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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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Kinoshita D, Suzuki K, Usui E, Hada M, Yuki H, Niida T, Minami Y, Lee H, McNulty I, Ako J, Ferencik M, Kakuta T, Jang IK. High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation With Optical Coherence Tomography. JACC Cardiovasc Imaging 2024; 17:382-391. [PMID: 37715773 DOI: 10.1016/j.jcmg.2023.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Although patients with high-risk plaque (HRP) on coronary computed tomography angiography (CTA) are reportedly at increased risk for future cardiovascular events, individual HRP features have not been systematically validated against high-resolution intravascular imaging. OBJECTIVES The aim of this study was to correlate HRP features on CTA with plaque characteristics on optical coherence tomography (OCT). METHODS Patients who underwent both CTA and OCT before coronary intervention were enrolled. Plaques in culprit vessels identified by CTA were evaluated with the use of OCT at the corresponding sites. HRP was defined as a plaque with at least 2 of the following 4 features: positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC). Patients were followed for up to 3 years. RESULTS The study included 448 patients, with a median age of 67 years and of whom 357 (79.7%) were male, and 203 (45.3%) presented with acute coronary syndromes. A total of 1,075 lesions were analyzed. All 4 HRP features were associated with thin-cap fibroatheroma. PR was associated with all OCT features of plaque vulnerability, LAP was associated with lipid-rich plaque, macrophage, and cholesterol crystals, NRS was associated with cholesterol crystals, and SC was associated with microvessels. The cumulative incidence of the composite endpoint (target vessel nontarget lesion revascularization and cardiac death) was significantly higher in patients with HRP than in those without HRP (4.7% vs 0.5%; P = 0.010). CONCLUSIONS All 4 HRP features on CTA were associated with features of vulnerability on OCT. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194).
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Affiliation(s)
- Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
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3
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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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Marinho LL, Rached FH, Morikawa AT, Tavoni TM, Cardoso APT, Torres RVA, Assuncao AN, Serrano CV, Nomura CH, Maranhão RC. Safety and possible anti-inflammatory effect of paclitaxel associated with LDL-like nanoparticles (LDE) in patients with chronic coronary artery disease: a double-blind, placebo-controlled pilot study. Front Cardiovasc Med 2024; 11:1342832. [PMID: 38450375 PMCID: PMC10915057 DOI: 10.3389/fcvm.2024.1342832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Studies in cholesterol-fed rabbits showed that anti-proliferative chemotherapeutic agents such as paclitaxel associated with solid lipid nanoparticles (LDE) have marked anti-atherosclerotic effects. In addition, association with LDE nearly abolishes paclitaxel toxicity. We investigated whether treatment with LDE-paclitaxel changes plaque progression by coronary CT angiography and is safe in patients with chronic coronary artery disease. Methods We conducted a prospective, randomized, double-blind, placebo-controlled pilot study in patients with multi-vessel chronic coronary artery disease. Patients were randomized to receive IV infusions of LDE-paclitaxel (paclitaxel dose: 175 mg/m2 body surface) or LDE alone (placebo group), administered every 3 weeks for 18 weeks. All participants received guideline-directed medical therapy. Clinical and laboratory safety evaluations were made at baseline and every 3 weeks until the end of the study. Analysis of inflammatory biomarkers and coronary CTA was also performed at baseline and 4 weeks after treatment. Results Forty patients aged 65.6 ± 8 years, 20 in LDE-paclitaxel and 20 in placebo group were enrolled. Among those, 58% had diabetes, 50% had myocardial infarction, and 91% were in use of statin and aspirin. Baseline demographics, risk factors, and laboratory results were not different between groups. In all patients, no clinical or laboratory toxicities were observed. From the baseline to the end of follow-up, there was a non-significant trend toward a decrease in IL-6 levels and hsCRP in the LDE-paclitaxel group (-16% and -28%, respectively), not observed in placebo. Regarding plaque progression analysis, variation in plaque parameter values was wide, and no difference between groups was observed. Conclusion In patients with multivessel chronic coronary artery disease and optimized medical therapy, LDE-paclitaxel was safe and showed clues of potential benefits in reducing inflammatory biomarkers. Clinical Trial Registration https://clinicaltrials.gov/study/NCT04148833, identifier (NCT04148833).
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Affiliation(s)
- Lucas Lage Marinho
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Hanna Rached
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Aleksandra Tiemi Morikawa
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Thauany Martins Tavoni
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | - Carlos Vicente Serrano
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Cesar Higa Nomura
- Department of Radiology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Raul Cavalcante Maranhão
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
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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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Park HB, Arsanjani R, Sung JM, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study. Eur Heart J Cardiovasc Imaging 2023; 24:1536-1543. [PMID: 37232393 DOI: 10.1093/ehjci/jead110] [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: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
AIMS To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020). CONCLUSION In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02803411.
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Affiliation(s)
- Hyung-Bok Park
- Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Ran Heo
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sang-Eun Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Habib Samady
- Department of Cardiology, Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Peter H Stone
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, 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 10029, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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7
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Williams C, Han D, Takagi H, Fordyce CB, Sellers S, Blanke P, Lin FY, Shaw LJ, Lee SE, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Bax JJ, Leipsic JA, Chang HJ. Effects of renin-angiotensin-aldosterone-system inhibitors on coronary atherosclerotic plaques: The PARADIGM registry. Atherosclerosis 2023; 383:117301. [PMID: 37769454 DOI: 10.1016/j.atherosclerosis.2023.117301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIMS Inhibition of Renin-Angiotensin-Aldosterone-System (RAAS) has been hypothesized to improve endothelial function and reduce plaque inflammation, however, their impact on the progression of coronary atherosclerosis is unclear. We aim to study the effects of RAAS inhibitor on plaque progression and composition assessed by serial coronary CT angiography (CCTA). METHODS We performed a prospective, multinational study consisting of a registry of patients without history of CAD, who underwent serial CCTAs. Patients using RAAS inhibitors were propensity matched to RAAS inhibitor naïve patients based on clinical and CCTA characteristics at baseline. Atherosclerotic plaques in CCTAs were quantitatively analyzed for percent atheroma volume (PAV) according to plaque composition. Interactions between RAAS inhibitor use and baseline PAV on plaque progression were assessed in the unmatched cohort using a multivariate linear regression model. RESULTS Of 1248 patients from the registry, 299 RAAS inhibitor taking patients were matched to 299 RAAS inhibitor naïve patients. Over a mean interval of 3.9 years, there was no significant difference in annual progression of total PAV between RAAS inhibitor naïve vs taking patients (0.75 vs 0.79%/year, p = 0.66). With interaction testing in the unmatched cohort, however, RAAS inhibitor use was significantly associated with lower non-calcified plaque progression (Beta coefficient -0.100, adjusted p = 0.038) with higher levels of baseline PAV. CONCLUSIONS The use of RAAS inhibitors over a period of nearly 4 years did not significantly impact on total atherosclerotic plaque progression or various plaque components. However, interaction testing to assess the differential effect of RAAS inhibition based on baseline PAV suggested a significant decrease in progression of non-calcified plaque in patients with a higher burden of baseline atherosclerosis, which should be considered hypothesis generating.
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Affiliation(s)
- Curtis Williams
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenobu Takagi
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eun Ju Chun
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Ji Min Sung
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Georgia Heart Institute, Gainesville, USA
| | - Peter H Stone
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Hyuk-Jae Chang
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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8
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Qiao HY, Wu Y, Li HC, Zhang HY, Wu QH, You QJ, Ma X, Hu SD. Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression. J Thorac Imaging 2023; 38:186-193. [PMID: 36728026 PMCID: PMC10128899 DOI: 10.1097/rti.0000000000000697] [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] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP). METHODS A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients' images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software. RESULTS A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P <0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P <0.001) was significantly better than that based rarely on %DS (AUC=0.61, P =0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P <0.001). CONCLUSIONS Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.
