DOI: 10.14503/thij-21-7550] [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] [Indexed: 12/15/2022]
Abstract
Coronary computed tomography angiography has emerged as an important diagnostic modality for evaluation of acute chest pain in the emergency department for patients at low to intermediate risk for acute coronary syndromes. Several clinical trials have shown excellent negative predictive value of coronary computed tomography angiography to detect obstructive coronary artery disease. Cardiac biomarkers such as troponins and creatine kinase MB, along with history, electrocardiogram, age, risk factors, troponin score, and Thrombolysis in Myocardial Infarction score should be used in conjunction with coronary computed tomography angiography for safe and rapid discharge of patients from the emergency department. Coronary computed tomography angiography along with high-sensitivity troponin assays could be effective for rapid evaluation of acute chest pain in the emergency department, but high-sensitivity troponins are not always available. Emergency department physicians are not quite comfortable making clinical decisions, especially if the coronary stenosis is in the range of 50% to 70%. In these cases, further evaluation with functional testing, such as nuclear stress testing or stress echocardiogram, is a common approach in many centers; however, newer methods such as fractional flow reserve computed tomography could be safely incorporated in coronary computed tomography angiography to help with clinical decision-making in these scenarios.
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Affiliation(s)
- Suraj Dahal
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Matthew J. Budoff
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - Sion K. Roy
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, California
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46
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Karády J, Ferencik M, Mayrhofer T, Meyersohn NM, Bittner DO, Staziaki PV, Szilveszter B, Hallett TR, Lu MT, Puchner SB, Simon TG, Foldyna B, Ginsburg GS, McGarrah RW, Voora D, Shah SH, Douglas PS, Hoffmann U, Corey KE. Risk factors for cardiovascular disease among individuals with hepatic steatosis. Hepatol Commun 2022; 6:3406-3420. [PMID: 36281983 PMCID: PMC9701472 DOI: 10.1002/hep4.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in adults with hepatic steatosis (HS). However, risk factors for CVD in HS are unknown. We aimed to identify factors associated with coronary artery disease (CAD) and incident major adverse cardiovascular events (MACE) in individuals with HS. We performed a nested cohort study of adults with HS detected on coronary computed tomography in the PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) trial. Obstructive CAD was defined as ≥50% coronary stenosis. MACE included hospitalization for unstable angina, nonfatal myocardial infarction, or all-cause death. Multivariate modeling, adjusted for age, sex, atherosclerotic CVD (ASCVD) risk score and body mass index, identified factors associated with obstructive CAD. Cox regression, adjusted for ASCVD risk score, determined the predictors of MACE. A total of 959 of 3,756 (mean age 59.4 years, 55.0% men) had HS. Obstructive CAD was present in 15.2% (145 of 959). Male sex (adjusted odds ratio [aOR] = 1.83, 95% confidence interval [CI] 1.18-1.2.84; p = 0.007), ASCVD risk score (aOR = 1.05, 95% CI 1.03-1.07; p < 0.001), and n-terminal pro-b-type natriuretic peptide (NT-proBNP; aOR = 1.90, 95% CI 1.38-2.62; p < 0.001) were independently associated with obstructive CAD. In the 25-months median follow-up, MACE occurred in 4.4% (42 of 959). Sedentary lifestyle (adjusted hazard ratio [aHR] = 2.53, 95% CI 1.27-5.03; p = 0.008) and NT-proBNP (aOR = 1.50, 95% CI 1.01-2.25; p = 0.046) independently predicted MACE. Furthermore, the risk of MACE increased by 3% for every 1% increase in ASCVD risk score (aHR = 1.03, 95% CI 1.01-1.05; p = 0.02). Conclusion: In individuals with HS, male sex, NT-pro-BNP, and ASCVD risk score are associated with obstructive CAD. Furthermore, ASCVD, NT-proBNP, and sedentary lifestyle are independent predictors of MACE. These factors, with further validation, may help risk-stratify adults with HS for incident CAD and MACE.
