1
|
Faridi KF, Lahan S, Budoff MJ, Cury RC, Feldman T, Pan AP, Fialkow J, Nasir K. Serum Lipoproteins Are Associated With Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. JACC. ADVANCES 2024; 3:101049. [PMID: 39129991 PMCID: PMC11312344 DOI: 10.1016/j.jacadv.2024.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 08/13/2024]
Abstract
Background The relationship between atherogenic lipoproteins and subclinical coronary atherosclerosis has not been thoroughly evaluated in low-risk adults. Objectives The purpose of this study was to assess the association of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (apoB) with coronary atherosclerosis in adults without traditional risk factors. Methods We assessed atherosclerosis on coronary computed tomography angiography among asymptomatic adults in the Miami Heart Study not taking lipid-lowering therapy and without hypertension, diabetes, or active tobacco use. Prevalence of atherosclerosis was evaluated based on serum LDL-C, non-HDL-C, and apoB, and multivariable logistic regression with forward selection was used to assess variables associated with coronary plaque. Results Among 1,033 adults 40 to 65 years of age, 55.0% were women and 86.3% had estimated 10-year atherosclerotic cardiovascular disease risk <5%. Coronary atherosclerosis prevalence was 35.9% (50.6% in men; 23.8% in women) and 3.4% had ≥1 high-risk plaque feature. Atherosclerosis prevalence increased with LDL-C, ranging from 13.2% in adults with LDL-C <70 mg/dL up to 48.2% with ≥160 mg/dL. Higher LDL-C (adjusted OR [aOR]: 1.13 [95% CI: 1.08-1.18] per 10 mg/dL), age (aOR: 1.43 [95% CI: 1.28-1.60] per 5 years), male sex (aOR: 3.81 [95% CI: 2.86-5.10]), and elevated lipoprotein(a) (aOR: 1.46 [95% CI: 1.01-2.09]) were associated with atherosclerosis. Higher serum non-HDL-C and apoB were similarly associated with atherosclerosis. In adults with optimal risk factors, 21.2% had atherosclerosis with greater prevalence at higher lipoprotein levels. Conclusions Among asymptomatic middle-aged adults without traditional risk factors, coronary atherosclerosis is common and increasingly prevalent at higher levels of atherogenic lipoproteins. These findings emphasize the importance of lipid-lowering strategies to prevent development and progression of atherosclerosis regardless of risk factors.
Collapse
Affiliation(s)
- Kamil F. Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shubham Lahan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Alan P. Pan
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| |
Collapse
|
2
|
Çap M, Ramasamy A, Parasa R, Tanboga IH, Maung S, Morgan K, Yap NAL, Abou Gamrah M, Sokooti H, Kitslaar P, Reiber JHC, Dijkstra J, Torii R, Moon JC, Mathur A, Baumbach A, Pugliese F, Bourantas CV. Efficacy of human experts and an automated segmentation algorithm in quantifying disease pathology in coronary computed tomography angiography: A head-to-head comparison with intravascular ultrasound imaging. J Cardiovasc Comput Tomogr 2024; 18:142-153. [PMID: 38143234 DOI: 10.1016/j.jcct.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/26/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) analysis is currently performed by experts and is a laborious process. Fully automated edge-detection methods have been developed to expedite CCTA segmentation however their use is limited as there are concerns about their accuracy. This study aims to compare the performance of an automated CCTA analysis software and the experts using near-infrared spectroscopy-intravascular ultrasound imaging (NIRS-IVUS) as a reference standard. METHODS Fifty-one participants (150 vessels) with chronic coronary syndrome who underwent CCTA and 3-vessel NIRS-IVUS were included. CCTA analysis was performed by an expert and an automated edge detection method and their estimations were compared to NIRS-IVUS at a segment-, lesion-, and frame-level. RESULTS Segment-level analysis demonstrated a similar performance of the two CCTA analyses (conventional and automatic) with large biases and limits of agreement compared to NIRS-IVUS estimations for the total atheroma (ICC: 0.55 vs 0.25, mean difference:192 (-102-487) vs 243 (-132-617) and percent atheroma volume (ICC: 0.30 vs 0.12, mean difference: 12.8 (-5.91-31.6) vs 20.0 (0.79-39.2). Lesion-level analysis showed that the experts were able to detect more accurately lesions than the automated method (68.2 % and 60.7 %) however both analyses had poor reliability in assessing the minimal lumen area (ICC 0.44 vs 0.36) and the maximum plaque burden (ICC 0.33 vs 0.33) when NIRS-IVUS was used as the reference standard. CONCLUSIONS Conventional and automated CCTA analyses had similar performance in assessing coronary artery pathology using NIRS-IVUS as a reference standard. Therefore, automated segmentation can be used to expedite CCTA analysis and enhance its applications in clinical practice.
Collapse
Affiliation(s)
- Murat Çap
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, University of Health Sciences Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Ramya Parasa
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Ibrahim H Tanboga
- Istanbul Nisantasi University Medical School, Department of Cardiology & Biostatistics, Istanbul, Turkey
| | - Soe Maung
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Kimberley Morgan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Nathan A L Yap
- Barts and the London School of Medicine and Dentistry, London, UK
| | | | | | | | - Johan H C Reiber
- Medis Medical Imaging, Leiden, the Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
| |
Collapse
|
3
|
Moradi M, Jahromi AS. Prognostic value of mitral annular calcification in coronary atherosclerotic disease assessed by coronary computed tomographic angiography. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:3. [PMID: 38524747 PMCID: PMC10956555 DOI: 10.4103/jrms.jrms_53_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/06/2023] [Accepted: 09/21/2023] [Indexed: 03/26/2024]
Abstract
Background There is a lack of evidence on the link between mitral annular calcification (MAC) and coronary atherosclerotic diseases. The present investigation was undertaken to detect the clinical and prognostic value of MAC in coronary atherosclerotic diseases in patients who underwent coronary computed tomographic (CT) angiography. Materials and Methods Two hundred and five individuals with MAC and without it (n = 85 and 120, respectively) were included in the present cross-sectional study. Coronary artery disease-reporting and data system (CAD-RADS) at coronary CT angiography was used to define the severity of coronary atherosclerotic diseases. Patients were classified into no or non-significant CAD (CAD-RADS 0-2) and significant CAD (CAD-RADS 3-5) according to the severity of coronary atherosclerotic diseases. The association of MAC with two mentioned groups (no or non-significant CAD and significant CAD) was assessed using the Chi-squared test and logistic regression in crude and adjusted models. Results Patients with MAC were significantly older (69.34 ± 8.20 vs. 60.64 ± 11.42, P < 0.001), had lower glomerular infiltration rate (69.67 ± 20.92 vs. 78.00 ± 20.23, P = 0.005), and higher coronary artery calcification score (352.87 ± 495.85 vs. 200.55 ± 426.13, P = 0.05) in comparison to those without MAC. However, the significant difference between the two groups regarding coronary artery calcification score disappeared after adjustment for confounders (P = 0.14). In addition, a statistically significant positive link between MAC and significant CAD was observed (odds ratio [OR] [95% confidence interval (CI)]: 1.96 [1.04-3.71], P = 0.04). Nevertheless, the association became statistically insignificant after adjustment for confounders (OR [95% CI]: 1.60 [0.78-3.28], P = 0.2). Conclusion The findings of the study revealed that MAC has no independent prognostic value in coronary atherosclerotic diseases evaluated by coronary CT angiography.
Collapse
Affiliation(s)
- Maryam Moradi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | |
Collapse
|
4
|
Huang Z, Ding Y, Yang Y, Zhao S, Zhang S, Xiao J, Ding C, Guo N, Li Z, Zhou S, Cao G, Wang X. Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates. Acta Radiol 2024; 65:123-132. [PMID: 36847335 DOI: 10.1177/02841851231158730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Limited studies have investigated the accuracy of therapeutic decision-making using machine learning-based coronary computed tomography angiography (ML-CCTA) compared with CCTA. PURPOSE To investigate the performance of ML-CCTA for therapeutic decision compared with CCTA. MATERIAL AND METHODS The study population consisted of 322 consecutive patients with stable coronary artery disease. The SYNTAX score was calculated with an online calculator based on ML-CCTA results. Therapeutic decision-making was determined by ML-CCTA results and the ML-CCTA-based SYNTAX score. The therapeutic strategy and the appropriate revascularization procedure were selected using ML-CCTA, CCTA, and invasive coronary angiography (ICA) independently. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of ML-CCTA and CCTA for selecting revascularization candidates were 87.01%, 96.43%, 95.71%, 89.01%, 91.93%, and 85.71%, 87.50%, 86.27%, 86.98%, 86.65%, respectively, using ICA as the standard reference. The area under the receiver operating characteristic curve (AUC) of ML-CCTA for selecting revascularization candidates was significantly higher than CCTA (0.917 vs. 0.866, P = 0.016). Subgroup analysis showed the AUC of ML-CCTA for selecting percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) candidates was significantly higher than CCTA (0.883 vs. 0.777, P < 0.001, 0.912 vs. 0.826, P = 0.003, respectively). CONCLUSION ML-CCTA could distinguish between patients who need revascularization and those who do not. In addition, ML-CCTA showed a slightly superior to CCTA in making an appropriate decision for patients and selecting a suitable revascularization strategy.
Collapse
Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ding
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengchao Zhao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Ding
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiguang Zhou
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guijuan Cao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
5
|
Ohashi H, Bouisset F, Buytaert D, Seki R, Sonck J, Sakai K, Belmonte M, Kitslaar P, Updegrove A, Amano T, Andreini D, De Bruyne B, Collet C. Coronary CT Angiography in the Cath Lab: Leveraging Artificial Intelligence to Plan and Guide Percutaneous Coronary Intervention. Interv Cardiol 2023; 18:e26. [PMID: 38125928 PMCID: PMC10731535 DOI: 10.15420/icr.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 12/23/2023] Open
Abstract
The role of coronary CT angiography for the diagnosis and risk stratification of coronary artery disease is well established. However, its potential beyond the diagnostic phase remains to be determined. The current review focuses on the insights that coronary CT angiography can provide when planning and performing percutaneous coronary interventions. We describe a novel approach incorporating anatomical and functional pre-procedural planning enhanced by artificial intelligence, computational physiology and online 3D CT guidance for percutaneous coronary interventions. This strategy allows the individualisation of patient selection, optimisation of the revascularisation strategy and effective use of resources.