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Affiliation(s)
| | - Yong Wu
- Departments of Medical Imaging
| | - Hai Cheng Li
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | - Hai Yan Zhang
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | | | - Qing Jun You
- Thoracic Surgery, Affiliated Hospital of Jiangnan University
| | - Xin Ma
- School of Medicine, Jiangnan University, Wuxi, Jiangsu
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9
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Heinsen LJ, Pararajasingam G, Andersen TR, Auscher S, Sheta HM, Precht H, Engdam KB, Hangaard J, Lambrechtsen J, Knop FK, Egstrup K. Liraglutide treatment is associated with progression of coronary artery fibrous plaque: a prospective 1-year follow-up study in asymptomatic patients with type 2 diabetes. BMC Cardiovasc Disord 2023; 23:214. [PMID: 37118678 PMCID: PMC10148401 DOI: 10.1186/s12872-023-03228-5] [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: 12/12/2022] [Accepted: 04/05/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the association between clinically indicated liraglutide treatment and coronary artery plaque progression during 1-year follow-up in asymptomatic diabetes. METHODS Patients were divided into a group receiving liraglutide (Lira+) and a group not receiving liraglutide (Lira-). Coronary computed tomography angiography (CCTA) was performed to assess total atheroma volume (TAV) and subtypes of plaque volumes (dense calcium, fibrous, fibrous-fatty, and necrotic core plaque) and the plaque progression during one year follow-up. RESULTS Fifty-five patients (27%) receiving liraglutide and 149 (73%) how did not were included. Changes in TAV during 1-year of follow-up were similar in the two groups (38 ± 180 (Lira+) vs. -1 ± 160 mm3 (Lira-), P = 0.13). A greater increase in fibrous plaque volume was seen in the Lira + vs. the Lira- group (34 ± 129 vs. -2 ± 101 mm3, P = 0.04). Changes over 1-year in the other plaque subtypes were similar in the two groups. Treatment duration of liraglutide was not associated with changes in TAV. CONCLUSION In patients with T2D without known prior coronary artery disease, liraglutide treatment was associated with a significant increase in coronary artery fibrous plaque volume during 1-year follow-up.
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Affiliation(s)
- Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark.
| | - Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Søren Auscher
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Hussam Mahmoud Sheta
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Helle Precht
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
- Institute of Regional Research, University of Southern Denmark, Winsløwsparken 19, 5000, Odense C, Denmark
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Sygehusvej 24, 6000, Kolding, Kolding, Denmark
| | - Kalle Brunebjerg Engdam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Jørgen Hangaard
- Department of Endocrinology, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
| | - Filip Krag Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, Gentofte, 2820, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, Svendborg, 5700, Denmark
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10
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Lee SE, 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, de Araújo Gonçalves P, Pontone G, Shin S, Kitslaar PH, Reiber JH, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Association Between Changes in Perivascular Adipose Tissue Density and Plaque Progression. JACC Cardiovasc Imaging 2022; 15:1760-1767. [DOI: 10.1016/j.jcmg.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
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11
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Manubolu VS, Budoff MJ. Achieving coronary plaque regression: a decades-long battle against coronary artery disease. Expert Rev Cardiovasc Ther 2022; 20:291-305. [PMID: 35466832 DOI: 10.1080/14779072.2022.2069559] [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: 10/18/2022]
Abstract
INTRODUCTION Traditionally atherosclerosis was thought to be progressive and medical treatment solely focused on delaying the progression of atherosclerosis rather than treating the disease itself. Multiple recent studies, however, have demonstrated a significant decrease in cardiovascular mortality with the use of additional anti-atherosclerotic therapies beyond statins. Consistent with these observations, mechanistic studies indicate that these additional anti-atherosclerotic therapies have a positive effect on both halting and reversing the course of atherosclerosis. AREAS COVERED We examine the progression of atherosclerosis and the efficacy of various anti-atherosclerotic treatment classes in this review utilizing multimodality imaging techniques. Searches were conducted in electronic databases: PubMed and EMBASE for all peer reviewed publications that examined coronary plaque progression, regression and stabilization using different imaging modalities and antiatherosclerosis therapies. The keywords coronary plaque, coronary angiography, IVUS, intravascular OCT, CCTA in conjunction with the various therapies included in this review were searched in different combinations. All relevant published articles on this topic were identified and their reference lists were screened for relevance. EXPERT COMMENTARY Though lipoprotein levels have traditionally been the target for antiatherosclerosis medication, several newer strategies have emerged creating novel targets in the treatment of coronary atherosclerosis. Using a combination of antiatherosclerosis therapies in conjunction with noninvasive imaging modalities like CCTA to directly visualize the plaque, is currently the focus of the future, with the aim of preventing and reversing atherosclerosis.
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Affiliation(s)
| | - Matthew J Budoff
- Department of Cardiology, Lundquist Institute, Torrance, CA, USA
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12
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Pasterkamp G, den Ruijter HM, Giannarelli C. False Utopia of One Unifying Description of the Vulnerable Atherosclerotic Plaque: A Call for Recalibration That Appreciates the Diversity of Mechanisms Leading to Atherosclerotic Disease. Arterioscler Thromb Vasc Biol 2022; 42:e86-e95. [PMID: 35139657 DOI: 10.1161/atvbaha.121.316693] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is a complex disease characterized by the formation of arterial plaques with a broad diversity of morphological phenotypic presentations. Researchers often apply one description of the vulnerable plaque as a gold standard in preclinical and clinical research that could be applied as a surrogate measure of a successful therapeutic intervention, despite the variability in lesion characteristics that may underly a thrombotic occlusion. The complex mechanistic interplay underlying progression of atherosclerotic disease is a consequence of the broad range of determinants such as sex, risk factors, hemodynamics, medications, and the genetic landscape. Currently, we are facing an overwhelming amount of data based on genetic, transcriptomic, proteomic, and metabolomic studies that all point to heterogeneous molecular profiles of atherosclerotic lesions that lead to a myocardial infarction or stroke. The observed molecular diversity implies that one unifying model cannot fully recapitulate the natural history of atherosclerosis. Despite emerging data obtained from -omics studies, a description of a natural history of atherosclerotic disease in which cell-specific expression of proteins or genes are included is still lacking. This also applies to the insights provided by genome-wide association studies. This review will critically discuss the dogma that the progression of atherosclerotic disease can be captured in one unifying natural history model of atherosclerosis.
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Affiliation(s)
- Gerard Pasterkamp
- Circulatory Health Laboratories (G.P., H.M.d.R.), University Medical Center Utrecht, the Netherlands.,Central Diagnostics Laboratories (G.P.), University Medical Center Utrecht, the Netherlands
| | - Hester M den Ruijter
- Circulatory Health Laboratories (G.P., H.M.d.R.), University Medical Center Utrecht, the Netherlands.,Laboratory of Experimental Cardiology (H.M.d.R.), University Medical Center Utrecht, the Netherlands
| | - Chiara Giannarelli
- NYU Cardiovascular Research Center (C.G.), New York University Grossman School of Medicine.,Department of Pathology (C.G.), New York University Grossman School of Medicine
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13
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Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art. Eur J Prev Cardiol 2022; 29:608-624. [PMID: 33930129 DOI: 10.1093/eurjpc/zwab067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Abstract
Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features' extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Andreas Angelopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Charalambos Antoniades
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
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14
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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15
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Zhang D, Xing H, Wang R, Tian J, Ju Z, Zhang L, Chen H, He Y, Song X. A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:762351. [PMID: 35295265 PMCID: PMC8920558 DOI: 10.3389/fcvm.2022.762351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions. Methods This study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion. Results In this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, p = 0.004) and final success (73.3 vs. 95.2%, p = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min. Conclusions Grouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.
