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Chen CL, Wu YJ, Yang SC, Wu FZ. New look at the power of zero coronary artery calcium (CAC) in Asian population: a systemic review and meta-analysis. Cardiovasc Diagn Ther 2024; 14:377-387. [PMID: 38975010 PMCID: PMC11223936 DOI: 10.21037/cdt-23-474] [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: 12/14/2023] [Accepted: 04/03/2024] [Indexed: 07/09/2024]
Abstract
Background Numerous studies have validated a 5-year warranty period for heart health in Western populations with a coronary artery calcium (CAC) score of zero. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. This meta-analysis aimed to clarify the uncertainty surrounding the prevalence, warranty period, and prognostic implications of zero CAC scores in Asian populations. It also examined the impact of sex on subclinical CAC progression. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. The study aimed to shed light on these issues by exploring the specificities of subclinical CAC progression in the Asian context. Methods Our systematic literature search, from the study's inception to October 2023, targeted studies on subclinical CAC progression in the Asian population with a zero CAC score. We searched the Cochrane Library, and PubMed. The search terms included "zero score", "coronary calcification", "zero CAC score", and "CAC scan". Results We evaluated seven published studies through a meta-analysis and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). In this meta-analysis of three observational studies addressing zero CAC prevalence (n=7,661), the pooled prevalence of zero CAC scores in the Asian population was 18.2% [95% confidence interval (CI): 12.5-25.9%]. A significant difference in follow-up warranty period was observed between the CAC zero group and subclinical CAC progression group (mean difference, 1.26 years; 95% CI: 0.94-1.58; P<0.001). Furthermore, the conversion rate of subclinical CAC progression differed significantly between males and females (risk ratio, 2.37; 95% CI: 1.98-2.84; P<0.001). Analysis of four studies revealed a notable discrepancy in the major adverse cardiovascular event (MACE) rate between the CAC (-) and CAC (+) groups (risk ratio, 4.78; 95% CI: 2.21-10.36; P<0.001). Conclusions The meta-analysis of zero CAC scores in Asian populations suggested an 18.2% prevalence. A 5-year warranty period was noted, with heightened subclinical CAC progression likelihood after this duration. Additionally, sex-based differences were observed in subclinical CAC progression rates. These findings will provide clinical cardiovascular risk stratification for guiding gender-specific clinical decision-making in asymptomatic in Asian individuals.
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Affiliation(s)
- Chien-Liang Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Shu-Ching Yang
- Institute of Education, National Sun Yat-sen University, Kaohsiung
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
- Institute of Education, National Sun Yat-sen University, Kaohsiung
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Faculty of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
- Shu-Zen Junior College of Medicine and Management, Kaohsiung
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Ivachevska VV, Supyk RR, Ivachevskyi MM, Hechko MM, Varvarynets AV. Coronary artery calcium score as independent risk factor of obstructive coronary artery disease. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:424-428. [PMID: 38691782 DOI: 10.36740/wlek202403108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Aim: To prove an independence of CAC score comparatively to conventional risk factors such as age, and dyslipidemia especially in patients under forty years of age. PATIENTS AND METHODS Materials and Methods: Thirty-four asymptomatic adult patients with no prior established atherosclerotic cardiovascular disease, diabetes mellitus or severe comorbidities, except of complex clinical examination, underwent CT scan with evaluation of coronary artery calcium score. RESULTS Results: The average total cholesterol level in the group was (5.62±1.02) mmol/l, indicating the presence of dyslipidemia. The average HDL level was (1.26±0.24) mmol/l, suggesting an average risk of atherosclerosis. The average LDL levels were within the borderline range at (3.63±1.01) mmol/l. The average triglyceride level was within the safe range at (1.93±1.08) mmol/l. The atherogenicity coefficient indicated a moderate risk of atherosclerosis with an average value of 3.64±1.31. The average coronary artery calcium score was 56.71±143.85, indicating minor plaques and a moderate risk of coronary artery disease. Correlation analysis revealed no significant correlation between age and the CAC score (r=0.1, p>0.05). However, reliable direct correlation of weak strength was found between the CAC score and LDL level (r=0.35, p<0.05). Direct correlations of weak strength were also observed between age and the levels of total cholesterol, LDL and the atherogenicity coefficient (r=0.43, 0.49, 0.42 respectively, p<0.05). CONCLUSION Conclusions: Coronary artery calcium score is a valuable screening tool for identifying potential obstructive coronary artery disease, not only for individuals aged forty and above, but also for younger asymptomatic patients.
