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Baskaran L, Yan L, Tan CS, Ho WW, Tan SY, Williams MC, Han D, Nakanishi R, Cerci RJ, Ng MY, Shaw LJ, Chua TSJ, Douglas P, Winther S. Evaluating the American Heart Association/American College of Cardiology Guideline-Recommended and Contemporary Pretest Probability Models in a Mixed Asian Cohort: The Contribution of Coronary Artery Calcium. J Am Heart Assoc 2024; 13:e033879. [PMID: 38934865 DOI: 10.1161/jaha.123.033879] [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: 12/07/2023] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Most pretest probability (PTP) tools for obstructive coronary artery disease (CAD) were Western -developed. The most appropriate PTP models and the contribution of coronary artery calcium score (CACS) in Asian populations remain unknown. In a mixed Asian cohort, we compare 5 PTP models: local assessment of the heart (LAH), CAD Consortium (CAD2), risk factor-weighted clinical likelihood, the American Heart Association/American College of Cardiology and the European Society of Cardiology PTP and 3 extended versions of these models that incorporated CACS: LAH(CACS), CAD2(CACS), and the CACS-clinical likelihood. METHODS AND RESULTS The study cohort included 771 patients referred for stable chest pain. Obstructive CAD prevalence was 27.5%. Calibration, area under the receiver-operating characteristic curves (AUC) and net reclassification index were evaluated. LAH clinical had the best calibration (χ2 5.8; P=0.12). For CACS models, LAH(CACS) showed least deviation between observed and expected cases (χ2 37.5; P<0.001). There was no difference in AUCs between the LAH clinical (AUC, 0.73 [95% CI, 0.69-0.77]), CAD2 clinical (AUC, 0.72 [95% CI, 0.68-0.76]), risk factor-weighted clinical likelihood (AUC, 0.73 [95% CI: 0.69-0.76) and European Society of Cardiology PTP (AUC, 0.71 [95% CI, 0.67-0.75]). CACS improved discrimination and reclassification of the LAH(CACS) (AUC, 0.88; net reclassification index, 0.46), CAD2(CACS) (AUC, 0.87; net reclassification index, 0.29) and CACS-CL (AUC, 0.87; net reclassification index, 0.25). CONCLUSIONS In a mixed Asian cohort, Asian-derived LAH models had similar discriminatory performance but better calibration and risk categorization for clinically relevant PTP cutoffs. Incorporating CACS improved discrimination and reclassification. These results support the use of population-matched, CACS-inclusive PTP tools for the prediction of obstructive CAD.
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Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology National Heart Centre Singapore Singapore Singapore
- Duke-NUS Medical School National University of Singapore Singapore Singapore
- CVS.AI National Heart Research Institute of Singapore Singapore Singapore
| | - Linxuan Yan
- Duke-NUS Medical School National University of Singapore Singapore Singapore
| | - Chun S Tan
- Department of Cardiology National Heart Centre Singapore Singapore Singapore
| | - Woon W Ho
- Department of Cardiology National Heart Centre Singapore Singapore Singapore
| | - Swee Y Tan
- Department of Cardiology National Heart Centre Singapore Singapore Singapore
- Duke-NUS Medical School National University of Singapore Singapore Singapore
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science Edinburgh UK
| | - Donghee Han
- Department of Imaging Cedars-Sinai Medical Center Los Angeles CA USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine Toho University Omori Medical Center Tokyo Japan
| | | | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong Pok Fu Lam Hong Kong
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai Blavatnik Family Women's Health Research Institute New York NY USA
| | - Terrance S J Chua
- Department of Cardiology National Heart Centre Singapore Singapore Singapore
- Duke-NUS Medical School National University of Singapore Singapore Singapore
| | - Pamela Douglas
- Division of Cardiology Duke University School of Medicine Durham NC USA
| | - Simon Winther
- Department of Cardiology Gødstrup Hospital Herning Denmark
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Krievins DK, Zellans E, Latkovskis G, Kumsars I, Krievina AK, Jegere S, Erglis A, Lacis A, Plopa E, Stradins P, Ivanova P, Zarins CK. Diagnosis and treatment of ischemia-producing coronary stenoses improves 5-year survival of patients undergoing major vascular surgery. J Vasc Surg 2024; 80:240-248. [PMID: 38518962 DOI: 10.1016/j.jvs.2024.02.043] [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: 01/26/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Patients undergoing vascular surgery procedures have poor long-term survival due to coexisting coronary artery disease (CAD), which is often asymptomatic, undiagnosed, and undertreated. We sought to determine whether preoperative diagnosis of asymptomatic (silent) coronary ischemia using coronary computed tomography (CT)-derived fractional flow reserve (FFRCT) together with postoperative ischemia-targeted coronary revascularization can reduce adverse cardiac events and improve long-term survival following major vascular surgery METHODS: In this observational cohort study of 522 patients with no known CAD undergoing elective carotid, peripheral, or aneurysm surgery we compared two groups of patients. Group I included 288 patients enrolled in a prospective Institutional Review Board-approved study of preoperative coronary CT angiography (CTA) and FFRCT testing to detect silent coronary ischemia with selective postoperative coronary revascularization in addition to best medical therapy (BMT) (FFRCT guided), and Group II included 234 matched controls with standard preoperative cardiac evaluation and postoperative BMT alone with no elective coronary revascularization (Usual Care). In the FFRCT group, lesion-specific coronary ischemia was defined as FFRCT ≤0.80 distal to a coronary stenosis, with severe ischemia defined as FFRCT ≤0.75. Results were available for patient management decisions. Endpoints included all-cause death, cardiovascular death, myocardial infarction (MI), and major adverse cardiovascular events (MACE [death, MI, or stroke]) during 5-year follow-up. RESULTS The two groups were similar in age, gender, and comorbidities. In FFRCT, 65% of patients had asymptomatic lesion-specific coronary ischemia, with severe ischemia in 52%, multivessel ischemia in 36% and left main ischemia in 8%. The status of coronary ischemia was unknown in Usual Care. Vascular surgery was performed as planned in both cohorts with no difference in 30-day mortality. In FFRCT, elective ischemia-targeted coronary revascularization was performed in 103 patients 1 to 3 months following surgery. Usual Care had no elective postoperative coronary revascularizations. At 5 years, compared with Usual Care, FFRCT guided had fewer all-cause deaths (16% vs 36%; hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.22-0.60; P < .001), fewer cardiovascular deaths (4% vs 21%; HR, 0.11; 95% CI, 0.04-0.33; P < .001), fewer MIs (4% vs 24%; HR, 0.13; 95% CI, 0.05-0.33; P < .001), and fewer MACE (20% vs 47%; HR, 0.36; 95% CI, 0.23-0.56; P < .001). Five-year survival was 84% in FFRCT compared with 64% in Usual Care (P < .001). CONCLUSIONS Diagnosis of silent coronary ischemia with ischemia-targeted coronary revascularization in addition to BMT following major vascular surgery was associated with fewer adverse cardiovascular events and improved 5-year survival compared with patients treated with BMT alone as per current guidelines.
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Affiliation(s)
- Dainis K Krievins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia.
| | - Edgars Zellans
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Gustavs Latkovskis
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Indulis Kumsars
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia
| | | | - Sanda Jegere
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Aigars Lacis
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Peteris Stradins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; Riga Stradins University, Riga, Latvia
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Natanzon SS, Han D, Kuronuma K, Gransar H, Miller RJH, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. Self-reported exercise activity influences the relationship between coronary computed tomography angiographic finding and mortality. J Cardiovasc Comput Tomogr 2024; 18:327-333. [PMID: 38589269 DOI: 10.1016/j.jcct.2024.03.011] [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: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
AIM Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n = 1643, 17%), mild exercise (n = 3156, 32%), moderate exercise (n = 3542, 36%), and high exercise (n = 1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p < 0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p < 0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p = 0.912). CONCLUSION Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.
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Affiliation(s)
- Sharon Shalom Natanzon
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Lee YJ, Park G, Lee SG, Cho YK, Yoon HJ, Kim U, Jang JY, Oh SJ, Lee SJ, Hong SJ, Ahn CM, Kim BK, Chang HJ, Ko YG, Choi D, Hong MK, Jang Y, Kim JS. Predictive value of plaque characteristics for identification of lesions causing ischemia. Int J Cardiol 2024; 406:132097. [PMID: 38663808 DOI: 10.1016/j.ijcard.2024.132097] [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: 03/15/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Functional assessment using fractional flow reserve (FFR) and anatomical assessment using optical coherence tomography (OCT) are used in clinical practice for patients with intermediate coronary stenosis. Moreover, coronary computed tomography angiography (CTA) is a common noninvasive imaging technique for evaluating suspected coronary artery disease before being referred for angiography. This study aimed to investigate the association between FFR and plaque characteristics assessed using coronary CTA and OCT for intermediate coronary stenosis. METHODS Based on a prospective multicenter registry, 159 patients having 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography, and both FFR measurements and OCT examinations were performed during angiography. A stenotic lesion identified with FFR ≤0.80 was deemed diagnostic of an ischemia-causing lesion. The predictive value of plaque characteristics assessed using coronary CTA and OCT for identifying lesions causing ischemia was analyzed. RESULTS Stenosis severity and plaque characteristics on coronary CTA and OCT differed between lesions that caused ischemia and those that did not. In multivariate analysis, low attenuation plaque on coronary CTA (odds ratio [OR]=2.78; P=0.038), thrombus (OR=5.13; P=0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors of ischemic lesions. Increasing the number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia. CONCLUSIONS Comprehensive anatomical evaluation of coronary stenosis may provide additional supportive information for predicting the lesions causing ischemia.
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Affiliation(s)
- Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geunhee Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seul-Gee Lee
- Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Kyeong Cho
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Hyuck Jun Yoon
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Ung Kim
- Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Ji-Yong Jang
- National Health Insurance Service Ilsan Hospital, Goyang-city, Republic of Korea
| | - Seung-Jin Oh
- National Health Insurance Service Ilsan Hospital, Goyang-city, Republic of Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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He A, Wilkins B, Lan NSR, Othman F, Sehly A, Bhat V, Jaltotage B, Dwivedi G, Leipsic J, Ihdayhid AR. Cardiac computed tomography post-transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2024; 18:319-326. [PMID: 38782668 DOI: 10.1016/j.jcct.2024.04.014] [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: 01/29/2024] [Revised: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is performed to treat aortic stenosis and is increasingly being utilised in the low-to-intermediate-risk population. Currently, attention has shifted towards long-term outcomes, complications and lifelong maintenance of the bioprosthesis. Some patients with TAVR in-situ may develop significant coronary artery disease over time requiring invasive coronary angiography, which may be problematic with the TAVR bioprosthesis in close proximity to the coronary ostia. In addition, younger patients may require a second transcatheter heart valve (THV) to 'replace' their in-situ THV because of gradual structural valve degeneration. Implantation of a second THV carries a risk of coronary obstruction, thereby requiring comprehensive pre-procedural planning. Unlike in the pre-TAVR period, cardiac CT angiography in the post-TAVR period is not well established. However, post-TAVR cardiac CT is being increasingly utilised to evaluate mechanisms for structural valve degeneration and complications, including leaflet thrombosis. Post-TAVR CT is also expected to have a significant role in risk-stratifying and planning future invasive procedures including coronary angiography and valve-in-valve interventions. Overall, there is emerging evidence for post-TAVR CT to be eventually incorporated into long-term TAVR monitoring and lifelong planning.
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Affiliation(s)
- Albert He
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Ben Wilkins
- Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Farrah Othman
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Amro Sehly
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Vikas Bhat
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | | | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, Curtin University, Perth, Australia.
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Vecsey-Nagy M, Varga-Szemes A, Schoepf UJ, Tremamunno G, Fink N, Zsarnoczay E, Szilveszter B, Graafen D, Halfmann MC, Vattay B, Boussoussou M, O'Doherty J, Suranyi PS, Maurovich-Horvat P, Emrich T. Ultra-high resolution coronary CT angiography on photon-counting detector CT: bi-centre study on the impact of quantum iterative reconstruction on image quality and accuracy of stenosis measurements. Eur J Radiol 2024; 176:111517. [PMID: 38805884 DOI: 10.1016/j.ejrad.2024.111517] [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: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To assess the impact of different quantum iterative reconstruction (QIR) levels on objective and subjective image quality of ultra-high resolution (UHR) coronary CT angiography (CCTA) images and to determine the effect of strength levels on stenosis quantification using photon-counting detector (PCD)-CT. METHOD A dynamic vessel phantom containing two calcified lesions (25 % and 50 % stenosis) was scanned at heart rates of 60, 80 and 100 beats per minute with a PCD-CT system. In vivo CCTA examinations were performed in 102 patients. All scans were acquired in UHR mode (slice thickness0.2 mm) and reconstructed with four different QIR levels (1-4) using a sharp vascular kernel (Bv64). Image noise, signal-to-noise ratio (SNR), sharpness, and percent diameter stenosis (PDS) were quantified in the phantom, while noise, SNR, contrast-to-noise ratio (CNR), sharpness, and subjective quality metrics (noise, sharpness, overall image quality) were assessed in patient scans. RESULTS Increasing QIR levels resulted in significantly lower objective image noise (in vitro and in vivo: both p < 0.001), higher SNR (both p < 0.001) and CNR (both p < 0.001). Sharpness and PDS values did not differ significantly among QIRs (all pairwise p > 0.008). Subjective noise of in vivo images significantly decreased with increasing QIR levels, resulting in significantly higher image quality scores at increasing QIR levels (all pairwise p < 0.001). Qualitative sharpness, on the other hand, did not differ across different levels of QIR (p = 0.15). CONCLUSIONS The QIR algorithm may enhance the image quality of CCTA datasets without compromising image sharpness or accurate stenosis measurements, with the most prominent benefits at the highest strength level.