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Affiliation(s)
- Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haoran Xing
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Yi He
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiantao Song
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16
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Takagi H, Leipsic JA, Indraratna P, Gulsin G, Khasanova E, Tzimas G, Lin FY, Shaw LJ, Lee SE, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Bax JJ, Chang HJ. Association of Tube Voltage With Plaque Composition on Coronary CT Angiography: Results From PARADIGM Registry. JACC Cardiovasc Imaging 2021; 14:2429-2440. [PMID: 34419398 DOI: 10.1016/j.jcmg.2021.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to investigate the impact of low tube voltage scanning heterogeneity of coronary luminal attenuation on plaque quantification and characterization with coronary computed tomography angiography (CCTA). BACKGROUND The impact of low tube voltage and coronary luminal attenuation on quantitative coronary plaque remains uncertain. METHODS A total of 1,236 consecutive patients (age: 60 ± 9 years; 41% female) who underwent serial CCTA at an interval of ≥2 years were included from an international registry. Patients with prior revascularization or nonanalyzable coronary CTAs were excluded. Total coronary plaque volume was assessed and subclassified based on specific Hounsfield unit (HU) threshold: necrotic core, fibrofatty plaque, and fibrous plaque and dense calcium. Luminal attenuation was measured in the aorta. RESULTS With increasing luminal HU (<350, 350-500, and >500 HU), percent calcified plaque was increased (16%, 27%, and 40% in the median; P < 0.001), and fibrofatty plaque (26%, 13%, and 4%; P < 0.001) and necrotic core (1.6%, 0.3%, and 0.0%; P < 0.001) were decreased. Higher tube voltage scanning (80, 100, and 120 kV) resulted in decreasing luminal attenuation (689 ± 135, 497 ± 89, and 391 ± 73 HU; P < 0.001) and calcified plaque volume (59%, 34%, and 23%; P < 0.001) and increased fibrofatty plaque (3%, 9%, and 18%; P < 0.001) and necrotic core (0.2%, 0.1%, and 0.6%; P < 0.001). Mediation analysis showed that the impact of 100 kV on plaque composition, compared with 120 kV, was primarily caused by an indirect effect through blood pool attenuation. Tube voltage scanning of 80 kV maintained a direct effect on fibrofatty plaque and necrotic core in addition to an indirect effect through the luminal attenuation. CONCLUSIONS Low tube voltage usage affected plaque morphology, mainly through an increase in luminal HU with a resultant increase in calcified plaque and a reduction in fibrofatty and necrotic core. These findings should be considered as CCTA-based plaque measures are being used to guide medical management and, in particular, when being used as a measure of treatment response. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
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Affiliation(s)
- Hidenobu Takagi
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Praveen Indraratna
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Gaurav Gulsin
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Elina Khasanova
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere (IRCCS) Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Mississippi, USA
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere (IRCCS) Milan, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale Marche, Urbino, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere (IRCCS) Milan, Italy
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter H Stone
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California, 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, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Hyuk-Jae Chang
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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17
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Low attenuation plaque volume on coronary computed tomography angiography is associated with plaque progression. Coron Artery Dis 2021; 33:176-181. [PMID: 34618752 DOI: 10.1097/mca.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-related clinical factors, laboratory factors, and some imaging factors may lead to statistical bias when investigating coronary plaque progression. In this study, we avoided patient characteristics by comparing morphological characteristics of plaque progression and nonprogression within the same patient with multiple plaques. METHODS From August 2011 to December 2018, 177 consecutive patients with 424 plaques who were followed with coronary computed tomography angiography (CTA) were reviewed retrospectively. Follow-up images of the plaques were used to determine whether the plaque volume or stenosis grade increased. The plaques were divided into progressive and nonprogressive groups. Logistic regression analysis was used to identify the factors associated with plaque progression. Through clinical follow-up, we analyzed whether the factors associated with plaque progression were related to major adverse cardiac events (MACEs). RESULTS There were 223 plaques that progressed during a mean follow-up period of 27.6 ± 15.9 months. The univariate logistic regression model revealed that only low attenuation plaque (LAP) volume (P = 0.02) was associated with plaque progression. After a mean post-CTA follow-up period of 36.7 ± 18.4 months, 37 patients experienced MACEs, and LAP volume was significantly related to future MACEs. CONCLUSION Only a high baseline LAP volume was associated with plaque progression, and patients with progressive plaques and a high LAP volume were more likely to have future MACEs. More attention should be given to plaques with LAP volumes larger than 2.4 mm3.
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18
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van den Hoogen IJ, van Rosendael AR, Lin FY, Gianni U, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Hyun Choi J, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Chang HJ, Min JK, Shaw LJ, Bax JJ. Measurement of compensatory arterial remodelling over time with serial coronary computed tomography angiography and 3D metrics. Eur Heart J Cardiovasc Imaging 2021; 23:1336-1344. [PMID: 34468717 DOI: 10.1093/ehjci/jeab138] [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: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The magnitude of alterations in which coronary arteries remodel and narrow over time is not well understood. We aimed to examine changes in coronary arterial remodelling and luminal narrowing by three-dimensional (3D) metrics from serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicentre registry of patients with suspected coronary artery disease who underwent clinically indicated serial CCTA (median interscan interval = 3.3 years), we quantitatively measured coronary plaque, vessel, and lumen volumes on both scans. Primary outcome was the per-segment change in coronary vessel and lumen volume from a change in plaque volume, focusing on arterial remodelling. Multivariate generalized estimating equations including statins were calculated comparing associations between groups of baseline percent atheroma volume (PAV) and location within the coronary artery tree. From 1245 patients (mean age 61 ± 9 years, 39% women), a total of 5721 segments were analysed. For each 1.00 mm3 increase in plaque volume, the vessel volume increased by 0.71 mm3 [95% confidence interval (CI) 0.63 to 0.79 mm3, P < 0.001] with a corresponding reduction in lumen volume by 0.29 mm3 (95% CI -0.37 to -0.21 mm3, P < 0.001). Serial 3D arterial remodelling and luminal narrowing was similar in segments with low and high baseline PAV (P ≥ 0.496). No differences were observed between left main and non-left main segments, proximal and distal segments and side branch and non-side branch segments (P ≥ 0.281). CONCLUSIONS Over time, atherosclerotic coronary plaque reveals prominent outward arterial remodelling that co-occurs with modest luminal narrowing. These findings provide additional insight into the compensatory mechanisms involved in the progression of coronary atherosclerosis.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - 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
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 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
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Ontact Health, Inc, Seoul, South Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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19
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Chao CJ, Lakshmanan S, Ceponiene I, Luo Y, Nakanishi R, Nezarat N, Kanisawa M, Budoff MJ. New carotid plaque, but not the progression of intima-media thickness, predicts the progression of high-risk coronary plaque. Coron Artery Dis 2021; 32:554-560. [PMID: 33417340 DOI: 10.1097/mca.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) is regarded as a controversial risk marker for cardiovascular disease (CVD). We aimed to evaluate the role of CIMT and carotid plaque progression as predictors for the progression of coronary plaque and compositions. METHODS In the Garlic 4 study, asymptomatic patients with intermediate CVD risk (Framingham risk score 6-20%) were recruited for a serial carotid ultrasound, and coronary artery calcium score (CAC)/coronary computed tomography angiography (CCTA) studies for subclinical atherosclerosis at a baseline and 1 year. The association between progression of quantitatively measured coronary plaque compositions and the progression of CIMT/carotid plaque was analyzed. A P value <0.05 is considered as statistically significant. RESULTS Forty-seven consecutive patients were included. The mean age was 58.5 ± 6.6 years, and 69.1 % were male. New carotid plaque appeared in 34.0 % (n = 16) of participants, and 55.3 % (n = 26) of subjects had coronary plaque progression. In multilinear regression analysis, adjusted by age, gender, and statin use, the development of new carotid plaque was significantly associated with an increase in noncalcified coronary plaque [β (SE) 2.0 (0.9); P = 0.025] and necrotic core plaque (1.7 (0.6); P = 0.009). In contrast, CIMT progression was not associated with the progression of coronary plaque, or coronary artery calcium (CAC) (P = NS). CONCLUSION Compared to CIMT, carotid plaque is a better indicator of coronary plaque progression. The appearance of a new carotid plaque is associated with significant progression of necrotic core and noncalcified plaque, which are high-risk coronary plaque components.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
- Lundquist Institute, California, USA
| | | | - Indre Ceponiene
- Lundquist Institute, California, USA
- Department of Cardiology, Lithuanian University of Health Sciences, Lithuania
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20
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Yoon YE, Baskaran L, Lee BC, Pandey MK, Goebel B, Lee SE, 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, de Araújo Gonçalves P, Pontone G, Shin S, Narula J, Bax JJ, Lin FYH, Shaw L, Chang HJ. Differential progression of coronary atherosclerosis according to plaque composition: a cluster analysis of PARADIGM registry data. Sci Rep 2021; 11:17121. [PMID: 34429500 PMCID: PMC8385056 DOI: 10.1038/s41598-021-96616-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022] Open
Abstract
Patient-specific phenotyping of coronary atherosclerosis would facilitate personalized risk assessment and preventive treatment. We explored whether unsupervised cluster analysis can categorize patients with coronary atherosclerosis according to their plaque composition, and determined how these differing plaque composition profiles impact plaque progression. Patients with coronary atherosclerotic plaque (n = 947; median age, 62 years; 59% male) were enrolled from a prospective multi-national registry of consecutive patients who underwent serial coronary computed tomography angiography (median inter-scan duration, 3.3 years). K-means clustering applied to the percent volume of each plaque component and identified 4 clusters of patients with distinct plaque composition. Cluster 1 (n = 52), which comprised mainly fibro-fatty plaque with a significant necrotic core (median, 55.7% and 16.0% of the total plaque volume, respectively), showed the least total plaque volume (PV) progression (+ 23.3 mm3), with necrotic core and fibro-fatty PV regression (− 5.7 mm3 and − 5.6 mm3, respectively). Cluster 2 (n = 219), which contained largely fibro-fatty (39.2%) and fibrous plaque (46.8%), showed fibro-fatty PV regression (− 2.4 mm3). Cluster 3 (n = 376), which comprised mostly fibrous (62.7%) and calcified plaque (23.6%), showed increasingly prominent calcified PV progression (+ 21.4 mm3). Cluster 4 (n = 300), which comprised mostly calcified plaque (58.7%), demonstrated the greatest total PV increase (+ 50.7mm3), predominantly increasing in calcified PV (+ 35.9 mm3). Multivariable analysis showed higher risk for plaque progression in Clusters 3 and 4, and higher risk for adverse cardiac events in Clusters 2, 3, and 4 compared to that in Cluster 1. Unsupervised clustering algorithms may uniquely characterize patient phenotypes with varied atherosclerotic plaque profiles, yielding distinct patterns of progressive disease and outcome.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. .,Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. .,Cardiovascular Center, Seoul National University Bundang Hospital, Sungnam, South Korea.