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Lee H, Ahn HJ, Park HE, Han D, Chang HJ, Chun EJ, Han HW, Sung J, Jung HO, Choi SY. The effect of non-optimal lipids on the progression of coronary artery calcification in statin-naïve young adults: results from KOICA registry. Front Cardiovasc Med 2023; 10:1173289. [PMID: 37534276 PMCID: PMC10392939 DOI: 10.3389/fcvm.2023.1173289] [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: 02/24/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Despite the importance of attaining optimal lipid levels from a young age to secure long-term cardiovascular health, the detailed impact of non-optimal lipid levels in young adults on coronary artery calcification (CAC) is not fully explored. We sought to investigate the risk of CAC progression as per lipid profiles and to demonstrate lipid optimality in young adults. Methods From the KOrea Initiative on Coronary Artery calcification (KOICA) registry that was established in six large volume healthcare centers in Korea, 2,940 statin-naïve participants aged 20-45 years who underwent serial coronary calcium scans for routine health check-ups between 2002 and 2017 were included. The study outcome was CAC progression, which was assessed by the square root method. The risk of CAC progression was analyzed according to the lipid optimality and each lipid parameter. Results In this retrospective cohort (mean age, 41.3 years; men 82.4%), 477 participants (16.2%) had an optimal lipid profile, defined as triglycerides <150 mg/dl, LDL cholesterol <100 mg/dl, and HDL cholesterol >60 mg/dl. During follow-up (median, 39.7 months), CAC progression was observed in 434 participants (14.8%), and more frequent in the non-optimal lipid group (16.5% vs. 5.7%; p < 0.001). Non-optimal lipids independently increased the risk of CAC progression [adjusted hazard ratio (aHR), 1.97; p = 0.025], in a dose-dependent manner. Even in relatively low-risk participants with an initial calcium score of zero (aHR, 2.13; p = 0.014), in their 20 s or 30 s (aHR 2.15; p = 0.041), and without other risk factors (aHR 1.45; p = 0.038), similar results were demonstrable. High triglycerides had the greatest impact on CAC progression in this young adult population. Conclusion Non-optimal lipid levels were significantly associated with the risk of CAC progression in young adults, even at low-risk. Screening and intervention for non-optimal lipid levels, particularly triglycerides, from an early age might be of clinical value.
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Affiliation(s)
- Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Hyuk-Jae Chang
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, Republic of Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke and Vascular Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
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Lee JO, Park EA, Park D, Lee W. Deep Learning-Based Automated Quantification of Coronary Artery Calcification for Contrast-Enhanced Coronary Computed Tomographic Angiography. J Cardiovasc Dev Dis 2023; 10:jcdd10040143. [PMID: 37103022 PMCID: PMC10146297 DOI: 10.3390/jcdd10040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Background: We evaluated the accuracy of a deep learning-based automated quantification algorithm for coronary artery calcium (CAC) based on enhanced ECG-gated coronary CT angiography (CCTA) with dedicated coronary calcium scoring CT (CSCT) as the reference. Methods: This retrospective study included 315 patients who underwent CSCT and CCTA on the same day, with 200 in the internal and 115 in the external validation sets. The calcium volume and Agatston scores were calculated using both the automated algorithm in CCTA and the conventional method in CSCT. The time required for computing calcium scores using the automated algorithm was also evaluated. Results: Our automated algorithm extracted CACs in less than five minutes on average with a failure rate of 1.3%. The volume and Agatston scores by the model showed high agreement with those from CSCT with concordance correlation coefficients of 0.90–0.97 for the internal and 0.76–0.94 for the external. The accuracy for classification was 92% with a 0.94 weighted kappa for the internal and 86% with a 0.91 weighted kappa for the external set. Conclusions: The deep learning-based and fully automated algorithm efficiently extracted CACs from CCTA and reliably assigned categorical classification for Agatston scores without additional radiation exposure.
