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Nilsson S, Qvick A, Henriksson M, Lawesson SS, Holm ACS, Leander K. Menopausal Vasomotor Symptoms and Subclinical Atherosclerotic Cardiovascular Disease: A Population-Based Study. J Am Heart Assoc 2024; 13:e033648. [PMID: 39166434 DOI: 10.1161/jaha.123.033648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/01/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Menopausal vasomotor symptoms (VMS) are increasingly emphasized as a potentially important cardiovascular risk factor, but their role is still unclear. We assessed the association between VMS and subclinical atherosclerotic cardiovascular disease in peri- and postmenopausal women. METHODS AND RESULTS Using a cross-sectional study design, questionnaire data were collected from a population-based sample of women aged 50 to 64. The questionnaire asked whether menopause was/is associated with bothersome VMS. A 4-point severity scale was used: (1) never, (2) mild, (3) moderate, and (4) severe. The VMS duration and time of onset were also assessed. Associations with subclinical atherosclerotic cardiovascular disease, detected via coronary computed tomography angiography, coronary artery calcium score, and carotid ultrasound were assessed using the outcome variables "any coronary atherosclerosis," "segmental involvement score >3," "coronary artery calcium score >100," and "any carotid plaque," using logistic regression. Covariate adjustments included socioeconomic, lifestyle, and clinical factors. Of 2995 women, 14.2% reported ever severe, 18.1% ever moderate, and 67.7% ever mild/never VMS. Using the latter as reference, ever severe VMS were significantly associated with coronary computed tomography angiography-detected coronary atherosclerosis (multivariable adjusted odds ratio, 1.33 [95% CI, 1.02-1.72]). Corresponding results for ever severe VMS persisting >5 years or beginning before the final menstrual period were 1.50 (95% CI, 1.07-2.11) and 1.66 (95% CI, 1.10-2.50), respectively. No significant association was observed with segmental involvement score >3, coronary artery calcium score >100, or with any carotid plaque. CONCLUSIONS Ever occurring severe, but not moderate, VMS were significantly associated with subclinical coronary computed tomography angiography-detected atherosclerosis, independent of a broad range of cardiovascular risk factors and especially in case of long durations or early onset.
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Affiliation(s)
- Sigrid Nilsson
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Angelika Qvick
- Unit of Cardiovascular and Nutritional Epidemiology Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Moa Henriksson
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Anna-Clara Spetz Holm
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
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Scala A, Marchini F, Meossi S, Zanarelli L, Sanguettoli F, Frascaro F, Bianchi N, Cocco M, Erriquez A, Tonet E, Campo G, Pavasini R. Future of invasive and non-invasive hemodynamic assessment for coronary artery disease management. Minerva Cardiol Angiol 2024; 72:385-404. [PMID: 38934267 DOI: 10.23736/s2724-5683.23.06461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Coronary artery disease represents a global health challenge. Accurate diagnosis and evaluation of hemodynamic parameters are crucial for optimizing patient management and outcomes. Nowadays a wide range of both non-invasive and invasive methods are available to assess the hemodynamic impact of both epicardial coronary stenosis and vasomotor disorders. In fact, over the years, important developments have reshaped the nature of both invasive and non-invasive diagnostic techniques, and the future holds promises for further innovation and integration. Non-invasive techniques have progressively evolved and currently a broad spectrum of methods are available, from cardiac magnetic resonance imaging with pharmacological stress and coronary computed tomography (CT) to the newer application of FFR-CT and perfusion CT. Invasive methods, on the contrary, have developed to a full-physiology approach, able not only to identify functionally significant lesions but also to evaluate microcirculation and vasospastic disease. The aim of this review is to summarize the current state-of-the-art of invasive and non-invasive hemodynamic assessment for CAD management.
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Affiliation(s)
- Antonella Scala
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Sofia Meossi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Luca Zanarelli
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | | | - Federica Frascaro
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Nicola Bianchi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Marta Cocco
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy -
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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Alyami B, Santer M, Seetharam K, Velu D, Gadde E, Patel B, Hamirani YS. Non-Calcified Coronary Artery Plaque on Coronary Computed Tomography Angiogram: Prevalence and Significance. Tomography 2023; 9:1755-1771. [PMID: 37736993 PMCID: PMC10514817 DOI: 10.3390/tomography9050140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE We aimed to assess the prevalence of non-calcified plaque (NCP) on computed tomography angiography (CCTA) in symptomatic and asymptomatic individuals. In addition, we seek to compare plaque assessment on CCTA with intravascular ultrasound-virtual histology (IVUS-VH) and to assess the prognostic value of non-calcified plaques (NCPs). BACKGROUND The CCTA can characterize coronary plaques and help quantify burden. Furthermore, it can provide additional prognostic information which can enable further risk stratification of patients. METHODS We performed a broad comprehensive review of the current literature pertaining to CCTA and primarily isolated NCP in symptomatic and asymptomatic patients. In addition, our review included studies correlating plaque on CT with IVUS-VH. CONCLUSIONS NCP is the initial precursor of calcified plaque and serves as a prominent marker of early coronary atherosclerosis. By detecting NCP during early stages, several measures can be implemented which can alter the evolutionary course of the underlying disease. This can potentially lead to a lower incidence of cardiovascular events.
