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Zito A, Galli M, Biondi-Zoccai G, Abbate A, Douglas PS, Princi G, D'Amario D, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis. Ann Intern Med 2023; 176:817-826. [PMID: 37276592 DOI: 10.7326/m23-0231] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND There is uncertainty about which diagnostic strategy for detecting coronary artery disease (CAD) provides better outcomes. PURPOSE To compare the effect on clinical management and subsequent health effects of alternative diagnostic strategies for the initial assessment of suspected stable CAD. DATA SOURCES PubMed, Embase, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized clinical trials comparing diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD. DATA EXTRACTION Three investigators independently extracted study data. DATA SYNTHESIS The strongest available evidence was for 3 of the 6 comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) (4 trials), CCTA versus exercise electrocardiography (ECG) (2 trials), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) (5 trials). Compared with direct ICA referral, CCTA was associated with no difference in cardiovascular death and myocardial infarction (relative risk [RR], 0.84 [95% CI, 0.52 to 1.35]; low certainty) but less index ICA (RR, 0.23 [CI, 0.22 to 0.25]; high certainty) and index revascularization (RR, 0.71 [CI, 0.63 to 0.80]; moderate certainty). Moreover, CCTA was associated with a reduction in cardiovascular death and myocardial infarction compared with exercise ECG (RR, 0.66 [CI, 0.44 to 0.99]; moderate certainty) and SPECT-MPI (RR, 0.64 [CI, 0.45 to 0.90]; high certainty). However, CCTA was associated with more index revascularization (RR, 1.78 [CI, 1.33 to 2.38]; moderate certainty) but less downstream testing (RR, 0.56 [CI, 0.45 to 0.71]; very low certainty) than exercise ECG. Low-certainty evidence compared SPECT-MPI versus exercise ECG (2 trials), SPECT-MPI versus stress cardiovascular magnetic resonance imaging (1 trial), and stress echocardiography versus exercise ECG (1 trial). LIMITATION Most comparisons primarily rely on a single study, many studies were underpowered to detect potential differences in direct health outcomes, and individual patient data were lacking. CONCLUSION For the initial assessment of patients with suspected stable CAD, CCTA was associated with similar health effects to direct ICA referral, and with a health benefit compared with exercise ECG and SPECT-MPI. Further research is needed to better assess the relative performance of each diagnostic strategy. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42022329635).
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (M.G.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (G.B.)
| | - Antonio Abbate
- Mediterranea Cardiocentro, Napoli, Italy (G.B.); Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia (A.A.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (P.S.D.)
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy (D.D.)
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
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Spirito A, Sticchi A, Praz F, Gräni C, Messerli F, Siontis GC. Impact of design characteristics among studies comparing coronary computed tomography angiography to noninvasive functional testing in chronic coronary syndromes. Am Heart J 2023; 256:104-116. [PMID: 36400186 DOI: 10.1016/j.ahj.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is widely adopted to detect obstructive coronary artery disease (CAD) in patients with chronic coronary syndromes (CCS). However, it is unknown to which extent study-specific characteristics yield different conclusions. METHODS We summarized non-randomized and randomized studies comparing CCTA and noninvasive functional testing for CCS with information on the outcome of myocardial infarction (MI). We evaluated the differential effect according to study characteristics using random-effect meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustments. RESULTS Fifteen studies (8 non-randomized, 7 randomized) were included. CCTA was associated with decrease in relative (odds ratio (OR) 0.54, 95%CI 0.47 to 0.62, P < .001) and absolute MI risk (risk difference (RD) -0.4%, 95%CI -0.6 to -0.1, P = .005). The results remained consistent among the non-randomized (RD -0.4%, 95%CI -0.7 to -0.1, P=.029), but not among the randomized trials where there was no difference in the observed risk (RD 0.2%, 95%CI -0.6 to 0.1, P = .158). CCTA was not associated with MI reduction in studies with clinical outcome definition (OR 0.77, 95%CI 0.41 to 1.44, P = .212), research driven follow-up (OR 0.54, 95%CI 0.24 to 1.21, P = .090), central event assessment (OR 0.63, 95%CI 0.21 to 1.86, P = .207), outcome adjudication (OR 0.74, 95%CI 0.24 to 2.23, P = .178), or at low-risk of bias (OR 0.74, 95%CI 0.24 to 2.23, P = .178). CONCLUSIONS Among studies of any design, CCTA was associated with lower risk of MI in CCS compared to noninvasive functional testing. This benefit was diminished among studies with clinical outcome definition, central outcome assessment/adjudication or at low-risk of bias.
