1
|
Huang Z, Huang R, Xu X, Fan Z, Xiong Z, Liang Q, Guo Y, Liao X, Zhuang X. Long-term physical activity time-in-target range in young adults with cardiovascular events in later life. Eur J Prev Cardiol 2024; 31:461-469. [PMID: 38123512 DOI: 10.1093/eurjpc/zwad403] [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: 09/25/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
AIMS Achieving at least 150 min per week of moderate-to-vigorous physical activity (PA) is a 'Class I, A level' recommendation for the primary prevention of cardiovascular disease. However, long-term PA is a complex behaviour and varied by lifetime, which was insufficiently reflected by the current studies. This study used time-in-target range (TTR) to measure the long-term PA level during young adulthood and investigated its relationship with cardiovascular events in later life. METHODS AND RESULTS Participants in the Coronary Artery Risk Development in Young Adults study were recruited (n = 2902) and allocated into four groups by PA TTR: <25% (n = 1028), 25 to <50% (n = 444), 50 to <75% (n = 424), 75 to 100% (n = 1006). TTR was estimated with linear interpolation across the first 15 years. The primary outcome was a composite of cardiovascular events. The mean (SD) age after the exposure period was 40.3 (3.6) years. After a median follow-up for an additional 18.9 years, the participants with a TTR of at least 75% had a 40% lower risk of the primary outcome (HR: 0.60; 95%CI: 0.38 to 0.95) compared with the lowest TTR group. Each 1-SD increase in TTR was also significantly associated with a 21% decreased risk of the primary outcome (HR: 0.79; 95%CI: 0.65-0.97). CONCLUSION Increasing PA is essential in young adulthood. In young adults, maintaining long-term guidelines-recommended PA levels may help to lower the risk of cardiovascular events in later life. Maintaining the guidelines-recommended PA level for at least 75% of time across young adulthood may be preferable.
Collapse
Affiliation(s)
- Zihao Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Rihua Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Xinghao Xu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Zhenyu Xiong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Qi Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Yue Guo
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, People's Republic of China
| |
Collapse
|
2
|
Selvam PV, Grandhi GR, Leucker TM, Arbab-Zadeh A, Gulati M, Blumenthal RS, Whelton SP. Recent advances in cardiovascular risk assessment: The added value of non-invasive anatomic imaging. J Cardiovasc Comput Tomogr 2024; 18:113-119. [PMID: 38326189 DOI: 10.1016/j.jcct.2024.01.012] [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: 07/12/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
In 2022, multiple original research studies were conducted highlighting the utility of coronary artery calcium (CAC) imaging in young individuals and provided further evidence for the role of CAC to improve atherosclerotic cardiovascular disease (ASCVD) risk assessment. Mean calcium density was shown to be a more reliable predictor than peak density in risk assessment. Additionally, in light of the ACC/AHA/Multispecialty Chest Pain Guideline's recent elevation of coronary computed tomography angiography (CCTA) to a Class I (level of evidence A) recommendation as an index diagnostic test for acute or stable chest pain, several studies support the utility of CCTA and guided future directions. This review summarizes recent studies that highlight the role of non-invasive imaging in enhancing ASCVD risk assessment across different populations.