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Affiliation(s)
- Jung Oh Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Correspondence: ; Tel.: +82-2-2072-2584
| | - Daebeom Park
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Ueng KC, Chiang CE, Chao TH, Wu YW, Lee WL, Li YH, Ting KH, Su CH, Lin HJ, Su TC, Liu TJ, Lin TH, Hsu PC, Wang YC, Chen ZC, Jen HL, Lin PL, Ko FY, Yen HW, Chen WJ, Hou CJY. 2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome. ACTA CARDIOLOGICA SINICA 2023; 39:4-96. [PMID: 36685161 PMCID: PMC9829849 DOI: 10.6515/acs.202301_39(1).20221103a] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 01/24/2023]
Abstract
Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians' focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient's circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.
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Affiliation(s)
- Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Wen-Lieng Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Yunlin Christian Hospital, Yunlin
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Hung-Ju Lin
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
| | - Ta-Chen Su
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Asia University Hospital, Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Hsu-Lung Jen
- Division of Cardiology, Cheng Hsin Rehabilitation Medical Center, Taipei
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Feng-You Ko
- Cardiovascular Center, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, Min Sheng General Hospital, Taoyuan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Huang Y, Ren Y, Yang H, Ding Y, Liu Y, Yang Y, Mao A, Yang T, Wang Y, Xiao F, He Q, Zhang Y. Using a machine learning-based risk prediction model to analyze the coronary artery calcification score and predict coronary heart disease and risk assessment. Comput Biol Med 2022; 151:106297. [PMID: 36435054 DOI: 10.1016/j.compbiomed.2022.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To calculate the coronary artery calcification score (CACS) obtained from coronary artery computed tomography angiography (CCTA) examination and combine it with the influencing factors of coronary artery calcification (CAC), which is then analyzed by machine learning (ML) to predict the probability of coronary heart disease(CHD). METHODS All patients who were admitted to the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from January 2019 to March 2022, suspected of CHD, and underwent CCTA inspection were retrospectively selected. The degree of CAC was quantified based on the Agatston score. To compare the correlation between the CACS and clinical-related factors, we collected 31 variables, including hypertension, diabetes, smoking, hyperlipidemia, among others. ML models containing the random forest (RF), radial basis function neural network (RBFNN),support vector machine (SVM),K-Nearest Neighbor algorithm (KNN) and kernel ridge regression (KRR) were used to assess the risk of CHD based on CACS and clinical-related factors. RESULTS Among the five ML models, RF achieves the best performance about accuracy (ACC) (78.96%), sensitivity (SN) (93.86%), specificity(Spe) (51.13%), and Matthew's correlation coefficient (MCC) (0.5192).It also has the best area under the receiver operator characteristic curve (ROC) (0.8375), which is far superior to the other four ML models. CONCLUSION Computer ML model analysis confirmed the importance of CACS in predicting the occurrence of CHD, especially the outstanding RF model, making it another advancement of the ML model in the field of medical analysis.
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Affiliation(s)
- Yue Huang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YingBo Ren
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Hai Yang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YiJie Ding
- Yangtze Delta Region Institute (Quzhou), University of Electronic Science and Technology of China, 324000, Quzhou, Zhejiang, China
| | - Yan Liu
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YunChun Yang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - AnQiong Mao
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Tan Yang
- Department of Cardiac and Vascular Surgery, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YingZi Wang
- Southwest Medical University, Luzhou, 646099, Sichuan, China
| | - Feng Xiao
- Southwest Medical University, Luzhou, 646099, Sichuan, China
| | - QiZhou He
- Department of Radiology,Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Ying Zhang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Agha AM, Pacor J, Grandhi GR, Mszar R, Khan SU, Parikh R, Agrawal T, Burt J, Blankstein R, Blaha MJ, Shaw LJ, Al-Mallah MH, Brackett A, Cainzos-Achirica M, Miller EJ, Nasir K. The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:1745-1757. [PMID: 36202453 DOI: 10.1016/j.jcmg.2022.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. OBJECTIVES The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). METHODS The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. RESULTS In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). CONCLUSIONS Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a "gatekeeper" for more advanced imaging among patients presenting with CP.