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Affiliation(s)
- Bandar Alyami
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Matthew Santer
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Karthik Seetharam
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
| | - Dhivya Velu
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
| | - Eswar Gadde
- Department of Medicine, West Virginia University, Charleston, WV 25304, USA;
| | - Bansari Patel
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Yasmin S. Hamirani
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
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Douhi A, Al-Enezi MS, Berrahmoune N, Khalil A, Fulop T, Nguyen M, Turcotte E, Croteau É, Bentourkia M. Non-calcified active atherosclerosis plaque detection with 18F-NaF and 18F-FDG PET/CT dynamic imaging. Phys Eng Sci Med 2023; 46:295-302. [PMID: 36715851 DOI: 10.1007/s13246-023-01218-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
Arterial inflammation is an indicator of atheromatous plaque vulnerability to detach and to obstruct blood vessels in the heart or in the brain thus causing heart attack or stroke. To date, it is difficult to predict the plaque vulnerability. This study was aimed to assess the behavior of 18F-sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG) uptake in the aorta and iliac arteries as a function of plaque density on CT images. We report metabolically active artery plaques associated to inflammation in the absence of calcification. 18 elderly volunteers were recruited and imaged with computed tomography (CT) and positron emission tomography (PET) with 18F-NaF and 18F-FDG. A total of 1338 arterial segments were analyzed, 766 were non-calcified and 572 had calcifications. For both 18F-NaF and 18F-FDG, the mean SUV values were found statistically significantly different between non-calcified and calcified artery segments. Clustering CT non-calcified segments, excluding blood, resulted in two clusters C1 and C2 with a mean density of 30.63 ± 5.06 HU in C1 and 43.06 ± 4.71 HU in C2 (P < 0.05), and their respective SUV were found statistically different in 18F-NaF and 18F-FDG. The 18F-NaF images showed plaques not detected on CT images, where the 18F-FDG SUV values were high in comparison to artery walls without plaques. The density on CT images alone corresponding to these plaques could be further investigated to see whether it can be an indicator of the active plaques.
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Affiliation(s)
- Abdelillah Douhi
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Mamdouh S Al-Enezi
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Nousra Berrahmoune
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Abdelouahed Khalil
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Tamas Fulop
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Michel Nguyen
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Eric Turcotte
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Étienne Croteau
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - M'hamed Bentourkia
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
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Kokov AN, Masenko VL, Barbarash OL. Prognostic significance of equivalent density of calcium deposits of coronary arteries in men with osteopenic syndrome and prior coronary artery bypass grafting: prospective study. TERAPEVT ARKH 2022; 94:467-472. [DOI: 10.26442/00403660.2022.04.201463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
Aim. Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up.
Materials and methods. A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.91.8 months.
Results. Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p0.001), a decrease in the T-criterion of the thigh (r=-0.21; p0.001) and lumbar vertebrae (r=-0.19; p0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.545.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis 30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD.
Conclusion. According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.
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Kovacs L, Kress TC, Belin de Chantemèle EJ. HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women. JACC Basic Transl Sci 2022; 7:410-421. [PMID: 35540101 PMCID: PMC9079796 DOI: 10.1016/j.jacbts.2021.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.
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Key Words
- CVD, cardiovascular disease
- FMD, flow-mediated dilatation
- HF, heart failure
- HIV
- HIV, human immunodeficiency virus
- MI, myocardial infarction
- NO, nitric oxide
- PAD, peripheral artery disease
- PH, pulmonary hypertension
- PLWH, people living with HIV
- cART, combination antiretroviral therapy
- cIMT, carotid intima-media thickness
- combination antiretroviral therapy
- endothelial dysfunction
- sex differences
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Affiliation(s)
- Laszlo Kovacs
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Taylor C Kress
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta Georgia, USA
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Jin GY. Use of Coronary CT Angiography as a Screening Tool for Coronary Artery Disease in Asymptomatic Healthy Individuals or Patients. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:54-69. [PMID: 36237344 PMCID: PMC9238211 DOI: 10.3348/jksr.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
심장 돌연사 환자들은 종종 흉통 또는 운동성 호흡곤란 등의 전조증상이 나타나지 않기 때문에 잠재적인 무증상 관상동맥 질환을 조기에 발견하는 것이 매우 중요하다. 관상동맥 전산화단층촬영 혈관조영술은 방사선 노출로 인한 위험성 때문에 무증상 환자에서 스크리닝 검사로 정당화되지 못했었지만 최근에 전산화단층촬영 기술의 비약적인 발전으로 방사선량을 1 mSv 미만으로 최소화함으로써 무증상 환자의 관상동맥 질환 선별 검사의 유용성에 대한 많은 연구가 진행되어 왔다. 그러나, 여전히 무증상 정상인 또는 환자의 관상동맥 질환 선별 검사에 대한 관상동맥 전산화단층촬영 혈관조영술의 유용성에 대해서는 다양한 의견들이 있다. 이 종설에서는 무증상 정상인 또는 환자들에게 관상동맥 질환 선별 검사로 관상동맥 칼슘 점수와 관상동맥 전산화단층촬영 혈관조영술 유용성에 대해서 다양한 문헌고찰을 통해서 알아보았다. 관상동맥 전산화단층촬영 혈관조영술상 무증상 정상인의 2.6%에서 70% 이상의 유의한 관상동맥 협착이 발견되었고, 선별 목적의 관상동맥 전산화단층촬영 혈관조영술이 무증상 건강한 사람의 미래의 심혈관 질환 발생을 예측할 수 있다. 그러나 현재 미국국립보건원에서 진행하고 있는 SCOT-HEART 2 연구가 끝나면 관상동맥 전산화단층촬영 혈관조영술이 무증상 성인의 심혈관 예방에 선별 검사로 적절한지 결정을 내릴 수 있을 것으로 생각된다.