Collapse
Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Frédéric Bouisset
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Toulouse University HospitalToulouse, France
| | | | | | | | - Koshiro Sakai
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Showa University HospitalTokyo, Japan
| | - Marta Belmonte
- Cardiovascular Center OLVAalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico IINaples, Italy
| | | | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi – Sant’AmbrogioMilan, Italy
- Department of Biomedical and Clinical Sciences, University of MilanMilan, Italy
| | - Bernard De Bruyne
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, University Hospital of LausanneLausanne, Switzerland
| | | |
Collapse
|
6
|
Meng Q, Hou Z, Gao Y, Zhao N, An Y, Lu B. Prognostic value of coronary CT angiography for the prediction of all-cause mortality and non-fatal myocardial infarction: a propensity score analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2247-2254. [PMID: 37589870 DOI: 10.1007/s10554-023-02918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
To explore the relationship between comprehensive assessment of coronary atherosclerosis by coronary CT angiography (CCTA) and all-cause mortality and non-fatal myocardial infarction in the Chinese population. Sixty-three patients from the prospective long-term study who experienced major adverse cardiovascular events (MACE) during the follow-up were included. No-MACE patients were 1:1 propensity-matched. Various qualitative and quantitative CCTA parameters, such as coronary artery calcium score (CACS), high-risk plaque, coronary artery disease (CAD) severity, number of obstructive vessels, segment involvement score (SIS), segment stenosis score (SSS), computed tomography-adapt Leaman score (CT-LeSc), and peri-coronary adipose tissue (PCAT) CT attenuation, were compared between both groups. Cox regression analysis was performed to determine the association between CCTA parameters and MACE. The MACE group had higher CACS, more high-risk plaques, more obstructive CAD, more obstructive vessels, higher PCAT CT attenuation, and higher coronary atherosclerotic burden (SIS: 5.76 ± 3.36 vs. 2.84 ± 3.07; SSS: 11.06 ± 8.41 vs. 3.94 ± 4.78; CT-LeSc: 11.25 ± 6.57 vs. 5.49 ± 5.82) than the control group (all p < 0.05). On multivariable analysis, hazard ratios were 1.058 for the SSS (p = 0.004), and 2.152 for the obstructive CAD. When the burden of coronary atherosclerosis was defined as the CT-LeSc, hazard ratios were 1.057 for the CT-LeSc (p = 0.036), and 2.272 for the obstructive CAD. The SSS, CT-LeSc, and presence of obstructive CAD were independently associated with the all-cause mortality and non-fatal myocardial infarction in the suspected CADs in the Chinese population.
Collapse
Affiliation(s)
- Qingchao Meng
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yang Gao
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Na Zhao
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yunqiang An
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
| |
Collapse
|
7
|
Xue R, Ren Z, Zhao H, Xu J, Li S, Lin S, Li J, Wen D, Zheng M. Prognostic value of coronary CT angiography and CT myocardial perfusion imaging among patients with and without Diabetes. Eur J Radiol 2023; 167:111063. [PMID: 37660486 DOI: 10.1016/j.ejrad.2023.111063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Whether stress CT myocardial perfusion imaging (CT-MPI) improves risk assessment in patients with diabetes mellitus (DM) remains unexplored. We aimed to evaluate the prognostic value of coronary CT angiography (CCTA) and stress CT-MPI in suspected coronary artery disease (CAD) patients with and without DM. METHODS A total of 334 patients with suspected CAD who underwent CCTA and stress CT-MPI from May 2020 to July 2021 were retrospectively analyzed. The endpoint was major adverse cardiovascular events (MACEs). Multivariable Cox regression analysis was used to evaluate the risk factors for MACEs, including clinical risk factors, CCTA characteristics and CT-MPI characteristics. RESULTS After a median follow-up of 21 months,15 patients of the DM group and 16 patients of the non-DM group experienced MACEs. Multivariate Cox stepwise regression analysis showed that abnormal perfusion myocardial segments ratio was associated with MACEs after adjusting for clinical risk factors and CCTA characteristics in all patients (HR:1.023, p < 0.001), DM group (HR:1.024, p = 0.008) and non-DM group (HR:1.028, p = 0.003). By adding CT-MPI characteristics to CCTA characteristics and clinical risk factors, the global chi-square for predicting MACEs increased from 62.24 to 78.84 in all patients (p < 0.001), from 19.18 to 27.30 in DM group (p = 0.004) and from 39.51 to 48.65 in non-DM group (p = 0.003); the increment of C-index in all patients, DM group and non-DM group were 0.018, 0.054 and 0.019, respectively. CONCLUSION In all patients and those with and without DM, CT-MPI has incremental prognostic value over clinical risk factors alone or combined with CCTA characteristics in predicting MACEs.
Collapse
Affiliation(s)
- Ruijia Xue
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Zilong Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Jingji Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Shuangxin Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | | | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# Changle West Road, Xi'an 710032, Shaanxi province, China.
| |
Collapse
|
8
|
Lima TP, Assuncao AN, Bittencourt MS, Liberato G, Arbab-Zadeh A, Lima JAC, Rochitte CE. Coronary computed tomography plaque-based scores predict long-term cardiovascular events. Eur Radiol 2023; 33:5436-5445. [PMID: 36806566 DOI: 10.1007/s00330-023-09408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD. METHODS The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3-9.1) years, and 73 patients met the composite endpoints of MACE. RESULTS Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001). CONCLUSIONS Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD. KEY POINTS • Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
Collapse
Affiliation(s)
- Thais Pinheiro Lima
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Antonildes N Assuncao
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Gabriela Liberato
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Carlos Eduardo Rochitte
- Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil.
- Cardiovascular Magnetic Resonance and Computed Tomography Department, Heart Institute, InCor, University of Sao Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| |
Collapse
|
9
|
Pugliese L, Ricci F, Sica G, Scaglione M, Masala S. Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2074. [PMID: 37370969 DOI: 10.3390/diagnostics13122074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.
Collapse
Affiliation(s)
- Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Francesca Ricci
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, 80131 Napoli, Italy
| | - Mariano Scaglione
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Masala
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
10
|
Karpouzas GA, Papotti B, Ormseth SR, Palumbo M, Hernandez E, Adorni MP, Zimetti F, Budoff MJ, Ronda N. ATP-binding cassette G1 membrane transporter-mediated cholesterol efflux capacity influences coronary atherosclerosis and cardiovascular risk in Rheumatoid Arthritis. J Autoimmun 2023; 136:103029. [PMID: 36996698 DOI: 10.1016/j.jaut.2023.103029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Cholesterol efflux capacity (CEC) measures the ability of high-density lipoprotein (HDL) to remove cholesterol from macrophages and reduce the lipid content of atherosclerotic plaques. CEC inversely associated with cardiovascular risk beyond HDL-cholesterol levels. CEC through the ATP-binding-cassette G1 (ABCG1) membrane transporter is impaired in rheumatoid arthritis (RA). We evaluated associations of ABCG1-CEC with coronary atherosclerosis, plaque progression and cardiovascular risk in RA. METHODS Coronary atherosclerosis (noncalcified, partially, fully-calcified, low-attenuation plaque) was assessed with computed tomography angiography in 140 patients and reevaluated in 99 after 6.9 ± 0.3 years. Cardiovascular events including acute coronary syndromes, stroke, cardiovascular death, claudication, revascularization and hospitalized heart failure were recorded. ABCG1-CEC was measured in Chinese hamster ovary cells as percentage of effluxed over total intracellular cholesterol. RESULTS ABCG1-CEC inversely associated with extensive atherosclerosis (≥5 plaques) (adjusted odds ratio 0.50 [95% CI 0.28-0.88]), numbers of partially-calcified (rate ratio [RR] 0.71 [0.53-0.94]) and low-attenuation plaques (RR 0.63 [0.43-0.91] per standard deviation increment). Higher ABCG1-CEC predicted fewer new partially-calcified plaques in patients with lower baseline and time-averaged CRP and fewer new noncalcified and calcified plaques in those receiving higher mean prednisone dose. ABCG1-CEC inversely associated with events in patients with but not without noncalcified plaques, with <median but not higher CRP and in prednisone users but not nonusers (p-for-interaction = 0.021, 0.033 and 0.008 respectively). CONCLUSION ABCG1-CEC inversely associated with plaque burden and vulnerability, and plaque progression conditionally on cumulative inflammation and corticosteroid dose. ABCG1-CEC inversely associated with events specifically in patients with noncalcified plaques, lower inflammation and in prednisone users.