| | - Lohendran Baskaran
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore
| | - Benjamin C Lee
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Benjamin Goebel
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 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
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Cardiovascular Center, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Centre 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
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal.,NOVA Medical School, Lisbon, Portugal
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Fay Yu-Huei Lin
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee Shaw
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, 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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21
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Luo G, Qian Y, Sheng X, Sun J, Wu Z, Liao F, Feng Q, Yin Y, Ding S, Pu J. Elevated Serum Levels of Soluble ST2 Are Associated With Plaque Vulnerability in Patients With Non-ST-Elevation Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:688522. [PMID: 34368249 PMCID: PMC8341076 DOI: 10.3389/fcvm.2021.688522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Recent studies have suggested that soluble suppression of tumorigenicity-2 (sST2), an inflammation-related protein receptor, is associated with atherosclerotic diseases. This study aimed to investigate the potential predictive value of sST2 on plaque vulnerability by assessing whether elevated serum levels of sST2 are associated with vulnerable plaque features in patients with non-ST-elevation acute coronary syndrome (ACS). Methods: A total of 120 patients with non-ST-elevation ACS (167 lesions) were prospectively enrolled and evaluated by standard coronary computed tomography angiography (CCTA) and coronary angiography in this study. Serum sST2 levels were measured by ELISA (Presage® ST2 Assay Kit, Critical Diagnostics), and semiautomated software (QAngioCT, Medis) was used to quantify coronary plaques. Results: The included patients were divided into 4 groups by serum sST2 level quartiles. Volumetric analysis of the whole lesion revealed that patients with higher sST2 levels had a larger absolute necrotic core (NC) volume (Quartile 4 vs. Quartile 1, 86.16 ± 59.71 vs. 45.10 ± 45.80 mm3, P = 0.001; Quartile 4 vs. Quartile 2, 86.16 ± 59.71 vs. 50.22 ± 42.56 mm3, P = 0.002) and a higher NC percentage (Quartile 4 vs. Quartile 1, 35.16 ± 9.82 vs. 23.21 ± 16.18%, P < 0.001; Quartile 4 vs. Quartile 2, 35.16 ± 9.82% vs. 22.50 ± 14.03%, P < 0.001; Quartile 4 vs. Quartile 3, 35.16 ± 9.82% vs. 25.04 ± 14.48%, P < 0.001). Correlation analysis revealed that serum sST2 levels were positively correlated with the NC (r = 0.323, P < 0.001) but negatively correlated with dense calcium (r = −0.208, P = 0.007). Furthermore, among those with plaque calcification, patients with spotty calcification exhibited higher serum sST2 levels than those with large calcification (26.06 ± 16.54 vs. 17.55 ± 7.65 ng/mL, P = 0.002). No significant differences in plaque components at the level of the minimal lumen area (MLA) were found among the groups. Conclusions: Serum sST2 levels were correlated with different coronary plaque components in patients with non-ST-elevation ACS. A higher serum level of sST2 was correlated with plaque vulnerability. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04797819.
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Affiliation(s)
- Guqing Luo
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuxuan Qian
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xincheng Sheng
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiateng Sun
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhinan Wu
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Fei Liao
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qi Feng
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yan Yin
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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22
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Lee SE, 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, de Araújo Gonçalves P, Pontone G, Shin S, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Association between Aortic Valve Calcification Progression and Coronary Atherosclerotic Plaque Volume Progression in the PARADIGM Registry. Radiology 2021; 300:79-86. [PMID: 33973837 DOI: 10.1148/radiol.2021202630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Aortic valve calcification (AVC) is a key feature of aortic stenosis, and patients with aortic stenosis often have coronary -artery disease. Therefore, proving the association between the progression of AVC and coronary atherosclerosis could improve follow-up and treatment strategies. Purpose To explore the association between the progression of AVC and the progression of total and plaque volume composition from a large multicenter registry of serial coronary CT angiographic examinations. Materials and Methods A prospective multinational registry (PARADIGM) of consecutive participants who underwent serial coronary CT angiography at intervals of every 2 years or more was performed (January 2003-December 2015). AVC and the total and plaque volume composition at baseline and follow-up angiography were quantitatively analyzed. Plaque volumes were normalized by using the mean total analyzed vessel length of the study population. Multivariable linear mixed-effects models were constructed. Results Overall, 594 participants (mean age ± standard deviation, 62 years ± 10; 330 men) were included (mean interval between baseline and follow-up angiography, 3.9 years ± 1.5). At baseline, the AVC score was 31 Agatston units ± 117, and the normalized total plaque volume at baseline was 122 mm3 ± 219. After adjustment for age, sex, clinical risk factors, and medication use, AVC was independently associated with total plaque volume (standardized β = 0.24; 95% CI: 0.16, 0.32; P < .001) and both calcified (β = 0.26; 95% CI: 0.18, 0.34; P < .001) and noncalcified (β = 0.17; 95% CI: 0.08, 0.25; P < .001) plaque volumes at baseline. The progression of AVC was associated with the progression of total plaque volume (β = 0.13; 95% CI: 0.03, 0.22; P = .01), driven solely by calcified plaque volume (β = 0.24; 95% CI: 0.14, 0.34; P < .001) but not noncalcified plaque volumes (β = -0.06; 95% CI: -0.14, 0.03; P = .17). Conclusion The overall burden of coronary atherosclerosis was associated with aortic valve calcification at baseline. However, the progression of aortic valve calcification was associated with only the progression of calcified plaque volume but not with the -progression of noncalcified plaque volume. Clinical trial registration no. NCT02803411 © RSNA, 2021 See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Sang-Eun Lee
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Ji Min Sung
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Daniele Andreini
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Mouaz H Al-Mallah
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Matthew J Budoff
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Filippo Cademartiri
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Kavitha Chinnaiyan
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Jung Hyun Choi
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Eun Ju Chun
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Edoardo Conte
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Ilan Gottlieb
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Martin Hadamitzky
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Yong Jin Kim
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Byoung Kwon Lee
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Jonathon A Leipsic
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Erica Maffei
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Hugo Marques
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Pedro de Araújo Gonçalves
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Gianluca Pontone
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Sanghoon Shin
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Peter H Stone
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Habib Samady
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Renu Virmani
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Jagat Narula
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Daniel S Berman
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Leslee J Shaw
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Jeroen J Bax
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Fay Y Lin
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - James K Min
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
| | - Hyuk-Jae Chang
- From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.)
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23
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Shan D, Dou G, Yang J, Wang X, Wang J, Zhang W, He B, Liu Y, Chen Y, Li Y. Epicardial Adipose Tissue Volume Is Associated with High Risk Plaque Profiles in Suspect CAD Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6663948. [PMID: 33953836 PMCID: PMC8057896 DOI: 10.1155/2021/6663948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/14/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the association between EAT volume and plaque precise composition and high risk plaque detected by coronary computed tomography angiography (CCTA). METHODS 101 patients with suspected coronary artery disease (CAD) underwent CCTA examination from March to July 2019 were enrolled, including 70 cases acute coronary syndrome (ACS) and 31 cases stable angina pectoris (SAP). Based on CCTA image, atherosclerotic plaque precise compositions were analyzed using dedicated quantitative software. High risk plaque was defined as plaque with more than 2 high risk features (spotty calcium, positive remolding, low attenuation plaque, napkin-ring sign) on CCTA image. The association between EAT volume and plaque composition was assessed as well as the different of correlation between ACS and SAP was analyzed. Multivariable logistic regression analysis was used to explore whether EAT volume was independent risk factors of high risk plaque (HRP). RESULTS EAT volume in the ACS group was significantly higher than that of the SAP group (143.7 ± 49.8 cm3 vs. 123.3 ± 39.2 cm3, P = 0.046). EAT volume demonstrated a significant positive correlation with total plaque burden (r = 0.298, P = 0.003), noncalcified plaque burden (r = 0.245, P = 0.013), lipid plaque burden (r = 0.250, P = 0.012), and homocysteine (r = 0.413, P ≤ 0.001). In ACS, EAT volume was positively correlated with total plaque burden (r = 0.309, P = 0.009), noncalcified plaque burden (r = 0.242, P = 0.044), and lipid plaque burden (r = 0.240, P = 0.045); however, no correlation was observed in SAP. Patients with HRP have larger EAT volume than those without HRP (169 ± 6.2 cm3 vs. 130.6 ± 5.3 cm3, P = 0.002). After adjustment by traditional risk factors and coronary artery calcium score (CACS), EAT volume was an independent risk predictor of presence of HRP (OR: 1.018 (95% CI: 1.006-1.030), P = 0.004). CONCLUSIONS With the increasing EAT volume, more dangerous plaque composition burdens increase significantly. EAT volume is a risk predictor of HRP independent of convention cardiovascular risk factors and CACS, which supports the potential impact of EAT on progression of coronary atherosclerotic plaque.