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Affiliation(s)
- Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Giuseppe Tremamunno
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University, Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Koranyi Sandor street 2, Budapest 1083, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Dirk Graafen
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
| | - Borbála Vattay
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Melinda Boussoussou
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Siemens Medical Solutions USA Inc, 40 Liberty Boulevard, Malvern, PA 19355, United States
| | - Pal Spruill Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Koranyi Sandor street 2, Budapest 1083, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
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7
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Nielsen S, Nyvad J, Christensen KL, Poulsen PL, Laugesen E, Grove EL, Buus NH. Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease. Atherosclerosis 2024; 394:117170. [PMID: 37558603 DOI: 10.1016/j.atherosclerosis.2023.06.076] [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: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnea (OSA) may accelerate arterial calcification, but the relation remains unexplored in diabetic kidney disease (DKD). We examined the associations between OSA, coronary calcification and large artery stiffness in patients with DKD and reduced renal function. METHODS Patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and urine albumin-creatinine ratio (UACR) > 30 mg/g were tested for OSA quantified by the apnea-hypopnea index (AHI, events/hour). Patients without OSA (AHI< 5) were compared to patients with moderate (AHI 15-29) or severe (AHI ≥30) OSA and underwent computed tomography angiography with coronary Agatston scoring (CAS) to quantify coronary calcification. Arterial stiffness was determined as carotid-femoral pulse wave velocity (PWV). RESULTS Among 114 patients with acceptable AHI recordings had 43 no OSA, 33 mild OSA and 38 moderate-severe OSA. Mean age of the 74 patients completing the study was 71.5 ± 9.4 years (73% males), eGFR 32.2 ± 12.3 ml/min/1.73 m2 and UACR 533 (192-1707) mg/g. CAS (ln-transformed) was significantly higher in patients with OSA compared to patients without (6.6 ± 1.7 vs. 5.6 ± 2.4, p = 0.04), and the same was observed for PWV (11.9 ± 2.7 vs. 10.5 ± 2.2 m/s, p = 0.02). In multivariable linear regression analyses adjusted for sex, age, body mass index, UACR, and mean arterial pressure, moderate-severe OSA remained significantly associated with PWV but not with CAS. Dominance analysis revealed OSA as the third and second most important factor relative to CAS and PWV respectively. CONCLUSIONS In DKD patients, moderate-severe OSA is a significant predictor of arterial stiffness but is not independently associated with coronary calcification.
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Affiliation(s)
- Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Løgstrup Poulsen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Esben Laugesen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
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Mortensen MB, Jensen JM, Rønnow Sand NP, Kragholm K, Blaha MJ, Grove EL, Sørensen HT, Olesen K, Maeng M, Løgstrup B, Busk M, Hauge EM, Navar AM, Bøtker HE, Nørgaard BL. Association of Autoimmune Diseases With Coronary Atherosclerosis Severity and Ischemic Events. J Am Coll Cardiol 2024; 83:2643-2654. [PMID: 38897674 DOI: 10.1016/j.jacc.2024.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Some autoimmune diseases carry elevated risk for atherosclerotic cardiovascular disease (ASCVD), yet the underlying mechanism and the influence of traditional risk factors remain unclear. OBJECTIVES This study sought to determine whether autoimmune diseases independently correlate with coronary atherosclerosis and ASCVD risk and whether traditional cardiovascular risk factors modulate the risk. METHODS The study included 85,512 patients from the Western Denmark Heart Registry undergoing coronary computed tomography angiography. A diagnosis of 1 of 18 autoimmune diseases was assessed. Adjusted OR (aOR) for any plaque, any coronary artery calcification (CAC), CAC of >90th percentile, and obstructive coronary artery disease as well as adjusted HR (aHR) for ASCVD were calculated. RESULTS During 5.3 years (Q1-Q3: 2.8-8.2 years) of follow-up, 3,832 ASCVD events occurred. A total of 4,064 patients had a diagnosis of autoimmune disease, which was associated with both presence of any plaque (aOR: 1.29; 95% CI: 1.20-1.40), any CAC (aOR: 1.28; 95% CI: 1.19-1.37), and severe CAC of >90th percentile (aOR: 1.53; 95% CI: 1.39-1.68), but not with having obstructive coronary artery disease (aOR: 1.04; 95% CI: 0.91-1.17). Patients with autoimmune diseases had a 46% higher risk (aHR: 1.46; 95% CI: 1.29-1.65) for ASCVD. Traditional cardiovascular risk factors were strongly associated with future ASCVD events, and a favorable cardiovascular risk factor profile in autoimmune patients was associated with ∼54% lower risk compared to patients with presence of risk factors (aHR: 0.46; 95% CI: 0.27-0.81). CONCLUSIONS Autoimmune diseases were independently associated with higher burden of coronary atherosclerosis and higher risk for future ASCVD events, with risk accentuated by traditional cardiovascular risk factors. These findings suggest that autoimmune diseases increase risk through accelerated atherogenesis and that cardiovascular risk factor control is key for improving prognosis in patients with autoimmune diseases.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Løgstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Ellen Margrethe Hauge
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Ann Marie Navar
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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9
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Yuki H, Sundt TM, Niida T, Suzuki K, Kinoshita D, Fujimoto D, Dey D, Lee H, McNulty I, Naganuma T, Nakamura S, Usui E, Kakuta T, Jang IK. Level of Perivascular Inflammation Is Significantly Lower Around the Left Internal Mammary Artery Than Around Native Coronary Arteries. J Am Heart Assoc 2024; 13:e033224. [PMID: 38879462 DOI: 10.1161/jaha.123.033224] [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: 10/21/2023] [Accepted: 05/16/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The left internal mammary artery (LIMA) is protected from developing atherosclerosis. Perivascular inflammation, which is closely associated with atherosclerosis, can be measured by perivascular adipose tissue attenuation on computed tomography angiography. Whether the absence of atherosclerosis in LIMA is related to the lower level of perivascular inflammation is unknown. This study was performed to compare the level of perivascular inflammation between LIMA in situ and native coronary arteries in patients with coronary artery disease. METHODS AND RESULTS A total of 573 patients who underwent both computed tomography angiography and optical coherence tomography imaging were included. The level of perivascular adipose tissue attenuation between LIMA in situ and coronary arteries was compared. Perivascular adipose tissue attenuation around LIMA in situ was significantly lower around the 3 coronary arteries (-82.9 [-87.3 to -78.0] versus -70.8 [-75.9 to -65.9]; P<0.001), irrespective of the level of pericoronary inflammation or the number of vulnerable features on optical coherence tomography. When patients were divided into high and low pericoronary inflammation groups, those in the high inflammation group had more target vessel failure (hazard ratio, 2.97 [95% CI, 1.16-7.59]; P=0.017). CONCLUSIONS The current study demonstrated that perivascular adipose tissue attenuation was significantly lower around LIMA in situ than around native coronary arteries. The lower level of perivascular inflammation may be related to the low prevalence of atherosclerosis in LIMA. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04523194.
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Affiliation(s)
- Haruhito Yuki
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Thoralf M Sundt
- Cardiac Surgery Division, Department of Surgery Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Takayuki Niida
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Keishi Suzuki
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Daisuke Kinoshita
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Daichi Fujimoto
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center Los Angeles CA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Iris McNulty
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Toru Naganuma
- Interventional Cardiology Unit New Tokyo Hospital Chiba Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit New Tokyo Hospital Chiba Japan
| | - Eisuke Usui
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Tsunekazu Kakuta
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Ik-Kyung Jang
- Cardiology Division Massachusetts General Hospital, Harvard Medical School Boston MA
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10
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Opara CC, Davey CH, Kityo C, Brinza E, Nazzindah R, Bittencourt MS, Oliveira V, Webel AR, Longenecker CT. Objectively measured physical activity among people with and without HIV in Uganda: associations with cardiovascular risk and coronary artery disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.07.24308634. [PMID: 38883713 PMCID: PMC11178025 DOI: 10.1101/2024.06.07.24308634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Africa has a disproportionate burden of HIV-related cardiovascular disease. We aimed to describe physical activity in people living with HIV (PLHIV) and people without HIV (PWOH) in Uganda and characterize its relationship with the presence of computed tomography angiography-detected (CCTA) coronary artery disease (CAD). Methods We performed a cross-sectional analysis of the Ugandan Study of HIV Effects on the Myocardium and Atherosclerosis using Computed Tomography (mUTIMA-CT) cohort. From 2017-2019, physical activity in PLHIV and PWOH was assessed by accelerometry over seven days. Participants additionally underwent CCTA. Univariable and multivariable modified Poisson regression was used to analyze the relationship between physical activity and CAD presence. Results 168 participants were analyzed. The median (IQR) age was 57 (53-58) years old and 64% were female. Males had more moderate-to-vigorous physical activity per week [68 minutes (12-144) vs 15 minutes (0-50), P<0.001] and less light physical activity [788 minutes (497-1,202) vs [1,059 (730-1490), P=0.001] compared to females, but there was no difference by HIV status. After adjusting for age, which accounted for 10% of the variation in steps taken, and sex, no significant associations were found between physical activity and coronary plaque. Conclusion Objectively measured physical activity was low compared to guideline recommendations, with males being somewhat more active than females and without significant differences by HIV status. Physical activity was not associated with the presence of CAD independently of age and sex.
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Affiliation(s)
- Chinonso C Opara
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, USA
| | | | - Cissy Kityo
- Joint Clinical Research Center, Kampala, Uganda
| | - Ellen Brinza
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, USA
| | | | | | - Vitor Oliveira
- University of Washington School of Nursing, Seattle, WA, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, WA, USA
| | - Chris T Longenecker
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
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11
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Nieman K, García-García HM, Hideo-Kajita A, Collet C, Dey D, Pugliese F, Weissman G, Tijssen JGP, Leipsic J, Opolski MP, Ferencik M, Lu MT, Williams MC, Bruining N, Blanco PJ, Maurovich-Horvat P, Achenbach S. Standards for quantitative assessments by coronary computed tomography angiography (CCTA): An expert consensus document of the society of cardiovascular computed tomography (SCCT). J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00341-1. [PMID: 38849237 DOI: 10.1016/j.jcct.2024.05.232] [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: 03/31/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024]
Abstract
In current clinical practice, qualitative or semi-quantitative measures are primarily used to report coronary artery disease on cardiac CT. With advancements in cardiac CT technology and automated post-processing tools, quantitative measures of coronary disease severity have become more broadly available. Quantitative coronary CT angiography has great potential value for clinical management of patients, but also for research. This document aims to provide definitions and standards for the performance and reporting of quantitative measures of coronary artery disease by cardiac CT.
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Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA, United States.
| | - Hector M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
| | | | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Francesca Pugliese
- NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Room G4-230, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, BC, Canada
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA, United States
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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12
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Khan H, Bansal K, Griffin WF, Cantlay C, Sidahmed A, Nurmohamed NS, Zeman RK, Katz RJ, Blankstein R, Earls JP, Choi AD. Assessment of atherosclerotic plaque burden: comparison of AI-QCT versus SIS, CAC, visual and CAD-RADS stenosis categories. Int J Cardiovasc Imaging 2024; 40:1201-1209. [PMID: 38630211 PMCID: PMC11213790 DOI: 10.1007/s10554-024-03087-x] [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: 10/05/2023] [Accepted: 03/13/2024] [Indexed: 06/29/2024]
Abstract
This study assesses the agreement of Artificial Intelligence-Quantitative Computed Tomography (AI-QCT) with qualitative approaches to atherosclerotic disease burden codified in the multisociety 2022 CAD-RADS 2.0 Expert Consensus. 105 patients who underwent cardiac computed tomography angiography (CCTA) for chest pain were evaluated by a blinded core laboratory through FDA-cleared software (Cleerly, Denver, CO) that performs AI-QCT through artificial intelligence, analyzing factors such as % stenosis, plaque volume, and plaque composition. AI-QCT plaque volume was then staged by recently validated prognostic thresholds, and compared with CAD-RADS 2.0 clinical methods of plaque evaluation (segment involvement score (SIS), coronary artery calcium score (CACS), visual assessment, and CAD-RADS percent (%) stenosis) by expert consensus blinded to the AI-QCT core lab reads. Average age of subjects were 59 ± 11 years; 44% women, with 50% of patients at CAD-RADS 1-2 and 21% at CAD-RADS 3 and above by expert consensus. AI-QCT quantitative plaque burden staging had excellent agreement of 93% (k = 0.87 95% CI: 0.79-0.96) with SIS. There was moderate agreement between AI-QCT quantitative plaque volume and categories of visual assessment (64.4%; k = 0.488 [0.38-0.60]), and CACS (66.3%; k = 0.488 [0.36-0.61]). Agreement between AI-QCT plaque volume stage and CAD-RADS % stenosis category was also moderate. There was discordance at small plaque volumes. With ongoing validation, these results demonstrate a potential for AI-QCT as a rapid, reproducible approach to quantify total plaque burden.