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Affiliation(s)
- Ali M Agha
- Baylor College of Medicine, Houston, Texas, USA
| | - Justin Pacor
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Reed Mszar
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Roosha Parikh
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Tanushree Agrawal
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeremy Burt
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Liaquat A, Khan A, Ullah Shah S, Iqbal H, Iqbal S, Rana AI, Ur Rahman H. Evaluating the use of coronary artery calcium scoring as a tool for coronary artery disease (CAD) risk stratification and its association with coronary stenosis and CAD risk factors: a single-centre, retrospective, cross-sectional study at a tertiary centre in Pakistan. BMJ Open 2022; 12:e057703. [PMID: 35906055 PMCID: PMC9345086 DOI: 10.1136/bmjopen-2021-057703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Coronary artery disease (CAD) risk stratification plays a fundamental role in the early detection and optimal management of CAD. The aim of our study is to investigate the use of coronary artery calcium scoring (CACS) as a tool for CAD risk stratification through evaluation of its correlation with the degree of coronary stenosis and its association with conventional cardiovascular risk factors in asymptomatic patients. DESIGN Single-centre, retrospective, cross-sectional study. SETTING The study was conducted at a tertiary centre (Shifa International Hospital) in Islamabad, Pakistan, through review of medical records of patients who underwent coronary CT between the years 2016 and 2020. PARTICIPANTS A total of 1014 patients were included in the study. The study population was analysed for presence of conventional risk factors (gender, age, diabetes, hypertension, body mass index, dyslipidaemia) and association with CACS (zero: n=534; minimal: 0 to ≤10, n=70; mild: >10 to ≤100, n=130; moderate: >100 to ≤400, n=118; and severe: >400, n=49). The association of CACS with the degree of coronary artery stenosis seen on CT scan (significant: ≥50% stenosis, n=216; non-significant: <50% stenosis, n=685) was also analysed. OUTCOME MEASURES The main outcome was the association of coronary artery stenosis with CACS. The secondary outcome was the association of CACS with conventional CAD risk factors. RESULTS A significant positive association was shown between CACS and coronary artery stenosis (zero vs minimal: OR 0.39, 95% CI 0.20 to 0.79, p=0.01; zero vs mild: OR 0.16, 95% CI 0.10 to 0.27, p<0.0001; zero vs moderate: OR 0.05, 95% CI 0.03 to 0.08, p<0.0001; zero vs severe: OR 0.02, 95% CI 0.01 to 0.050, p<0.0001). Age >45 (OR 1.03, 95% CI 1.01 to 1.05, p<0.0001), hypertension (OR 1.16, 95% CI 0.79 to 1.71, p=0.001) and diabetes (OR 1.33, 95% CI 0.88 to 1.99, p<0.0001) were associated with an increased risk of coronary artery stenosis. Moreover, plaques with higher calcium burden were found in the left anterior descending artery (mean CACS: 386.15±203.89), followed by right coronary (239.77±219.83) and left circumflex (175.56±153.54) arteries. CONCLUSION The results indicate a strong positive association of CACS with coronary artery stenosis. CACS was also significantly associated with conventional CAD risk factors in this population.