Collapse
Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA.
| | - Bianca Papotti
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124, Parma, Italy
| | - Sarah R Ormseth
- Division of Rheumatology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Marcella Palumbo
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124, Parma, Italy
| | - Elizabeth Hernandez
- Division of Rheumatology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Maria Pia Adorni
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124, Parma, Italy
| | - Francesca Zimetti
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124, Parma, Italy
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124, Parma, Italy
| |
Collapse
|
11
|
Abazid RM, Romsa JG, Warrington JC, Akincioglu C, Smettei OA, Bureau Y, Tzemos N, Vezina WC. Prognostic value of coronary computed tomography angiography compared to radionuclide myocardial perfusion imaging in patients With coronary stents. Front Cardiovasc Med 2023; 10:1087113. [PMID: 37008323 PMCID: PMC10064085 DOI: 10.3389/fcvm.2023.1087113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectivesThe aim of this study is to compare the prognostic value of coronary computed tomography angiography (CCTA) with single-photon emission computed tomography (SPECT) in predicting cardiovascular events in patients with stents.DesignRetrospective analysis.SettingUniversity Hospital, London, Ontario Canada.ParticipantsBetween January 2007 and December 2018, 119 patients post-percutaneous coronary intervention (PCI) who were referred for hybrid imaging with CTA and 2-day rest/stress SPECT were enrolled.Primary and secondary outcome measuresPatients were followed for any major adverse cardiovascular event (MACE) including: All-cause mortality, Non-fatal myocardial infarction (MI), Unplanned revascularization, Cerebrovascular accident and hospitalization for arrhythmia or heart failure. We define hard cardiac events (HCE) as: cardiac death, non-fatal MI or unplanned revascularization. We used two cut-off values to define obstructive lesions with CCTA ≥50% and ≥70% in any coronary segment. SPECT scan defined as abnormal in the presence of >5% reversible myocardial perfusion defect.ResultsDuring the follow-up period of 7.2 ± 3.4 years. 45/119 (37.8%) patients experienced 57 MACE: Ten deaths (2 cardiac deaths and 8 of non-cardiac deaths), 29 acute coronary syndrome including non-fatal MI (25 required revascularization), 7 hospitalizations for heart failure, 6 cerebrovascular accidents and 5 new atrial fibrillation. 31 HCEs were reported. Cox regression analysis showed that obstructive coronary stenosis (≥50% and ≥70%) and abnormal SPECT were associated of MACE (p = 0.037, 0.018 and 0.026), respectively. In contrast, HCEs were significantly associated with obstructive coronary stenosis of ≥50% and ≥70% with p = 0.004 and p = 0.007, respectively. In contrast, abnormal SPECT was a nonsignificant predictor of HCEs (p = 0.062).ConclusionObstructive coronary artery stenosis on CCTA can predict MACE and HCE. However, abnormal SPECT can only predict MACE but not HCE in patients post-PCI with a follow-up period of approximately 7 years.
Collapse
Affiliation(s)
- Rami M. Abazid
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Jonathan G. Romsa
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - James C. Warrington
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Osama A. Smettei
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Yves Bureau
- Medical Biophysics, Western University, London, ON, Canada
- Department of Psycholoy, Lawson Health Research Institute, London, ON, Canada
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Internal Medicine, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - William C. Vezina
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| |
Collapse
|
12
|
Ahmed Z, Campeau D, Gong H, Rajendran K, Rajiah P, McCollough C, Leng S. High-pitch, high temporal resolution, multi-energy cardiac imaging on a dual-source photon-counting-detector CT. Med Phys 2023; 50:1428-1435. [PMID: 36427356 PMCID: PMC10033375 DOI: 10.1002/mp.16124] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure the accuracy of material decomposition using a dual-source photon-counting-detector (DS-PCD) CT operated in the high-pitch helical scanning mode and compare the results against dual-source energy-integrating-detector (DS-EID) CT, which requires use of a low-pitch value in dual-energy mode. METHODS A DS-PCD CT and a DS-EID CT were used to scan a cardiac motion phantom consisting of a 3-mm diameter iodine cylinder. Iodine maps were reconstructed using DS-PCD in high-pitch mode and DS-EID in low-pitch mode. Image-based circularity, diameter, and iodine concentration of the iodine cylinder were calculated and compared between the two scanners. With institutional review board approval, in vivo exams were performed with the DS-PCD CT in high-pitch mode. Images were qualitatively compared against patients with similar heart rates that were scanned with DS-EID CT in low-pitch dual-energy mode. RESULTS On iodine maps, the mean circularity was 0.97 ± 0.02 with DS-PCD in high-pitch mode and 0.95 ± 0.06 with DS-EID in low-pitch mode. The mean diameter was 2.9 ± 0.2 mm with DS-PCD and 3.1 ± 0.2 mm with DS-EID, both of which are close to the 3 mm ground truth. For DS-PCD, the mean iodine concentration was 9.6 ± 0.8 mg/ml and this was consistent with the 9.4 ± 0.6 mg/ml value obtained with the cardiac motion disabled. For DS-EID, the concentration was 12.7 ± 1.2 mg/ml with motion enabled and 11.7 ± 0.5 mg/ml disabled. The background noise in the iodine maps was 15.1 HU with DS-PCD and 14.4 HU with DS-EID, whereas the volume CT dose index (CTDIvol ) was 3 mGy with DS-PCD and 11 mGy with DS-EID. On comparison of six patients (three on PCD, three on EID) with similar heart rates, DS-PCD provided iodine maps with well-defined coronaries even at a high heart rate of 86 beats per minute. Meanwhile, there were substantial motion artifacts in iodine maps obtained with DS-EID for patients with similar heart rates. CONCLUSION In a cardiac motion phantom, DS-PCD CT can perform accurate material decomposition in high-pitch mode, providing iodine maps with excellent geometric accuracy and robustness to motion at approximately 38% of the dose for similar noise as DS-EID CT.
Collapse
Affiliation(s)
- Zaki Ahmed
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - David Campeau
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN
| |
Collapse
|
13
|
Ihdayhid AR, Lan NSR, Figtree GA, Patel S, Arnott C, Hamilton-Craig C, Psaltis PJ, Leipsic J, Fairbairn T, Wahi S, Hillis GS, Rankin JM, Dwivedi G, Nicholls SJ. Contemporary Chest Pain Evaluation: The Australian Case for Cardiac CT. Heart Lung Circ 2023; 32:297-306. [PMID: 36610819 DOI: 10.1016/j.hlc.2022.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/07/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023]
Abstract
Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allow for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.
Collapse
Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Curtin University, Perth, WA, Australia.
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sanjay Patel
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Cardiovascular Division, The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Peter J Psaltis
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jonathon Leipsic
- University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | | | - Sudhir Wahi
- Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Graham S Hillis
- Department of Cardiology and University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| |
Collapse
|
14
|
Su X, Cai X, Pan Y, Sun J, Jing J, Wang M, Meng X, Wang Y, Wei T, He Y. Discordance of apolipoprotein B with low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol and coronary atherosclerosis. Eur J Prev Cardiol 2022; 29:2349-2358. [PMID: 36166398 DOI: 10.1093/eurjpc/zwac223] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
AIMS High level of apolipoprotein B (Apo B) is associated with incident subclinical atherosclerosis. The present study evaluated the associations between discordant Apo B with low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and coronary atherosclerotic burden. METHODS AND RESULTS This study enrolled 3043 participants aged 50-75 years from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study that was conducted in the community in Lishui City, China. Discordant Apo B with LDL-C and non-HDL-C were defined by residuals and medians. Coronary atherosclerotic burden was evaluated by segment involvement score (SIS) and segment stenosis score (SSS) which were determined by computed tomography angiography. We performed discordance analyses examining associations of discordant Apo B with LDL-C or non-HDL-C with the coronary atherosclerotic burden. The mean age of participants was 61.2 ± 6.7 years, 53.6% were females. Participants with discordant high Apo B relative to non-HDL-C were at higher odds of plaques [odds ratio (OR), 1.30; 95% confidence interval (CI), 1.08-1.57], SIS [common odds ratio (cOR), 1.35; 95% CI, 1.14-1.60], and SSS (cOR, 1.40; 95% CI, 1.18-1.67) compared with concordant group. However, discordantly low Apo B with non-HDL-C was associated with decreased odds of the coronary atherosclerotic plaques and its burden. Similar results were shown for discordant analyses for Apo B with LDL-C. CONCLUSION Discordantly high Apo B with LDL-C and non-HDL-C were associated with an increased odds of the coronary atherosclerotic plaques and its burden. These findings highlighted the importance of Apo B for primary prevention of coronary atherosclerosis.
Collapse
Affiliation(s)
- Xin Su
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingping Sun
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| |
Collapse
|
15
|
Long term prognostic value for a normal CCTA. J Cardiovasc Comput Tomogr 2022; 16:531-532. [DOI: 10.1016/j.jcct.2022.07.006] [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: 12/30/2021] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022]
|
16
|
Alnabelsi T, Ahmed AI, Han Y, Al Rifai M, Nabi F, Cainzos-Achirica M, Al-Mallah MH. Added Prognostic Value of Plaque Burden to Computed Tomography Angiography and Myocardial Perfusion Imaging in Patients with Diabetes. Am J Med 2022; 135:761-768.e7. [PMID: 35081387 DOI: 10.1016/j.amjmed.2021.12.010] [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: 06/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to compare the added prognostic value of plaque burden to cardiac computed tomographic angiography (CCTA) anatomic assessment and single-photon emission computed tomography (SPECT) physiologic assessment in patients with diabetes undergoing both tests. METHODS Consecutive patients with diabetes who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected coronary artery disease were included. Stenosis severity and segment involvement score (SIS) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed from date of imaging for major adverse cardiovascular events (MACE). RESULTS A total of 778 patients were included (mean age 60.6 ± 14.4 years, 55% males). After a median follow-up of 31 months, 87 (11%) patients experienced a MACE. In multivariable Cox regression models, SIS significantly predicted outcomes in models including obstructive stenosis and ischemia (hazard ratio 1.17, 95% confidence interval 1.10-1.24, P < .001; hazard ratio 1.16, 95% confidence interval 1.10-1.23, P < .001, respectively), and improved discrimination (Harrel's C 0.75, P = .006; 0.76, P = .006 in models with CCTA obstructive stenosis and SPECT ischemia, respectively). Results were consistent using subgroups of summed scores by composition of plaque (calcified vs noncalcified) and alternate definitions of obstructive stenosis. CONCLUSION Our results suggest that in high-risk patients with diabetes and suspected coronary disease, SIS has incremental prognostic value over ischemia by SPECT or stenosis by CCTA in predicting incident cardiovascular outcomes.