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Affiliation(s)
- Dongkai Shan
- Department of Cardiovascular Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guanhua Dou
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junjie Yang
- Department of Cardiovascular Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xi Wang
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingjing Wang
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bai He
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuqi Liu
- Department of Cardiovascular Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiovascular Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yang Li
- Department of Cardiovascular Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
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24
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Shaw LJ, Blankstein R, Bax JJ, Ferencik M, Bittencourt MS, Min JK, Berman DS, Leipsic J, Villines TC, Dey D, Al'Aref S, Williams MC, Lin F, Baskaran L, Litt H, Litmanovich D, Cury R, Gianni U, van den Hoogen I, R van Rosendael A, Budoff M, Chang HJ, E Hecht H, Feuchtner G, Ahmadi A, Ghoshajra BB, Newby D, Chandrashekhar YS, Narula J. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. J Cardiovasc Comput Tomogr 2021; 15:93-109. [PMID: 33303383 DOI: 10.1016/j.jcct.2020.11.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
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Affiliation(s)
- Leslee J Shaw
- Weill Cornell School of Medicine, New York, NY, USA.
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - James K Min
- Weill Cornell School of Medicine; Cleerly, Inc. (started in 2020), New York, NY, USA
| | - Daniel S Berman
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Fay Lin
- Weill Cornell School of Medicine, New York, NY, USA
| | | | - Harold Litt
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Litmanovich
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, FL, USA
| | | | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | - Amir Ahmadi
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - David Newby
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, NY, USA
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25
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Serial coronary CT angiography-derived fractional flow reserve and plaque progression can predict long-term outcomes of coronary artery disease. Eur Radiol 2021; 31:7110-7120. [PMID: 33630163 DOI: 10.1007/s00330-021-07726-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/29/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the utility of coronary CT angiography-derived fractional flow reserve (FFRCT) and plaque progression in patients undergoing serial coronary CT angiography for predicting major adverse cardiovascular events (MACE). METHODS This retrospective study evaluated patients suspected or known coronary artery disease who underwent serial coronary CT angiography examinations between January 2006 and December 2017 and followed up until June 2019. The primary endpoint was MACE, defined as acute coronary syndrome, rehospitalization due to progressive angina, percutaneous coronary intervention, or cardiac death. FFRCT and plaque parameters were analyzed on a per-vessel and per-patient basis. Univariable and multivariable COX regression analysis determined predictors of MACE. The prognostic value of FFRCT and plaque progression were assessed in nested models. RESULTS Two hundred eighty-four patients (median age, 61 years (interquartile range, 54-70); 202 males) were evaluated. MACE was observed in 45 patients (15.8%, 45/284). By Cox multivariable regression modeling, vessel-specific FFRCT ≤ 0.80 was associated with a 2.4-fold increased risk of MACE (HR (95% CI): 2.4 (1.3-4.4); p = 0.005) and plaque progression was associated with a 9-fold increased risk of MACE (HR (95% CI): 9 (3.5-23); p < 0.001) after adjusting for clinical and imaging risk factors. FFRCT and plaque progression improved the prediction of events over coronary artery calcium (CAC) score and high-risk plaques (HRP) in the receiver operating characteristics analysis (area under the curve: 0.70 to 0.86; p = 0.002). CONCLUSIONS Fractional flow reserve and plaque progression assessed by serial coronary CT angiography predicted the risk of future MACE. KEY POINTS • Vessel-specific CT angiography-derived fractional flow reserve (FFRCT) ≤ 0.80 and plaque progression improved the prediction of events over current risk factors. • Major adverse cardiovascular events (MACE) significantly increased with the presence of plaque progression at follow-up stratified by the FFRCT change group.
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26
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van Rosendael AR, Lin FY, van den Hoogen IJ, Ma X, Gianni U, Al Hussein Alawamlh O, Al'Aref SJ, Peña JM, Andreini D, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Raff GL, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Han D, Berman DS, Virmani R, Samady H, Stone P, Narula J, Bax JJ, Shaw LJ, Min JK, Chang HJ. Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events. J Cardiovasc Comput Tomogr 2021; 15:322-330. [PMID: 33451974 DOI: 10.1016/j.jcct.2020.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/25/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE). METHODS The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted. RESULTS The study population comprised 1166 patients (age 60.5 ± 9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P < 0.001. CONCLUSIONS Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Inge J van den Hoogen
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Umberto Gianni
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Omar Al Hussein Alawamlh
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Subhi J Al'Aref
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Jessica M Peña
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | | | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - 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
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leslee J Shaw
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Henzel J, Kępka C, Kruk M, Makarewicz-Wujec M, Wardziak Ł, Trochimiuk P, Dzielińska Z, Demkow M. High-Risk Coronary Plaque Regression After Intensive Lifestyle Intervention in Nonobstructive Coronary Disease: A Randomized Study. JACC Cardiovasc Imaging 2020; 14:1192-1202. [PMID: 33341413 DOI: 10.1016/j.jcmg.2020.10.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The authors sought to study the impact of diet and lifestyle intervention on changes in atherosclerotic plaque volume and composition. BACKGROUND Lifestyle and diet modification are the leading strategies to manage coronary artery disease; however, their direct impact on atherosclerosis remains unknown. Coronary plaque composition is related to the risk of future cardiovascular events independent of stenosis severity and can be conveniently evaluated with computed tomography angiography (CTA). METHODS We enrolled 92 patients (41% women; mean age 60 ± 7.7 years) with nonobstructive (<70% stenosis) coronary atherosclerosis identified by CTA. Participants were randomized (1:1) to either the DISCO (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography) intervention group (systematic follow-up by a dietitian to adhere to the Dietary Approaches to Stop Hypertension nutrition model together with optimal medical therapy [OMT]) or the control group (OMT alone). In all patients, CTA was repeated after 66.9 ± 13.7 weeks. The outcome was change (Δ) in atheroma volume and plaque composition. Based on atherosclerotic tissue attenuation ranges in Hounsfield units (HU), the following components of coronary plaque were distinguished: dense calcium (>351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque combined with necrotic core (-30 to 150 HU), referred to as noncalcified plaque. RESULTS Percent atheroma volume increased in the control arm (Δ = +1.1 ± 3.4%; p = 0.033) versus no significant change in the experimental arm (Δ = +1.0% ± 4.2%; p = 0.127; intergroup p = 0.851). There was a reduction in noncalcified plaque in both the experimental arm (Δ = -51.3 ± 79.5 mm3 [-1.7 ± 2.7%]; p < 0.001) and the control arm (Δ = -21.3 ± 57.7 [-0.7 ± 1.9%]; p = 0.018), which was greater in the DISCO intervention group (intergroup p = 0.045). No differences in fibrous component or dense calcium changes were observed between the groups. CONCLUSIONS Controlled diet and lifestyle intervention together with OMT may slow the progression of atherosclerosis and reduce noncalcified plaque volume compared to OMT alone. (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography [DISCO-CT]; NCT02571803).
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Affiliation(s)
- Jan Henzel
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Cezary Kępka
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland.
| | - Mariusz Kruk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | | | - Łukasz Wardziak
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Piotr Trochimiuk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Zofia Dzielińska
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marcin Demkow
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
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Khraishah H, Jaffer FA. Intravascular Molecular Imaging: Near-Infrared Fluorescence as a New Frontier. Front Cardiovasc Med 2020; 7:587100. [PMID: 33330648 PMCID: PMC7719823 DOI: 10.3389/fcvm.2020.587100] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Despite exciting advances in structural intravascular imaging [intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] that have enabled partial assessment of atheroma burden and high-risk features associated with acute coronary syndromes, structural-based imaging modalities alone do not comprehensively phenotype the complex pathobiology of atherosclerosis. Near-infrared fluorescence (NIRF) is an emerging molecular intravascular imaging modality that allows for in vivo visualization of pathobiological and cellular processes at atheroma plaque level, including inflammation, oxidative stress, and abnormal endothelial permeability. Established intravascular NIRF imaging targets include macrophages, cathepsin protease activity, oxidized low-density lipoprotein and abnormal endothelial permeability. Structural and molecular intravascular imaging provide complementary information about plaque microstructure and biology. For this reason, integrated hybrid catheters that combine NIRF-IVUS or NIRF-OCT have been developed to allow co-registration of morphological and molecular processes with a single pullback, as performed for standalone IVUS or OCT. NIRF imaging is approaching application in clinical practice. This will be accelerated by the use of FDA-approved indocyanine green (ICG), which illuminates lipid- and macrophage-rich zones of permeable atheroma. The ability to comprehensively phenotype coronary pathobiology in patients will enable a deeper understanding of plaque pathobiology, improve local and patient-based risk prediction, and usher in a new era of personalized therapy.