Collapse
Affiliation(s)
- Pooja V Selvam
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Gowtham R Grandhi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thorsten M Leucker
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Armin Arbab-Zadeh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
3
|
van Rosendael AR, Crabtree T, Bax JJ, Nakanishi R, Mushtaq S, Pontone G, Andreini D, Buechel RR, Gräni C, Feuchtner G, Patel TR, Choi AD, Al-Mallah M, Nabi F, Karlsberg RP, Rochitte CE, Alasnag M, Hamdan A, Cademartiri F, Marques H, Kalra D, German DM, Gupta H, Hadamitzky M, Deaño RC, Khalique O, Knaapen P, Hoffmann U, Earls J, Min JK, Danad I. Rationale and design of the CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) study. J Cardiovasc Comput Tomogr 2024; 18:11-17. [PMID: 37951725 PMCID: PMC10923095 DOI: 10.1016/j.jcct.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND In the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total coronary plaque volume and low attenuation plaque volume. The primary aim of CONFIRM2, (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is to perform comprehensive quantification of CCTA findings, including coronary, non-coronary cardiac, non-cardiac vascular, non-cardiac findings, and relate them to clinical variables and cardiovascular clinical outcomes. DESIGN CONFIRM2 is a multicenter, international observational cohort study designed to evaluate multidimensional associations between quantitative phenotype of cardiovascular disease and future adverse clinical outcomes in subjects undergoing clinically indicated CCTA. The targeted population is heterogenous and includes patients undergoing CCTA for atherosclerotic evaluation, valvular heart disease, congenital heart disease or pre-procedural evaluation. Automated software will be utilized for quantification of coronary plaque, stenosis, vascular morphology and cardiac structures for rapid and reproducible tissue characterization. Up to 30,000 patients will be included from up to 50 international multi-continental clinical CCTA sites and followed for 3-4 years. SUMMARY CONFIRM2 is one of the largest CCTA studies to establish the clinical value of a multiparametric approach to quantify the phenotype of cardiovascular disease by CCTA using automated imaging solutions.
Collapse
Affiliation(s)
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Toral R Patel
- Cardiology at Stroobants Heart and Vascular Institute and UVA Cardiology, Lynchburg, VA, United States of America
| | - Andrew D Choi
- Cardiology and Radiology, George Washington University, Washington, DC, United States of America
| | - Mouaz Al-Mallah
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Cedars Sinai Heart Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Filippo Cademartiri
- Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy & SYNLAB IRCCS SDN, Naples, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa and Católica Medical School, Portugal
| | - Dinesh Kalra
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - David M German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States of America
| | - Himanshu Gupta
- Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Ridgewood, NJ, United States of America
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Roderick C Deaño
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Omar Khalique
- Division of Cardiovascular Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands
| | - Udo Hoffmann
- Cleerly, Inc, Denver, CO, United States of America
| | - James Earls
- Cleerly, Inc, Denver, CO, United States of America
| | - James K Min
- Cleerly, Inc, Denver, CO, United States of America
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
4
|
Chen X, Zhao J, Cai Q, Chen R, Wu W, Wang P, Zhang G, Zhen J. Relationship between Coronary Artery Calcium Score and Coronary Stenosis. Cardiol Res Pract 2023; 2023:5538111. [PMID: 38144902 PMCID: PMC10746374 DOI: 10.1155/2023/5538111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023] Open
Abstract
Background The coronary artery calcium score (CACS) is commonly employed to quantify the degree of calcification in coronary atherosclerosis. Indeed, increased coronary stenosis severity is associated with a progressive increase in CACS. Objectives This study sought to explore the association between CACS and coronary stenosis of ≥50% and ≥70%. Methods We conducted a retrospective analysis of patient data collected between July 1, 2017, and March 3, 2022, at Jiangmen Central Hospital. A total of 208 patients, presenting with both symptomatic and asymptomatic manifestations and suspected coronary artery disease (CAD), were included. Statistical analyses included ROC curve assessments, subgroup analyses based on age, and comparisons of CACS values against the presence of coronary stenosis ≥50% and ≥70%. Results Ultimately, 208 patients were included, with a median age of 65.0 years and a median CACS of 115.7 (interquartile range: 13.7-369.4). A CACS threshold of ≥1300 demonstrated a specificity of 100% for coronary stenosis of ≥50%. Notably, the percentage of patients with obstructive CAD showing CACS = 0 was significantly higher in those under 65 years (15.1%) compared to patients over 65 years (3.8%) (P=0.005). The inflection point, at which the risk probability for coronary stenosis of ≥50% shifted from being a protective factor to a risk factor, was observed when CACS fell within the range of 63.3 to 66.0. Conclusion CACS demonstrates good performance for the detection of coronary artery stenosis.