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Affiliation(s)
- Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessandro Sticchi
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franz Messerli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Assessment of the Efficiency of Non-Invasive Diagnostic Imaging Modalities for Detecting Myocardial Ischemia in Patients Suspected of Having Stable Angina. Healthcare (Basel) 2022; 11:healthcare11010023. [PMID: 36611483 PMCID: PMC9818638 DOI: 10.3390/healthcare11010023] [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: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to assess and compare the efficiency of non-invasive imaging modalities in detecting myocardial ischemia in patients with suspected stable angina as easy-to-understand indices. Our study included 1000 patients with chest pain and possible stable myocardial ischemia. The modalities to be assessed were cardiac magnetic resonance imaging (CMRI), single-photon emission computed tomography, positron emission computed tomography (PET), stress echocardiography, and fractional flow reserve derived from coronary computed tomography angiography (FFRCT). As a simulation study, we assumed that all five imaging modalities were performed on these patients, and a decision tree analysis was conducted. From the results, the following efficiencies were assessed and compared: (1) number of true positive (TP), false positive (FP), false negative (FN), and true negative (TN) test results; (2) positive predictive value (PPV); (3) negative predictive value (NPV); (4) post-test probability; (5) diagnostic accuracy (DA); and (6) number needed to diagnose (NND). In the basic settings (pre-test probability: 30%), PET generated the highest TP (267) and NPV (95%, 95% confidence interval (CI): 93-96%). In contrast, CMRI produced the highest TN (616), PPV (76%, 95% CI: 71-80%), and DA (88%, 95% CI: 86-90%) and the lowest NND (1.33, 95% CI: 1.24-1.47). Although FFRCT generated the highest TP (267) and lowest FN (33), it generated the highest FP (168). In terms of detecting myocardial ischemia, compared with the other modalities, PET and CMRI were more efficient. The results of our study might be helpful for both patients and medical professionals associated with their examination.
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De Campos D, Teixeira R, Saleiro C, Lopes J, Botelho A, Gonçalves L. Computed tomography coronary angiography as the noninvasive in stable coronary artery disease? Long-term outcomes meta-analysis. Future Cardiol 2022; 18:407-416. [PMID: 35119305 DOI: 10.2217/fca-2021-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare outcomes of coronary computed tomography angiography (CCTA) with that of functional testing (FT) in stable coronary artery disease. Methods: We searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs). A random-effects meta-analysis targeting all-cause death and nonfatal acute coronary syndromes was performed. Results: Eight RCTs enrolling 29,579 patients were included. Pooled relative risk (RR) for the primary end point was similar between CCTA and FT (RR = 0.97; 95% CI: 0.76-1.22). CCTA outperformed FT in nonfatal myocardial infarction (MI) (RR = 0.59; 95% CI: 0.41-0.83) and in downstream testing (OR: 0.47; 95% CI: 0.21-1.01). Conclusion: Updated data of stable coronary artery disease suggests that CCTA improved nonfatal MI and downstream testing.
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Affiliation(s)
- Diana De Campos
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal
| | - Rogério Teixeira
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, 3000-370, Coimbra, Portugal
| | - Carolina Saleiro
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal
| | - João Lopes
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal
| | - Ana Botelho
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal
| | - Lino Gonçalves
- Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, R. Larga 2, 3000-370, Coimbra, Portugal
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5
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Serruys PW, Hara H, Garg S, Kawashima H, Nørgaard BL, Dweck MR, Bax JJ, Knuuti J, Nieman K, Leipsic JA, Mushtaq S, Andreini D, Onuma Y. Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:713-736. [PMID: 34384554 DOI: 10.1016/j.jacc.2021.06.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/09/2023]
Abstract
Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Computed tomography coronary anatomy with functionality assessment could potentially become a first line in diagnosis. Noninvasive imaging assessment of plaque burden and morphology is becoming a valuable substitute for intravascular imaging. Recently, wall shear stress and perivascular inflammation have been introduced. These assessments could support risk management for both primary and secondary cardiovascular prevention. Anatomy, functionality, and plaque composition by CTA tend to replace invasive assessment. Complete CTA assessment could provide a 1-stop-shop for diagnosis, risk management, and decision-making on treatment.