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Affiliation(s)
- Hufsa Khan
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Kopal Bansal
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - William F Griffin
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Cantlay
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Alfateh Sidahmed
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Nick S Nurmohamed
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Robert K Zeman
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Richard J Katz
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Ron Blankstein
- Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - James P Earls
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
- Cleerly Healthcare, Denver, CO, USA
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
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13
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Kawai N, Noda Y, Nakamura F, Kaga T, Suzuki R, Miyoshi T, Mori F, Hyodo F, Kato H, Matsuo M. Low-tube-voltage whole-body CT angiography with extremely low iodine dose: a comparison between hybrid-iterative reconstruction and deep-learning image-reconstruction algorithms. Clin Radiol 2024; 79:e791-e798. [PMID: 38403540 DOI: 10.1016/j.crad.2024.02.002] [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: 09/08/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
AIM To evaluate arterial enhancement, its depiction, and image quality in low-tube potential whole-body computed tomography (CT) angiography (CTA) with extremely low iodine dose and compare the results with those obtained by hybrid-iterative reconstruction (IR) and deep-learning image-reconstruction (DLIR) methods. MATERIALS AND METHODS This prospective study included 34 consecutive participants (27 men; mean age, 74.2 years) who underwent whole-body CTA at 80 kVp for evaluating aortic diseases between January and July 2020. Contrast material (240 mg iodine/ml) with simultaneous administration of its quarter volume of saline, which corresponded to 192 mg iodine/ml, was administered. CT raw data were reconstructed using adaptive statistical IR-Veo of 40% (hybrid-IR), DLIR with medium- (DLIR-M), and high-strength level (DLIR-H). A radiologist measured CT attenuation of the arteries and background noise, and the signal-to-noise ratio (SNR) was then calculated. Two reviewers qualitatively evaluated the arterial depictions and diagnostic acceptability on axial, multiplanar-reformatted (MPR), and volume-rendered (VR) images. RESULTS Mean contrast material volume and iodine weight administered were 64.1 ml and 15.4 g, respectively. The SNRs of the arteries were significantly higher in the following order of the DLIR-H, DLIR-M, and hybrid-IR (p<0.001). Depictions of six arteries on axial, three arteries on MPR, and four arteries on VR images were significantly superior in the DLIR-M or hybrid-IR than in the DLIR-H (p≤0.009 for each). Diagnostic acceptability was significantly better in the DLIR-M and DLIR-H than in the hybrid-IR (p<0.001-0.005). CONCLUSION DLIR-M showed well-balanced arterial depictions and image quality compared with the hybrid-IR and DLIR-H.
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Affiliation(s)
- N Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Y Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - F Nakamura
- Department of Radiology, Gifu Municipal Hospital, 7-1 Kashima, Gifu 500-8513, Japan
| | - T Kaga
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - R Suzuki
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - T Miyoshi
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - F Mori
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - F Hyodo
- Department of Pharmacology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, Japan
| | - H Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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14
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Tandon R, Agakishiev D, Freese RL, Thompson J, Nijjar PS. Heart Rate Lowering for Coronary CTA with Ivabradine in End-Stage Liver Disease. Radiol Cardiothorac Imaging 2024; 6:e230402. [PMID: 38814188 PMCID: PMC11211931 DOI: 10.1148/ryct.230402] [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: 12/22/2023] [Revised: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024]
Abstract
In a study of 282 patients with end-stage liver disease undergoing coronary CT angiography, administration of a single dose of ivabradine (up to 15 mg) was found to be safe and effective at heart rate lowering.
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Affiliation(s)
- Rishabh Tandon
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Dzhalal Agakishiev
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Rebecca L. Freese
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Julie Thompson
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Prabhjot S. Nijjar
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
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15
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Groen RA, van Dijkman PR, Jukema JW, Bax JJ, Lamb HJ, de Graaf MA. Coronary calcifications as assessed on routine non-gated chest CT; a gatekeeper to tailor downstream additional imaging in patients with stable chest pain. IJC HEART & VASCULATURE 2024; 52:101418. [PMID: 38737706 PMCID: PMC11087706 DOI: 10.1016/j.ijcha.2024.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Background and aims Currently applied methods for risk-assessment in coronary artery disease (CAD) often overestimate patients' risk for obstructive CAD. To enhance risk estimation, assessment of coronary artery calcium (CAC) can be applied. In 10 % of patients presenting with stable chest pain a previous non-gated computed tomography (CT) has been performed, suitable for CAC-assessment. This study is the first to investigate the clinical utility of CAC-assessment on non-gated CT for risk-assessment of obstructive CAD in symptomatic patients. Methods For this analysis, all patients referred for coronary computed tomography angiography (CCTA), in whom a previous non-gated chest CT was performed were included. The extent of CAC was assessed on chest CT and ordinally scored. CAD was assessed on CCTA and obstructive CAD defined as stenosis of ≥70 %. Patients were stratified according to CAC-severity and percentages of patients with obstructive CAD were compared between the CAC groups. Results In total, 170 patients of 32-88 years were included and 35 % were male. The percentage of obstructive CAD between the CAC groups differed significantly (p < 0.01). A calcium score of 0 ruled out obstructive CAD irrespective of sex, pre-test probability, type of complaints and number of risk factors with a 100 % certainty. Furthermore, a mild CAC score ruled out obstructive CAD in patients with low - intermediate PTP or non-anginal complaints with 100 % certainty. Conclusion When available, CAC on non-gated chest CT can accurately rule out obstructive CAD and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging in patients presenting with stable chest pain.
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Affiliation(s)
- Roos A. Groen
- Leiden University Medical Center, Department of Cardiology, The Netherlands
| | | | - J. Wouter Jukema
- Leiden University Medical Center, Department of Cardiology, The Netherlands
- Netherlands Heart Institute, Utrecht, Leiden, The Netherlands
| | - Jeroen J. Bax
- Leiden University Medical Center, Department of Cardiology, The Netherlands
| | - Hildo. J. Lamb
- Leiden University Medical Center, Department of Radiology, The Netherlands
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16
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Nurmohamed NS, Cole JH, Budoff MJ, Karlsberg RP, Gupta H, Sullenberger LE, Quesada CG, Rahban H, Woods KM, Uzzilia JR, Purga SL, Aquino M, Hoffmann U, Min JK, Earls JP, Choi AD. Impact of atherosclerosis imaging-quantitative computed tomography on diagnostic certainty, downstream testing, coronary revascularization, and medical therapy: the CERTAIN study. Eur Heart J Cardiovasc Imaging 2024; 25:857-866. [PMID: 38270472 PMCID: PMC11139521 DOI: 10.1093/ehjci/jeae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/26/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. METHODS AND RESULTS In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. CONCLUSION The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Jason H Cole
- Cardiology Associates of Mobile, Mobile, AL, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | - Himanshu Gupta
- Division of Cardiac Imaging, Valley Heart and Vascular Institute, Valley Health System, Ridgewood, NJ, USA
| | | | - Carlos G Quesada
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | | | | | | | | | | | | | - James P Earls
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
- Cleerly Inc., Denver, CO, USA
| | - Andrew D Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
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17
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Liu J, Lv N, Wang J, Zhao J, Li Z, Li Y, Gu Y, Han X, Zhang W, Lu Z, Hou Z, Dang A. Coronary computed tomography angiography-derived total coronary plaque burden associated with subsequent cardiovascular outcomes following percutaneous coronary intervention. Eur Radiol 2024:10.1007/s00330-024-10784-7. [PMID: 38780767 DOI: 10.1007/s00330-024-10784-7] [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: 12/13/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To investigate the association of coronary plaque burden variables derived from coronary computed tomography angiography (CCTA) before patients underwent their first percutaneous coronary intervention (PCI) procedure and major adverse cardiovascular events (MACEs) after PCI. METHODS Patients who underwent CCTA before their first PCI were included retrospectively. A radiologist and a cardiologist analyzed CCTA images on a dedicated workstation. The coronary plaque burden variables included total plaque volume, total percent atheroma volume, volumes and fractions of total low-attenuation plaque, total fibrous plaque, and total calcified plaque. The primary outcomes were MACEs, a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unscheduled coronary revascularization. RESULTS A total of 230 patients were included in the final analysis. During a median follow-up of 4.8 years, 67 MACEs occurred. Total plaque volume, total percent atheroma volume, volumes of total low-attenuation plaque and total fibrous plaque but not their fractions were independent predictors for MACEs. Compared with the first tertiles, the hazard ratio of the third tertile of total plaque volume, total percent atheroma volume, total low-attenuation plaque volume, and total fibrous plaque volume were 2.06 (95% CI: 1.03-4.15), 2.15 (95% CI: 1.02-4.51), 3.04 (95% CI: 1.45-6.36), and 2.23 (95% CI: 1.11-4.46), respectively. Neither total calcified plaque volume nor fraction was associated with MACEs independently. CONCLUSION Selected pre-PCI CCTA-derived variables, including total percent atheroma volume, volumes of total plaque, total low-attenuation plaque and total fibrous plaque, were significantly associated with MACEs after PCI, suggesting that CCTA before PCI reveals the residual risk after revascularization. CLINICAL RELEVANCE STATEMENT The coronary plaque burden variables derived from coronary computed tomography angiography before percutaneous coronary intervention are independently associated with major adverse cardiovascular events, which could be instrumental in optimizing patient management. KEY POINTS Coronary plaque burden is associated with cardiovascular events in patients with coronary artery disease. Selected total plaque burden variables derived from coronary computed tomography angiography before percutaneous coronary intervention were associated with poor prognosis. Routine coronary computed tomography angiography before percutaneous coronary intervention might be helpful in reducing future risks.
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Affiliation(s)
- Jinxing Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Naqiang Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jiangshui Wang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zuozhi Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yifan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yingzhen Gu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xiaorong Han
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wei Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhongfei Lu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Aimin Dang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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18
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Sakamoto T, Usui E, Hoshino M, Hada M, Nagamine T, Hanyu Y, Nogami K, Ueno H, Setoguchi M, Tahara T, Matsuda K, Mineo T, Wakasa N, Sugiyama T, Yonetsu T, Sasano T, Kakuta T. Association of Coronary Computed Tomography-Defined Myocardial Bridge With Pre- and Post-Procedural Fractional Flow Reserve in Patients Undergoing Elective Percutaneous Coronary Intervention. Circ J 2024:CJ-23-0934. [PMID: 38763754 DOI: 10.1253/circj.cj-23-0934] [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] [Indexed: 05/21/2024]
Abstract
BACKGROUND Myocardial bridge (MB) is a common coronary anomaly characterized by a tunneled course through the myocardium. Coronary computed tomography angiography (CCTA) can identify MB. The impact of MB detected by CCTA on coronary physiological parameters before and after percutaneous coronary intervention (PCI) is unknown.Methods and Results: We investigated 141 consecutive patients who underwent pre-PCI CCTA and fractional flow reserve (FFR)-guided elective PCI for de novo single proximal lesions in the left anterior descending artery (LAD). We compared clinical demographics and physiological parameters between patients with and without CCTA-defined MB. MB was identified in 46 (32.6%) patients using pre-PCI CCTA. The prevalence of diabetes was higher among patients with MB. Median post-PCI FFR values were significantly lower among patients with than without MB (0.82 [interquartile range 0.79-0.85] vs. 0.85 [interquartile range 0.82-0.89]; P=0.003), whereas pre-PCI FFR values were similar between the 2 groups. Multivariable linear regression analysis revealed that the presence of MB and greater left ventricular mass volume in the LAD territory were independently associated with lower post-PCI FFR values. Multivariable logistic regression analysis also revealed that the presence of MB and lower pre-PCI FFR values were independent predictors of post-PCI FFR values ≤0.80. CONCLUSIONS CCTA-defined MB independently predicted both lower post-PCI FFR as a continuous variable and ischemic FFR as a categorical variable in patients undergoing elective PCI for LAD.
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Affiliation(s)
- Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Mirei Setoguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tomohiro Tahara
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Takashi Mineo
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Nobutaka Wakasa
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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19
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Yu MM, Wang ML, Wang JJ, Lin BL, Zhao X, Tao XW, Chen YY, Li PY, Zhang JK, Ge JB, Jin H, Zeng MS. Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque. J Am Coll Cardiol 2024; 83:1743-1755. [PMID: 38692827 DOI: 10.1016/j.jacc.2024.03.367] [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: 01/11/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Lipoprotein(a) (Lp[a]) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association has yet to be fully elucidated. OBJECTIVES This multicenter study aimed to investigate whether association between Lp(a) and MI risk is reinforced by the presence of low-attenuation plaque (LAP) identified by coronary computed tomography angiography (CCTA). METHODS In a derivation cohort, a total of 5,607 patients with stable chest pain suspected of coronary artery disease who underwent CCTA and Lp(a) measurement were prospectively enrolled. In validation cohort, 1,122 patients were retrospectively collected during the same period. High Lp(a) was defined as Lp(a) ≥50 mg/dL. The primary endpoint was a composite of time to fatal or nonfatal MI. Associations were estimated using multivariable Cox proportional hazard models. RESULTS During a median follow-up of 8.2 years (Q1-Q3: 7.2-9.3 years), the elevated Lp(a) levels were associated with MI risk (adjusted HR [aHR]: 1.91; 95% CI: 1.46-2.49; P < 0.001). There was a significant interaction between Lp(a) and LAP (Pinteraction <0.001) in relation to MI risk. When stratified by the presence or absence of LAP, Lp(a) was associated with MI in patients with LAP (aHR: 3.03; 95% CI: 1.92-4.76; P < 0.001). Mediation analysis revealed that LAP mediated 73.3% (P < 0.001) for the relationship between Lp(a) and MI. The principal findings remained unchanged in the validation cohort. CONCLUSIONS Elevated Lp(a) augmented the risk of MI during 8 years of follow-up, especially in patients with LAP identified by CCTA. The presence of LAP could reinforce the relationship between Lp(a) and future MI occurrence.
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Affiliation(s)
- Meng-Meng Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ming-Liang Wang
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin-Jin Wang
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Bo-Li Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Zhao
- Department of Cardiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | | | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng-Yang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jing-Kun Zhang
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Radiology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China.
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.
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20
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Mortensen MB, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Thomsen KK, Bøtker HE, Leipsic J, Sand NPR. Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study. J Cardiovasc Comput Tomogr 2024; 18:243-250. [PMID: 38246785 DOI: 10.1016/j.jcct.2024.01.010] [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: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFRCT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. METHODS Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 % coronary stenosis. A per-patient lowest FFRCT-value ≤0.80 represented an abnormal test result. Patients with FFRCT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFRCT) ≥1 vessels with FFRCT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. RESULTS Amongst 769 patients (619 [80 %] stenosis ≥50 %, 510 [66 %] FFRCT ≤0.80), 174 (23 %) reported recurrent angina at follow-up. An FFRCT ≤0.80 vs > 0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 % CI: 1.31-2.52, p < 0.001. Risk of recurrent angina in CR-FFRCT (n = 135) was similar to patients with FFRCT >0.80, 13 % vs 15 %, RR: 0.93; 95 % CI: 0.62-1.40, p = 0.72, while IR-FFRCT (n = 90) and non-revascularized patients with FFRCT ≤0.80 (n = 285) had increased risk, 37 % vs 15 % RR: 2.50; 95 % CI: 1.68-3.73, p < 0.001 and 30 % vs 15 %, RR: 2.03; 95 % CI: 1.44-2.87, p < 0.001, respectively. Use of antianginal medication was similar across study groups. CONCLUSION In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFRCT provides information regarding risk of recurrent angina.