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Affiliation(s)
- Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.,Division of Cardiology, Cardiovascular Research Center and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Farouc A Jaffer
- Division of Cardiology, Cardiovascular Research Center and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Wellman Center for Photomedicine and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
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29
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Sex Differences in Compositional Plaque Volume Progression in Patients With Coronary Artery Disease. JACC Cardiovasc Imaging 2020; 13:2386-2396. [PMID: 32828763 DOI: 10.1016/j.jcmg.2020.06.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study sought to explore sex-based differences in total and compositional plaque volume (PV) progression. BACKGROUND It is unclear whether sex has an impact on PV progression in patients with coronary artery disease (CAD). METHODS The study analyzed a prospective multinational registry of consecutive patients with suspected CAD who underwent 2 or more clinically indicated coronary computed tomography angiography (CTA) at ≥2-year intervals. Total and compositional PV at baseline and follow-up were quantitatively analyzed and normalized using the analyzed total vessel length. Multivariate linear regression models were constructed. RESULTS Of the 1,255 patients included (median coronary CTA interval 3.8 years), 543 were women and 712 were men. Women were older (62 ± 9 years of age vs. 59 ± 9 years of age; p < 0.001) and had higher total cholesterol levels (195 ± 41 mg/dl vs. 187 ± 39 mg/dl; p = 0.002). Prevalence of hypertension, diabetes, and family history of CAD were not different (all p > 0.05). At baseline, men possessed greater total PV (31.3 mm3 [interquartile range (IQR): 0 to 121.8 mm3] vs. 56.7 mm3 [IQR: 6.8 to 152.1 mm3] p = 0.005), and there was an approximately 9-year delay in women in developing total PV than in men. The prevalence of high-risk plaques was greater in men than women (31% vs. 20%; p < 0.001). In multivariate analysis, after adjusting for age, clinical risk factors, medication use, and total PV at baseline, despite similar total PV progression rates, female sex was associated with greater calcified PV progression (β = 2.83; p = 0.004) but slower noncalcified PV progression (β = -3.39; p = 0.008) and less development of high-risk plaques (β = -0.18; p = 0.049) than in men. CONCLUSIONS The compositional PV progression differed according to sex, suggesting that comprehensive plaque evaluation may contribute to further refining of risk stratification according to sex. (NCT02803411).
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Lee SE, 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, de Araújo Gonçalves P, Pontone G, Shin S, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. Int J Cardiovasc Imaging 2020; 36:2357-2364. [PMID: 32779077 DOI: 10.1007/s10554-020-01960-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 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, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | - 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
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | | | | | - Sanghoon Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- 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, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Shaikh K, Ellenberg SS, Nakanishi R, Snyder PJ, Lee J, Wenger NK, Lewis CE, Swerdloff RS, Preston P, Hamal S, Stephens-Sheilds A, Bhasin S, Cherukuri L, Cauley JA, Crandall JP, Cunningham GR, Ensrud KE, Matsumoto AM, Molich ME, Alla VM, Birudaraju D, Nezarat N, Rai K, Almeida S, Roy SK, Sheikh M, Trad G, Budoff MJ. Biomarkers and Noncalcified Coronary Artery Plaque Progression in Older Men Treated With Testosterone. J Clin Endocrinol Metab 2020; 105:5648063. [PMID: 31784747 PMCID: PMC7209773 DOI: 10.1210/clinem/dgz242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recent results from the Cardiovascular Trial of the Testosterone Trials showed that testosterone treatment of older men with low testosterone was associated with greater progression of noncalcified plaque (NCP). We evaluated the effect of anthropometric measures and cardiovascular biomarkers on plaque progression in individuals in the Testosterone Trial. METHODS The Cardiovascular part of the trial included 170 men aged 65 years or older with low testosterone. Participants received testosterone gel or placebo gel for 12 months. The primary outcome was change in NCP volume from baseline to 12 months, as determined by coronary computed tomography angiography (CCTA). We assayed several markers of cardiovascular risk and analyzed each marker individually in a model as predictive variables and change in NCP as the dependent variable. RESULTS Of 170 enrollees, 138 (73 testosterone, 65 placebo) completed the study and were available for the primary analysis. Of 10 markers evaluated, none showed a significant association with the change in NCP volume, but a significant interaction between treatment assignment and waist-hip ratio (WHR) (P = 0.0014) indicated that this variable impacted the testosterone effect on NCP volume. The statistical model indicated that for every 0.1 change in the WHR, the testosterone-induced 12-month change in NCP volume increased by 26.96 mm3 (95% confidence interval, 7.72-46.20). CONCLUSION Among older men with low testosterone treated for 1 year, greater WHR was associated with greater NCP progression, as measured by CCTA. Other biomarkers and anthropometric measures did not show statistically significant association with plaque progression.
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Affiliation(s)
- Kashif Shaikh
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
- Correspondence: Kashif Shaikh, MD, Advanced Cardiac Imaging Fellow, Division of Cardiology, Harbor UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California. E-mail:
| | - Susan S Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rine Nakanishi
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juhwan Lee
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory Heart and Vascular Center Emory University School of Medicine, Atlanta, Georgia
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Alabama
| | - Ronald S Swerdloff
- Division of Endocrinology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Peter Preston
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sajad Hamal
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Alisa Stephens-Sheilds
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shalender Bhasin
- Department of Family and Preventive Medicine, Division of Epidemiology, University of California, San Diego School of Medicine, La Jolla, California
| | - Lavanya Cherukuri
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jill P Crandall
- Divisions of Endocrinology and Geriatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Glenn R Cunningham
- Departments of Medicine and Molecular & Cellular Biology, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine and Baylor St. Luke’s Medical Center, Houston, Texas
| | - Kristine E Ensrud
- Department of Medicine, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Alvin M Matsumoto
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Puget Sound Health System, and Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Mark E Molich
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Divya Birudaraju
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Negin Nezarat
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Kelash Rai
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Shone Almeida
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Sion K Roy
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Mohammad Sheikh
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - George Trad
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Mathew J Budoff
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
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Sakellarios AI, Pezoulas VC, Bourantas C, Naka KK, Michalis LK, Serruys PW, Stone G, Garcia-Garcia HM, Fotiadis DI. Prediction of atherosclerotic disease progression combining computational modelling with machine learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2760-2763. [PMID: 33018578 DOI: 10.1109/embc44109.2020.9176435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive serial computed tomography coronary angiography (CTCA) was acquired from 32 patients and 3D reconstruction of 58 coronary arteries was achieved. The arterial geometries were utilized for blood flow and LDL transport modelling. Navier-Stokes and convection-diffusion equations were employed for simulation of blood flow and LDL transport, respectively. Disease progression was assessed comparing the follow-up and baseline arterial models after co-registration using side branches as anatomical landmarks. A machine learning model for predicting disease progression was built using the Gradient Boosted Trees (GBT) algorithm. The Accuracy, Sensitivity, Specificity and AUC of the developed methodology for predicting lumen area decrease equal was 0.68, 0.56, 0.34 and 0.59, respectively. The best results were found for the prediction of plaque area increase by 20%, with 0.73, 0.67, 0.86, and 0.76 accuracy, sensitivity, specificity andAUC, respectively. This approach outperforms significantly the predictive capability of models based on binary logistic regression.
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Lee SE, 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, de Araújo Gonçalves P, Pontone G, Raff GL, Shin S, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA. JACC Cardiovasc Imaging 2020; 13:1409-1417. [DOI: 10.1016/j.jcmg.2019.09.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/21/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
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Abstract
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease.