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Affiliation(s)
- Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. https://twitter.com/hara_hironori
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Juhani Knuuti
- Heart Center, Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Yang S, Lee SP, Park JB, Lee H, Kang SH, Lee SE, Kim JB, Choi SY, Kim YJ, Chang HJ. PM2.5 concentration in the ambient air is a risk factor for the development of high-risk coronary plaques. Eur Heart J Cardiovasc Imaging 2021; 20:1355-1364. [PMID: 31410457 DOI: 10.1093/ehjci/jez209] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS We aimed to investigate whether long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) in the ambient air is related to the development or growth of coronary plaques. METHODS AND RESULTS This study involved 364 residents of Seoul, Korea, who underwent serial coronary computed tomographic angiography (CCTA) at an interval of ≥2 years. Each participant's average concentration of residential PM2.5 between the two CCTAs was calculated. Primary endpoint was the development of high-risk plaque (HRP), defined as a plaque with low attenuation, spotty calcium, and positive remodelling. Secondary endpoints were the volume increase of total plaque and its component volume. Among those without HRP at baseline (n = 341), 20 patients developed HRP at follow-up CCTA, the residential PM2.5 concentration of which was significantly higher than those without HRP at follow-up (25.8 ± 2.0 vs. 25.0 ± 1.7 μg/m3 for patients with newly developed HRP vs. patients without HRP at follow-up; P = 0.047). An increase in PM2.5 concentration was associated with increased incidence of HRP at follow-up [adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.22-2.15, P < 0.001]. In a secondary analysis, the PM2.5 concentration was associated with an increased risk of the formation of either fibrofatty or necrotic core component in newly developed plaques (aHR 1.41, 95% CI 1.23-1.61, P < 0.001), and with a higher risk of total plaque volume progression in the pre-existing plaques (aHR 1.14, 95% CI 1.05-1.23, P = 0.002). CONCLUSION Exposure to higher concentration of PM2.5 in the ambient air is significantly associated with the development of high-risk coronary plaques.
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Affiliation(s)
- Seokhun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 737, Yeoksam-dong, Gangnam-gu, Seoul 06236, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 737, Yeoksam-dong, Gangnam-gu, Seoul 06236, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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7
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Hwang D, Kim HJ, Lee SP, Lim S, Koo BK, Kim YJ, Kook W, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Raff GL, Shin S, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Lin FY, Virmani R, Samady H, Stone PH, Narula J, Bax JJ, Shaw LJ, Min JK, Chang HJ. Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis. JACC Cardiovasc Imaging 2021; 14:1410-1421. [PMID: 33454260 DOI: 10.1016/j.jcmg.2020.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study sought to identify distinct patient groups and their association with outcome based on the patient similarity network using quantitative coronary plaque characteristics from coronary computed tomography angiography (CTA). BACKGROUND Coronary CTA can noninvasively assess coronary plaques quantitatively. METHODS Patients who underwent 2 coronary CTAs at a minimum of 24 months' interval were analyzed (n = 1,264). A similarity Mapper network of patients was built by topological data analysis (TDA) based on the whole-heart quantitative coronary plaque analysis on coronary CTA to identify distinct patient groups and their association with outcome. RESULTS Three distinct patient groups were identified by TDA, and the patient similarity network by TDA showed a closed loop, demonstrating a continuous trend of coronary plaque progression. Group A had the least coronary plaque amount (median 12.4 mm3 [interquartile range (IQR): 0.0 to 39.6 mm3]) in the entire coronary tree. Group B had a moderate coronary plaque amount (31.7 mm3 [IQR: 0.0 to 127.4 mm3]) with relative enrichment of fibrofatty and necrotic core (32.6% [IQR: 16.7% to 46.2%] and 2.7% [IQR: 0.1% to 6.9%] of the total plaque, respectively) components. Group C had the largest coronary plaque amount (187.0 mm3 [IQR: 96.7 to 306.4 mm3]) and was enriched for dense calcium component (46.8% [IQR: 32.0% to 63.7%] of the total plaque). At follow-up, total plaque volume, fibrous, and dense calcium volumes increased in all groups, but the proportion of fibrofatty component decreased in groups B and C, whereas the necrotic core portion decreased in only group B (all p < 0.05). Group B showed a higher acute coronary syndrome incidence than other groups (0.3% vs. 2.6% vs. 0.6%; p = 0.009) but both group B and C had a higher revascularization incidence than group A (3.1% vs. 15.5% vs. 17.8%; p < 0.001). Incorporating group information from TDA demonstrated increase of model fitness for predicting acute coronary syndrome or revascularization compared with that incorporating clinical risk factors, percentage diameter stenosis, and high-risk plaque features. CONCLUSIONS The TDA of quantitative whole-heart coronary plaque characteristics on coronary CTA identified distinct patient groups with different plaque dynamics and clinical outcomes. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Haneol J Kim
- Department of Mathematical Science, Seoul National University, Seoul, South Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
| | - Seonhee Lim
- Department of Mathematical Science, Seoul National University, Seoul, South Korea.