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Affiliation(s)
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | | | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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21
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Lee SE, Hong Y, Hong J, Jung J, Sung JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Leipsic JA, Maffei E, Marques H, Gonçalves PDA, Pontone G, Shin S, Stone PH, Samady H, Virmani R, Narula J, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Prediction of the development of new coronary atherosclerotic plaques with radiomics. J Cardiovasc Comput Tomogr 2024; 18:274-280. [PMID: 38378314 DOI: 10.1016/j.jcct.2024.02.003] [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: 11/20/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Radiomics is expected to identify imaging features beyond the human eye. We investigated whether radiomics can identify coronary segments that will develop new atherosclerotic plaques on coronary computed tomography angiography (CCTA). METHODS From a prospective multinational registry of patients with serial CCTA studies at ≥ 2-year intervals, segments without identifiable coronary plaque at baseline were selected and radiomic features were extracted. Cox models using clinical risk factors (Model 1), radiomic features (Model 2) and both clinical risk factors and radiomic features (Model 3) were constructed to predict the development of a coronary plaque, defined as total PV ≥ 1 mm3, at follow-up CCTA in each segment. RESULTS In total, 9583 normal coronary segments were identified from 1162 patients (60.3 ± 9.2 years, 55.7% male) and divided 8:2 into training and test sets. At follow-up CCTA, 9.8% of the segments developed new coronary plaque. The predictive power of Models 1 and 2 was not different in both the training and test sets (C-index [95% confidence interval (CI)] of Model 1 vs. Model 2: 0.701 [0.690-0.712] vs. 0.699 [0.0.688-0.710] and 0.696 [0.671-0.725] vs. 0.0.691 [0.667-0.715], respectively, all p > 0.05). The addition of radiomic features to clinical risk factors improved the predictive power of the Cox model in both the training and test sets (C-index [95% CI] of Model 3: 0.772 [0.762-0.781] and 0.767 [0.751-0.787], respectively, all p < 00.0001 compared to Models 1 and 2). CONCLUSION Radiomic features can improve the identification of segments that would develop new coronary atherosclerotic plaque. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT0280341.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea; CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Youngtaek Hong
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jongsoo Hong
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Juyeong Jung
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - 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
| | - 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
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Dental and Surgical Sciences, University of Milan, Milan, Italy
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Habib Samady
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, TX, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fay Y Lin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, 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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Schuppert C, Salatzki J, André F, Riffel J, Mangold DL, Melzig C, Hagar MT, Kauczor HU, Weber TF, Rengier F, Do TD. Feasibility of Reduced Iodine Loads for Vascular Assessment Prior to Transcatheter Aortic Valve Implantation (TAVI) Using Spectral Detector CT. Diagnostics (Basel) 2024; 14:879. [PMID: 38732294 PMCID: PMC11082960 DOI: 10.3390/diagnostics14090879] [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: 01/18/2024] [Revised: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
Reduced iodine loads for computed tomography (CT)-based vascular assessment prior to transcatheter aortic valve implantation (TAVI) may be feasible in conjunction with a spectral detector CT scanner. This prospective single-center study considered 100 consecutive patients clinically referred for pre-TAVI CT. They were examined on a dual-layer detector CT scanner to obtain an ECG-gated cardiac scan and a non-ECG-gated aortoiliofemoral scan. Either a standard contrast media (SCM) protocol using 80 mL Iohexol 350 mgI/mL (iodine load: 28 gI) or a body-mass-index adjusted reduced contrast media (RCM) protocol using 40-70 mL Iohexol 350 mgI/mL (iodine load: 14-24.5 gI) were employed. Conventional images and virtual monoenergetic images at 40-80 keV were reconstructed. A threshold of 250 HU was set for sufficient attenuation along the arterial access pathway. A qualitative assessment used a five-point Likert scale. Sufficient attenuation in the thoracic aorta was observed for all patients in both groups using conventional images. In the abdominal, iliac, and femoral segments, sufficient attenuation was observed for the majority of patients when using virtual monoenergetic images (SCM: 96-100% of patients, RCM: 88-94%) without statistical difference between both groups. Segments with attenuation measurements below the threshold remained qualitatively assessable as well. Likert scores were 'excellent' for virtual monoenergetic images 50 keV and 55 keV in both groups (RCM: 1.2-1.4, SCM: 1.2-1.3). With diagnostic image quality maintained, it can be concluded that reduced iodine loads of 14-24.5 gI are feasible for pre-TAVI vascular assessment on a spectral detector CT scanner.
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Affiliation(s)
- Christopher Schuppert
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Janek Salatzki
- Clinic of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Florian André
- Clinic of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology and Angiology, Robert Bosch Hospital, 70376 Stuttgart, Germany
| | - David L. Mangold
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Claudius Melzig
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Hans-Ulrich Kauczor
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Tim F. Weber
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Fabian Rengier
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thuy D. Do
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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23
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Niida T, Kinoshita D, Suzuki K, Yuki H, Fujimoto D, Dey D, Lee H, McNulty I, Ferencik M, Yonetsu T, Kakuta T, Jang IK. Layered plaque is associated with high levels of vascular inflammation and vulnerability in patients with stable angina pectoris. J Thromb Thrombolysis 2024:10.1007/s11239-024-02982-3. [PMID: 38649561 DOI: 10.1007/s11239-024-02982-3] [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] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
Layered plaque, a signature of previous plaque destabilization and healing, is a known predictor for rapid plaque progression; however, the mechanism of which is unknown. The aim of the current study was to compare the level of vascular inflammation and plaque vulnerability in layered plaques to investigate possible mechanisms of rapid plaque progression. This is a retrospective, observational, single-center cohort study. Patients who underwent both coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) for stable angina pectoris (SAP) were selected. Plaques were defined as any tissue (noncalcified, calcified, or mixed) within or adjacent to the lumen. Perivascular inflammation was measured by pericoronary adipose tissue (PCAT) attenuation at the plaque levels on CTA. Features of plaque vulnerability were assessed by OCT. Layered plaques were defined as plaques presenting one or more layers of different optical densities and a clear demarcation from underlying components on OCT. A total of 475 plaques from 195 patients who presented with SAP were included. Layered plaques (n = 241), compared with non-layered plaques (n = 234), had a higher level of vascular inflammation (-71.47 ± 10.74 HU vs. -73.69 ± 10.91 HU, P = 0.026) as well as a higher prevalence of the OCT features of plaque vulnerability, including lipid-rich plaque (83.8% vs. 66.7%, P < 0.001), thin-cap fibroatheroma (26.1% vs. 17.5%, P = 0.026), microvessels (61.8% vs. 34.6%, P < 0.001), and cholesterol crystals (38.6% vs. 25.6%, P = 0.003). Layered plaque was associated with a higher level of vascular inflammation and a higher prevalence of plaque vulnerability, which might play an important role in rapid plaque progression.Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT04523194 .
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Affiliation(s)
- Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daichi Fujimoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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24
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Sperry BW, Vamenta MS, Gunta SP, Thompson RC, Einstein AJ, Castillo M, Chaudhary PD, Bremner LI, Cohen YA, Bateman TM, McGhie AI. Influence of Body Mass Index on Radiation Exposure Across Imaging Modalities in the Evaluation of Chest Pain. J Am Heart Assoc 2024; 13:e033566. [PMID: 38591342 DOI: 10.1161/jaha.123.033566] [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: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Essential to a patient-centered approach to imaging individuals with chest pain is knowledge of differences in radiation effective dose across imaging modalities. Body mass index (BMI) is an important and underappreciated predictor of effective dose. This study evaluated the impact of BMI on estimated radiation exposure across imaging modalities. METHODS AND RESULTS This was a retrospective analysis of patients with concern for cardiac ischemia undergoing positron emission tomography (PET)/computed tomography (CT), cadmium zinc telluride single-photon emission CT (SPECT) myocardial perfusion imaging, or coronary CT angiography (CCTA) using state-of-the-art imaging modalities and optimal radiation-sparing protocols. Radiation exposure was calculated across BMI categories based on established cardiac imaging-specific conversion factors. Among 9046 patients (mean±SD age, 64.3±13.1 years; 55% men; mean±SD BMI, 30.6±6.9 kg/m2), 4787 were imaged with PET/CT, 3092 were imaged with SPECT/CT, and 1167 were imaged with CCTA. Median (interquartile range) radiation effective doses were 4.4 (3.9-4.9) mSv for PET/CT, 4.9 (4.0-6.3) mSv for SPECT/CT, and 6.9 (4.0-11.2) mSv for CCTA. Patients at a BMI <20 kg/m2 had similar radiation effective dose with all 3 imaging modalities, whereas those with BMI ≥20 kg/m2 had the lowest effective dose with PET/CT. Radiation effective dose and variability increased dramatically with CCTA as BMI increased, and was 10 times higher in patients with BMI >45 kg/m2 compared with <20 kg/m2 (median, 26.9 versus 2.6 mSv). After multivariable adjustment, PET/CT offered the lowest effective dose, followed by SPECT/CT, and then CCTA (P<0.001). CONCLUSIONS Although median radiation exposure is modest across state-of-the-art PET/CT, SPECT/CT, and CCTA systems using optimal radiation-sparing protocols, there are significant variations across modalities based on BMI. These data are important for making patient-centered decisions for ischemic testing.
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Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - Mary Stefanie Vamenta
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
- Department of Radiology Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Michelle Castillo
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Priyanka D Chaudhary
- Department of Radiology Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Luca I Bremner
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Vagelos College of Physicians and Surgeons Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Yosef A Cohen
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
- Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - A Iain McGhie
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
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25
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Latkovskis G, Krievins D, Zellans E, Kumsars I, Krievina A, Angena A, Jegere S, Erglis A, Lacis A, Zarins C. Ischemia-Guided Coronary Revascularization Following Lower-Extremity Revascularization Improves 5-Year Survival of Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther 2024:15266028241245909. [PMID: 38616613 DOI: 10.1177/15266028241245909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE To determine whether diagnosis of asymptomatic (silent) coronary ischemia using coronary computed tomography (CT)-derived fractional flow reserve (FFRCT) together with targeted coronary revascularization of ischemia-producing coronary lesions following lower-extremity revascularization can reduce adverse cardiac events and improve long-term survival of patients with chronic limb-threatening ischemia (CLTI). MATERIALS AND METHODS Prospective cohort study of CLTI patients with no cardiac history or symptoms undergoing elective lower-extremity revascularization. Patients with pre-operative coronary computed tomography angiography (CTA) and FFRCT evaluation with selective post-operative coronary revascularization (FFRCT group) were compared with patients with standard pre-operative evaluation and no post-operative coronary revascularization (control group). Lesion-specific coronary ischemia was defined as FFRCT≤0.80 distal to a coronary stenosis with FFRCT≤0.75 indicating severe ischemia. Endpoints included all-cause death, cardiac death, myocardial infarction (MI) and major adverse cardiovascular (CV) events (MACE=CV death, MI, stroke, or unplanned coronary revascularization) during 5 year follow-up. RESULTS In the FFRCT group (n=111), FFRCT analysis revealed asymptomatic (silent) coronary ischemia (FFRCT≤0.80) in 69% of patients, with severe ischemia (FFRCT≤0.75) in 58%, left main ischemia in 8%, and multivessel ischemia in 40% of patients. The status of coronary ischemia in the control group (n=120) was unknown. Following lower-extremity revascularization, 42% of patients in FFRCT had elective coronary revascularization with no elective revascularization in controls. Both groups received guideline-directed medical therapy. During 5 year follow-up, compared with control, the FFRCT group had fewer all-cause deaths (24% vs 47%, hazard ratio [HR]=0.43 [95% confidence interval [CI]=0.27-0.69], p<0.001), fewer cardiac deaths (5% vs 26%, HR=0.18 [95% CI=0.07-0.45], p<0.001), fewer MIs (7% vs 28%, HR=0.21 [95% CI=0.10-0.47], p<0.001), and fewer MACE events (14% vs 39%, HR=0.28 [95% CI=0.15-0.51], p<0.001). CONCLUSIONS Ischemia-guided coronary revascularization of CLTI patients with asymptomatic (silent) coronary ischemia following lower-extremity revascularization resulted in more than 2-fold reduction in all-cause death, cardiac death, MI, and MACE with improved 5 year survival compared with patients with standard cardiac evaluation and care (76% vs 53%, p<0.001). CLINICAL IMPACT Silent coronary ischemia in patients with chronic limb-threatening ischemia (CLTI) is common even in the absence of cardiac history or symptoms. FFRCT is a convenient tool to diagnose silent coronary ischemia perioperatively. Our data suggest that post-surgery elective FFRCT-guided coronary revascularization reduces adverse cardiac events and improves long-term survival in this very-high risk patient group. Randomized study is warranted to finally test this concept.
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Affiliation(s)
- Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Dainis Krievins
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Edgars Zellans
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Indulis Kumsars
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | | | | | - Sanda Jegere
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Aigars Lacis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
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26
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Gould SW, Harty MP, Cartoski M, Krishnan V, Givler N, Ostrowski J, Tsuda T. Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children. Cardiol Young 2024; 34:838-845. [PMID: 37877254 DOI: 10.1017/s1047951123003438] [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] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children. MATERIALS Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability. RESULTS Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval. CONCLUSIONS Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient's body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.