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Affiliation(s)
- Afrose Liaquat
- Biochemistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Saeed Ullah Shah
- Cardiology, Shifa International Hospitals, Islamabad, Pakistan
- Cardiology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hania Iqbal
- Shifa International Hospitals, Islamabad, Pakistan
| | - Safa Iqbal
- Shifa International Hospitals, Islamabad, Pakistan
| | - Atif Iqbal Rana
- Radiology, Shifa International Hospitals, Islamabad, Pakistan
| | - Habib Ur Rahman
- Cardiology, Shifa International Hospitals, Islamabad, Pakistan
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Association of arterial stiffness with coronary artery calcium score in the general-population: the Swedish CArdioPulmonary bioImage study. J Hypertens 2022; 40:933-939. [PMID: 35142741 DOI: 10.1097/hjh.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Coronary artery calcium score (CACS) is a marker of subclinical atherosclerosis. However, there is little data related to the association between arterial stiffness and CACS in the general population. The aim of this study was to explore the association between carotid femoral-pulse wave velocity (c-f PWV), a widely accepted marker of arterial stiffness, and CACS. METHODS Participants with complete measurements on c-f PWV, CACS and confounding variables from the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort were included in the final study population (n = 8725). CACS was divided into three categories (≤10, >10 and ≤100, and >100) and multinomial logistic regression was performed to explore the association between these categories of CACS and quartiles of c-f PWV, and for per one standard deviation (SD) increment of c-f PWV. RESULTS CACS ≤10, >10 and ≤100, and >100 were present in 69.3, 17.8 and 12.9% of the study population, respectively. The odds ratio (OR) for CACS >100 for the fourth quartile (Q4) of c-f PWV vs. Q1 (reference category) was 1.62 (95% confidence interval [CI] 1.25-2.12) after adjustments. One standard deviation increase in c-f PWV was independently associated with a higher odds of having a CACS category >100 (OR: 1.25, 95% CI 1.14-1.36) in the final multivariable model. CONCLUSION c-f PWV is positively associated with increased risk of higher CACS, and can be valuable in identifying individuals at risk for sub-clinical atherosclerosis. VIDEO ABSTRACT http://links.lww.com/HJH/B863.
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Masud R, Khan AUH, Baqai HZ, Iqbal A. The Correlation of MTHFR SNPs, Homocysteine, and Conventional Risk Predictors with Coronary Artery Disease. RUSS J GENET+ 2021. [DOI: 10.1134/s1022795421110077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Ebaid NY, Khalifa DN, Ragheb AS, Abdelsamie MM, Alsowey AM. Validation of Coronary Artery Disease Reporting and Data System (CAD-RADS) and Application of Coronary Artery Calcium Data and Reporting System (CAC-DRS) as New Standardized Tools in the Management of Coronary Artery Disease Patients. Int J Gen Med 2021; 14:7503-7514. [PMID: 34754223 PMCID: PMC8572090 DOI: 10.2147/ijgm.s336662] [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: 09/07/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives The coronary artery disease reporting and data system (CAD-RADS) is intended to standardize the reporting of CCTA and the subsequent management guidelines of CAD. The present study was conducted to investigate the validation of CAD-RADS and the application of coronary calcium grading in CAD management. Patients and Methods The current study is a single-center prospective study that involved 177 participants with chest pain who were submitted to coronary CT angiography (CCTA). Two reviewers independently assessed CCTA results and gave each patient a CAD-RADS category. The reference standard for determining the clinical utility of CAD-RADS was invasive coronary angiography (ICA). The inter-reviewer agreement (IRA) was tested using the intra-class correlation (ICC). Results The study enrolled 111 cases with non-significant CAD and 66 cases with significant CAD based on ICA findings. According to the reviewer, the CAD-RADS had a sensitivity, specificity, and accuracy of 90.9 to 100%, 89.2 to 94.6%, and 93.16 to 93.2%, respectively, for predicting severe CAD. The IRA for CAD-RADS categories was excellent (ICC = 0.960). The best cut-off value for predicting severe CAD was CAD-RADS > 3. Significant relation between Ca and severe CAD (p<0.001) was detected. Conclusion The current study provides a good understanding of CAD-RADS as a standard tool with high diagnostic accuracy.