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Affiliation(s)
- Julia Karády
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,MTA‐SE Cardiovascular Imaging Research GroupHeart and Vascular Center, Semmelweis UniversityBudapestHungary
| | - Maros Ferencik
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOregonUSA
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,School of Business StudiesStralsund University of Applied SciencesStralsundGermany
| | - Nandini M. Meyersohn
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | - Daniel O. Bittner
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,Department of CardiologyFriedrich‐Alexander University Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Pedro V. Staziaki
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | - Balint Szilveszter
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,MTA‐SE Cardiovascular Imaging Research GroupHeart and Vascular Center, Semmelweis UniversityBudapestHungary
| | - Travis R. Hallett
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | - Michael T. Lu
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | - Stefan B. Puchner
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA,Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - Tracey G. Simon
- Division of GastroenterologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Borek Foldyna
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | | | - Robert W. McGarrah
- Duke Molecular Physiology InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - Deepak Voora
- Duke Center for Applied Genomics & Precision MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Svati H. Shah
- Duke Molecular Physiology InstituteDuke UniversityDurhamNorth CarolinaUSA,Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Pamela S. Douglas
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Udo Hoffmann
- Cardiovascular Imaging Research CenterHarvard Medical School, Massachusetts General HospitalBostonMassachusettsUSA
| | - Kathleen E. Corey
- Division of GastroenterologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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47
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Naghshtabrizi B, Alvandi M, Shaghaghi Z, Hadei SK, Fariba F, Moradi M, Rabie MAS. Transient ischemic dilation or transient RV visualization in patients with normal SPECT stress myocardial perfusion imaging: Correlation with CT coronary artery calcium scoring and coronary angiography. J Nucl Cardiol 2022; 29:2149-2156. [PMID: 34228333 DOI: 10.1007/s12350-021-02704-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ancillary findings on MPI, such as transient ischemic dilation (TID) and transient right ventricular visualization (TRV), are recognized as markers of extensive CAD and predictive of adverse outcomes. They usually occur in association with stress-induced regional MPI abnormalities. However, the clinical significance of these ancillary markers in the presence of normal stress MPI is incompletely understood. METHODS From a cohort of 564 consecutive patients referred for clinical SPECT stress MPI, 44 patients had normal stress SPECT MPI and either TID (n = 28) or TRV (n = 16). These imaging findings were correlated with CT coronary calcium (CAC), CT coronary angiography (CTA), and invasive coronary angiography (ICA) in patients with severe CAC ≥ 1000 HU. TID and TRV were quantified as stress/rest ratios. Severe CAD was defined as > 70% luminal stenosis on CTA or ICA. RESULTS The median TID ratio was 1.23, with a range of 1.13-1.48; the median TRV ratio was 1.30, with a range of 1.20-1.48. Of 44 patients with TID or TRV, only 9 patients (20.5%) had severe obstructive > 70% CAD by angiography (6 of 28 patients (21.5%) with TID and 3 of 16 patients (19%) with TRV). Severe multi-vessel CAD occurred in only 2 of 44 patients (4.5%). In contrast, of 9 patients with CAC > 1000 HU, 6 (67%) had severe obstructive CAD. CONCLUSION In patients with normal stress SPECT MPI and TID or TRV, the incidence of severe obstructive CAD was relatively low and predominantly single-vessel CAD. These findings do not support the concept that TID or TRV with normal stress MPI is predictive of high-risk CAD.
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Affiliation(s)
- Behshad Naghshtabrizi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Alvandi
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zahra Shaghaghi
- Department of Nuclear Medicine and Molecular Imaging, Clinical Development Research Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kamaledin Hadei
- Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farnaz Fariba
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Moradi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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48
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Meah MN, Bularga A, Tzolos E, Chapman AR, Daghem M, Hung JD, Chiong J, Taggart C, Wereski R, Gray A, Dweck MR, Roobottom C, Curzen N, Kardos A, Felmeden D, Mills NL, Slomka PJ, Newby DE, Dey D, Williams MC. Distinguishing Type 1 from Type 2 Myocardial Infarction by Using CT Coronary Angiography. Radiol Cardiothorac Imaging 2022; 4:e220081. [PMID: 36339063 PMCID: PMC9627233 DOI: 10.1148/ryct.220081] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
Purpose To determine whether quantitative plaque characterization by using CT coronary angiography (CTCA) can discriminate between type 1 and type 2 myocardial infarction. Materials and Methods This was a secondary analysis of two prospective studies (ClinicalTrials.gov registration nos. NCT03338504 [2014-2019] and NCT02284191 [2018-2020]) that performed blinded quantitative plaque analysis on findings from CTCA in participants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regression analyses were performed to identify predictors of type 1 myocardial infarction. Results Overall, 155 participants (mean age, 64 years ± 12 [SD]; 114 men) and 36 participants (mean age, 67 years ± 12; 19 men) had type 1 and type 2 myocardial infarction, respectively, and 136 participants (62 years ± 12; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR: 35%-50%] vs 35% [IQR: 29%-46%]), noncalcified (39% [IQR: 31%-46%] vs 34% [IQR: 29%-40%]), and low-attenuation (4.15% [IQR: 1.88%-5.79%] vs 1.64% [IQR: 0.89%-2.28%]) plaque burdens (P < .05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (P = .4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI: 1.84, 6.96]; P < .001), with better discrimination than noncalcified plaque burden and maximal area of coronary stenosis (C statistic, 0.75 [95% CI: 0.67, 0.83] vs 0.62 [95% CI: 0.53, 0.71] and 0.61 [95% CI: 0.51, 0.70] respectively; P ≤ .001 for both). Conclusion Higher low-attenuation coronary plaque burden in patients with type 1 myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction.Keywords: Ischemia/Infarction, CT Angiography, Quantitative CTClinical trial registration nos. NCT03338504 and NCT02284191 Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Mohammed N. Meah