Collapse
Affiliation(s)
- Xinyan Chen
- Department of Cardiology, Guangdong Medical University, Zhanjiang, Guangdong 524000, China
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Jianbin Zhao
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Qingqing Cai
- Department of Cardiology, Guangdong Medical University, Zhanjiang, Guangdong 524000, China
| | - Rong Chen
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Wenhao Wu
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Peng Wang
- Department of Network Information, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Gaoxing Zhang
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, China
| | - Jinhuan Zhen
- Department of Cardiology, Guangdong Medical University, Zhanjiang, Guangdong 524000, China
- Department of Cardiology, Kaiping Second People's Hospital, Jiangmen, Guangdong 529300, China
| |
Collapse
|
5
|
Hariri E, Asbeutah AA, Malik A, Amangurbanova M, Chedid G, Daher R, Al Hammoud M, Welty FK. Eicosapentaenoic and docosahexaenoic acid supplementation and coronary artery calcium progression in patients with coronary artery disease: A secondary analysis of a randomized trial. Atherosclerosis 2023; 387:117388. [PMID: 38056242 DOI: 10.1016/j.atherosclerosis.2023.117388] [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: 04/05/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIMS We previously reported that an omega-3 fatty acid index ≥4% with high-dose eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) prevented progression of noncalcified plaque. Higher coronary artery calcium (CAC) scores and progression of CAC are associated with increased cardiovascular events and mortality. We examined the effect of EPA + DHA on CAC score. METHODS A total of 242 patients with coronary artery disease (CAD) on statin therapy were randomized to 1.86 g EPA and 1.5 g DHA daily or none (control) for 30 months. The CAC score was measured at baseline and 30-months with non-contrast, cardiac computed tomography. RESULTS Both EPA + DHA and control groups had significant progression in CAC scores over 30 months (median change:183.5 vs 221.0, respectively, p < 0.001) despite a 13.6% reduction in triglyceride level with EPA + DHA. No significant difference was observed between groups for the total group, by baseline CAC scores of <100, 100-399, 400-999 and ≥1000 or quartiles of achieved levels of EPA, DHA and the omega-3 fatty acid index. Similar rates of CAC progression were noted in those on high-intensity statin compared to low- and moderate-intensity statin. CONCLUSIONS EPA and DHA added to statin resulted in similar CAC progression over 30 months regardless of baseline CAC categories, statin intensity and achieved levels of EPA, DHA and the omega-3 fatty acid index.
Collapse
Affiliation(s)
- Essa Hariri
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, MD, USA
| | - Abdul Aziz Asbeutah
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abdulaziz Malik
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maral Amangurbanova
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Georges Chedid
- The Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ralph Daher
- Department of Internal Medicine, Cooper University Healthcare, Camden, NJ, USA
| | - Mazen Al Hammoud
- The Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| |
Collapse
|
6
|
He Z, Luo J, Lv M, Li Q, Ke W, Niu X, Zhang Z. Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques. Front Neurol 2023; 14:1159288. [PMID: 37900593 PMCID: PMC10603250 DOI: 10.3389/fneur.2023.1159288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.