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Affiliation(s)
- Gong Yong Jin
- Department of Radiology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Vecsey-Nagy M, Jermendy ÁL, Suhai FI, Panajotu A, Csőre J, Borzsák S, Fontanini DM, Kolossváry M, Vattay B, Boussoussou M, Csobay-Novák C, Merkely B, Maurovich-Horvat P, Szilveszter B. Model-based adaptive filter for a dedicated cardiovascular CT scanner: Assessment of image noise, sharpness and quality. Eur J Radiol 2021; 145:110032. [PMID: 34800835 DOI: 10.1016/j.ejrad.2021.110032] [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: 07/04/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) are ubiquitously applied in the reconstruction of coronary CT angiography (CCTA) datasets. However, currently no data is available on the impact of a model-based adaptive filter (MBAF2), recently developed for a dedicated cardiac scanner. PURPOSE Our aim was to determine the effect of MBAF2 on subjective and objective image quality parameters of coronary arteries on CCTA. METHODS Images of 102 consecutive patients referred for CCTA were evaluated. Four reconstructions of coronary images (FBP, ASIR, MBAF2, ASIR + MBAF2) were co-registered and cross-section were assessed for qualitative (graininess, sharpness, overall image quality) and quantitative [image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] image quality parameters. Image noise and signal were measured in the aortic root and the left main coronary artery, respectively. Graininess, sharpness, and overall image quality was assessed on a 4-point Likert scale. RESULTS As compared to FBP, ASIR, and MBAF2, ASIR + MBAF2 resulted in reduced image noise [53.1 ± 12.3, 30.6 ± 8.5, 36.3 ± 4.2, 26.3 ± 4.0 Hounsfield units (HU), respectively; p < 0.001], improved SNR (8.4 ± 2.6, 14.1 ± 3.6, 11.8 ± 2.3, 16.3 ± 3.3 HU, respectively; p < 0.001) and CNR (9.4 ± 2.7, 15.9 ± 4.0, 13.3 ± 2.5, 18.3 ± 3.5 HU, respectively; p < 0.001). No difference in sharpness was observed amongst the reconstructions (p = 0.08). Although ASIR + MBAF2 was non-superior to ASIR regarding overall image quality (p = 0.99), it performed better than FBP (p < 0.001) and MBAF2 (p < 0.001) alone. CONCLUSION The combination of ASIR and MBAF2 resulted in reduced image noise and improved SNR and CNR. The implementation of MBAF2 in clinical practice may result in improved noise reduction performance and could potentiate radiation dose reduction.
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Affiliation(s)
- Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary.
| | - Ádám Levente Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Ferenc Imre Suhai
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Judit Csőre
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Sarolta Borzsák
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | | | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary; Medical Imaging Centre, Semmelweis University, 78.a Ulloi av., 1082 Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68. Varosmajor st., 1122 Budapest, Hungary
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Sirajuddin A, Mirmomen SM, Kligerman SJ, Groves DW, Burke AP, Kureshi F, White CS, Arai AE. Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings. Radiographics 2021; 41:990-1021. [PMID: 34019437 PMCID: PMC8262179 DOI: 10.1148/rg.2021200125] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is expensive and has risks including vascular access site complications and contrast material–induced nephropathy. Invasive coronary angiography requires fractional flow reserve (FFR) measurement to determine the physiologic significance of a coronary artery stenosis. Multiple noninvasive cardiac imaging modalities can also anatomically delineate or functionally assess for significant coronary artery stenosis, as well as detect the presence of myocardial infarction (MI). While coronary CT angiography can help assess the degree of anatomic stenosis, its inability to assess the physiologic significance of lesions limits its specificity. Physiologic significance of coronary artery stenosis can be determined by cardiac MR vasodilator or dobutamine stress imaging, CT stress perfusion imaging, FFR CT, PET myocardial perfusion imaging (MPI), SPECT MPI, and stress echocardiography. Clinically unrecognized MI, another clear indicator of physiologically significant coronary artery disease, is relatively common and is best evaluated with cardiac MRI. The authors illustrate the spectrum of imaging findings of ischemic heart disease (coronary artery disease, myocardial ischemia, and MI); highlight the advantages and disadvantages of the various noninvasive imaging methods used to assess ischemic heart disease, as illustrated by recent clinical trials; and summarize current indications and contraindications for noninvasive imaging techniques for detection of ischemic heart disease. Online supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Arlene Sirajuddin
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - S Mojdeh Mirmomen
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Seth J Kligerman
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Daniel W Groves
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Allen P Burke
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Faraz Kureshi
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Charles S White
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Andrew E Arai
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
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10