Collapse
Affiliation(s)
| | | | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
| | | | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
| | | | | |
Collapse
|
17
|
Stress Perfusion Cardiac Magnetic Resonance in Long-Standing Non-Infarcted Chronic Coronary Syndrome with Preserved Systolic Function. Diagnostics (Basel) 2022; 12:diagnostics12040786. [PMID: 35453834 PMCID: PMC9031407 DOI: 10.3390/diagnostics12040786] [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: 01/31/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (heart failure) and all major cardiac events (MACE) including death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, or resuscitated cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and ischemia, respectively, were considered. Higher ischemic burden was predictive of disease progression (OR: 1.59, 95%CI: 1.18–2.14; p-value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing.
Collapse
|
18
|
Andreini D, Conte E, Mushtaq S, Magatelli M, Traversari F, Gigante C, Belmonte M, Gaudenzi-Asinelli M, Annoni A, Formenti A, Mancini ME, Guglielmo M, Baggiano A, Melotti E, Muscogiuri G, Rondinelli M, Pontone G, Bartorelli AL, Pepi M, Genovese S. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study. Nutr Metab Cardiovasc Dis 2022; 32:586-595. [PMID: 35109998 DOI: 10.1016/j.numecd.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk). METHODS AND RESULTS The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65-21.87), p = 0.006 and 3.46 (2.00-5.97); p < 0.001]. CONCLUSION The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries.
Collapse
Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | | | - Marco Magatelli
- Cardiology Division, Castiglione delle Siviere Hospital, Mantova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | |
Collapse
|
19
|
Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part I. Eur Heart J Cardiovasc Imaging 2022; 23:299-314. [PMID: 35076061 PMCID: PMC8863074 DOI: 10.1093/ehjci/jeab293] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiac computed tomography (CT) was introduced in the late 1990's. Since then, an increasing body of evidence on its clinical applications has rapidly emerged. From an initial emphasis on its technical efficiency and diagnostic accuracy, research around cardiac CT has now evolved towards outcomes-based studies that provide information on prognosis, safety, and cost. Thanks to the strong and compelling data generated by large, randomized control trials, the scientific societies have endorsed cardiac CT as pivotal diagnostic test for the management of appropriately selected patients with acute and chronic coronary syndrome. This consensus document endorsed by the European Association of Cardiovascular Imaging is divided into two parts and aims to provide a summary of the current evidence and to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. This first part focuses on the most established applications of cardiac CT from primary prevention in asymptomatic patients, to the evaluation of patients with chronic coronary syndrome, acute chest pain, and previous coronary revascularization.
Collapse
Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
| |
Collapse
|
20
|
Kolossváry M, Celentano D, Gerstenblith G, Bluemke DA, Mandler RN, Fishman EK, Bhatia S, Chen S, Lai S, Lai H. HIV indirectly accelerates coronary artery disease by promoting the effects of risk factors: longitudinal observational study. Sci Rep 2021; 11:23110. [PMID: 34848791 PMCID: PMC8632934 DOI: 10.1038/s41598-021-02556-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Our objective was to assess whether human immunodeficiency virus (HIV)-infection directly or indirectly promotes the progression of clinical characteristics of coronary artery disease (CAD). 300 African Americans with asymptomatic CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV-infected) who underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years) were randomly selected from 1429 participants of a prospective epidemiological study between May 2004 and August 2015. We calculated Agatston-scores, number of coronary plaques and segment stenosis score (SSS). Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use on CAD. There was no significant difference in annual progression rates between HIV-infected and—uninfected regarding Agatston-scores (10.8 ± 25.1/year vs. 7.2 ± 17.8/year, p = 0.17), the number of plaques (0.2 ± 0.3/year vs. 0.3 ± 0.5/year, p = 0.11) or SSS (0.5 ± 0.8/year vs. 0.5 ± 1.3/year, p = 0.96). Multivariately, HIV-infection was not associated with Agatston-scores (8.3, CI: [− 37.2–53.7], p = 0.72), the number of coronary plaques (− 0.1, CI: [− 0.5–0.4], p = 0.73) or SSS (− 0.1, CI: [− 1.0–0.8], p = 0.84). ASCVD risk scores and years of cocaine-use significantly increased all CAD outcomes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-medications were associated with any of the CAD outcomes. HIV-infection is not directly associated with CAD and therefore HIV-infected are not destined to have worse CAD profiles. However, HIV-infection may indirectly promote CAD progression as risk factors may have a more prominent role in the acceleration of CAD in these patients.
Collapse
Affiliation(s)
- Márton Kolossváry
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Pathology #301, Baltimore, MD, 21287, USA.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor str., Budapest, Hungary, 1122
| | - David Celentano
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 614 Wolfe N Wolfe St, Baltimore, MD, 21205, USA
| | - Gary Gerstenblith
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - David A Bluemke
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20814, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA
| | - Sandeepan Bhatia
- Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, 21201, USA
| | - Shaoguang Chen
- Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, 21201, USA
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Pathology #301, Baltimore, MD, 21287, USA. .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 614 Wolfe N Wolfe St, Baltimore, MD, 21205, USA. .,Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA. .,Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA. .,Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, 21201, USA.
| | - Hong Lai
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA.,Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, 21201, USA
| |
Collapse
|
21
|
Han D, Chen B, Gransar H, Achenbach S, Al-Mallah MH, Budoff MJ, Cademartiri F, Maffei E, Callister TQ, Chinnaiyan K, Chow BJW, DeLago A, Hadamitzky M, Hausleiter J, Kaufmann PA, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Cury RC, Pontone G, Andreini D, Marques H, Rubinshtein R, Chang HJ, Lin FY, Shaw LJ, Min JK, Berman DS. Prognostic significance of plaque location in non-obstructive coronary artery disease: from the CONFIRM registry. Eur Heart J Cardiovasc Imaging 2021; 23:1240-1247. [PMID: 34791117 DOI: 10.1093/ehjci/jeab223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
AIM Obstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined. METHODS AND RESULTS From the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry, 4644 patients without obstructive CAD were included in this study. The degree of stenosis was classified as 0 (no) and 1-49% (non-obstructive). Proximal involvement was defined as any plaque present in the left main or the proximal segment of the left anterior descending artery, left circumflex artery, and right coronary artery. Extensive CAD was defined as segment involvement score of >4. During a median follow-up of 5.2 years (interquartile range 4.1-6.0), 340 (7.3%) MACE occurred. Within the non-obstructive CAD group (n = 2065), proximal involvement was observed in 1767 (85.6%) cases. When compared to non-obstructive CAD patients without proximal involvement, those with proximal involvement had an increased MACE risk (log-rank P = 0.033). Multivariate Cox analysis showed when compared to patients with no CAD, proximal non-obstructive CAD was associated with increased MACE risk [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.47-2.45, P < 0.001] after adjusting for extensive CAD and conventional cardiovascular risk factors; however, non-proximal non-obstructive CAD did not increase MACE risk (HR 1.26, 95% CI 0.79-2.01, P = 0.339). CONCLUSIONS Independent of plaque extent, proximal coronary involvement was associated with increased MACE risk in patients with non-obstructive CAD. The plaque location information by coronary computed tomography angiography may provide additional risk prediction over CAD extent in patients with non-obstructive CAD.
Collapse
Affiliation(s)
- Donghee Han
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Billy Chen
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Stephan Achenbach
- Department of Medicine, University of Erlangen, Schloßplatz 4, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202 USA
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, 1000 W Carson St, Torrance, CA 90502, USA
| | - Filippo Cademartiri
- Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Erica Maffei
- Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd Hendersonville, TN 37075 USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3535 W 13 Mile Rd #742, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
| | - Augustin DeLago
- Capitol Cardiology Associate, 7 Southwoods Blvd, Albany, NY 12211 USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 München, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 München, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Jongno-gu, Seoul 03080, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, 1081 Burrard Street Vancouver, BC V6Z 1Y6, Canada
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020 Innsbruck, Austria
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milano, MI, Italy
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milano, MI, Italy
| | - Hugo Marques
- Department of Surgery, Curry Cabral Hospital, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medicine, 428 East, 72nd Street, New York, NY 10021
| | - Leslee J Shaw
- Department of Population Health Science, Blavatnik Women's Health Research Institute, Mount Sinai School of Medicine, NY, USA
| | - James K Min
- Cleerly, Inc., 101 Greenwich St, New York, NY 10006, USA
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| |
Collapse
|
22
|
Lee H, Jeon YJ, Kang BJ, Lee TY, Park EJ, Park S, Ann SH, Kim YG, Lee Y, Choi SH, Park GM. Frequency and Significance of Right Bundle Branch Block and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals. Am J Cardiol 2021; 158:30-36. [PMID: 34462052 DOI: 10.1016/j.amjcard.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
Limited data exist regarding the association between right bundle branch block (RBBB) and subclinical coronary atherosclerosis. This study investigated the influence of RBBB on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography (CCTA) in an asymptomatic population. We retrospectively analyzed 7,205 asymptomatic individuals (mean age 54.4 ± 7.9 years and 4,695 men [65.2%]) with no prior history of coronary artery disease who voluntarily underwent CCTA and 12-lead electrocardiographic evaluation as part of a general health examination. The degree and extent of subclinical coronary atherosclerosis were evaluated by CCTA, and ≥50% diameter stenosis was defined as significant. The association between RBBB and subclinical coronary atherosclerosis was determined by logistic regression and propensity score matching analyses. Of study participants, 116 (1.6%) had RBBB. After adjustment for cardiovascular risk factors, there were no statistically significant differences in the adjusted odds ratios of RBBB for any atherosclerotic plaque (0.87, 95% confidence interval [CI] 0.57 to 1.32), calcified plaque (0.78, 95% CI 0.51 to 1.19), noncalcified plaque (1.44, 95% CI 0.77 to 2.69), mixed plaque (1.12, 95% CI 0.52 to 2.39), and significant coronary artery stenosis (0.92, 95% CI 0.48 to 1.74). Similarly, in the 5: 1 propensity score-matched population (n = 696), there were no statistically significant differences in the odds ratios for any subclinical coronary atherosclerosis between participants with and without RBBB (p for all >0.05). In conclusion, through this large cross-sectional study of asymptomatic individuals who underwent CCTA and electrocardiography evaluation, individuals with RBBB were not associated with an increased risk of subclinical coronary atherosclerosis compared with those without RBBB.