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Affiliation(s)
- Noha Yahia Ebaid
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Nabil Khalifa
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmad Sabry Ragheb
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Li PY, Chen RY, Wu FZ, Mar GY, Wu MT, Wang FW. Use of Coronary Computed Tomography Angiography to Screen Hospital Employees with Cardiovascular Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5462. [PMID: 34065262 PMCID: PMC8160889 DOI: 10.3390/ijerph18105462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine how coronary computed tomography angiography (CCTA) can be employed to detect coronary artery disease in hospital employees, enabling early treatment and minimizing damage. All employees of our hospital were assessed using the Framingham Risk Score. Those with a 10-year risk of myocardial infarction or death of >10% were offered CCTA; the Coronary Artery Disease Reporting and Data System (CAD-RADS) score was the outcome. A total of 3923 hospital employees were included, and the number who had received CCTA was 309. Among these 309, 31 (10.0%) had a CAD-RADS score of 3-5, with 10 of the 31 (32.3%) requiring further cardiac catheterization; 161 (52.1%) had a score of 1-2; and 117 (37.9%) had a score of 0. In the multivariate logistic regression, only age of ≥ 55 years (p < 0.05), hypertension (p < 0.05), and hyperlipidemia (p < 0.05) were discovered to be significant risk factors for a CAD-RADS score of 3-5. Thus, regular and adequate control of chronic diseases is critical for patients, and more studies are required to be confirmed if there are more significant risk factors.
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Affiliation(s)
- Po-Yi Li
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (P.-Y.L.); (R.-Y.C.)
| | - Ru-Yih Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (P.-Y.L.); (R.-Y.C.)
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (F.-Z.W.); (M.-T.W.)
| | - Guang-Yuan Mar
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan;
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (F.-Z.W.); (M.-T.W.)
| | - Fu-Wei Wang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (P.-Y.L.); (R.-Y.C.)
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Choi EJ, Lee SY. Index of Cardiac Age Index and Cardiometabolic Biomarkers in Adults with Metabolic Syndrome. Metab Syndr Relat Disord 2021; 19:288-295. [PMID: 33656387 DOI: 10.1089/met.2020.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The presence of metabolic syndrome (MetS) seems to alter or accelerate the aging process of tissues or organs including the heart. We aim to investigate whether MetS are associated with an index of cardiac age calculated by parameters derived from 128-slice cardiac multidetector computed tomography (MDCT) and cardiometabolic biomarkers in adults. Materials and Methods: In this cross-sectional study, the data were collected from 135 subjects who underwent a comprehensive health checkup, including cardiac MDCT in adults (age ≥18 years). Cardiometabolic biomarkers and an index of cardiac age were measured. Results: Sixty-one (45.2%) had MetS and 44 subjects (32.6%) presented with moderate or severe coronary artery stenosis (CAS) on cardiac MDCT. MetS had positive correlations with several anthropometric variables, metabolic variables [triglyceride, gamma-glutamyl transpeptidase (GGT), homeostatic model assessment of insulin resistance (HOMA-IR)], and systolic blood pressure, cardiac parameters, an index of cardiac age and CAS, whereas had a negative correlation with high-density lipoprotein cholesterol. The diagnostic accuracy for MetS had similar area under the curve among the four variables (index of cardiac age, CAS, HOMA-IR, GGT). On age-adjusted multivariate analysis, only high index of cardiac age (≥55.0 years), and high HOMA-IR (≥1.22) were significantly and independently associated with MetS [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.19-5.18, P = 0.016 and OR 3.41, 95% CI 1.65-7.06, P = 0.001, respectively]. Conclusion: Adults with MetS had higher index of cardiac age and higher HOMA-IR, compared with adults without MetS.
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Affiliation(s)
- Eun Jung Choi
- Department of Family Medicine, Daedong Hospital, Busan, South Korea
| | - Sang Yeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, South Korea.,Family Medicine Clinic, Pusan National University Yangsan Hospital, Yangsan, South Korea.,Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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14
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Lee H, Park HE, Yoon JW, Choi SY. Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population. Diabetes Metab J 2021; 45:219-230. [PMID: 33108855 PMCID: PMC8024146 DOI: 10.4093/dmj.2019.0161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression. METHODS This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units. RESULTS During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m2, increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators. CONCLUSION Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.