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Anda Bularga
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Evangelos Tzolos
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Andrew R. Chapman
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Marwa Daghem
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - John D. Hung
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Justin Chiong
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Caelan Taggart
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Ryan Wereski
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Alasdair Gray
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Marc R. Dweck
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Carl Roobottom
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Nick Curzen
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Attila Kardos
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Dirk Felmeden
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Nicholas L. Mills
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - Piotr J. Slomka
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
| | - David E. Newby
- From the British Heart Foundation Centre of Cardiovascular Science,
University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D.,
J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher
Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.);
University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine,
University of Southampton, Southampton, England (N.C.); University Hospital
Southampton, Southampton, England (N.C.); Department of Cardiology, Milton
Keynes University Hospital, School of Sciences and Medicine, University of
Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation
Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences,
Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh
Imaging, Queen’s Medical Research Institute University of Edinburgh,
Edinburgh, Scotland (D.E.N., M.C.W.)
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49
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Lee JW, Choe YH, Kim SM, Choi JH, Pak S, Choo KS, Kim JS, Lee CE, Kim YH. Comparison of diagnostic performance between dynamic versus static adenosine-stress myocardial CT perfusion to detect hemodynamically significant coronary artery stenosis: A prospective multicenter study. Medicine (Baltimore) 2022; 101:e30477. [PMID: 36086714 PMCID: PMC10980466 DOI: 10.1097/md.0000000000030477] [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: 10/22/2021] [Accepted: 08/02/2022] [Indexed: 12/30/2022] Open
Abstract
Myocardial computed tomography perfusion (CTP) imaging is a noninvasive method for detecting myocardial ischemia. This study aimed to compare the diagnostic performance of dynamic and static adenosine-stress CTPs for detecting hemodynamically significant coronary stenosis. We prospectively enrolled 42 patients (mean age, 59.7 ± 8.8 years; 31 males) with ≥40% coronary artery stenosis. All patients underwent dynamic CTP for adenosine stress. The static CTP was simulated by choosing the seventh dynamic dataset after the initiation of the contrast injection. Diagnostic performance was compared with invasive fractional flow reserve (FFR) <0.8 as the reference. Of the 125 coronary vessels in 42 patients, 20 (16.0%) in 16 (38.1%) patients were categorized as hemodynamically significant. Dynamic and static CTP yielded similar diagnostic accuracy (90.4% vs 88.8% using visual analysis, P = .558; 77.6% vs 80.8% using quantitative analysis, P = .534; 78.4% vs 82.4% using combined visual and quantitative analyses, P = .426). The diagnostic accuracy of combined coronary computed tomography angiography (CCTA) and dynamic CTP (89.6% using visual analysis, P = .011; 88.8% using quantitative analysis, P = .018; 89.6% using combined visual and quantitative analyses, P = .011) and that of combined CCTA and static CTP (88.8% using visual analysis, P = .018; 90.4% using quantitative analysis, P = .006; 91.2% using combined visual and quantitative analyses, P = .003) were significantly higher than that of CCTA alone (77.6%). Dynamic CTP and static CTP showed similar diagnostic performance in the detection of hemodynamically significant stenosis.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Emergency Medicine and Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongyong Pak
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Chong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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50
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Roberto Schetz Alves M, Momoli J, Lindsey Pilato E, Lenci Marques G. Origin, Course, and Angulation of Coronary Artery Anomaly - A Case Report. Cureus 2022; 14:e28669. [PMID: 36199653 PMCID: PMC9526454 DOI: 10.7759/cureus.28669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital coronary artery anomalies are a rare diagnosis that can be silent when the patient is asymptomatic. Although these abnormalities may, in most cases, not present clinical alterations, in some cases, they prove to be a cause of myocardial ischemia and sudden death. We report the case of a 20-year-old asymptomatic patient, seen in a routine cardiology consultation, evidenced in an ergometric test ST-segment depression. In this case, follow-up was carried out with coronary angiotomography and scintigraphy to understand the reason for this finding. After the angiotomography has evidenced the diagnosis of anomalous origin and course of the right coronary artery and the trunk of the left coronary artery, in addition to anomalous angulation of the right coronary vessel.
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