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Venuraju SM, Lahiri A, Jeevarethinam A, Rakhit RD, Shah PK, Nilsson J. Association of Epicardial Fat Volume With the Extent of Coronary Atherosclerosis and Cardiovascular Adverse Events in Asymptomatic Patients With Diabetes. Angiology 2021; 72:442-450. [PMID: 33467865 DOI: 10.1177/0003319720984607] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epicardial adipose tissue has a paracrine effect, enhancing coronary artery atherosclerotic plaque development. This study evaluated epicardial fat volume (EFV), adipokines, coronary atherosclerosis, and adverse cardiovascular events in a cohort of asymptomatic patients with type 2 diabetes mellitus (T2DM). Epicardial fat volume was calculated using data from computed tomography coronary angiograms. Adipokines and inflammatory cytokines were also assayed and correlated with EFV. Epicardial fat volume was also assessed as a predictor of coronary artery calcium (CAC) score, number of coronary artery plaques, and significant plaque (>50% luminal stenosis). Data from the EFV analysis were available for 221 (85.7%) participants. Median EFV was 97.4 cm3, mean body mass index was 28.1 kg/m2, and mean duration of T2DM was 13 years. Statistically significant, but weak, correlations were observed between several adipokines, inflammatory cytokines, and EFV. Epicardial fat volume was a significant univariate (P = .01), but not multivariate, predictor of the number of coronary plaques, but not of CAC score or significant plaque. After a mean follow-up of 22.8 months, 12 adverse cardiovascular events were reported, exclusively in participants with EFV >97.4 cm3. Epicardial fat volume has limited utility as a marker of coronary artery plaque in patients with T2DM and is weakly correlated with adipokine expression.
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Affiliation(s)
- Shreenidhi M Venuraju
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- 40531British Cardiac Research Trust, London, United Kingdom
- Bedford Hospital, Bedford, United Kingdom
| | - Avijit Lahiri
- 40531British Cardiac Research Trust, London, United Kingdom
- Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom
- Imperial College School of Medicine, Imperial College London, United Kingdom
- Healthcare Science, Middlesex University, London, United Kingdom
| | - Anand Jeevarethinam
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- 40531British Cardiac Research Trust, London, United Kingdom
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Roby D Rakhit
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- Department of Cardiology, Royal Free Hospital, London, United Kingdom
| | | | - Jan Nilsson
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences, Lund University, Sweden
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11
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Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
With coronary artery disease (CAD) projected to remain the leading cause of global mortality, prevention strategies seem to be the only effective approach able to reduce the burden and improve mortality and morbidity. At this moment, diagnostic strategies focus mainly on symptomatic patients, ignoring the occurrence of major cardiovascular events as the only manifestation of CAD. As two thirds of fatal myocardial infarction are resulting from plaque rupture, an approach based on the “vulnerable plaque” concept is mandatory in order to improve patient diagnosis, treatment, and, by default, prognosis. Given that the main studies focus on a plaque-centered approach, this is a prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be “vulnerable” by developing acute cardiovascular events.
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12
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Xu W, Zhang S, Zhou Q, Chen W. VHPKQHR peptide modified magnetic mesoporous nanoparticles for MRI detection of atherosclerosis lesions. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:2440-2448. [DOI: 10.1080/21691401.2019.1626411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Wan Xu
- MOE Key Laboratory of Laser Life Science and Institute of Laser Life Science, South China Normal University, Guangzhou, China
- College of Biophotonics, South China Normal University, Guangzhou, China
| | - Shuihua Zhang
- Guangzhou Universal Medical Imaging Diagnostic Center, Universal Medical Imaging, Guangzhou, China
| | - Quan Zhou
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Wenli Chen
- MOE Key Laboratory of Laser Life Science and Institute of Laser Life Science, South China Normal University, Guangzhou, China
- College of Biophotonics, South China Normal University, Guangzhou, China
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13
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Effect of Tube Voltage on Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography With Machine Learning: Results From the MACHINE Registry. AJR Am J Roentgenol 2019; 213:325-331. [PMID: 31039021 DOI: 10.2214/ajr.18.20774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. Coronary CT angiography (CCTA)-based methods allow noninvasive estimation of fractional flow reserve (cFFR), recently through use of a machine learning (ML) algorithm (cFFRML). However, attenuation values vary according to the tube voltage used, and it has not been shown whether this significantly affects the diagnostic performance of cFFR and cFFRML. Therefore, the purpose of this study is to retrospectively evaluate the effect of tube voltage on the diagnostic performance of cFFRML. MATERIALS AND METHODS. A total of 525 coronary vessels in 351 patients identified in the MACHINE consortium registry were evaluated in terms of invasively measured FFR and cFFRML. CCTA examinations were performed with a tube voltage of 80, 100, or 120 kVp. For each tube voltage value, correlation (assessed by Spearman rank correlation coefficient), agreement (evaluated by intraclass correlation coefficient and Bland-Altman plot analysis), and diagnostic performance (based on ROC AUC value, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the cFFRML in terms of detection of significant stenosis were calculated. RESULTS. For tube voltages of 80, 100, and 120 kVp, the Spearman correlation coefficient for cFFRML in relation to the invasively measured FFR value was ρ = 0.684, ρ = 0.622, and ρ = 0.669, respectively (p < 0.001 for all). The corresponding intraclass correlation coefficient was 0.78, 0.76, and 0.77, respectively (p < 0.001 for all). Sensitivity was 100.0%, 73.5%, and 85.0%, and specificity was 76.2%, 79.0%, and 72.8% for tube voltages of 80, 100, and 120 kVp, respectively. The ROC AUC value was 0.90, 0.82, and 0.80 for 80, 100, and 120 kVp, respectively (p < 0.001 for all). CONCLUSION. CCTA-derived cFFRML is a robust method, and its performance does not vary significantly between examinations performed using tube voltages of 100 kVp and 120 kVp. However, because of rapid advancements in CT and postprocessing technology, further research is needed.