Collapse
Affiliation(s)
- Zhiwei He
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiaying Luo
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengna Lv
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingwen Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Ke
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuan Niu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
7
|
Mézquita AJV, Biavati F, Falk V, Alkadhi H, Hajhosseiny R, Maurovich-Horvat P, Manka R, Kozerke S, Stuber M, Derlin T, Channon KM, Išgum I, Coenen A, Foellmer B, Dey D, Volleberg RHJA, Meinel FG, Dweck MR, Piek JJ, van de Hoef T, Landmesser U, Guagliumi G, Giannopoulos AA, Botnar RM, Khamis R, Williams MC, Newby DE, Dewey M. Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group. Nat Rev Cardiol 2023; 20:696-714. [PMID: 37277608 DOI: 10.1038/s41569-023-00880-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
The detection and characterization of coronary artery stenosis and atherosclerosis using imaging tools are key for clinical decision-making in patients with known or suspected coronary artery disease. In this regard, imaging-based quantification can be improved by choosing the most appropriate imaging modality for diagnosis, treatment and procedural planning. In this Consensus Statement, we provide clinical consensus recommendations on the optimal use of different imaging techniques in various patient populations and describe the advances in imaging technology. Clinical consensus recommendations on the appropriateness of each imaging technique for direct coronary artery visualization were derived through a three-step, real-time Delphi process that took place before, during and after the Second International Quantitative Cardiovascular Imaging Meeting in September 2022. According to the Delphi survey answers, CT is the method of choice to rule out obstructive stenosis in patients with an intermediate pre-test probability of coronary artery disease and enables quantitative assessment of coronary plaque with respect to dimensions, composition, location and related risk of future cardiovascular events, whereas MRI facilitates the visualization of coronary plaque and can be used in experienced centres as a radiation-free, second-line option for non-invasive coronary angiography. PET has the greatest potential for quantifying inflammation in coronary plaque but SPECT currently has a limited role in clinical coronary artery stenosis and atherosclerosis imaging. Invasive coronary angiography is the reference standard for stenosis assessment but cannot characterize coronary plaques. Finally, intravascular ultrasonography and optical coherence tomography are the most important invasive imaging modalities for the identification of plaques at high risk of rupture. The recommendations made in this Consensus Statement will help clinicians to choose the most appropriate imaging modality on the basis of the specific clinical scenario, individual patient characteristics and the availability of each imaging modality.
Collapse
Affiliation(s)
| | - Federico Biavati
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany
- Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Stuber
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Keith M Channon
- Radcliffe Department of Medicine, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adriaan Coenen
- Department of Radiology, Erasmus University, Rotterdam, Netherlands
| | - Bernhard Foellmer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rick H J A Volleberg
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Felix G Meinel
- Department of Radiology, University Medical Centre Rostock, Rostock, Germany
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology and Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tim van de Hoef
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ulf Landmesser
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Giulio Guagliumi
- Division of Cardiology, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany.
- Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany.
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The aim of this study was to highlight the current best practice for atherosclerotic cardiovascular disease (CVD) risk evaluation, including selective use of adjunctive tools for risk stratification [e.g. coronary artery calcium (CAC) scoring] and risk enhancement [e.g. lipoprotein(a) [Lp(a)], polygenic risk scoring (PRS)]. RECENT FINDINGS New studies have evaluated the efficacy of various risk assessment tools. These studies demonstrate the role of Lp(a) as a risk-enhancing factor ready for more widespread use. CAC is the gold standard method of assessing subclinical atherosclerosis, enabling true risk stratification of patients, and informing net benefit assessment for initiating or titrating lipid-lowering therapy (LLT). SUMMARY Lp(a) concentration and CAC scoring, apart from the traditional risk factors, add the most value to the current CVD risk assessment approaches of all available tools, especially in terms of guiding LLT. In addition to new integrative tools such as the MESA CHD Risk Score and Coronary Age calculator, the future of risk assessment may include PRS and more advanced imaging techniques for atherosclerosis burden. Soon, polygenic risk scoring may be used to identify the age at which to begin CAC scoring, with CAC scores guiding preventive strategies.