Collapse
Affiliation(s)
- Hyeji Lee
- Department Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Byung Ju Kang
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Tae Young Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun Ji Park
- Medical Information Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yongjik Lee
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seong Hoon Choi
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
| |
Collapse
|
23
|
Dual-energy CT plaque characteristics of post mortem thin-cap fibroatheroma in comparison to infarct-related culprit lesions. Heart Vessels 2021; 37:400-410. [PMID: 34608510 DOI: 10.1007/s00380-021-01942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Improvement of non-invasive identification of high-risk plaque may increase the preventive options of acute coronary syndrome. To describe the characteristics of thin-cap fibroatheroma (TCFA) in a post mortem model in comparison to characteristics of culprit lesions in patients with non-ST-elevation-myocardial-infarction (NSTEMI) using the dual energy computed tomography (DECT). Three post mortem hearts were prepared with iodine-contrast, inserted in a Kyoto phantom and scanned by DECT. Six TCFA were identified using histopathological analysis (cap thickness < 65 μm and necrotic core > 10% of the plaque area). In the NSTEMI group, 29 patients were scheduled to DECT prior to coronary angiography and invasive treatment. Culprit lesions were identified blinded for the patient history by two independent invasive cardiologists using the coronary angiography. The DECT analysis of TCFA and culprit lesions was performed retrospectively with determination of effective atomic number (Effective-Z), Hounsfield Unit (HU), plaque type (non-calcified, predominantly non-calcified, predominantly calcified or calcified), spotty calcification,, plaque length, plaque volume and plaque burden and the remodeling index. The Effective-Z, HU and plaqueburden were significantly different between TCFA and culprit lesions (P < 0.05).The TCFA plaques were more calcified in comparison to culprit lesions (P < 0.05). No significant difference in the other plaque characteristics was observed. The use of DECT demonstrated different Effective-Z values and different characteristics of post mortem TCFA in comparison to in vivo culprit lesions. This finding may highlight, that not all TCFA should be considered as vulnerable.
Collapse
|
24
|
Huang Z, Zhang S, Jin N, Hu Y, Xiao J, Li Z, Yang Y, Sun R, Wang Z, Li X, Xie Y, Wang X. Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD. BMC Cardiovasc Disord 2021; 21:476. [PMID: 34602055 PMCID: PMC8487531 DOI: 10.1186/s12872-021-02286-x] [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: 06/15/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD. METHODS 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using time dependent receiver-operating characteristic (ROC) curves and The Hosmer-Lemeshow goodness-of-fit test was employed to evaluate calibration. RESULTS A total of 540 patients died from all causes with a median follow-up of 4.3 ± 2.1 years. Kaplan-Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI 0.420-1.764) for CAD-RADS 1 to HR 2.761 (95% CI 1.961-3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HRs for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The area under the time dependent ROC curve for prediction of all-cause death was 0.7917, 0.7805, 0.7991for CAD-RADS in 1 year, 3 year, 5 year, respectively, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index. CONCLUSIONS The CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes in prognostic value of all-cause mortality. Traditional and simplest CAD classification should be preferable, given the more number of groups and complexity of CAD-RADS and Duke prognostic index, without using more time consuming classification.
Collapse
Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Nan Jin
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun Hu
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Ruihong Sun
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Zheng Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Xiang Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Yuanliang Xie
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
| |
Collapse
|
25
|
Stojan G, Li J, Budoff M, Arbab-Zadeh A, Petri MA. High-risk coronary plaque in SLE: low-attenuation non-calcified coronary plaque and positive remodelling index. Lupus Sci Med 2021; 7:7/1/e000409. [PMID: 32723810 PMCID: PMC7388871 DOI: 10.1136/lupus-2020-000409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/13/2020] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Abstract
Background Positive remodelling index and presence of low-attenuation non-calcified plaque (LANCP) are characteristic vessel changes in unstable coronary plaques. We sought to characterise these high-risk plaque features in patients with systemic lupus erythematosus (SLE) and to compare them with controls. Methods A total of 72 patients who satisfied the SLICC classification criteria for SLE had coronary CT angiography (CCTA) studies, 30 of which had follow-up CCTA, as screening for occult coronary atherosclerotic disease in asymptomatic individuals. A total of 100 consecutive controls with no known history of lupus, heart disease or revascularisation who had two coronary CT angiograms at least 1 year apart were included in the study. These were asymptomatic patients referred by their primary physicians for screening of coronary artery disease and the screening interval was decided by the primary physicians. The methodology for image acquisition was identical. Results LANCP burden at baseline was significantly greater in patients with SLE compared with controls. LANCP volume was significantly greater in patients over 60 years of age (p<0.05) and in those with current prednisone dose >10 mg/day. LANCP burden remained stable over follow-up. There were no significant differences in remodelling index compared with controls. Conclusion This is the first study describing high-risk CCTA features of coronary plaque in patients with SLE. Both LANCP and positive remodelling are common in SLE. These characteristic vessel changes may identify patients with SLE at increased risk of cardiovascular events and those in need for more frequent cardiac monitoring.
Collapse
Affiliation(s)
- George Stojan
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessica Li
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew Budoff
- Cardiology, David Geffen School of Medicine, Los Angeles, California, USA.,Cardiology, UCLA, Los Angeles, California, USA
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
26
|
Computed tomography of coronary artery atherosclerosis: A review. J Med Imaging Radiat Sci 2021; 52:S19-S39. [PMID: 34479831 DOI: 10.1016/j.jmir.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022]
Abstract
Coronary artery atherosclerosis resulting in ischemic cardiac disease is the leading cause of mortality in the United States. In symptomatic patients, invasive diagnostic methods like catheter angiography, intravascular ultrasound, or vascular endoscopy may be used. However, for primary prevention of atherosclerotic coronary artery disease in asymptomatic patients, non-invasive methods are more commonly utilized like stress imaging, single-photon emission computed tomography (SPECT) and coronary artery calcification scoring. Coronary computed tomographic angiography (CCTA) is an excellent diagnostic tool for detection of coronary artery plaque and ability to identify resultant stenoses with an excellent negative predictive value which can potentially result in optimal exclusion of the presence of coronary artery disease. Long term follow up after a negative CCTA has repeatedly demonstrated very low incidence of future adverse coronary events, attesting its predictive value. CCTA based management is associated with improved CAD outcome in stable angina. Coronary CTA is valuable in acute chest pain evaluation in the emergency department helping in better triage. CT perfusion and CT-FFR are both very promising tools for assessment of hemodynamic significance of coronary artery stenosis.
Collapse
|
27
|
Cheng IT, Wong KT, Li EK, Wong PCH, Lai BT, Yim IC, Ying SK, Kwok KY, Li M, Li TK, Lee JJ, Lee AP, Tam LS. Comparison of carotid artery ultrasound and Framingham risk score for discriminating coronary artery disease in patients with psoriatic arthritis. RMD Open 2021; 6:rmdopen-2020-001364. [PMID: 32973102 PMCID: PMC7539857 DOI: 10.1136/rmdopen-2020-001364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives This study aimed to assess the performance of carotid ultrasound (US) parameters alone or in combination with Framingham Risk Score (FRS) in discriminating patients with psoriatic arthritis (PsA) with and without coronary artery disease (CAD). Methods Ninety-one patients with PsA (56 males; age: 50±11 years, disease duration: 9.4±9.2 years) without overt cardiovascular (CV) diseases were recruited. Carotid intima-media thickness (cIMT), the presence of plaque and total plaque area (TPA) was determined by high-resolution US. CAD was defined as the presence of any coronary plaque on coronary CT angiography (CCTA). Obstructive-CAD (O-CAD) was defined as >50% stenosis of the lumen. Results Thirty-five (38%) patients had carotid plaque. Fifty-four (59%) patients had CAD (CAD+) and 9 (10%) patients had O-CAD (O-CAD+). No significant associations between the presence of carotid plaque and CAD were found. However, cIMT and TPA were higher in both the CAD+ and O-CAD+ group compared with the CAD− or O-CAD− groups, respectively. Multivariate logistic regression analysis revealed that mean cIMT was an independent explanatory variable associated with CAD and O-CAD, while maximum cIMT and TPA were independent explanatory variables associated with O-CAD after adjusting for covariates. The optimal cut-offs for detecting the presence of CAD were FRS >5% and mean cIMT at 0.62 mm (AUC: 0.71; sensitivity: 67%; specificity: 76%), while the optimal cut-offs for detecting the presence of O-CAD were FRS >10% in combination with mean cIMT at 0.73 mm (AUC: 0.71; sensitivity: 56%; specificity: 85%). Conclusion US parameters including cIMT and TPA may be considered in addition to FRS for CV risk stratification in patients with PsA.