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Affiliation(s)
- Sharon W Gould
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - M Patricia Harty
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Vijay Krishnan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Nicole Givler
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - John Ostrowski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
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27
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Andreini D, Belmonte M, Penicka M, Van Hoe L, Mileva N, Paolisso P, Nagumo S, Nørgaard BL, Ko B, Otake H, Koo BK, Jensen JM, Mizukami T, Munhoz D, Updegrove A, Taylor C, Leipsic J, Sonck J, De Bruyne B, Collet C. Impact of coronary CT image quality on the accuracy of the FFR CT Planner. Eur Radiol 2024; 34:2677-2688. [PMID: 37798406 DOI: 10.1007/s00330-023-10228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/03/2023] [Accepted: 07/30/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess the accuracy of a virtual stenting tool based on coronary CT angiography (CCTA) and fractional flow reserve (FFR) derived from CCTA (FFRCT Planner) across different levels of image quality. MATERIALS AND METHODS Prospective, multicenter, single-arm study of patients with chronic coronary syndromes and lesions with FFR ≤ 0.80. All patients underwent CCTA performed with recent-generation scanners. CCTA image quality was adjudicated using the four-point Likert scale at a per-vessel level by an independent committee blinded to the FFRCT Planner. Patient- and technical-related factors that could affect the FFRCT Planner accuracy were evaluated. The FFRCT Planner was applied mirroring percutaneous coronary intervention (PCI) to determine the agreement with invasively measured post-PCI FFR. RESULTS Overall, 120 patients (123 vessels) were included. Invasive post-PCI FFR was 0.88 ± 0.06 and Planner FFRCT was 0.86 ± 0.06 (mean difference 0.02 FFR units, the lower limit of agreement (LLA) - 0.12, upper limit of agreement (ULA) 0.15). CCTA image quality was assessed as excellent (Likert score 4) in 48.3%, good (Likert score 3) in 45%, and sufficient (Likert score 2) in 6.7% of patients. The FFRCT Planner was accurate across different levels of image quality with a mean difference between FFRCT Planner and invasive post-PCI FFR of 0.02 ± 0.07 in Likert score 4, 0.02 ± 0.07 in Likert score 3 and 0.03 ± 0.08 in Likert score 2, p = 0.695. Nitrate dose ≥ 0.8mg was the only independent factor associated with the accuracy of the FFRCT Planner (95%CI - 0.06 to - 0.001, p = 0.040). CONCLUSION The FFRCT Planner was accurate in predicting post-PCI FFR independent of CCTA image quality. CLINICAL RELEVANCE STATEMENT Being accurate in predicting post-PCI FFR across a wide spectrum of CT image quality, the FFRCT Planner could potentially enhance and guide the invasive treatment. Adequate vasodilation during CT acquisition is relevant to improve the accuracy of the FFRCT Planner. KEY POINTS • The fractional flow reserve derived from coronary CT angiography (FFRCT) Planner is a novel tool able to accurately predict fractional flow reserve after percutaneous coronary intervention. • The accuracy of the FFRCT Planner was confirmed across a wide spectrum of CT image quality. Nitrates dose at CT acquisition was the only independent predictor of its accuracy. • The FFRCT Planner could potentially enhance and guide the invasive treatment.
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Affiliation(s)
- Daniele Andreini
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital, IRCCS, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Medical University of Sofia, Sofia, Bulgaria
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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28
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Holmes KR, Gulsin GS, Fairbairn TA, Hurwitz-Koweek L, Matsuo H, Nørgaard BL, Jensen JM, Sand NPR, Nieman K, Bax JJ, Pontone G, Chinnaiyan KM, Rabbat MG, Amano T, Kawasaki T, Akasaka T, Kitabata H, Rogers C, Patel MR, Payne GW, Leipsic JA, Sellers SL. Impact of Smoking on Coronary Volume-to-Myocardial Mass Ratio: An ADVANCE Registry Substudy. Radiol Cardiothorac Imaging 2024; 6:e220197. [PMID: 38483246 PMCID: PMC11056751 DOI: 10.1148/ryct.220197] [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: 09/17/2022] [Revised: 10/30/2023] [Accepted: 01/26/2024] [Indexed: 04/19/2024]
Abstract
Purpose To examine the relationship between smoking status and coronary volume-to-myocardial mass ratio (V/M) among individuals with coronary artery disease (CAD) undergoing CT fractional flow reserve (CT-FFR) analysis. Materials and Methods In this secondary analysis, participants from the ADVANCE registry evaluated for suspected CAD from July 15, 2015, to October 20, 2017, who were found to have coronary stenosis of 30% or greater at coronary CT angiography (CCTA) were included if they had known smoking status and underwent CT-FFR and V/M analysis. CCTA images were segmented to calculate coronary volume and myocardial mass. V/M was compared between smoking groups, and predictors of low V/M were determined. Results The sample for analysis included 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants). After adjustment for demographic and clinical factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0; P = .002), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5; P = .02). However, both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4; P < .001 [unadjusted] and P = .002 [unadjusted], respectively). Current smoking status (odds ratio [OR], 0.74 [95% CI: 0.59, 0.93]; P = .009), former smoking status (OR, 0.81 [95% CI: 0.68, 0.97]; P = .02), stenosis of 50% or greater (OR, 0.62 [95% CI: 0.52, 0.74]; P < .001), and diabetes (OR, 0.67 [95% CI: 0.56, 0.82]; P < .001) were independent predictors of low V/M. Conclusion Both current and former smoking status were independently associated with low V/M. Keywords: CT Angiography, Cardiac, Heart, Ischemia/Infarction Clinical trial registration no. NCT02499679 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Kenneth R. Holmes
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gaurav S. Gulsin
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Timothy A. Fairbairn
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Lynne Hurwitz-Koweek
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hitoshi Matsuo
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Bjarne L. Nørgaard
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jesper M. Jensen
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Niels-Peter Rønnow Sand
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Koen Nieman
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jeroen J. Bax
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gianluca Pontone
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Kavitha M. Chinnaiyan
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Mark G. Rabbat
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tetsuya Amano
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tomohiro Kawasaki
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Takashi Akasaka
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hironori Kitabata
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Campbell Rogers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Manesh R. Patel
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Geoffrey W. Payne
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jonathon A. Leipsic
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Stephanie L. Sellers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
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Kristiansen CH, Tetteroo PM, Dobrolinska MM, Lauritzen PM, Velthuis BK, Greuter MJW, Suchá D, de Jong PA, van der Werf NR. Halved contrast medium dose coronary dual-layer CT-angiography - phantom study of tube current and patient characteristics. Int J Cardiovasc Imaging 2024; 40:931-940. [PMID: 38386192 PMCID: PMC11052773 DOI: 10.1007/s10554-024-03062-6] [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: 12/25/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
Virtual mono-energetic images (VMI) using dual-layer computed tomography (DLCT) enable substantial contrast medium (CM) reductions. However, the combined impact of patient size, tube voltage, and heart rate (HR) on VMI of coronary CT angiography (CCTA) remains unknown. This phantom study aimed to assess VMI levels achieving comparable contrast-to-noise ratio (CNR) in CCTA at 50% CM dose across varying tube voltages, patient sizes, and HR, compared to the reference protocol (100% CM dose, conventional at 120 kVp). A 5 mm artificial coronary artery with 100% (400 HU) and 50% (200 HU) iodine CM-dose was positioned centrally in an anthropomorphic thorax phantom. Horizontal coronary movement was matched to HR (at 0, < 60, 60-75, > 75 bpm), with varying patient sizes simulated using phantom extension rings. Raw data was acquired using a clinical CCTA protocol at 120 and 140 kVp (five repetitions). VMI images (40-70 keV, 5 keV steps) were then reconstructed; non-overlapping 95% CNR confidence intervals indicated significant differences from the reference. Higher CM-dose, reduced VMI, slower HR, higher tube voltage, and smaller patient sizes demonstrated a trend of higher CNR. Regardless of HR, patient size, and tube voltage, no significant CNR differences were found compared to the reference, with 100% CM dose at 60 keV, or 50% CM dose at 40 keV. DLCT reconstructions at 40 keV from 120 to 140 kVp acquisitions facilitate 50% CM dose reduction for various patient sizes and HR with equivalent CNR to conventional CCTA at 100% CM dose, although clinical validation is needed.
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Affiliation(s)
- C H Kristiansen
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - P M Tetteroo
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M M Dobrolinska
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland
| | - P M Lauritzen
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
- Department of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - B K Velthuis
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D Suchá
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A de Jong
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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Randhawa MK, Takigami AK, Thondapu V, Ranganath PG, Zhang E, Parakh A, Goiffon RJ, Baliyan V, Foldyna B, Lu MT, Tower-Rader A, Meyersohn NM, Hedgire S, Ghoshhajra BB. Selective Use of CT Fractional Flow at a Large Academic Medical Center: Insights from Clinical Implementation after 1 Year of Practice. Radiol Cardiothorac Imaging 2024; 6:e230073. [PMID: 38573127 PMCID: PMC11056747 DOI: 10.1148/ryct.230073] [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: 03/16/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician's discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Vikas Thondapu
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Praveen G. Ranganath
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Eric Zhang
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Anushri Parakh
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Reece J. Goiffon
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Vinit Baliyan
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Borek Foldyna
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Michael T. Lu
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Albree Tower-Rader
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Nandini M. Meyersohn
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Sandeep Hedgire
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Brian B. Ghoshhajra
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
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31
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Stanley GA, Scherer MD, Hajostek MM, Yammine H, Briggs CS, CrespoSoto HO, Nussbaum T, Arko FR. Utilization of coronary computed tomography angiography and computed tomography-derived fractional flow reserve in a critical limb-threatening ischemia cohort. J Vasc Surg Cases Innov Tech 2024; 10:101272. [PMID: 38435790 PMCID: PMC10907840 DOI: 10.1016/j.jvscit.2023.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/23/2023] [Indexed: 03/05/2024] Open
Abstract
Objective Patients with peripheral arterial disease (PAD) have a significant risk of myocardial infarction and death secondary to concomitant coronary artery disease (CAD). This is particularly true in patients with critical limb-threatening ischemia (CLTI) who exceed a 20% mortality rate at 6 months despite standard treatment with risk factor modification. Although systematic preoperative coronary testing is not recommended for patients with PAD without cardiac symptoms, the clinical manifestations of CAD are often muted in patients with CLTI due to poor mobility and activity intolerance. Thus, the true incidence and impact of "silent" CAD in a CLTI cohort is unknown. This study aims to determine the prevalence of ischemia-producing coronary artery stenosis in a CLTI cohort using coronary computed tomography angiography (cCTA) and computed tomography (CT)-derived fractional flow reserve (FFRCT), a noninvasive imaging modality that has shown significant correlation to cardiac catheterization in the detection of clinically relevant coronary ischemia. Methods Patients presenting with newly diagnosed CLTI at our institution from May 2020 to April 2021 were screened for underlying CAD. Included subjects had no known history of CAD, no cardiac symptoms, and no anginal equivalent complaints at presentation. Patients underwent cCTA and FFRCT evaluation and were classified by the anatomic location and severity of CAD. Significant coronary ischemia was defined as FFRCT ≤0.80 distal to a >30% coronary stenosis, and severe coronary ischemia was documented at FFRCT ≤0.75, consistent with established guidelines. Results A total of 170 patients with CLTI were screened; 65 patients (38.2%) had no coronary symptoms and met all inclusion/exclusion criteria. Twenty-four patients (31.2%) completed cCTA and FFRCT evaluation. Forty-one patients have yet to complete testing secondary to socioeconomic factors (insurance denial, transportation inaccessibility, testing availability, etc). The mean age of included subjects was 65.4 ± 7.0 years, and 15 (62.5%) were male. Patients presented with ischemic rest pain (n = 7; 29.1%), minor tissue loss (n = 14; 58.3%) or major tissue loss (n = 3; 12.5%). Significant (≥50%) coronary artery stenosis was noted on cCTA in 19 of 24 patients (79%). Significant left main coronary artery stenosis was identified in two patients (10%). When analyzed with FFRCT, 17 patients (71%) had hemodynamically significant coronary ischemia (FFRCT ≤0.8), and 54% (n = 13) had lesion-specific severe coronary ischemia (FFRCT ≤0.75). The mean FFRCT in patients with coronary ischemia was 0.70 ± 0.07. Multi-vessel disease pattern was present in 53% (n = 9) of patients with significant coronary stenosis. Conclusions The use of cCTA-derived fractional flow reserve demonstrates a significant percentage of patients with CLTI have silent (asymptomatic) coronary ischemia. More than one-half of these patients have lesion-specific severe ischemia, which may be associated with increased mortality when treated solely with risk factor modification. cCTA and FFRCT diagnosis of significant coronary ischemia has the potential to improve cardiac care, perioperative morbidity, and long-term survival curves of patients with CLTI. Systemic improvements in access to care will be needed to allow for broad application of these imaging assessments should they prove universally valuable. Additional study is required to determine the benefit of selective coronary revascularization in patients with CLTI.