Collapse
Affiliation(s)
| | - Erfan Tasdighi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Shaw LJ, Blankstein R. Next Step for Hybrid PET-CT Imaging: Automation of CAC Scores. JACC Cardiovasc Imaging 2023; 16:688-690. [PMID: 37137579 DOI: 10.1016/j.jcmg.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Macchi C, Sirtori CR, Corsini A, Mannuccio Mannucci P, Ruscica M. Pollution from fine particulate matter and atherosclerosis: A narrative review. ENVIRONMENT INTERNATIONAL 2023; 175:107923. [PMID: 37119653 DOI: 10.1016/j.envint.2023.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/22/2023]
Abstract
According to the WHO, the entire global population is exposed to air pollution levels higher than recommended for health preservation. Air pollution is a complex mixture of nano- to micro-sized particles and gaseous components that poses a major global threat to public health. Among the most important air pollutants, causal associations have been established between particulate matter (PM), mainly < 2.5 μm, and cardiovascular diseases (CVD), i.e., hypertension, coronary artery disease, ischemic stroke, congestive heart failure, arrhythmias as well as total cardiovascular mortality. Aim of this narrative review is to describe and critically discuss the proatherogenic effects of PM2.5 that have been attributed to many direct or indirect effects comprising endothelial dysfunction, a chronic low-grade inflammatory state, increased production of reactive oxygen species, mitochondrial dysfunction and activation of metalloproteases, all leading to unstable arterial plaques. Higher concentrations of air pollutants are associated with the presence of vulnerable plaques and plaque ruptures witnessing coronary artery instability. Air pollution is often disregarded as a CVD risk factor, in spite of the fact that it is one of the main modifiable factors relevant for prevention and management of CVD. Thus, not only structural actions should be taken in order to mitigate emissions, but health professionals should also take care to counsel patients on the risks of air pollution.
Collapse
Affiliation(s)
- Chiara Macchi
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Cesare R Sirtori
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy; Department of Cardio-Thoracic-Vascular Diseases - Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy.
| |
Collapse
|
11
|
Coronary artery calcification on routine CT has prognostic and treatment implications for all ages. Clin Radiol 2023; 78:412-420. [PMID: 36935258 DOI: 10.1016/j.crad.2023.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
AIMS Guidelines have recommended reporting coronary artery calcification (CAC) if present on chest CT imaging regardless of indication. This study assessed CAC prevalence, prognosis and the potential clinical impact of its reporting. METHODS We performed a single-centre retrospective analysis (January-December 2015) of 1400 chest CTs (200 consecutive within each age group: <40, 40-49, 50-59, 60-69, 70-79, 80-89, ≥90). CTs were re-reviewed for CAC presence and severity and excluded if prior coronary intervention. Comorbidities, statin prescription and clinical outcomes (myocardial infarction [MI], stroke, all-cause mortality) were recorded. The impact of reporting CAC was assessed against pre-existing statin prescriptions. RESULTS 1343 patients were included (mean age 63±20 years, 56% female). Inter- and intra-observer variability for CAC presence at re-review was almost perfect (κ 0.89, p < 0.001; κ 0.90, p < 0.001) and for CAC grading was substantial and almost perfect (κ 0.68, p < 0.001; κ 0.91, p < 0.001). CAC was observed in 729/1343 (54%), more frequently in males (p < 0.001) and rising age (p < 0.001). A high proportion of patients with CAC in all age groups had no prior statin prescription (range: 42% [80-89] to 100% [<40]). The 'number needed to report' CAC presence to potentially impact management across all ages was 2. 689 (51%) patients died (median follow-up 74-months). CAC presence was associated with risk of MI, stroke and all-cause mortality (p < 0.001). After adjusting for confounders, severe calcification predicted risk of all-cause mortality (HR 1.8 [1.2-2.5], p = 0.002). CONCLUSION Grading of CAC was reproducible, and although prevalence rose with age, prognostic and treatment implications were maintained in all ages.