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Woong Kook
- Department of Mathematical Science, Seoul National University, Seoul, South Korea
| | - Daniele Andreini
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan University Hospital, Busan, South Korea
| | - Edoardo Conte
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Hugo Marques
- Department of Radiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- Department of Radiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Gianluca Pontone
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Fay Y Lin
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leslee J Shaw
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - James K Min
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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8
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Cardiac-CT and cardiac-MR cost-effectiveness: a literature review. Radiol Med 2020; 125:1200-1207. [PMID: 32970273 DOI: 10.1007/s11547-020-01290-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 01/18/2023]
Abstract
Cardiovascular diseases are still among the first causes of death worldwide with a huge impact on healthcare systems. Within these conditions, the correct diagnosis of coronary artery disease with the most appropriate imaging-based evaluations is of utmost importance. The sustainability of the healthcare systems, considering the high economic burden of modern cardiac imaging equipments, makes cost-effective analysis an important tool, currently used for weighing different costs and health outcomes, when policy makers have to allocate funds and to prioritize interventions, getting the most out of their financial resources. This review aims at evaluating cost-effective analysis in the more recent literature, focused on the role of Calcium Score, coronary computed tomography angiography and cardiac magnetic resonance.
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Hwang IC, Lee H, Yoon YE, Choi IS, Kim HL, Chang HJ, Lee JY, Choi JA, Kim HJ, Cho GY, Park JB, Lee SP, Kim HK, Kim YJ, Sohn DW. Risk stratification of non-obstructive coronary artery disease for guidance of preventive medical therapy. Atherosclerosis 2019; 290:66-73. [DOI: 10.1016/j.atherosclerosis.2019.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022]
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Sun Z, Ng CKC, Squelch A. Synchrotron radiation computed tomography assessment of calcified plaques and coronary stenosis with different slice thicknesses and beam energies on 3D printed coronary models. Quant Imaging Med Surg 2019; 9:6-22. [PMID: 30788242 DOI: 10.21037/qims.2018.09.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background To investigate the effect of different slice thicknesses and beam energies on the visualization and assessment of coronary artery stenosis caused by calcified plaques using synchrotron radiation computed tomography (CT) based on 3D printed coronary artery models. Methods Patient-specific 3D coronary models were created based on 3 sample coronary CT angiographic cases with calcified plaques in the left coronary arteries. In addition to the original significant coronary stenosis (>70%) shown on these CT images, stenoses of <50% and >90% were created in the segmented coronary models for simulation of different degrees of stenosis. The coronary lumen and calcification were printed with soft and rigid materials to simulate properties of coronary wall and calcified plaque, respectively. The models were scanned with synchrotron radiation CT with beam energies of 30, 40 and 50 keV and spatial resolution of 0.019×0.019×0.019 mm3 voxel size. Original high-resolution images were reconstructed with slice thicknesses of 0.095, 0.208, 0.302 and 0.491 mm to determine the effect of spatial resolution on plaque and coronary stenosis assessment based on 2D axial and 3D virtual intravascular endoscopy (VIE) images. Results Three coronary artery models were successfully printed with plaques placed in the coronary arteries to simulate different degrees of stenosis. 2D and 3D VIE images reconstructed with slice thicknesses of 0.095, 0.208 and 0.302 mm allowed for accurate assessment of coronary plaques and lumen stenosis with no significant differences (P>0.05). Synchrotron radiation CT images reconstructed with a slice thickness of 0.491 mm resulted in overestimation of coronary stenosis when compared to other images on 2D and 3D VIE views (<50% vs. 55-72%; 70-79% vs. 80-90%) with significant differences (P<0.05). Similarly, irregular plaque appearances were observed on 2D and 3D VIE images with a slice thickness of 0.491 mm when compared to others using thin slice thicknesses. The scanning protocol with beam energy of 30 keV provided optimal visualization of coronary lumen and plaque appearances. Conclusions This study shows the feasibility of using 3D printed coronary artery models to simulate calcifications and different degrees of coronary stenosis. High resolution synchrotron radiation CT imaging with the 30 keV beam energy enables accurate assessment of coronary stenosis in the presence of calcification, thus highlighting the importance of high spatial resolution in the diagnosis of calcified coronary plaques.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, Western Australia, Australia.,Computational Image Analysis Group, Curtin Institute for Computation, Curtin University, Perth, Western Australia, Australia
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