Collapse
Affiliation(s)
- Isaac T Cheng
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Ka Tak Wong
- Diagnostic and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - Edmund K Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Shirley K Ying
- Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | | | - Martin Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- School of Public Health Division of Biostatistics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong
| | - Alex P Lee
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
28
|
Coronary computed tomography angiography in patients with stable coronary artery disease. Trends Cardiovasc Med 2021; 32:421-428. [PMID: 34454051 DOI: 10.1016/j.tcm.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 01/07/2023]
Abstract
The treatment of coronary artery disease (CAD), which is defined by stable anatomical atherosclerotic and functional alterations of epicardial vessels or microcirculation, focuses on managing intermittent angina symptoms and preventing major adverse cardiovascular events with optimal medical therapy. When patients with known CAD present with angina and no acute coronary syndrome, they have historically been evaluated with a variety of noninvasive stress tests that utilize electrocardiography, radionuclide scintigraphy, echocardiography, or magnetic resonance imaging for determining the presence and extent of inducible myocardial ischemia. Patient event-free survival, however, is largely driven by the coronary atherosclerotic disease burden, which is not directly assessed by functional testing. Direct evaluation of coronary atherosclerotic disease by coronary computed tomography angiography (coronary CTA) has emerged as the first line noninvasive imaging modality as it improves diagnostic accuracy and positively influences clinical management. Compared to functional assessment of CAD, coronary CTA-guided management results in improved patient outcomes by facilitating prevention of myocardial infarction. Other strengths of coronary CTA include detailed atherosclerotic plaque characterization and the ability to assess functional significance of specific lesions, which may further improve risk assessment and prognosis and lead to more appropriate referrals for additional testing, such as invasive coronary angiography.
Collapse
|
29
|
Slim AM, Fentanes E, Cheezum MK, Parsons IT, Maroules C, Chen B, Abbara S, Branch K, Nagpal P, Shah NR, Thomas DM, Villines TC, Blankstein R, Shaw LJ, Budoff M, Nicol E. The role of cardiovascular CT in occupational health assessment for coronary heart disease: An expert consensus document from the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2021; 15:290-303. [PMID: 33926854 DOI: 10.1016/j.jcct.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | | | - Billy Chen
- Cedars-Sinai Medical Center, Baldwin Park, CA, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Prashant Nagpal
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nishant R Shah
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Dustin M Thomas
- Parkview Health, Parkview Research Center, Fort Wayne, IN, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ed Nicol
- Royal Brompton Hospital, London, UK
| |
Collapse
|
30
|
Conte E, Mushtaq S, Pontone G, Li Piani L, Ravagnani P, Galli S, Collet C, Sonck J, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Annoni A, Mancini ME, Formenti A, Muscogiuri G, Magatelli M, Nicoli F, Poggi C, Fiorentini C, Bartorelli AL, Pepi M, Montorsi P, Andreini D. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners. Eur Heart J Cardiovasc Imaging 2021; 21:191-201. [PMID: 31093656 DOI: 10.1093/ehjci/jez089] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. METHODS AND RESULTS From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001). CONCLUSIONS CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume.
Collapse
Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Letizia Li Piani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Paolo Ravagnani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Stefano Galli
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Carlos Collet
- Centrum voor hart en vaatziekten, University of Brussel, Brussel, Belgium.,Cardiovascular Center Aalst, OLV Hospital, Department of Cardiology, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Department of Cardiology, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Luca Di Odoardo
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Andrea Annoni
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Maria Elisabetta Mancini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Alberto Formenti
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Marco Magatelli
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Flavia Nicoli
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Carlotta Poggi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Cesare Fiorentini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via Parea 4, 20100 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| |
Collapse
|
31
|
Nakamura S, Ishida M, Nakata K, Ichikawa Y, Takase S, Takafuji M, Ito H, Nakamori S, Kurita T, Dohi K, Sakuma H. Long-term prognostic value of whole-heart coronary magnetic resonance angiography. J Cardiovasc Magn Reson 2021; 23:56. [PMID: 33993891 PMCID: PMC8127259 DOI: 10.1186/s12968-021-00749-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA. METHODS A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina. RESULTS Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan-Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022). CONCLUSIONS In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.
Collapse
Affiliation(s)
- Satoshi Nakamura
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Kei Nakata
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masafumi Takafuji
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Haruno Ito
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Mie, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Mie, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
32
|
Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
33
|
Karpouzas GA, Bui VL, Ronda N, Hollan I, Ormseth SR. Biologics and atherosclerotic cardiovascular risk in rheumatoid arthritis: a review of evidence and mechanistic insights. Expert Rev Clin Immunol 2021; 17:355-374. [PMID: 33673792 DOI: 10.1080/1744666x.2021.1899809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Cardiovascular disease is a leading comorbidity in rheumatoid arthritis. Timely introduction of biologic therapies in a treat-to-target approach has optimized disease-related outcomes and attenuated accrual of comorbidities, including cardiovascular risk.Areas covered: A literature search in MEDLINE (via PubMed) was performed between January 2009 and November 2020. This manuscript explores recent developments in atherosclerotic cardiovascular risk in RA compared with non-RA individuals; it synopsizes differences in vascular function and inflammation, prevalence, burden, vulnerability, and progression of atherosclerotic plaque and their underlying cellular and molecular mechanisms. Finally, it reviews the recent literature on cardioprotective benefits of biologics and draws mechanistic links with inhibition of new plaque formation, stabilization of high-risk lesions and improvement in endothelial function, arterial stiffness, lipid metabolism, and traditional cardiac risk factors.Expert opinion: Increasing evidence points to a solid cardioprotective influence of earlier, longer, and ongoing use of biologic treatments in RA. Nevertheless, the precise mechanistic effects of plaque progression and remodeling, vascular stiffness, endothelial dysfunction, lipid metabolism, and traditional cardiac risk factors are less rigorously characterized.
Collapse
Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Viet L Bui
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Ivana Hollan
- The Norwegian University of Science and Technology, Gjøvik, Norway.,Beitostølen Sport and Health Centre, Beitostølen, Norway
| | - Sarah R Ormseth
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
34
|
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: 115] [Impact Index Per Article: 38.3] [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.
Collapse
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
| |
Collapse
|
35
|
Porro B, Conte E, Zaninoni A, Bianchi P, Veglia F, Barbieri S, Fiorelli S, Eligini S, Di Minno A, Mushtaq S, Tremoli E, Cavalca V, Andreini D. Red Blood Cell Morphodynamics: A New Potential Marker in High-Risk Patients. Front Physiol 2021; 11:603633. [PMID: 33519509 PMCID: PMC7838560 DOI: 10.3389/fphys.2020.603633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
In the last years, a substantial contribution of red blood cells (RBCs) in cardiovascular homeostasis has been evidenced, as these cells are able to regulate cardiovascular function by the export of adenosine triphosphate and nitric oxide as well as to maintain redox balance through a well-developed antioxidant system. Recently a link between high-risk plaque (HRP) features and myocardial ischemia, in the absence of severe lumen stenosis, has been evidenced. Nonobstructive coronary artery disease (nonob CAD) has been associated in fact with a greater 1-year risk of myocardial infarction and all-cause mortality compared with no apparent CAD. This new evidence increases interest in searching new triggers to identify these high-risk patients, in the absence/or on top of traditional hazard markers. In this study, we investigated the existence of any association between RBC morphodynamics and HRP features in individuals with different grades of coronary stenosis detected by coronary computed tomography angiography (CCTA). Ninety-one consecutive individuals who underwent CCTA [33 no CAD; 26 nonobstructive (nonob), and 32 obstructive (ob) CAD] were enrolled. RBC morphodynamic features, i.e., RBC aggregability and deformability, were analyzed by means of Laser Assisted Optical Rotation Cell Analyzer (LoRRca MaxSis). The putative global RBC morphodynamic (RMD) score and the related risk chart, associating the extent of HRP (e.g., the non-calcified plaque volume) with both the RMD score and the max % stenosis were computed. In nonob CAD group only positive correlations between RBC rigidity, osmotic fragility or aggregability and HRP features (plaque necrotic core, fibro-fatty and fibro-fatty plus necrotic core plaque volumes) were highlighted. Interestingly, in this patient cohort three of these RBC morphodynamic features result to be independent predictors of the presence of non-calcified plaque volume in this patients group. The risk chart created shows that only in nonob CAD plaque vulnerability increases according to the score quartile. Findings of this work, by evidencing the association between erythrocyte morphodynamic characteristics assessed by LoRRca and plaque instability in a high-risk cohort of nonob CAD, suggest the use of these blood cell features in the identification of high-risk patients, in the absence of severe coronary stenosis.
Collapse
Affiliation(s)
- Benedetta Porro
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Anna Zaninoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Paola Bianchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Simone Barbieri
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Susanna Fiorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sonia Eligini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alessandro Di Minno
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Viviana Cavalca
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| |
Collapse
|
36
|
Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis. J Clin Med 2021; 10:jcm10030521. [PMID: 33535691 PMCID: PMC7867151 DOI: 10.3390/jcm10030521] [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: 12/12/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 12/16/2022] Open
Abstract
In the present article, an overview of advanced analysis of coronary atherosclerosis by coronary computed tomography angiography (CCTA) is provided, focusing on the potential application of this technique in a primary prevention setting. Coronary artery calcium score (CACS) has a well-demonstrated prognostic value even in a primary prevention setting; however, fibro-fatty, high-risk coronary plaque may be missed by this tool. On the contrary, even if not recommended for primary prevention in the general population, CCTA may enable early high-risk atherosclerosis detection, and specific subgroups of patients may benefit from its application. However, further studies are needed to determine the possible use of CCTA in a primary prevention setting.