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Affiliation(s)
| | | | | | - Halim Yammine
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | | | | | - Tzvi Nussbaum
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Frank R. Arko
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
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32
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Pontone G, Rossi A, Baggiano A, Andreini D, Conte E, Fusini L, Gebhard C, Rabbat MG, Guaricci A, Guglielmo M, Muscogiuri G, Mushtaq S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Lee SE, Maffei E, Marques H, Samady H, Shin S, Sung JM, van Rosendael A, Virmani R, Bax JJ, Leipsic JA, Lin FY, Min JK, Narula J, Shaw LJ, Chang HJ. Progression of non-obstructive coronary plaque: a practical CCTA-based risk score from the PARADIGM registry. Eur Radiol 2024; 34:2665-2676. [PMID: 37750979 DOI: 10.1007/s00330-023-09880-x] [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: 09/18/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES No clear recommendations are endorsed by the different scientific societies on the clinical use of repeat coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). This study aimed to develop and validate a practical CCTA risk score to predict medium-term disease progression in patients at a low-to-intermediate probability of CAD. METHODS Patients were part of the Progression of AtheRosclerotic PlAque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry. Specifically, 370 (derivation cohort) and 219 (validation cohort) patients with two repeat, clinically indicated CCTA scans, non-obstructive CAD, and absence of high-risk plaque (≥ 2 high-risk features) at baseline CCTA were included. Disease progression was defined as the new occurrence of ≥ 50% stenosis and/or high-risk plaque at follow-up CCTA. RESULTS In the derivation cohort, 104 (28%) patients experienced disease progression. The median time interval between the two CCTAs was 3.3 years (2.7-4.8). Odds ratios for disease progression derived from multivariable logistic regression were as follows: 4.59 (95% confidence interval: 1.69-12.48) for the number of plaques with spotty calcification, 3.73 (1.46-9.52) for the number of plaques with low attenuation component, 2.71 (1.62-4.50) for 25-49% stenosis severity, 1.47 (1.17-1.84) for the number of bifurcation plaques, and 1.21 (1.02-1.42) for the time between the two CCTAs. The C-statistics of the model were 0.732 (0.676-0.788) and 0.668 (0.583-0.752) in the derivation and validation cohorts, respectively. CONCLUSIONS The new CCTA-based risk score is a simple and practical tool that can predict mid-term CAD progression in patients with known non-obstructive CAD. CLINICAL RELEVANCE STATEMENT The clinical implementation of this new CCTA-based risk score can help promote the management of patients with non-obstructive coronary disease in terms of timing of imaging follow-up and therapeutic strategies. KEY POINTS • No recommendations are available on the use of repeat CCTA in patients with non-obstructive CAD. • This new CCTA score predicts mid-term CAD progression in patients with non-obstructive stenosis at baseline. • This new CCTA score can help guide the clinical management of patients with non-obstructive CAD.
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Affiliation(s)
- Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Edoardo Conte
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Chaterine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Edward Hines Jr. VA Hospital, Hines, Chicago, IL, USA
| | - Andrea Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, Bari, Italy
| | - Marco Guglielmo
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal
- NOVA Medical School, Lisbon, 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
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - 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, Seoul, South Korea
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR, Marche, Urbino, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Ji Min Sung
- Yonsei‑Cedars‑Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Alexander van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Turku Heart Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, 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
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Hyuk-Jae Chang
- Yonsei‑Cedars‑Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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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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34
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Lu MT, Ribaudo H, Foldyna B, Zanni MV, Mayrhofer T, Karady J, Taron J, Fitch KV, McCallum S, Burdo TH, Paradis K, Hedgire SS, Meyersohn NM, DeFilippi C, Malvestutto CD, Sturniolo A, Diggs M, Siminski S, Bloomfield GS, Alston-Smith B, Desvigne-Nickens P, Overton ET, Currier JS, Aberg JA, Fichtenbaum CJ, Hoffmann U, Douglas PS, Grinspoon SK. Effects of Pitavastatin on Coronary Artery Disease and Inflammatory Biomarkers in HIV: Mechanistic Substudy of the REPRIEVE Randomized Clinical Trial. JAMA Cardiol 2024; 9:323-334. [PMID: 38381407 PMCID: PMC10882511 DOI: 10.1001/jamacardio.2023.5661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024]
Abstract
Importance Cardiovascular disease (CVD) is increased in people with HIV (PWH) and is characterized by premature noncalcified coronary plaque. In the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), pitavastatin reduced major adverse cardiovascular events (MACE) by 35% over a median of 5.1 years. Objective To investigate the effects of pitavastatin on noncalcified coronary artery plaque by coronary computed tomography angiography (CTA) and on inflammatory biomarkers as potential mechanisms for MACE prevention. Design, Setting, and Participants This double-blind, placebo-controlled randomized clinical trial enrolled participants from April 2015 to February 2018 at 31 US clinical research sites. PWH without known CVD who were taking antiretroviral therapy and had low to moderate 10-year CVD risk were included. Data were analyzed from April to November 2023. Intervention Oral pitavastatin calcium, 4 mg per day. Main Outcomes and Measures Coronary CTA and inflammatory biomarkers at baseline and 24 months. The primary outcomes were change in noncalcified coronary plaque volume and progression of noncalcified plaque. Results Of 804 enrolled persons, 774 had at least 1 evaluable CTA. Plaque changes were assessed in 611 who completed both CT scans. Of 611 analyzed participants, 513 (84.0%) were male, the mean (SD) age was 51 (6) years, and the median (IQR) 10-year CVD risk was 4.5% (2.6-7.0). A total of 302 were included in the pitavastatin arm and 309 in the placebo arm. The mean noncalcified plaque volume decreased with pitavastatin compared with placebo (mean [SD] change, -1.7 [25.2] mm3 vs 2.6 [27.1] mm3; baseline adjusted difference, -4.3 mm3; 95% CI, -8.6 to -0.1; P = .04; 7% [95% CI, 1-12] greater reduction relative to placebo). A larger effect size was seen among the subgroup with plaque at baseline (-8.8 mm3 [95% CI, -17.9 to 0.4]). Progression of noncalcified plaque was 33% less likely with pitavastatin compared with placebo (relative risk, 0.67; 95% CI, 0.52-0.88; P = .003). Compared with placebo, the mean low-density lipoprotein cholesterol decreased with pitavastatin (mean change: pitavastatin, -28.5 mg/dL; 95% CI, -31.9 to -25.1; placebo, -0.8; 95% CI, -3.8 to 2.2). The pitavastatin arm had a reduction in both oxidized low-density lipoprotein (-29% [95% CI, -32 to -26] vs -13% [95% CI, -17 to -9]; P < .001) and lipoprotein-associated phospholipase A2 (-7% [95% CI, -11 to -4] vs 14% [95% CI, 10-18]; P < .001) compared with placebo at 24 months. Conclusions and Relevance In PWH at low to moderate CVD risk, 24 months of pitavastatin reduced noncalcified plaque volume and progression as well as markers of lipid oxidation and arterial inflammation. These changes may contribute to the observed MACE reduction in REPRIEVE. Trial Registration ClinicalTrials.gov Identifier: NCT02344290.
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Affiliation(s)
- Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Julia Karady
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sara McCallum
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tricia H. Burdo
- Department of Microbiology, Immunology, and Inflammation, Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Kayla Paradis
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sandeep S. Hedgire
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Nandini M. Meyersohn
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Audra Sturniolo
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marissa Diggs
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Gerald S. Bloomfield
- Department of Medicine, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Beverly Alston-Smith
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham
- ViiV Healthcare, Research Triangle Park, North Carolina
| | - Judith S. Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles
| | - Judith A. Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Pamela S. Douglas
- Duke University Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
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Nonaka H, Yahagi K, Komiyama K, Gonda Y, Horiuchi Y, Asami M, Yuzawa H, Tanaka J, Aoki J, Tanabe K. Valuable Predictors for Non-measurability of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography. Cureus 2024; 16:e59227. [PMID: 38807808 PMCID: PMC11130537 DOI: 10.7759/cureus.59227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Background The fractional flow reserve (FFR) derived from coronary computed tomography (CT) angiography (FFRCT) is a variable tool for coronary disease diagnosis that non-invasively provides the value of FFR. It can add physiological information to coronary CT angiography (CCTA) and reduce unnecessary invasive coronary angiography (CAG). However, it cannot be analyzed in some cases, which is also called "non-measurability." While FFRCT has become globally widespread, the current data on non-measurability are lacking. This study aimed to determine the rate of non-measurability and identify predictors thereof in routine clinical settings to explore potential approaches to reduce the non-measurability rate. Methods and results This retrospective observational single-center study included consecutive patients who underwent FFRCTanalysis in Japan. The mean age of the overall population was 71.3 ± 10.6, and an FFRCTof ≤0.8 was seen in 47.6% of patients with a measurable FFRCT. Of the 307 enrolled patients, FFRCT analysis was not feasible in 21 cases (6.8%). Heart rate (HR) at a CT scan and coronary calcium scores (CCS) were significantly higher in patients with non-measurability than those in patients whose FFRCT was appropriately analyzed (HR: 69.6±8.9 bpm vs. 61.0±11.1 bpm; p < 0.01; CCS; 931.2 (290.8, 1451.3) vs. 322.9 (100.7, 850.0); p < 0.01). Multiple logistic regression showed that HR was an independent predictor for non-measurability (odds ratio: 1.05; 95% confidential interval: 1.02, 1.09; p < 0.01)). Based on the receiver operating characteristic curve analysis, the optimal cut-off value of HR and CCS was 63 bpm (specificity: 67.1%; sensitivity: 76.2%) and 729.2 (specificity: 71.3%; sensitivity: 66.7%). In addition, the combination of two features (HR > 63 bpm and CCS > 729.2) showed a high negative predictive value (99.3%) for FFRCT non-measurability. Conclusions In this study, the rate of FFRCTnon-measurability was 6.8%. Higher HR at a CT scan and CCS were significantly associated with non-measurability, and in cases with both HR and CCS below a specified threshold, the likelihood of ruling out non-measurability could be significantly high. Our findings suggest that reducing the HR to ideally under 63 bpm at the time of the CT scan significantly ensures feasibility. Further study on large-scale cohorts is warranted.
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Affiliation(s)
- Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Yuki Gonda
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, JPN
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36
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Vattay B, Boussoussou M, Vecsey-Nagy M, Kolossváry M, Juhász D, Kerkovits N, Balogh H, Nagy N, Vértes M, Kiss M, Kubovje A, Merkely B, Maurovich Horvat P, Szilveszter B. Qualitative and quantitative image quality of coronary CT angiography using photon-counting computed tomography: Standard and Ultra-high resolution protocols. Eur J Radiol 2024; 175:111426. [PMID: 38493558 DOI: 10.1016/j.ejrad.2024.111426] [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: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE We aimed to identify the optimal reconstruction settings based on qualitative and quantitative image quality parameters on standard and ultra-high resolution (UHR) images using photon-counting CT (PCCT). METHOD We analysed 45 patients, 29 with standard and 16 with UHR acquisition, applying both smoother and sharper kernel settings. Coronary CT angiography images were performed on a dual-source PCCT system using standard (0.4/0.6 mm slice thickness, Bv40/Bv44 kernels, QIR levels 0-4) or UHR acquisition (0.2/0.4 mm slice thickness, Bv44/Bv56 kernels, QIR levels 0-4). Qualitative image quality was assessed using a 4-point Likert scale. Image noise (SD), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated in both the proximal and distal segments. RESULTS On standard resolution, larger slice thickness resulted in an average increase of 12.5 % in CNR, whereas sharper kernel led to an average 8.7 % decrease in CNR. Highest CNR was measured on 0.6 mm, Bv40, QIR4 images and lowest on 0.4 mm, Bv44, QIR0 images: 25.8 ± 4.1vs.8.3 ± 1.6 (p < 0.001). On UHR images, highest CNR was observed on 0.4 mm, Bv40, QIR4 and lowest on 0.2 mm, Bv56 and QIR0 images: 21.5 ± 3.9vs.3.6 ± 0.8 (p < 0.001). Highest qualitative image quality was found on images with Bv44 kernel and QIR level 3/4 with both slice thicknesses on standard reconstruction. Additionally, Bv56 with QIR4 on 0.2 mm slice thickness images showed highest subjective image quality. Preserved distal vessel visualization was detected using QIR 2-4, Bv56 and 0.2 mm slice thickness. CONCLUSIONS Photon-counting CT demonstrated high qualitative and quantitative image quality for the assessment of coronaries and stents.
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Affiliation(s)
- Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Melinda Boussoussou
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29 Haller Utca, 1096, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi Ut 96/B, 1034, Budapest, Hungary
| | - Dénes Juhász
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Nóra Kerkovits
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Hanna Balogh
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Norbert Nagy
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Miklós Vértes
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Máté Kiss
- Siemens Healthcare GmbH, Forchheim, Germany
| | - Anikó Kubovje
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Pál Maurovich Horvat
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary.
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37
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Jian W, Shen X, Zheng Z, Wu Z, Shi Y, Liu J. Association Between Red Blood Cell Distribution Width and Coronary Calcification in Patients Referred for Invasive Coronary Angiography. Angiology 2024:33197241238509. [PMID: 38468156 DOI: 10.1177/00033197241238509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
This study aimed to determine whether red cell distribution width (RDW) is associated with coronary calcification. A total of 4796 patients who underwent coronary computed tomography angiography and subsequent invasive coronary angiography were consecutively enrolled. Coronary artery calcium score (CACS), demographic, clinical, and laboratory data were collected from electronic medical records. RDW were expressed in two forms, as a coefficient of variation (CV) or as a standard deviation (SD). Multivariable ordinal logistic regression was used to investigate the association of RDW with CACS grades (CACS 0-99, 100-399, 400-999, and >1000). A significant association was found between elevated RDW-SD and higher CACS grades after full adjustment (adjusted OR per 1-SD increase: 1.11, 95% CI: 1.05-1.18; P < .001), while no significant association was found between RDW-CV and CACS grades. When RDW-SD was analyzed as a categorical variable, it was primarily the 4th quartile of RDW-SD that was associated with elevated CACS grades compared with the 1st quartile (adjusted OR: 1.25, 95% CI: 1.07-1.46; P = .006), while the 2nd and 3rd quartiles showed no significantly higher risk. RDW-SD is a more robust biomarker for coronary calcification compared with RDW-CV.