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14
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Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries. Coron Artery Dis 2019; 30:511-519. [PMID: 30985482 DOI: 10.1097/mca.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. PATIENTS AND METHODS Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. RESULTS Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance. CONCLUSION The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.
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Almeida SO, Budoff M. Effect of statins on atherosclerotic plaque. Trends Cardiovasc Med 2019; 29:451-455. [PMID: 30642643 DOI: 10.1016/j.tcm.2019.01.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 01/08/2023]
Abstract
Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Whether these benefits are purely through lipid lowering or pleiotropic (cholesterol independent) effects has yet to be fully understood. Advances in cardiac imaging, from intravascular ultrasound to multi-detector coronary computed tomography angiography, have furthered our understanding of statin's effect on atherosclerotic plaque. Notably, statins play a role in plaque regression with reduction in lipid content. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas.
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Affiliation(s)
- Shone O Almeida
- Los Angeles Biomedical Institute, 1124W Carson St, Torrance, CA 90502, USA.
| | - Matthew Budoff
- Los Angeles Biomedical Institute, 1124W Carson St, Torrance, CA 90502, USA
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Banchhor SK, Londhe ND, Araki T, Saba L, Radeva P, Khanna NN, Suri JS. Calcium detection, its quantification, and grayscale morphology-based risk stratification using machine learning in multimodality big data coronary and carotid scans: A review. Comput Biol Med 2018; 101:184-198. [DOI: 10.1016/j.compbiomed.2018.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023]
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17
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Kim C, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi BW, Choi D, Jang Y, Hong MK. Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina. Yonsei Med J 2018; 59:937-944. [PMID: 30187700 PMCID: PMC6127420 DOI: 10.3349/ymj.2018.59.8.937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50-69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). MATERIALS AND METHODS Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. RESULTS Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p<0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. CONCLUSION The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.
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Affiliation(s)
- Choongki Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Division of Cardiovascular Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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19
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Image Quality of Prospectively ECG-Triggered Coronary CT Angiography in Heart Transplant Recipients. AJR Am J Roentgenol 2017; 210:314-319. [PMID: 29091000 DOI: 10.2214/ajr.17.18546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cardiac allograft vasculopathy (CAV) is among the top causes of death 1 year after heart transplantation (HTx). Coronary CT angiography (CTA) is a potential alternative to invasive imaging in the diagnosis of CAV. However, the higher heart rate (HR) of HTx recipients prompts the use of retrospective ECG-gating, which is associated with higher radiation dose, a major concern in this patient population. Therefore, we sought to evaluate the feasibility and image quality of low-radiation-dose prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND METHODS In total, 1270 coronary segments were evaluated in 50 HTx recipients and 50 matched control subjects who did not undergo HTx. The control subjects were selected from our clinical database and were matched for age, sex, body mass index, HR, and coronary dominance. Scans were performed using 256-MDCT with prospective ECG-triggering. The degree of motion artifacts was evaluated on a per-segment basis on a 4-point Likert-type scale. RESULTS The median HR was 74.0 beats/min (interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0 beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p = 0.58). In the HTx group, more segments had diagnostic image quality compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p < 0.001). The mean effective radiation dose was low in both groups (3.7 mSv [IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the control group; p = 0.24). CONCLUSION Prospectively ECG-triggered coronary CTA examinations of HTx recipients yielded diagnostic image quality with low radiation dose. Coronary CTA is a promising noninvasive alternative to routine catheterization during follow-up of HTx recipients to diagnose CAV.