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Hou ZH, Lu B, Li ZN, An YQ, Gao Y, Yin WH, Budoff MJ. Quantification of atherosclerotic plaque volume in coronary arteries by computed tomographic angiography in subjects with and without diabetes. Chin Med J (Engl) 2020; 133:773-778. [PMID: 32149765 PMCID: PMC7147656 DOI: 10.1097/cm9.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes mellitus (DM) is considered a cardiovascular risk factor. The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus (DM) vs. those without DM. Methods This study recruited consecutive patients who underwent coronary computed tomography (CT) angiography (CCTA) between October 2016 and November 2017. Personal information including conventional cardiovascular risk factors was collected. Plaque phenotypes were automatically calculated for volume of different component. The volume of different plaque was compared between DM patients and those without DM. Results Among 6381 patients, 931 (14.59%) were diagnosed with DM. The prevalence of plaque in DM subjects was higher compared with nondiabetic group significantly (48.34% vs. 33.01%, χ2 = 81.84, P < 0.001). DM was a significant risk factor for the prevalence of plaque in a multivariate model (odds ratio [OR] = 1.465, 95% CI: 1.258–1.706, P < 0.001). The volume of total plaque and any plaque subtypes in the DM subjects was greater than those in nondiabetic patients significantly (P < 0.001). Conclusion The coronary artery atherosclerotic plaques were significantly higher in diabetic patients than those in non-diabetic patients.
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Affiliation(s)
- Zhi-Hui Hou
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Bin Lu
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Zhen-Nan Li
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Yun-Qiang An
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Yang Gao
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Wei-Hua Yin
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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Nomura CH, Assuncao-Jr AN, Guimarães PO, Liberato G, Morais TC, Fahel MG, Giorgi MCP, Meneghetti JC, Parga JR, Dantas-Jr RN, Cerri GG. Association between perivascular inflammation and downstream myocardial perfusion in patients with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2020; 21:599-605. [DOI: 10.1093/ehjci/jeaa023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/14/2019] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
Aims
To investigate the association between pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary computed tomography angiography (CTA) and coronary flow reserve (CFR) by positron emission tomography (PET) in patients with suspected coronary artery disease (CAD).
Methods and results
PCAT CT attenuation was measured in proximal segments of all major epicardial coronary vessels of 105 patients with suspected CAD. We evaluated the relationship between PCAT CT attenuation and other quantitative/qualitative CT-derived anatomic parameters with CFR by PET. Overall, the mean age was 60 ± 12 years and 93% had intermediate pre-test probability of obstructive CAD. Obstructive CAD (≥50% stenosis) was detected in 37 (35.2%) patients and impaired CFR (<2.0) in 32 (30.5%) patients. On a per-vessel analysis (315 vessels), obstructive CAD, non-calcified plaque volume, and PCAT CT attenuation were independently associated with CFR. In patients with coronary calcium score (CCS) <100, those with high-PCAT CT attenuation presented significantly lower CFR values than those with low-PCAT CT attenuation (2.47 ± 0.95 vs. 3.13 ± 0.89, P = 0.003). Among those without obstructive CAD, CFR was significantly lower in patients with high-PCAT CT attenuation (2.51 ± 0.95 vs. 3.02 ± 0.84, P = 0.021).
Conclusion
Coronary perivascular inflammation by CTA was independently associated with downstream myocardial perfusion by PET. In patients with low CCS or without obstructive CAD, CFR was lower in the presence of higher perivascular inflammation. PCAT CT attenuation might help identifying myocardial ischaemia particularly among patients who are traditionally considered non-high risk for future cardiovascular events.
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Affiliation(s)
- Cesar H Nomura
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
- Department of Radiology, Institute of Radiology, InRad, University of Sao Paulo Medical School, R. Dr. Ovidio Pires de Campos 75, Cerqueira Cesar, Sao Paulo - SP, 05403-010, Brazil
| | - Antonildes N Assuncao-Jr
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Patricia O Guimarães
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Gabriela Liberato
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Thamara C Morais
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Mateus G Fahel
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Maria C P Giorgi
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - José C Meneghetti
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Jose R Parga
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Roberto N Dantas-Jr
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Giovanni G Cerri
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
- Department of Radiology, Institute of Radiology, InRad, University of Sao Paulo Medical School, R. Dr. Ovidio Pires de Campos 75, Cerqueira Cesar, Sao Paulo - SP, 05403-010, Brazil
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van Rosendael AR, Lin FY, Ma X, van den Hoogen IJ, Gianni U, Al Hussein O, Al'Aref SJ, Peña JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Raff GL, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Bax JJ, Shaw LJ, Min JK, Chang HJ. Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study. J Cardiovasc Comput Tomogr 2020; 14:400-406. [PMID: 32063545 DOI: 10.1016/j.jcct.2020.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 01/29/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. METHODS The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. RESULTS The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. CONCLUSIONS PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Inge J van den Hoogen
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Umberto Gianni
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Omar Al Hussein
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Subhi J Al'Aref
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - 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
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leslee J Shaw
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Dahal S, Budoff MJ. Implications of serial coronary computed tomography angiography in the evaluation of coronary plaque progression. Curr Opin Lipidol 2019; 30:446-451. [PMID: 31592788 DOI: 10.1097/mol.0000000000000645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose is to review the use of coronary computed tomography (CT) angiography to assess coronary plaque burden/progression and to discuss about recent clinical trials that have utilized this imaging modality to study the effect of new pharmacotherapies on plaque burden/progression. RECENT FINDINGS There are numerous clinical trials that have utilized coronary CT angiography to demonstrate the potential benefits of statins, apixaban, rivaroxaban, aged garlic extract, biologic agents, and omega-3 fatty acids to reduce coronary plaque progression. Coronary CT angiography can identify high-risk plaques and can also quantify total plaque burden, both of which are independent risk factors to predict major adverse cardiac events. SUMMARY Coronary heart disease remains one of the leading cause of mortality in the world. Utilizing coronary CT angiography, it is possible to identify rupture-prone plaques and also to quantify the total plaque burden. New pharmacotherapies that have the potential to reduce plaque progression have been used in clinical trials and these trials have utilized coronary CT angiography to track coronary atheroma progression. In future, we will see frequent utilization of coronary CT angiography to track coronary atheroma.
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Affiliation(s)
- Suraj Dahal
- Department of Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, CDCRC, Torrance, California, USA
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Lee SE, Sung JM, Andreini D, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Kumar A, Lee BK, Leipsic JA, Maffei E, Marques H, Pontone G, Raff G, Shin S, Stone PH, Samady H, Virmani R, Narula J, Berman DS, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study. Eur Heart J Cardiovasc Imaging 2019; 20:1307-1314. [PMID: 30789215 PMCID: PMC6806249 DOI: 10.1093/ehjci/jez022] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/24/2018] [Accepted: 01/29/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS Coronary artery calcium score (CACS) is a strong predictor of major adverse cardiac events (MACE). Conversely, statins, which markedly reduce MACE risk, increase CACS. We explored whether CACS progression represents compositional plaque volume (PV) progression differently according to statin use. METHODS AND RESULTS From a prospective multinational registry of consecutive patients (n = 2252) who underwent serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with information regarding the use of statins and having a serial CACS were included. Patients were divided into non-statin (n = 246) and statin-taking (n = 408) groups. Coronary PVs (total, calcified, and non-calcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analysed, and CACS was measured from both CCTAs. Multivariate linear regression models were constructed for both statin-taking and non-statin group to assess the association between compositional PV change and change in CACS. In multivariate linear regression analysis, in the non-statin group, CACS increase was positively associated with both non-calcified (β = 0.369, P = 0.004) and calcified PV increase (β = 1.579, P < 0.001). However, in the statin-taking group, CACS increase was positively associated with calcified PV change (β = 0.756, P < 0.001) but was negatively associated with non-calcified PV change (β = -0.194, P = 0.026). CONCLUSION In the non-statin group, CACS progression indicates the progression of both non-calcified and calcified PV progression. However, under the effect of statins, CACS progression indicates only calcified PV progression, but not non-calcified PV progression. Thus, the result of serial CACS should be differently interpreted according to the use of statins.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Ji Min Sung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | - Jung Hyun Choi
- Department of Internal Medicine, Busan University Hospital, Busan, South Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, 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 Centre Munich, Munich, Germany
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Amit Kumar
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Byoung Kwon Lee
- Department of Internal Medicine, 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
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | | | - Gilbert Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Sanghoon Shin
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, South Korea
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Centre for Cardiovascular Health, New York, NY, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, ZA Leiden, The Netherlands
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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van Rosendael AR, Bax JJ, Arbab-Zadeh A. Noninvasive assessment of coronary atherosclerosis by cardiac computed tomography for risk stratifying patients with suspected coronary heart disease. J Cardiovasc Comput Tomogr 2019; 13:235-241. [PMID: 31563581 DOI: 10.1016/j.jcct.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Alexander R van Rosendael
- From the Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; The Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Jeroen J Bax
- From the Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; The Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Armin Arbab-Zadeh
- The Department of Medicine-Division of Cardiology Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine. Curr Cardiol Rep 2019; 21:72. [DOI: 10.1007/s11886-019-1170-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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43
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Precht H, Broersen A, Kitslaar PH, Dijkstra J, Gerke O, Thygesen J, Egstrup K, Leth PM, Hardt-Madsen M, Nielsen B, Falk E, Lambrechtsen J. A novel alignment procedure to assess calcified coronary plaques in histopathology, post-mortem computed tomography angiography and optical coherence tomography. Cardiovasc Pathol 2019; 39:25-29. [DOI: 10.1016/j.carpath.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/27/2022] Open
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Nozue T, Takamura T, Fukui K, Hibi K, Kishi S, Michishita I. Plaque Volume and Morphology are Associated with Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography. J Atheroscler Thromb 2018; 26:697-704. [PMID: 30568077 PMCID: PMC6711840 DOI: 10.5551/jat.47621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) accurately diagnoses ischemic lesions of intermediate stenosis severity. However, significant determinants of FFRCT have not been fully evaluated. Methods: This was a sub-analysis of the Treatment of Alogliptin on Coronary Atherosclerosis Evaluated by Computed Tomography-Based Fractional Flow Reserve trial. Thirty-nine diabetic patients (117 vessels) with intermediate coronary artery stenosis [percent diameter stenosis (%DS) <70%] in whom FFRCT was measured were included in this study. CCTA-defined, vessel-based volumetric and morphological characteristics of plaques were examined to determine their ability to predict FFRCT. Results: Patient-based, multivariate linear regression analysis showed that hemoglobinA1c, triglycerides, and the estimated glomerular filtration rate were significant independent factors associated with FFRCT. Vessel-based, univariate linear regression analysis showed that the total atheroma volume (r = -0.233, p=0.01) and the percentage atheroma volume (PAV) (r = −0.284, p=0.002) as well as %DS (r = −0.316, p=0.006) were significant determinants of FFRCT. Among the plaque components, significant negative correlations were observed between FFRCT and low- (r = −0.248, p=0.007) or intermediate-attenuation plaque volume (r = −0.186, p= 0.045), whereas calcified plaque volume was not associated with FFRCT. In the left anterior descending coronary artery (LAD), the plaque volume of each component was associated with FFRCT. Conclusions: Plaque volume, PAV, and %DS were significant determinants of FFRCT. Plaque morphology, particularly in LAD, was associated with FFRCT in diabetic patients with intermediate coronary artery stenosis.