Collapse
|
12
|
Boussoussou M, Vattay B, Szilveszter B, Simon J, Lin A, Vecsey-Nagy M, Konkoly G, Merkely B, Maurovich-Horvat P, Dey D, Kolossváry M. The effect of patient and imaging characteristics on coronary CT angiography assessed pericoronary adipose tissue attenuation and gradient. J Cardiovasc Comput Tomogr 2023; 17:34-42. [PMID: 36266205 DOI: 10.1016/j.jcct.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) pericoronary adipose tissue (PCAT) markers are promising indicators of inflammation. OBJECTIVE To determine the effect of patient and imaging parameters on the associations between non-calcified plaque (NCP) and PCAT attenuation and gradient. METHODS This was a single-center, retrospective analysis of consecutive patients with stable chest pain who underwent CCTA and had zero calcium scores. CCTA images were evaluated for the presence of NCP, obstructive stenosis, segment stenosis and involvement score (SSS, SIS), and high-risk plaque (HRP). PCAT markers were assessed using semi-automated software. Uni- and multivariable regression models correcting for patient and imaging characteristics between plaque and PCAT markers were evaluated. RESULTS Overall, 1652 patients had zero calcium score (mean age: 51 years ± 11 [SD], 871 women); PCAT attenuation values ranged between -123 HU and -51 HU, and 649 patients had plaque. In univariable analysis, the presence of NCP, SSS, SIS, and HRP were associated with PCAT attenuation (2, 1, 1, 6 HU; respectively; p < .001 all); while obstructive stenosis was not (1 HU, p = .58). In multivariable analysis, none of the plaque markers were associated with PCAT attenuation (0 HU p = .93, 0 HU p = .39, 1 HU p = .18, 2 HU p = .10, 1 HU p = .71, respectively), while patient and imaging characteristics showed significant associations, such as: male sex (1 HU, p = .003), heart rate [1/min] (-0.2 HU, p < .001), 120 kVp (8 HU, p < .001) and pixel spacing [mm3] (32 HU, p < .001). Similar results were observed for PCAT gradient. CONCLUSION PCAT markers were significantly associated with NCP, however the associations did not persist following correction for patient and imaging characteristics.
Collapse
Affiliation(s)
- Melinda Boussoussou
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Borbála Vattay
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Bálint Szilveszter
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Judit Simon
- Semmelweis University Medical Imaging Center, 1082 Budapest, Korányi Sándor street 2., Hungary
| | - Andrew Lin
- Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA, 90048, USA
| | - Milán Vecsey-Nagy
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Gábor Konkoly
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary
| | - Pál Maurovich-Horvat
- Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary; Semmelweis University Medical Imaging Center, 1082 Budapest, Korányi Sándor street 2., Hungary
| | - Damini Dey
- Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA, 90048, USA
| | - Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor street 68., Hungary.
| |
Collapse
|
13
|
Cademartiri F, Maurovich-Horvat P. Current role of coronary calcium in younger population and future prospects with photon counting technology. Eur Heart J Cardiovasc Imaging 2022; 24:25-26. [PMID: 36394362 PMCID: PMC9762930 DOI: 10.1093/ehjci/jeac214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Pàl Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Üllői út 26, 1085Hungary
| |
Collapse
|
14
|
Coronary Artery Calcium Testing in Symptomatic Patients. JACC: CARDIOVASCULAR IMAGING 2022; 15:1839-1841. [DOI: 10.1016/j.jcmg.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
15
|
Maniar Y, Blumenthal RS, Alfaddagh A. The role of coronary artery calcium in allocating pharmacotherapy for primary prevention of cardiovascular disease: The ABCs of CAC. Clin Cardiol 2022; 45:1107-1113. [DOI: 10.1002/clc.23918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yash Maniar
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Roger S. Blumenthal
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore Maryland USA
| |
Collapse
|
16
|
Shaw LJ, Chandrashekhar Y. Unfolding the Importance of Subclinical Atherosclerosis: Is it Time to Start Population Screening? JACC Cardiovasc Imaging 2022; 15:1680-1681. [PMID: 36075634 DOI: 10.1016/j.jcmg.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
17
|
Villines TC, Williams MC. The Fallacy of the Power of Zero. JACC. CARDIOVASCULAR IMAGING 2022; 15:1075-1077. [PMID: 35680216 DOI: 10.1016/j.jcmg.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|