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20
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Beloqui O, Moreno MU, San José G, Pejenaute Á, Cortés A, Landecho MF, Díez J, Fortuño A, Zalba G. Increased phagocytic NADPH oxidase activity associates with coronary artery calcification in asymptomatic men. Free Radic Res 2017; 51:389-396. [PMID: 28427294 DOI: 10.1080/10715762.2017.1321745] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vascular calcification is a common feature in atherosclerosis and associates with cardiovascular events. Oxidative stress may be involved in the pathogenesis of vascular calcification. Previous studies have shown that the phagocytic NADPH oxidase is associated with atherosclerosis. The objective of the present study was to investigate the association between phagocytic NADPH oxidase-mediated superoxide production and coronary artery calcium (CAC). NADPH oxidase-mediated superoxide production was determined by chemiluminescence and CAC by computed tomography in 159 asymptomatic men free of overt clinical atherosclerosis. Multivariate linear regression analyses were used to assess the relationship between CAC and NADPH oxidase-mediated superoxide production. Compared with individuals in the lowest score of CAC (= 0 Agatston units), those in the upper score (>400 Agatston units) showed higher superoxide production (p < 0.05). In correlation analysis, superoxide production positively (p < 0.01) correlated with CAC, which in multivariate analysis remained significant after adjusting for age, HDL-cholesterol, triglycerides, body mass index, smoking, arterial hypertension and diabetes mellitus. In conclusion, in a population of men without clinically overt atherosclerotic disease, increased NADPH oxidase-mediated superoxide production associated with enhanced CAC. Albeit descriptive, these findings suggest a potential involvement of phagocytic NADPH oxidase-mediated oxidative stress in CAC.
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Affiliation(s)
- Oscar Beloqui
- a Department of Internal Medicine , Clínica Universidad de Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain
| | - María U Moreno
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Division of Cardiovascular Pathophysiology , Program of Cardiovascular Diseases Centre for Applied Medical Research University of Navarra , Pamplona , Spain
| | - Gorka San José
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Division of Cardiovascular Pathophysiology , Program of Cardiovascular Diseases Centre for Applied Medical Research University of Navarra , Pamplona , Spain
| | - Álvaro Pejenaute
- d Department of Biochemistry and Genetics , University of Navarra , Pamplona , Spain
| | - Adriana Cortés
- d Department of Biochemistry and Genetics , University of Navarra , Pamplona , Spain
| | - Manuel F Landecho
- a Department of Internal Medicine , Clínica Universidad de Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain
| | - Javier Díez
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Division of Cardiovascular Pathophysiology , Program of Cardiovascular Diseases Centre for Applied Medical Research University of Navarra , Pamplona , Spain.,e Deparment of Cardiology and Cardiac Surgery , Clínica Universidad de Navarra , Pamplona , Spain
| | - Ana Fortuño
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Division of Cardiovascular Pathophysiology , Program of Cardiovascular Diseases Centre for Applied Medical Research University of Navarra , Pamplona , Spain
| | - Guillermo Zalba
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Division of Cardiovascular Pathophysiology , Program of Cardiovascular Diseases Centre for Applied Medical Research University of Navarra , Pamplona , Spain.,d Department of Biochemistry and Genetics , University of Navarra , Pamplona , Spain
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21
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Hong SJ, Her AY, Suh Y, Won H, Cho DK, Cho YH, Yoon YW, Lee K, Kang WC, Kim YH, Kim SW, Shin DH, Kim JS, Kim BK, Ko YG, Choi BW, Choi D, Jang Y, Hong MK. Coronary Computed Tomographic Angiography Does Not Accurately Predict the Need of Coronary Revascularization in Patients with Stable Angina. Yonsei Med J 2016; 57:1079-86. [PMID: 27401637 PMCID: PMC4960372 DOI: 10.3349/ymj.2016.57.5.1079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. MATERIALS AND METHODS Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. RESULTS Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. CONCLUSION CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.
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Affiliation(s)
- Sung Jin Hong
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ae Young Her
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yongsung Suh
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Hoyoun Won
- Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea
| | - Deok Kyu Cho
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Yun Hyeong Cho
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Young Won Yoon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyounghoon Lee
- Department of Internal Medicine, Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Woong Chol Kang
- Department of Internal Medicine, Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Yong Hoon Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Sozzi FB, Maiello M, Pelliccia F, Parato VM, Canetta C, Savino K, Lombardi F, Palmiero P. Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights. Echocardiography 2016; 33:1413-8. [DOI: 10.1111/echo.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | | | - Ketty Savino
- Hospital Santa Maria della Misericordia; Perugia Italy
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23
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Assessment of Coronary Artery Calcium on Low-Dose Coronary Computed Tomography Angiography With Iterative Reconstruction. J Comput Assist Tomogr 2016; 40:266-71. [PMID: 26720203 DOI: 10.1097/rct.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate whether coronary calcium scoring (CCS) is also feasible using low-radiation-dose coronary computed tomography angiography (CCTA) in combination with iterative reconstruction. METHODS Forty-three individuals without known coronary artery disease underwent both noncontrast CCS (±1 mSv) for reference Agatston scores and low-dose CCTA (±3 mSv). Raw CCTA data were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and model-based iterative reconstruction (MIR). Calcification volumes were derived with thresholds of >351 and >600 Hounsfield units (HU) and converted to proxy Agatston scores with linear regression analysis. RESULTS Intraclass correlation coefficients for Agatston scores versus CCTA volumes with FBP and iterative reconstruction were excellent (ranges 0.94-0.99 and 0.96-0.99 for >351 HU and >600 HU thresholds, respectively). The >351 HU threshold resulted in higher CCTA volume scores ranging from 65.9 (15.1-347.0) for HIR to 94.8 (42.0-423.0) for MIR (P = 0.001 and <0.001, respectively). The >600 HU threshold scores ranged from 14.1 (0.0-159.3) for HIR to 28.6 (0.0-215.6) for MIR (P = 0.003 and 0.027, respectively). At >351 HU, reclassification occurred in 21 individuals (49%) for FBP and HIR and 25 individuals (58%) for MIR. Reclassifications decreased with >600 HU to 10 (HIR, 23%), 8 (FBP, 19%), and 4 (MIR, 9%). CONCLUSIONS The CCS is feasible using iteratively reconstructed low-dose CCTA with a calcium threshold of >600 HU. Using MIR, only 9% of individuals were reclassified.