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Affiliation(s)
- Wen Jian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Xueqian Shen
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Zheng Wu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
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38
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Flores Tomasino G, Han D, Pimentel R, Paz W, Liang J, Cheng VY, Slomka P, Berman DS, Dey D. Reproducibility of artificial intelligence-enabled plaque measurements between systolic and diastolic phases from coronary computed tomography angiography. Eur Radiol 2024:10.1007/s00330-024-10688-6. [PMID: 38466392 DOI: 10.1007/s00330-024-10688-6] [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: 07/20/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Current coronary CT angiography (CTA) guidelines suggest both end-systolic and mid-diastolic phases of the cardiac cycle can be used for CTA image acquisition. However, whether differences in the phase of the cardiac cycle influence coronary plaque measurements is not known. We aim to explore the potential impact of cardiac phases on quantitative plaque assessment. METHODS We enrolled 39 consecutive patients (23 male, age 66.2 ± 11.5 years) who underwent CTA with dual-source CT with visually evident coronary atherosclerosis and with good image quality. End-systolic and mid- to late-diastolic phase images were reconstructed from the same CTA scan. Quantitative plaque and stenosis were analyzed in both systolic and diastolic images using artificial intelligence (AI)-enabled plaque analysis software (Autoplaque). RESULTS Overall, 186 lesions from 39 patients were analyzed. There were excellent agreement and correlation between systolic and diastolic images for all plaque volume measurements (Lin's concordance coefficient ranging from 0.97 to 0.99; R ranging from 0.96 to 0.98). There were no substantial intrascan differences per patient between systolic and diastolic phases (p > 0.05 for all) for total (1017.1 ± 712.9 mm3 vs. 1014.7 ± 696.2 mm3), non-calcified (861.5 ± 553.7 mm3 vs. 856.5 ± 528.7 mm3), calcified (155.7 ± 229.3 mm3 vs. 158.2 ± 232.4 mm3), and low-density non-calcified plaque volume (151.4 ± 106.1 mm3 vs. 151.5 ± 101.5 mm3) and diameter stenosis (42.5 ± 18.4% vs 41.3 ± 15.1%). CONCLUSION Excellent agreement and no substantial differences were observed in AI-enabled quantitative plaque measurements on CTA in systolic and diastolic images. Following further validation, standardized plaque measurements can be performed from CTA in systolic or diastolic cardiac phase. CLINICAL RELEVANCE STATEMENT Quantitative plaque assessment using artificial intelligence-enabled plaque analysis software can provide standardized plaque quantification, regardless of cardiac phase. KEY POINTS • The impact of different cardiac phases on coronary plaque measurements is unknown. • Plaque analysis using artificial intelligence-enabled software on systolic and diastolic CT angiography images shows excellent agreement. • Quantitative coronary artery plaque assessment can be performed regardless of cardiac phase.
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Affiliation(s)
- Guadalupe Flores Tomasino
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Donghee Han
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Raymond Pimentel
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - William Paz
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Juni Liang
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA.
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Belmonte M, Paolisso P, Gallinoro E, Bertolone DT, Caglioni S, Leone A, De Colle C, Viscusi MM, Bermpeis K, Storozhenko T, Mileva N, Sonck J, Wyffels E, Vanderheyden M, Collet C, De Bruyne B, Andreini D, Penicka M, Barbato E. Predictors of percutaneous coronary intervention derived from CCTA in patients with chronic coronary syndrome. J Cardiovasc Comput Tomogr 2024; 18:154-161. [PMID: 38238196 DOI: 10.1016/j.jcct.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND To identify anatomical and morphological plaque features predictors of PCI and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFRCT (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFRCT) when integrated into the score. METHODS Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFRCT available, referred to invasive coronary angiogram and assessment of fractional flow reserve. Plaque analysis was performed using validated semi-automated software. Logistic regression was performed to identify anatomical and morphological plaque features predictive of PCI. Optimal thresholds were defined by area under the receiver-operating characteristics curve (AUC) analysis. A scoring system was developed in a derivation cohort (70 % of the study population) and tested in a validation cohort (30 % of patients). RESULTS The overall study population included 340 patients (455 vessels), among which 238 patients (320 vessels) were included in the derivation cohort. At multivariate logistic regression analysis, absence of left main disease, diameter stenosis (DS), non-calcified plaque (NCP) volume, and percent atheroma volume (PAV) were independent predictors of PCI. Optimal thresholds were: DS ≥ 50 %, volume of NCP>113 mm3 and PAV>17 %. A weighted score (CT-PCI Score) ranging from 0 to 11 was obtained. The AUC of the score was 0.80 (95%CI 0.74-0.86). The integration of ΔFFRCT in the CT-PCI score led to a mild albeit not significant increase in the AUC (0.82, 95%CI 0.77-0.87, p = 0.328). CONCLUSIONS Plaque anatomy and morphology derived from CCTA could aid in identifying patients amenable to PCI.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor", Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
| | - Emanuele Barbato
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy.
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Broncano J, Rajiah PS, Vargas D, Sánchez-Alegre ML, Ocazionez-Trujillo D, Bhalla S, Williamson E, Fernández-Camacho JC, Luna A. Multimodality Imaging of Infective Endocarditis. Radiographics 2024; 44:e230031. [PMID: 38329903 DOI: 10.1148/rg.230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Prabhakar Shanta Rajiah
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Maria Luisa Sánchez-Alegre
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Ocazionez-Trujillo
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - José Carlos Fernández-Camacho
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
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Çap M, Ramasamy A, Parasa R, Tanboga IH, Maung S, Morgan K, Yap NAL, Abou Gamrah M, Sokooti H, Kitslaar P, Reiber JHC, Dijkstra J, Torii R, Moon JC, Mathur A, Baumbach A, Pugliese F, Bourantas CV. Efficacy of human experts and an automated segmentation algorithm in quantifying disease pathology in coronary computed tomography angiography: A head-to-head comparison with intravascular ultrasound imaging. J Cardiovasc Comput Tomogr 2024; 18:142-153. [PMID: 38143234 DOI: 10.1016/j.jcct.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/26/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) analysis is currently performed by experts and is a laborious process. Fully automated edge-detection methods have been developed to expedite CCTA segmentation however their use is limited as there are concerns about their accuracy. This study aims to compare the performance of an automated CCTA analysis software and the experts using near-infrared spectroscopy-intravascular ultrasound imaging (NIRS-IVUS) as a reference standard. METHODS Fifty-one participants (150 vessels) with chronic coronary syndrome who underwent CCTA and 3-vessel NIRS-IVUS were included. CCTA analysis was performed by an expert and an automated edge detection method and their estimations were compared to NIRS-IVUS at a segment-, lesion-, and frame-level. RESULTS Segment-level analysis demonstrated a similar performance of the two CCTA analyses (conventional and automatic) with large biases and limits of agreement compared to NIRS-IVUS estimations for the total atheroma (ICC: 0.55 vs 0.25, mean difference:192 (-102-487) vs 243 (-132-617) and percent atheroma volume (ICC: 0.30 vs 0.12, mean difference: 12.8 (-5.91-31.6) vs 20.0 (0.79-39.2). Lesion-level analysis showed that the experts were able to detect more accurately lesions than the automated method (68.2 % and 60.7 %) however both analyses had poor reliability in assessing the minimal lumen area (ICC 0.44 vs 0.36) and the maximum plaque burden (ICC 0.33 vs 0.33) when NIRS-IVUS was used as the reference standard. CONCLUSIONS Conventional and automated CCTA analyses had similar performance in assessing coronary artery pathology using NIRS-IVUS as a reference standard. Therefore, automated segmentation can be used to expedite CCTA analysis and enhance its applications in clinical practice.
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Affiliation(s)
- Murat Çap
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Ramya Parasa
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Ibrahim H Tanboga
- Istanbul Nisantasi University Medical School, Department of Cardiology & Biostatistics, Istanbul, Turkey
| | - Soe Maung
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Kimberley Morgan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Nathan A L Yap
- Barts and the London School of Medicine and Dentistry, London, UK
| | | | | | | | - Johan H C Reiber
- Medis Medical Imaging, Leiden, the Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
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42
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Tsugu T, Tanaka K, Belsack D, Nagatomo Y, Tsugu M, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery. Eur Radiol 2024; 34:1836-1845. [PMID: 37658136 PMCID: PMC10873436 DOI: 10.1007/s00330-023-09972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Computed tomography (CT)-derived fractional flow reserve (FFRCT) decreases continuously from proximal to distal segments of the vessel due to the influence of various factors even in non-obstructive coronary artery disease (NOCAD). It is known that FFRCT is dependent on vessel-length, but the relationship with other vessel morphologies remains to be explained. PURPOSE To investigate morphological aspects of the vessels that influence FFRCT in NOCAD in the right coronary artery (RCA). METHODS A total of 443 patients who underwent both FFRCT and invasive coronary angiography, with < 50% RCA stenosis, were evaluated. Enrolled RCA vessels were classified into two groups according to distal FFRCT: FFRCT ≤ 0.80 (n = 60) and FFRCT > 0.80 (n = 383). Vessel morphology (vessel length, lumen diameter, lumen volume, and plaque volume) and left-ventricular mass were assessed. The ratio of lumen volume and vessel length was defined as V/L ratio. RESULTS Whereas vessel-length was almost the same between FFRCT ≤ 0.80 and > 0.80, lumen volume and V/L ratio were significantly lower in FFRCT ≤ 0.80. Distal FFRCT correlated with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). Among all vessel-related parameters, V/L ratio showed the highest correlation with distal FFRCT (r = 0.61, p < 0.0001). Multivariable analysis showed that calcified plaque volume was the strongest predictor of distal FFRCT, followed by V/L ratio (β-coefficient = 0.48, p = 0.03). V/L ratio was the strongest predictor of a distal FFRCT ≤ 0.80 (cut-off 8.1 mm3/mm, AUC 0.88, sensitivity 90.0%, specificity 76.7%, 95% CI 0.84-0.93, p < 0.0001). CONCLUSIONS Our study suggests that V/L ratio can be a measure to predict subclinical coronary perfusion disturbance. CLINICAL RELEVANCE STATEMENT A novel marker of the ratio of lumen volume to vessel length (V/L ratio) is the strongest predictor of a distal CT-derived fractional flow reserve (FFRCT) and may have the potential to improve the diagnostic accuracy of FFRCT. KEY POINTS • Physiological FFRCT decline depends not only on vessel length but also on the lumen volume in non-obstructive coronary artery disease in the right coronary artery. • FFRCT correlates with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). • Of vessel-related parameters, V/L ratio is the strongest predictor of a distal FFRCT and an optimal cut-off value of 8.1 mm3/mm.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Mayuko Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
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Jian W, Dong Z, Shen X, Zheng Z, Wu Z, Shi Y, Han Y, Du J, Liu J. Machine learning-based coronary artery calcium score predicted from clinical variables as a prognostic indicator in patients referred for invasive coronary angiography. Eur Radiol 2024:10.1007/s00330-024-10629-3. [PMID: 38337067 DOI: 10.1007/s00330-024-10629-3] [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: 12/14/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Utilising readily available clinical variables, we aimed to develop and validate a novel machine learning (ML) model to predict severe coronary calcification, and further assessed its prognostic significance. METHODS This retrospective study enrolled patients who underwent coronary CT angiography and subsequent invasive coronary angiography. Multiple ML algorithms were used to train the models for predicting severe coronary calcification (cardiac CT-measured coronary artery calcium [CT-CAC] score ≥ 400). The ML-based CAC (ML-CAC) score derived from the ML predictive probability was stratified into quartiles for prognostic analysis. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS Overall, 5785 patients were divided into training (80%) and test sets (20%). For clinical practicability, we selected the nine-feature support vector machine model with good and satisfactory performance regarding both discrimination and calibration based on five repetitions of the 10-fold cross-validation in the training set (mean AUC = 0.715, Brier score = 0.202), and based on the test in the test set (AUC = 0.753, Brier score = 0.191). In the test set cohort (n = 1137), the primary endpoint was observed in 50 (4.4%) patients during a median 2.8 years' follow-up. The ML-CAC system was significantly associated with an increased risk of the primary endpoint (adjusted hazard ratio for trend 2.26, 95% CI 1.35-3.79, p = 0.002). There was no significant difference in the prognostic value between the ML-CAC and CT-CAC systems (C-index, 0.67 vs. 0.69; p = 0.618). CONCLUSION ML-CAC score predicted from clinical variables can serve as a novel prognostic indicator in patients referred for invasive coronary angiography. CLINICAL RELEVANCE STATEMENT In patients referred for invasive coronary angiography who have not undergone preoperative CT-measured coronary artery calcium scoring, machine learning-based coronary artery calcium score assessment can serve as an alternative for predicting the prognosis. KEY POINTS • The coronary artery calcium (CAC) score, a solid prognostic indicator, can be predicted using non-CT methods. • We developed a machine learning (ML)-CAC model utilising nine clinical variables to predict severe coronary calcification. • The ML-CAC system offers significant prognostic value in patients referred for invasive coronary angiography.
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Affiliation(s)
- Wen Jian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Zhujun Dong
- Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xueqian Shen
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Zheng Wu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Yingchun Han
- Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jie Du
- Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital of Capital Medical University, Beijing, China.