Collapse
|
37
|
Conte E, Dwivedi A, Mushtaq S, Pontone G, Lin FY, Hollenberg EJ, Lee SE, Bax J, Cademartiri F, Chinnaiyan K, Chow BJW, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Baggiano A, Leipsic J, Maffei E, Marques H, Plank F, Raff GL, van Rosendael AR, Villines TC, Weirich HG, Al’Aref SJ, Baskaran L, Cho I, Danad I, Han D, Heo R, Lee JH, Stuijfzand WJ, Gransar H, Lu Y, Sung JM, Park HB, Al-Mallah MH, de Araújo Gonçalves P, Berman DS, Budoff MJ, Samady H, Shaw LJ, Stone PH, Virmani R, Narula J, Min JK, Chang HJ, Andreini D. Age- and sex-related features of atherosclerosis from coronary computed tomography angiography in patients prior to acute coronary syndrome: results from the ICONIC study. Eur Heart J Cardiovasc Imaging 2021; 22:24-33. [PMID: 32793985 PMCID: PMC8218779 DOI: 10.1093/ehjci/jeaa210] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
AIMS Although there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS). METHODS AND RESULTS Within the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (<65 vs. ≥ 65 years old) for analysis. Older patients had higher total plaque volume than younger patients. Within specific subtypes of plaque volume, however, only calcified plaque volume was higher in older patients (135.9 ± 163.7 vs. 63.8 ± 94.2 mm3, P < 0.0001, respectively). Although no sex-related differences were recorded for calcified plaque volume, females had lower fibrous and fibrofatty plaque volume than males (Fibrofatty volume 29.6 ± 44.1 vs. 75.3 ± 98.6 mm3, P = 0.0001, respectively). No sex-related differences in the prevalence of qualitative high-risk plaque features were found, even after separate analyses considering age were performed. CONCLUSION Our data underline the importance of age- and sex-related differences in coronary atherosclerosis presentation, which should be considered during CCTA-based atherosclerosis quantification.
Collapse
Affiliation(s)
- Edoardo Conte
- Department of Clinical Sciences and Community Health, University of Milan,
Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Aeshita Dwivedi
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Saima Mushtaq
- Department of Clinical Sciences and Community Health, University of Milan,
Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan,
Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Fay Y Lin
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Emma J Hollenberg
- 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, Seoul, South Korea
- Department of Cardiovascular Imaging, Yonsei-Cedars-Sinai Integrative
Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei
University Health System, Seoul, South Korea
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands
| | - Filippo Cademartiri
- Department of Cardiovascular Imaging, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks,
MI, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa,
Ottawa, Ontario, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute,
Miami, FL, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center
Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine,
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
| | - Andrea Baggiano
- Department of Clinical Sciences and Community Health, University of Milan,
Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British
Columbia, Vancouver, British Columbia, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR, Marche, Urbino,
Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa,
Portugal
| | - Fabian Plank
- Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oaks,
MI, USA
| | - Alexander R van Rosendael
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands
| | - Todd C Villines
- Department of Medicine, University of Virginia Health System,
Charlottesville, VA, USA
| | - Harald G Weirich
- Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
| | - Subhi J Al’Aref
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - 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
| | - Iksung Cho
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
- Department of Cardiology, Chung-Ang University Hospital, Seoul,
South Korea
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center,
Amsterdam, the Netherlands
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hangyang University
Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Hangyang University
Medical Center, Seoul, Korea
| | - Wijnand J Stuijfzand
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars Sinai Medical Center,
Los Angeles, CA, USA
| | - Yao Lu
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
| | - Hyung-Bok Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
| | - Mouaz H Al-Mallah
- Department of Cardiovascular Medicin, 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, Los Angeles Biomedical Research
Institute, Torrance, CA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, USA
| | - Leslee J Shaw
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Renu Virmani
- Deparment 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-Josée and Henry R. Kravis Center for
Cardiovascular Health, New York, NY, USA
| | - James K Min
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY,
USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative
Cardiovascular Imaging Research Center, Yonsei University College of
Medicine, Seoul, South Korea
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan,
Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| |
Collapse
|
38
|
Jeffries A, Costello B, Corkill W, Varghese S, Tayeb H, Gallagher C, Clarke N, Tu SJ, Pitman BM, Hanna-Rivero N, Chang DD, Manek N, Kangaharan N, Wong CX. Prognostic value of coronary artery calcium scoring and computed tomography coronary angiography in remote Indigenous and non-Indigenous Australians. Int J Cardiol 2020; 328:241-246. [PMID: 33309632 DOI: 10.1016/j.ijcard.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The long-term prognostic utility of coronary calcification and coronary artery disease on computed tomography coronary angiography (CTCA) in remote Indigenous and non-Indigenous Australians is not known. METHODS Consecutive patients undergoing CTCA from 2013 to 2017 in Central Australia were followed-up for major adverse cardiovascular events (MACE). RESULTS 347 patients were included (50 ± 12 years; 47% female; 39% Indigenous). 172 (50.0%) exhibited coronary calcification. CTCA demonstrated no coronary artery disease (CAD) in 137 (39.5%), non-obstructive CAD in 149 (42.9%), and obstructive CAD in 61 (17.6%) patients. Although Indigenous ethnicity was associated with coronary calcification and baseline CAD in age- and gender-adjusted models, this association was non-significant after accounting for comorbidities. Over 4.6 years (IQR 3.52-5.68) of follow-up, MACE incidence rates per 100 person-years were 2.92 (CI 1.92-4.44) and 0.48 (CI 0.18-1.27) in those with and without calcification respectively (p = 0.001), and 0.15 (CI 0.02-1.09), 1.32 (CI 0.69-2.54), and 6.23 (CI 3.81-10.16) in patients with no, non-obstructive, and obstructive CAD respectively (p < 0.001). Coronary calcification and obstructive CAD were associated with 5-fold (HR 5.25, 95% CI 1.66-16.59, p = 0.005) and 6-fold (HR 6.35, 95% CI 2.70-14.89, p < 0.001) greater hazards of MACE respectively in multivariable models, with no significant interaction by ethnicity in these associations seen. CONCLUSIONS The prognostic value of coronary calcification and CAD on CTCA amongst remote Indigenous individuals appears similar to that seen in non-Indigenous populations. Our data suggest that coronary artery calcium scoring and CTCA can be used to risk-stratify in remote settings where a normal study is associated with an excellent prognosis for at least two years.
Collapse
Affiliation(s)
- Ashlee Jeffries
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Benedict Costello
- Baker IDI Heart & Diabetes Institute and Alfred Hospital, Melbourne, Australia
| | - Wendy Corkill
- Departments of Cardiology, Alice Springs, and Royal Darwin Hospitals, Australia
| | - Seeba Varghese
- Departments of Cardiology, Alice Springs, and Royal Darwin Hospitals, Australia
| | - Hussam Tayeb
- Departments of Cardiology, Alice Springs, and Royal Darwin Hospitals, Australia
| | - Celine Gallagher
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Nicholas Clarke
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Bradley M Pitman
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | | | - Donald D Chang
- School of Medicine, The University of Queensland Ochsner Clinical School, Queensland, Australia
| | - Nimisha Manek
- Departments of Cardiology, Alice Springs, and Royal Darwin Hospitals, Australia
| | | | - Christopher X Wong
- University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia..
| |
Collapse
|
39
|
Seitun S, Clemente A, De Lorenzi C, Benenati S, Chiappino D, Mantini C, Sakellarios AI, Cademartiri F, Bezante GP, Porto I. Cardiac CT perfusion and FFR CTA: pathophysiological features in ischemic heart disease. Cardiovasc Diagn Ther 2020; 10:1954-1978. [PMID: 33381437 PMCID: PMC7758766 DOI: 10.21037/cdt-20-414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 01/24/2023]
Abstract
Cardiac computed tomography (CCT) has rapidly evolved, becoming a powerful integrated tool for the evaluation of coronary artery disease (CAD), and being superior to other noninvasive methods due to its high accuracy and ability to simultaneously assess both lumen stenosis and atherosclerotic plaque burden. Furthermore, CCT is regarded as an effective gatekeeper for coronary angiography, and carries independent important prognostic information. In the last decade, the introduction of new functional CCT applications, namely CCT perfusion (CCTP) imaging and CT-derived fractional flow reserve (FFRCTA), has opened the door for accurate assessment of the haemodynamic significance of stenoses. These new CCT technologies, thus, share the unique advantage of assessing both myocardial ischemia and patient-specific coronary artery anatomy, providing an integrated anatomical/functional analysis. In the present review, starting from the pathophysiology of myocardial ischemia, we evaluate the existing evidence for functional CCT imaging and its value in relation to alternative, well-established, non-invasive imaging modalities and invasive indices of ischemia (currently the gold-standard). The knowledge of clinical applications, benefits, and limitations of these new CCT technologies will allow efficient and optimal use in clinical practice in the near future.
Collapse
Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy
| | - Cecilia De Lorenzi
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Stefano Benenati
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, “G. d’Annunzio” University, Chieti, Italy
| | - Antonis I. Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Gian Paolo Bezante
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Italo Porto
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| |
Collapse
|
40
|
Influence of contrast material density and kV setting on detectability of calcified plaques on coronary CT angiography. Eur J Radiol 2020; 132:109276. [DOI: 10.1016/j.ejrad.2020.109276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/13/2020] [Accepted: 09/06/2020] [Indexed: 11/16/2022]
|
41
|
Seitun S, Clemente A, Maffei E, Toia P, La Grutta L, Cademartiri F. Prognostic value of cardiac CT. Radiol Med 2020; 125:1135-1147. [PMID: 33047297 DOI: 10.1007/s11547-020-01285-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice.
Collapse
Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa, Italy
| | - Erica Maffei
- Department of Radiology - Area Vasta 1 - ASUR Marche, Ospedale Civile "Santa Maria della Misericordia" di Urbino, Viale Federico Comandino, 70, 61029, Urbino, PU, Italy
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | | | | |
Collapse
|
42
|
Verdoia M, Gioscia R, Marcolongo M, De Luca G. Noninvasive Imaging Risk Stratification with Computed Tomography Angiography for Coronary Artery Disease. Cardiol Clin 2020; 38:543-550. [PMID: 33036716 DOI: 10.1016/j.ccl.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The recent technological evolution of coronary computed tomography angiography (CTA) with improved sensitivity and high negative predictive value has extended its potential applications as a gatekeeper test before invasive coronary angiography. However, the definition of the most accurate diagnostic algorithms comprising CTA as a first-line strategy for ruling out coronary artery disease and the correct management of the patients according to the results of imaging tests still warrant better definition.