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24
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Lüscher TF. Imaging and outcomes in cardiac, valvular, and peripheral arterial disease. Eur Heart J 2016; 37:657-9. [DOI: 10.1093/eurheartj/ehw049] [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: 11/14/2022] Open
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25
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Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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26
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Lüscher TF. Deciding on coronary intervention: which lesion, which stent? Eur Heart J 2015; 36:3301-3. [PMID: 26668258 DOI: 10.1093/eurheartj/ehv652] [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: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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27
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Marinelli M, Positano V, Lorenzoni V, Caselli C, Mangione M, Marcheschi P, Puzzuoli S, Esposito N, L'Abbate GA, Neglia D. A modular informatics platform for effective support of collaborative and multicenter studies in cardiology. Health Informatics J 2015; 22:1083-1100. [PMID: 26547889 DOI: 10.1177/1460458215609743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Collaborative and multicenter studies permit a large number of patients to be enrolled within a reasonable time and providing the opportunity to collect different data. Informatics platforms play an important role in management, storage, and exchange of data between the participants involved in the study. In this article, we describe a modular informatics platform designed and developed to support collaborative and multicenter studies in cardiology. In each developed module, data management is implemented following local defined protocols. The modular characteristic of the developed platform allows independent transfer of different kinds of data, such as biological samples, imaging raw data, and patients' digital information. Moreover, it offers safe central storage of the data collected during the study. The developed platform was successfully tested during a European collaborative and multicenter study, focused on evaluating multimodal non-invasive imaging to diagnose and characterize ischemic heart disease.
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Affiliation(s)
| | | | | | | | - Maurizio Mangione
- Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Scuola Superiore Sant'Anna, Italy.,Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Institute of Clinical Physiology, CNR, Italy; Fondazione G. Monasterio CNR-Regione Toscana, Italy
| | | | - Stefano Puzzuoli
- Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Scuola Superiore Sant'Anna, Italy.,Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Institute of Clinical Physiology, CNR, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Italy.,Institute of Clinical Physiology, CNR, Italy; Fondazione G. Monasterio CNR-Regione Toscana, Italy
| | | | | | - Danilo Neglia
- Institute of Clinical Physiology, CNR, Italy; Fondazione G. Monasterio CNR-Regione Toscana, Italy
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28
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Lüscher TF. Imaging, prevention, and rehabilitation. Eur Heart J 2015; 36:1489-91. [DOI: 10.1093/eurheartj/ehv180] [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: 11/14/2022] Open
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29
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Kim JJ, Hwang BH, Choi IJ, Choo EH, Lim S, Kim JK, Koh YS, Kim DB, Jang SW, Cho EJ, Lee JM, Kim PJ, Cho JH, Jung JI, Seung KB, Min JK, Chang K. Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: evaluation by Coronary CT angiography. Eur Heart J Cardiovasc Imaging 2015; 16:1065-73. [DOI: 10.1093/ehjci/jev106] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/02/2015] [Indexed: 11/13/2022] Open
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30
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Lüscher TF. Prevention in high-risk patients: a long-term committment. Eur Heart J 2015; 36:1137-9. [DOI: 10.1093/eurheartj/ehv107] [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: 11/14/2022] Open
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31
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Weintraub WS, Lüscher TF, Pocock S. The perils of surrogate endpoints. Eur Heart J 2015; 36:2212-8. [PMID: 25975658 DOI: 10.1093/eurheartj/ehv164] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 04/21/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- William S Weintraub
- Cardiology Section, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19317, USA
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
| | - Stuart Pocock
- Switzerland and London School of Hygiene and Tropical Medicine, London, UK
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32
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Lüscher TF. From prevention to plaque rupture and infarction. Eur Heart J 2015; 36:1003-4. [PMID: 25934672 DOI: 10.1093/eurheartj/ehv085] [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: 11/14/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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33
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Stefanini GG, Windecker S. Can coronary computed tomography angiography replace invasive angiography? Coronary computed tomography angiography cannot replace invasive angiography. Circulation 2015; 131:418-25; discussion 426. [PMID: 25623124 DOI: 10.1161/circulationaha.114.008148] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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34
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Maurovich-Horvat P, Károlyi M, Horváth T, Szilveszter B, Bartykowszki A, Jermendy ÁL, Panajotu A, Celeng C, Suhai FI, Major GP, Csobay-Novák C, Hüttl K, Merkely B. Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: A randomized controlled clinical trial. J Cardiovasc Comput Tomogr 2015; 9:139-45. [DOI: 10.1016/j.jcct.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/24/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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35
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Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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36