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Yamamoto T, Kawamori H, Toba T, Sasaki S, Fujii H, Hamana T, Osumi Y, Iwane S, Naniwa S, Sakamoto Y, Matsuhama K, Fukuishi Y, Hirata K, Otake H. Impact of Pericoronary Adipose Tissue Attenuation on Periprocedural Myocardial Injury in Patients With Chronic Coronary Syndrome. J Am Heart Assoc 2024; 13:e031209. [PMID: 38240235 PMCID: PMC11056154 DOI: 10.1161/jaha.123.031209] [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: 05/30/2023] [Accepted: 11/15/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perivascular inflammation contributes to the development of atherosclerosis and microcirculatory dysfunction. Pericoronary adipose tissue (PCAT) attenuation, measured by coronary computed tomography angiography, is a potential indicator of coronary inflammation. However, the relationship between PCAT attenuation, microcirculatory dysfunction, and periprocedural myocardial injury (PMI) remains unclear. METHODS AND RESULTS Patients with chronic coronary syndrome who underwent coronary computed tomography angiography before percutaneous coronary intervention were retrospectively identified. PCAT attenuation and adverse plaque characteristics were assessed using coronary computed tomography angiography. The extent of microcirculatory dysfunction was evaluated using the angio-based index of microcirculatory resistance before and after percutaneous coronary intervention. Overall, 125 consecutive patients were included, with 50 experiencing PMI (PMI group) and 75 without PMI (non-PMI group). Multivariable analysis showed that older age, higher angio-based index of microcirculatory resistance, presence of adverse plaque characteristics, and higher lesion-based PCAT attenuation were independently associated with PMI occurrence (odds ratio [OR], 1.07 [95% CI, 1.01-1.13]; P=0.02; OR, 1.06 [95% CI, 1.00-1.12]; P=0.04; OR, 6.62 [95% CI, 2.13-20.6]; P=0.001; and OR, 2.89 [95% CI, 1.63-5.11]; P<0.001, respectively). High PCAT attenuation was correlated with microcirculatory dysfunction before and after percutaneous coronary intervention and its exacerbation during percutaneous coronary intervention. Adding lesion-based PCAT attenuation to the presence of adverse plaque characteristics improved the discriminatory and reclassification ability in predicting PMI. CONCLUSIONS Adding PCAT attenuation at the culprit lesion level to coronary computed tomography angiography-derived adverse plaque characteristics may provide incremental benefit in identifying patients at risk of PMI. Our results highlight the importance of microcirculatory dysfunction in PMI development, particularly in the presence of lesions with high PCAT attenuation. REGISTRATION URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057722; Unique identifier: UMIN000050662.
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Affiliation(s)
- Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuta Fukuishi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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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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46
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Dai N, Tang X, Weng X, Cai H, Zhuang J, Yang G, Zhou F, Wu P, Liu B, Duan S, Yu Y, Guo W, Ju Z, Zhang L, Wang Z, Wang Y, Lu B, Shi H, Qian J, Ge J. Sex Differences in Coronary Inflammation and Atherosclerosis Phenotypes in Response to Imaging Marker of Stress-Related Neural Activity. Circ Cardiovasc Imaging 2024; 17:e016057. [PMID: 38377235 DOI: 10.1161/circimaging.123.016057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Sex-specific differences in coronary phenotypes in response to stress have not been elucidated. This study investigated the sex-specific differences in the coronary computed tomography angiography-assessed coronary response to mental stress. METHODS This retrospective study included patients with coronary artery disease and without cancer who underwent resting 18F-fluorodexoyglucose positron emission tomography/computed tomography and coronary computed tomography angiography within 3 months. 18F-flourodeoxyglucose resting amygdalar uptake, an imaging biomarker of stress-related neural activity, coronary inflammation (fat attenuation index), and high-risk plaque characteristics were assessed by coronary computed tomography angiography. Their correlation and prognostic values were assessed according to sex. RESULTS A total of 364 participants (27.7% women and 72.3% men) were enrolled. Among those with heightened stress-related neural activity, women were more likely to have a higher fat attenuation index (43.0% versus 24.0%; P=0.004), while men had a higher frequency of high-risk plaques (53.7% versus 39.3%; P=0.036). High amygdalar 18F-flourodeoxyglucose uptake (B-coefficient [SE], 3.62 [0.21]; P<0.001) was selected as the strongest predictor of fat attenuation index in a fully adjusted linear regression model in women, and the first-order interaction term consisting of sex and stress-related neural activity was significant (P<0.001). Those with enhanced imaging biomarkers of stress-related neural activity showed increased risk of major adverse cardiovascular event both in women (24.5% versus 5.1%; adjusted hazard ratio, 3.62 [95% CI, 1.14-17.14]; P=0.039) and men (17.2% versus 6.9%; adjusted hazard ratio, 2.72 [95% CI, 1.10-6.69]; P=0.030). CONCLUSIONS Imaging-assessed stress-related neural activity carried prognostic values irrespective of sex; however, a sex-specific mechanism linking psychological stress to coronary plaque phenotypes existed in the current hypothesis-generating study. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05545618.
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Affiliation(s)
- Neng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China (N.D., X.T., X.W., J.Q., J.G.)
- National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., X.T., X.W., J.Q., J.G.)
| | - Xianglin Tang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China (N.D., X.T., X.W., J.Q., J.G.)
- National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., X.T., X.W., J.Q., J.G.)
| | - Xinyu Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China (N.D., X.T., X.W., J.Q., J.G.)
- National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., X.T., X.W., J.Q., J.G.)
| | - Haidong Cai
- Department of Nuclear Medicine (H.C.), Shanghai Tenth People's Hospital, China
| | - Jianhui Zhuang
- Department of Cardiology (J.Z.), Shanghai Tenth People's Hospital, China
| | - Guangjie Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Shandong, China (G.Y., Z.W.)
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (F.Z., L.Z.)
| | - Ping Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China (P.W.)
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China (P.W.)
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China (B.L., Y.W.)
- The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, China (B.L., Y.W.)
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (B.L.)
| | | | - Yongfu Yu
- School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education (Y.Y.), Fudan University, Shanghai, China
| | - Weifeng Guo
- Department of Radiology, Zhongshan Hospital (W.G.), Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, China (W.G.)
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine and Health Science, China (Z.J.)
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (F.Z., L.Z.)
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Shandong, China (G.Y., Z.W.)
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China (B.L., Y.W.)
- The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, China (B.L., Y.W.)
| | - Bin Lu
- State Key Laboratory of Cardiovascular Disease and National Center for Cardiovascular Diseases, Beijing, China (B.L.)
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital (H.S.), Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China (N.D., X.T., X.W., J.Q., J.G.)
- National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., X.T., X.W., J.Q., J.G.)
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China (N.D., X.T., X.W., J.Q., J.G.)
- National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., X.T., X.W., J.Q., J.G.)
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Yuki H, Isselbacher E, Niida T, Suzuki K, Kinoshita D, Fujimoto D, Lee H, McNulty I, Nakamura S, Kakuta T, Jang I. Protruding Aortic Plaque and Coronary Plaque Vulnerability. J Am Heart Assoc 2024; 13:e032742. [PMID: 38193293 PMCID: PMC10926811 DOI: 10.1161/jaha.123.032742] [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: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Protruding aortic plaque is known to be associated with an increased risk for future cardiac and cerebrovascular events. However, the relationship between protruding aortic plaque and coronary plaque characteristics has not been systematically investigated. METHODS AND RESULTS A total of 615 patients who underwent computed tomography angiography, and preintervention optical coherence tomography imaging were included. Coronary plaque characteristics were compared to evaluate coronary plaque vulnerability in patients with protruding aortic plaque on computed tomography angiography. 615 patients, the 186 (30.2%) patients with protruding aortic plaque were older and had more comorbidities such as hypertension, chronic kidney disease, and a prior myocardial infarction than those without. They also had a higher prevalence of coronary plaques with vulnerable features such as thin-cap fibroatheroma (85 [45.7%] versus 120 [28.0%], P<0.001), lipid-rich plaque (165 [88.7%] versus 346 [80.7%], P=0.014), macrophages (147 [79.0%] versus 294 [68.5%], P=0.008), layered plaque (117 [62.9%] versus 213 [49.7%], P=0.002), and plaque rupture (96 [51.6%] versus 111 [25.9%], P<0.001). Patients with protruding aortic plaque experienced more major adverse cardiac and cerebrovascular events, including all-cause mortality, nonfatal acute coronary syndromes, and stroke (27 [14.7%] versus 21 [4.9%], P<0.001; 8 [4.3%] versus 1 [0.2%], P<0.001; 5 [2.7%] versus 3 [0.7%], P=0.030; and 5 [2.7%] versus 2 [0.5%], P=0.013, respectively). CONCLUSIONS The current study demonstrates that patients with protruding aortic plaque have more features of coronary plaque vulnerability and are at increased risk of future adverse events.
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Affiliation(s)
- Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Eric Isselbacher
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Daichi Fujimoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo HospitalChibaJapan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General HospitalTsuchiura, IbarakiJapan
| | - Ik‐Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
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48
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Lu ZF, Yin WH, Schoepf UJ, Abrol S, Ma JW, Zhao L, Su XM, An YQ, Xiao ZC, Lu B. Prediction value of pericoronary fat attenuation index for coronary in-stent restenosis. Eur Radiol 2024:10.1007/s00330-023-10527-0. [PMID: 38224375 DOI: 10.1007/s00330-023-10527-0] [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: 07/22/2023] [Revised: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES As a novel imaging marker, pericoronary fat attenuation index (FAI) reflects the local coronary inflammation which is one of the major mechanisms for in-stent restenosis (ISR). We aimed to validate the ability of pericoronary FAI to predict ISR in patients undergoing percutaneous coronary intervention (PCI). MATERIALS AND METHODS Patients who underwent coronary CT angiography (CCTA) before PCI within 1 week between January 2017 and December 2019 at our hospital and had follow-up invasive coronary angiography (ICA) or CCTA were enrolled. Pericoronary FAI was measured at the site where stents would be placed. ISR was defined as ≥ 50% diameter stenosis at follow-up ICA or CCTA in the in-stent area. Multivariable analysis using mixed effects logistic regression models was performed to test the association between pericoronary FAI and ISR at lesion level. RESULTS A total of 126 patients with 180 target lesions were included in the study. During 22.5 months of mean interval time from index PCI to follow-up ICA or CCTA, ISR occurred in 40 (22.2%, 40/180) stents. Pericoronary FAI was associated with a higher risk of ISR (adjusted OR = 1.12, p = 0.028). The optimum cutoff was - 69.6 HU. Integrating the dichotomous pericoronary FAI into current state of the art prediction model for ISR improved the prediction ability of the model significantly (△area under the curve = + 0.064; p = 0.001). CONCLUSION Pericoronary FAI around lesions with subsequent stent placement is independently associated with ISR and could improve the ability of current prediction model for ISR. CLINICAL RELEVANCE STATEMENT Pericoronary fat attenuation index can be used to identify the lesions with high risk for in-stent restenosis. These lesions may benefit from extra anti-inflammation treatment to avoid in-stent restenosis. KEY POINTS • Pericoronary fat attenuation index reflects the local coronary inflammation. • Pericoronary fat attenuation index around lesions with subsequent stents placement can predict in-stent restenosis. • Pericoronary fat attenuation index can be used as a marker for future in-stent restenosis.
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Affiliation(s)
- Zhong-Fei Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, #20 Yuhuangdingdong Street, Yantai, People's Republic of China
| | - Wei-Hua Yin
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sameer Abrol
- Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jing-Wen Ma
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
| | - Li Zhao
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
| | - Xiao-Ming Su
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
| | - Yun-Qiang An
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China
| | - Zhi-Cheng Xiao
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, #20 Yuhuangdingdong Street, Yantai, People's Republic of China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China.
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49
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Suzuki K, Kinoshita D, Yuki H, Niida T, Sugiyama T, Yonetsu T, Araki M, Nakajima A, Seegers LM, Dey D, Lee H, McNulty I, Takano M, Kakuta T, Mizuno K, Jang IK. Higher Noncalcified Plaque Volume Is Associated With Increased Plaque Vulnerability and Vascular Inflammation. Circ Cardiovasc Imaging 2024; 17:e015769. [PMID: 38205654 DOI: 10.1161/circimaging.123.015769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Recently, it was reported that noncalcified plaque (NCP) volume was an independent predictor for cardiac events. Pericoronary adipose tissue (PCAT) attenuation is a marker of vascular inflammation and has been associated with increased cardiac mortality. The aim of this study was to evaluate the relationships between NCP volume, plaque vulnerability, and PCAT attenuation. METHODS Patients who underwent preintervention coronary computed tomography angiography and optical coherence tomography were enrolled. Plaque volume was measured by computed tomography angiography, plaque vulnerability by optical coherence tomography, and the level of coronary inflammation by PCAT attenuation. The plaques were divided into 2 groups of high or low NCP volume based on the median NCP volume. RESULTS Among 704 plaques in 454 patients, the group with high NCP volume had a higher prevalence of lipid-rich plaque (87.2% versus 75.9%; P<0.001), thin-cap fibroatheroma (38.1% versus 20.7%; P<0.001), macrophage (77.8% versus 63.4%; P<0.001), microvessel (58.2% versus 42.9%; P<0.001), and cholesterol crystal (42.0% versus 26.7%; P<0.001) than the group with low NCP plaque volume. The group with high NCP volume also had higher PCAT attenuation than the group with low NCP volume (-69.6±10.0 versus -73.5±10.6 Hounsfield unit; P<0.001). In multivariable analysis, NCP volume was significantly associated with thin-cap fibroatheroma and high PCAT attenuation. In the analysis of the combination of PCAT attenuation and NCP volume, the prevalence of thin-cap fibroatheroma was the highest in the high PCAT attenuation and high NCP volume group and the lowest in the low PCAT attenuation and low NCP volume group. CONCLUSIONS Higher NCP volume was associated with higher plaque vulnerability and vascular inflammation. The combination of PCAT attenuation and NCP volume may help identify plaque vulnerability noninvasively. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04523194.
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Affiliation(s)
- Keishi Suzuki
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Daisuke Kinoshita
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Haruhito Yuki
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Takayuki Niida
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.S., T.Y., M.A.)
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.S., T.Y., M.A.)
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.S., T.Y., M.A.)
| | - Akihiro Nakajima
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (A.N.)
| | - Lena Marie Seegers
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Hang Lee
- Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Iris McNulty
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan (M.T.)
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (T.K.)
| | - Kyoichi Mizuno
- Mitsukoshi Health and Welfare Foundation, Tokyo, Japan (K.M.)
| | - Ik-Kyung Jang
- Cardiology Division (K.S., D.K., H.Y., T.N., L.M.S., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
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50
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Chamberlin JH, Baruah D, Smith C, McGuire A, Maisuria D, Kabakus IM. Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review. Semin Roentgenol 2024; 59:7-19. [PMID: 38388099 DOI: 10.1053/j.ro.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Jordan H Chamberlin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
| | - Carter Smith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Aaron McGuire
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhruw Maisuria
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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