Collapse
Affiliation(s)
- Monica Verdoia
- Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, Biella 13900, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy.
| | - Rocco Gioscia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy
| | - Marco Marcolongo
- Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, Biella 13900, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy
| |
Collapse
|
43
|
Coronary Plaque Features on CTA Can Identify Patients at Increased Risk of Cardiovascular Events. JACC Cardiovasc Imaging 2020; 13:1704-1717. [DOI: 10.1016/j.jcmg.2019.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
|
44
|
From CT to artificial intelligence for complex assessment of plaque-associated risk. Int J Cardiovasc Imaging 2020; 36:2403-2427. [PMID: 32617720 DOI: 10.1007/s10554-020-01926-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
The recent technological developments in the field of cardiac imaging have established coronary computed tomography angiography (CCTA) as a first-line diagnostic tool in patients with suspected coronary artery disease (CAD). CCTA offers robust information on the overall coronary circulation and luminal stenosis, also providing the ability to assess the composition, morphology, and vulnerability of atherosclerotic plaques. In addition, the perivascular adipose tissue (PVAT) has recently emerged as a marker of increased cardiovascular risk. The addition of PVAT quantification to standard CCTA imaging may provide the ability to extract information on local inflammation, for an individualized approach in coronary risk stratification. The development of image post-processing tools over the past several years allowed CCTA to provide a significant amount of data that can be incorporated into machine learning (ML) applications. ML algorithms that use radiomic features extracted from CCTA are still at an early stage. However, the recent development of artificial intelligence will probably bring major changes in the way we integrate clinical, biological, and imaging information, for a complex risk stratification and individualized therapeutic decision making in patients with CAD. This review aims to present the current evidence on the complex role of CCTA in the detection and quantification of vulnerable plaques and the associated coronary inflammation, also describing the most recent developments in the radiomics-based machine learning approach for complex assessment of plaque-associated risk.
Collapse
|
45
|
Mushtaq S, Conte E, Pontone G, Baggiano A, Annoni A, Formenti A, Mancini ME, Guglielmo M, Muscogiuri G, Tanzilli A, Nicoli F, Bartorelli AL, Pepi M, Andreini D. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion. J Cardiovasc Comput Tomogr 2020; 14:294-302. [DOI: 10.1016/j.jcct.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 01/06/2023]
|
46
|
Ferrannini G, Manca ML, Magnoni M, Andreotti F, Andreini D, Latini R, Maseri A, Maggioni AP, Ostroff RM, Williams SA, Ferrannini E. Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study. Diabetes Care 2020; 43:843-851. [PMID: 31988066 DOI: 10.2337/dc19-1902] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Coronary artery disease (CAD) is a major challenge in patients with type 2 diabetes (T2D). Coronary computed tomography angiography (CCTA) provides a detailed anatomic map of the coronary circulation. Proteomics are increasingly used to improve diagnostic and therapeutic algorithms. We hypothesized that the protein panel is differentially associated with T2D and CAD. RESEARCH DESIGN AND METHODS In CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation-a cohort of 528 individuals with no previous cardiovascular event undergoing CCTA), participants were grouped into CAD- (clean coronaries) and CAD+ (diffuse lumen narrowing or plaques). Plasma proteins were screened by aptamer analysis. Two-way partial least squares was used to simultaneously rank proteins by diabetes status and CAD. RESULTS Though CAD+ was more prevalent among participants with T2D (HbA1c 6.7 ± 1.1%) than those without diabetes (56 vs. 30%, P < 0.0001), CCTA-based atherosclerosis burden did not differ. Of the 20 top-ranking proteins, 15 were associated with both T2D and CAD, and 3 (osteomodulin, cartilage intermediate-layer protein 15, and HTRA1) were selectively associated with T2D only and 2 (epidermal growth factor receptor and contactin-1) with CAD only. Elevated renin and GDF15, and lower adiponectin, were independently associated with both T2D and CAD. In multivariate analysis adjusting for the Framingham risk panel, patients with T2D were "protected" from CAD if female (P = 0.007), younger (P = 0.021), and with lower renin levels (P = 0.02). CONCLUSIONS We concluded that 1) CAD severity and quality do not differ between participants with T2D and without diabetes; 2) renin, GDF15, and adiponectin are shared markers by T2D and CAD; 3) several proteins are specifically associated with T2D or CAD; and 4) in T2D, lower renin levels may protect against CAD.
Collapse
Affiliation(s)
- Giulia Ferrannini
- Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Felicita Andreotti
- Institute of Cardiology, FPG IRCCS, Catholic University Medical School, Rome, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Latini
- Mario Negri Institute of Pharmacological Research-IRCCS, Milan, Italy
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | | | | | | |
Collapse
|
47
|
Benetos G, Buechel RR, Gonçalves M, Benz DC, von Felten E, Rampidis GP, Clerc OF, Messerli M, Giannopoulos AA, Gebhard C, Fuchs TA, Pazhenkottil AP, Kaufmann PA, Gräni C. Coronary artery volume index: a novel CCTA-derived predictor for cardiovascular events. Int J Cardiovasc Imaging 2020; 36:713-722. [PMID: 31894527 DOI: 10.1007/s10554-019-01750-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
Coronary computed tomography angiography (CCTA) provides critical prognostic information on plaque burden and stenosis severity of coronary arteries. We aimed to investigate the long-term prognostic value of coronary artery volume per myocardial mass as a potential new imaging parameter. Consecutive patients with suspected coronary artery disease (CAD) were included. Coronary artery volume index (CAVi) was defined as volume over myocardial mass. Additionally, obstructive CAD (≥ 70% stenosis) and segment severity score (SSS: sum of all segments scored according to lesion severity with 0 = no lesion, 1 = narrowing < 50%, 2 = stenosis 50-69% and 3 = stenosis ≥ 70%) were evaluated. Major adverse cardiovascular events (MACE) were defined as cardiac death, non-fatal myocardial infarction or revascularization. The association of CAVi with MACE was evaluated using Cox regression hazards ratios (HR) and Kaplan Meier curves. In a total of 325 patients, 36 (11.1%) patients experienced MACE during the mean follow-up of 5.4 ± 1.7 years. Patients with low-CAVi (< 27.9 mm3/g) experienced more MACE than patients with high-CAVI (17.2% versus 4.5%, p < 0.001, Kaplan Meier curve p = 0.001). SSS, obstructive CAD and low-CAVi were all significant predictors of MACE in univariable analysis (HR 1.14, 95% CI 1.09-1.19, p < 0.001; HR 5.51, 95% CI 2.86-10.60, p < 0.001; and HR 3.79, 95% CI 1.66-8.65, p = 0.002, respectively). CAVi maintained significant association with MACE when adjusted to SSS (CAVi HR 2.43, 95% CI 1.02-5.75, p = 0.04) or obstructive CAD (CAVi HR 2.4, 95% CI 1.002-5.75, p = 0.049). CAVi could further risk stratify patients without obstructive CAD when stratifying patients according to obstructive CAD (Kaplan-Meier curve p = 0.049). CAVi is a novel CCTA-derived imaging parameter, yielding independent prognostic value over stenosis and plaque burden.
Collapse
Affiliation(s)
- Georgios Benetos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Marisa Gonçalves
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georgios P Rampidis
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
48
|
Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain. J Cardiovasc Comput Tomogr 2020; 14:3-11. [DOI: 10.1016/j.jcct.2019.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 01/09/2023]
|
49
|
Tarr PE, Ledergerber B, Calmy A, Doco-Lecompte T, Marzel A, Weber R, Kaufmann PA, Nkoulou R, Buechel RR, Kovari H. Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J 2019; 39:2147-2154. [PMID: 29590332 DOI: 10.1093/eurheartj/ehy163] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/06/2018] [Indexed: 12/31/2022] Open
Abstract
Aims HIV-positive persons have increased cardiovascular event rates but data on the prevalence of subclinical atherosclerosis compared with HIV-negative persons are not uniform. We assessed subclinical atherosclerosis utilizing coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA. Methods and results We assessed the association of HIV infection, cardiovascular risk profile, and HIV-related factors with subclinical atherosclerosis in univariable and multivariable analyses. HIV-positive participants (median duration of HIV infection, 15 years) were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score >0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI) 0.40-0.82; P < 0.01], lower coronary segment severity score (aOR 0.72; 95% CI 0.53-0.99; P = 0.04), and lower segment involvement score (aOR 0.71, 95% CI 0.52-0.97; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; 95% CI 1.09-3.56; P = 0.02). Conclusion HIV-positive persons in Switzerland had a similar degree of non-calcified/mixed plaque and high-risk plaque, and may have less calcified coronary plaque, and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores.
Collapse
Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Thanh Doco-Lecompte
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | | |
Collapse
|
50
|
Williams MC, Newby DE, Nicol ED. Coronary atherosclerosis imaging by CT to improve clinical outcomes. J Cardiovasc Comput Tomogr 2019; 13:281-287. [PMID: 30952611 PMCID: PMC6928571 DOI: 10.1016/j.jcct.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/13/2019] [Accepted: 03/25/2019] [Indexed: 01/13/2023]
Abstract
Coronary artery disease remains an important cause of morbidity and mortality world-wide. Coronary Computed Tomography Angiography (CCTA) has excellent diagnostic accuracy and the identification and stratification of coronary artery disease is associated with improved prognosis in multiple studies. Recent randomized controlled trials have shown that in patients with stable coronary artery disease, CCTA is associated with improved diagnosis, changes in investigations, changes in medical treatment and appropriate selection for revascularization. Importantly this diagnostic approach reduces the long-term risk of fatal and non-fatal myocardial infarction. The identification of adverse plaques on CCTA is known to be associated with an increased risk of acute coronary syndrome, but does not appear to be predictive of long-term outcomes independent of coronary artery calcium burden. Future research will involve the assessment of outcomes after CCTA in patients with acute chest pain and asymptomatic patients. In addition, more advanced quantification of plaque subtypes, vascular inflammation and coronary flow dynamics may identify further patients at increased risk.
Collapse
Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
| | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| |
Collapse
|