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Affiliation(s)
- Heesun Lee
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Eun Park
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Su-Yeon Choi
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author: Su-Yeon Choi https://orcid.org/0000-0001-9977-4740 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, Korea E-mail:
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Bruns S, Wolterink JM, Takx RAP, Hamersvelt RW, Suchá D, Viergever MA, Leiner T, Išgum I. Deep learning from dual‐energy information for whole‐heart segmentation in dual‐energy and single‐energy non‐contrast‐enhanced cardiac CT. Med Phys 2020; 47:5048-5060. [DOI: 10.1002/mp.14451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Steffen Bruns
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
| | - Jelmer M. Wolterink
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
| | - Richard A. P. Takx
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Robbert W. Hamersvelt
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Dominika Suchá
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Max A. Viergever
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Tim Leiner
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
- Department of Radiology and Nuclear Medicine Amsterdam UMC – location AMC Amsterdam1105 AZ Netherlands
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Debates over NICE Guideline Update: What Are the Roles of Nuclear Cardiology in the Initial Evaluation of Stable Chest Pain? Nucl Med Mol Imaging 2019; 53:301-312. [PMID: 31723359 DOI: 10.1007/s13139-019-00607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.
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Mlynarska A, Mlynarski R, Sosnowski M. Usefulness of the Coronary Artery Calcium Score in Predicting Subsequent Coronary Interventions-A Ten-Year Single-Center Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2132. [PMID: 31208148 PMCID: PMC6617306 DOI: 10.3390/ijerph16122132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 01/26/2023]
Abstract
There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients' management over a period of ten years after application of the CACS. Methods: The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)-G1: CACS = 0 AU (52 pts); G2: CACS = 1-399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI-Percutaneous Coronary Intervention; CABG-Coronary Artery Bypass Graft) were also analyzed. Results: The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; p = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714-0.841); in CABG, it was 0.825 (95% CI: 0.760-0.878) and the average for both groups was 0.838 (95% CI: 0.774-0.889). Conclusions: The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.
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Affiliation(s)
- Agnieszka Mlynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
- Department of Electrocardiology, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
| | - Rafal Mlynarski
- Department of Electrocardiology, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
| | - Maciej Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
- 3rd Division of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland.
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Buccheri S, D’Arrigo P, Franchina G, Capodanno D. Risk Stratification in Patients with Coronary Artery Disease: A Practical Walkthrough in the Landscape of Prognostic Risk Models. Interv Cardiol 2018; 13:112-120. [PMID: 30443266 PMCID: PMC6234492 DOI: 10.15420/icr.2018.16.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023] Open
Abstract
Although a combination of multiple strategies to prevent and treat coronary artery disease (CAD) has led to a relative reduction in cardiovascular mortality over recent decades, CAD remains the greatest cause of morbidity and mortality worldwide. A variety of individual factors and circumstances other than clinical presentation and treatment type contribute to determining the outcome of CAD. It is increasingly understood that personalised medicine, by taking these factors into account, achieves better results than "one-size-fitsall" approaches. In recent years, the multiplication of risk scoring systems for CAD has generated some degree of uncertainty regarding whether, when and how predictive models should be adopted when making clinical decisions. Against this background, this article reviews the most accepted risk models for patients with evidence of CAD to provide practical guidance within the current landscape of tools developed for prognostic risk stratification.
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Affiliation(s)
- Sergio Buccheri
- CAST, AOU. Policlinico-Vittorio Emanuele, University of CataniaCatania, Italy
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala UniversityUppsala, Sweden
| | - Paolo D’Arrigo
- CAST, AOU. Policlinico-Vittorio Emanuele, University of CataniaCatania, Italy
| | - Gabriele Franchina
- CAST, AOU. Policlinico-Vittorio Emanuele, University of CataniaCatania, Italy
| | - Davide Capodanno
- CAST, AOU. Policlinico-Vittorio Emanuele, University of CataniaCatania, Italy
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