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Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
| | | | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Ichiro Michishita
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
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Foster P, Sokoll L, Li J, Gerstenblith G, Fishman EK, Kickler T, Chen S, Tai H, Lai H, Lai S. Circulating levels of cardiac troponin T are associated with coronary noncalcified plaque burden in HIV-infected adults: a pilot study. Int J STD AIDS 2018; 30:223-230. [PMID: 30381028 DOI: 10.1177/0956462418800873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV infection and/or antiretroviral therapy may increase the risk of subclinical coronary atherosclerosis. However, patients with chronic kidney disease (CKD) and those without IV access cannot undergo contrast-enhanced coronary CT angiography (CCTA). This study was to explore the relationship between cardiac troponin T (cTnT) levels and the extent of coronary plaque burden, as assessed by CCTA in those with HIV infection. Between June and September 2017, 58 HIV-infected participants were recruited and underwent contrast-enhanced CCTA. cTnT was measured with the Elecsys Troponin T Gen 5 STAT assay, and noncalcified plaque burden was quantified using coronary plaque analysis. Robust regression model was employed to perform primary statistical analysis. Univariate robust regression analysis indicated that male gender, cardiovascular risk score defined by the 2013 ACC/AHA cardiovascular risk score algorithm, and cTnT levels were significantly associated with noncalcified plaque volume index (NCPI). Final robust regression analyses showed that only cTnT (log scale) was independently associated with the NCPI (regression coefficient: 0.0453 with 95% CI: 0.0151, 0.0755, p = 0.003). These results of this study suggest that cTnT may be a promising marker for coronary plaque burden, especially in patients with HIV-associated CKD or without IV access.
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Affiliation(s)
- Parker Foster
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lori Sokoll
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ji Li
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary Gerstenblith
- 2 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- 3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas Kickler
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shaoguang Chen
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hong Tai
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hong Lai
- 3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shenghan Lai
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,2 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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On the Pathophysiology of Coronary Artery Disease: We Were Told Where to Go But Not How to Get There. JACC Cardiovasc Imaging 2018; 11:1795-1798. [PMID: 30343082 DOI: 10.1016/j.jcmg.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/13/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022]
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Assessment of factors associated with measurability of fractional flow reserve derived from coronary computed tomography angiography in type 2 diabetic patients with intermediate coronary artery stenosis. Int J Cardiovasc Imaging 2018; 35:359-365. [PMID: 30341670 DOI: 10.1007/s10554-018-1476-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 01/01/2023]
Abstract
Recently, fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFRCT) has been developed. However, FFRCT cannot be calculated for all patients from CCTA datasets. The purpose of the present study, therefore, was to evaluate the predictors that results in cases being inappropriate for FFRCT processing. This study was a sub-analysis of the TRACT trial, from which 50 patients were divided into 2 groups according to FFRCT measurability (measurable [group M] or not measurable [group N]) using CCTA examination at baseline. Thirty-nine (78%) patients comprised group M and 11 (22%) comprised group N. Heart rate at CCTA examination (72 beats/min vs. 63 beats/min; p = 0.007) and Agatston score (665 vs. 33; p = 0.002) in group N were significantly higher than those in group M. Multivariate logistic regression analyses revealed that heart rate at CCTA examination (OR 1.348 [95% CI 1.167-1.556]; p < 0.001) and Agatston score (OR 1.002 [95% CI 1.000-1.003]; p = 0.004) were significant, independent factors associated with non-measurability of FFRCT. The frequency of poor image quality was highest in patients with heart rate > 65 beats/min and Agatston score > 400 (p < 0.0001). In conclusions, high heart rate at the time of CCTA examination and higher Agatston score were associated with poor image quality that resulted in cases being inappropriate for FFRCT processing. Heart rate control at CCTA examination is necessary to acquire good-quality images required for computing FFRCT.
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48
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Effects of Statins on Coronary Atherosclerotic Plaques. JACC Cardiovasc Imaging 2018; 11:1475-1484. [DOI: 10.1016/j.jcmg.2018.04.015] [Citation(s) in RCA: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 01/11/2023]
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49
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Multicenter AIDS Cohort Study Quantitative Coronary Plaque Progression Study: rationale and design. Coron Artery Dis 2018; 29:23-29. [PMID: 28777120 DOI: 10.1097/mca.0000000000000546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM The association of HIV with coronary atherosclerosis has been established; however, the progression of coronary atherosclerosis over time among participants with HIV is not well known. The Multicenter AIDS Cohort Study Quantitative Coronary Plaque Progression Study is a large prospective multicenter study quantifying progression of coronary plaque assessed by serial coronary computed tomography angiography (CTA). PATIENTS AND METHODS HIV-infected and uninfected men who were enrolled in the Multicenter AIDS Cohort Study Cardiovascular Substudy were eligible to complete a follow-up contrast coronary CTA 3-6 years after baseline. We measured coronary plaque volume and characteristics (calcified and noncalcified plaque including fibrous, fibrous-fatty, and low attenuation) and vulnerable plaque among HIV-infected and uninfected men using semiautomated plaque software to investigate the progression of coronary atherosclerosis over time. CONCLUSION We describe a novel, large prospective multicenter study investigating incidence, transition of characteristics, and progression in coronary atherosclerosis quantitatively assessed by serial coronary CTAs among HIV-infected and uninfected men.
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50
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Lee SE, Sung JM, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Hyun Choi J, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. Circ Cardiovasc Imaging 2018; 11:e007562. [DOI: 10.1161/circimaging.117.007562] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.)
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.)
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.)
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.)
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.)
| | - Fay Y. Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.)
| | - Amit Kumar
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.)
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich (M.H.)
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul National University Hospital, South Korea (Y.-J.K.)
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy (E.C., G.A., G.P.)
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy (E.C., G.A., G.P.)
| | - Matthew J. Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.)
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.)
| | - Byoung Kwon Lee
- Gangnam Severance Hospital (B.K.L.), Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, South Korea (E.J.C.)
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale Marche Marche, Urbino, Italy (E.M.)
| | | | - Jonathon A. Leipsic
- Department of Radiology, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (J.A.L.)
| | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, South Korea (S.S.)
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.R., K.C.)
| | - Gilbert Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.R., K.C.)
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD (R.V.)
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.S., L.J.S.)
| | - Peter H. Stone
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.H.S.)
| | - Daniel S. Berman
- Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.)
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY (J.N.)
| | - Leslee J. Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.S., L.J.S.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B.)
| | - James K. Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.)
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.)
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.)
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