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Hur J, Lee KH, Hong SR, Suh YJ, Hong YJ, Lee HJ, Kim YJ, Lee HS, Chang HJ, Choi BW. Prognostic value of coronary computed tomography angiography in stroke patients. Atherosclerosis 2015; 238:271-7. [DOI: 10.1016/j.atherosclerosis.2014.10.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 01/07/2023]
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Ede H, Erkoç MF, Okur A, Erbay AR. Impaired aortic elasticity and diastolic functions are associated with findings of coronary computed tomographic angiography. Med Sci Monit 2014; 20:2061-8. [PMID: 25348859 PMCID: PMC4214696 DOI: 10.12659/msm.892502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Aortic elasticity and diastolic functions are helpful parameters in assessment of CAD. In this study we aimed to learn whether diastolic function and aortic elastic properties measured by echocardiography are associated with coronary calcium score (CACS), epicardial fat volume (EFV), and plaque area measured by coronary tomographic angiography. MATERIAL AND METHODS We enrolled 106 consecutive patients suspected of CAD undergoing coronary CTA and transthoracic echocardiography in this prospective study. Total CACS, plaque area, and EFV were calculated via CTA. Aortic stiffness index (ASI) and aortic distensibility (AD) were measured via echocardiography. RESULTS The patients with diastolic dysfunctions of any degree had significantly higher ASI, higher CACS, higher plaque area, and EFV. We found that as the ASI increases, the CACS and total coronary plaque area both increase, showing that there is a strong positive correlation between ASI, CACS, and total coronary plaque area. There was a significant correlation between ASI and EFV, but with a lower statistical value. CONCLUSIONS Aortic elasticity was correlated with CACS and plaque area. Diastolic dysfunction was observed more commonly among patients with higher CACS and EFV. Epicardial fat volume was not as strong as CACS in reflecting aortic elasticity.
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Affiliation(s)
- Hüseyin Ede
- Department of Cardiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Mustafa Fatih Erkoç
- Department of Radiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Aylin Okur
- Department of Radiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ali Rıza Erbay
- Department of Cardiology, Bozok University School of Medicine, Yozgat, Turkey
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38
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Nakazato R, Otake H, Konishi A, Iwasaki M, Koo BK, Fukuya H, Shinke T, Hirata KI, Leipsic J, Berman DS, Min JK. Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging 2014; 16:373-9. [DOI: 10.1093/ehjci/jeu188] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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39
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Bala G, Cosyns B. Recent Advances in Visualizing Vulnerable Plaque: Focus on Noninvasive Molecular Imaging. Curr Cardiol Rep 2014; 16:520. [DOI: 10.1007/s11886-014-0520-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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40
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Sato A. Coronary plaque imaging by coronary computed tomography angiography. World J Radiol 2014; 6:148-159. [PMID: 24876919 PMCID: PMC4037541 DOI: 10.4329/wjr.v6.i5.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/09/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Coronary computed tomography angiography (CTA) has become the useful noninvasive imaging modality alternative to the invasive coronary angiography for detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). With the development of technical aspects of coronary CTA, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes by coronary CTA. In this review we discuss the coronary plaque morphology estimated by CTA beyond coronary angiography including the comparison to the currently available other imaging modalities used to examine morphological characteristics of the atherosclerotic plaque. Furthermore, this review underlies the value of a combined assessment of coronary anatomy and myocardial perfusion in patients with CAD, and adds to an increasing body of evidence suggesting an added diagnostic value when combining both modalities. We hope that an integrated, multi-modality imaging approach will become the gold standard for noninvasive evaluation of coronary plaque morphology and outcome data in clinical practice.
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41
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Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol 2014; 11:390-402. [PMID: 24755916 DOI: 10.1038/nrcardio.2014.60] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Most acute coronary syndromes are caused by sudden luminal thrombosis due to atherosclerotic plaque rupture or erosion. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary heart disease. Coronary lesions prone to rupture have a distinct morphology compared with stable plaques, and provide a unique opportunity for noninvasive imaging to identify vulnerable plaques before they lead to clinical events. The submillimeter spatial resolution and excellent image quality of modern computed tomography (CT) scanners allow coronary atherosclerotic lesions to be detected, characterized, and quantified. Large plaque volume, low CT attenuation, napkin-ring sign, positive remodelling, and spotty calcification are all associated with a high risk of acute cardiovascular events in patients. Computation fluid dynamics allow the calculation of lesion-specific endothelial shear stress and fractional flow reserve, which add functional information to plaque assessment using CT. The combination of morphologic and functional characteristics of coronary plaques might enable noninvasive detection of vulnerable plaques in the future.
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Affiliation(s)
- Pál Maurovich-Horvat
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Maros Ferencik
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
| | - Szilard Voros
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794 USA
| | - Béla Merkely
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
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42
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2014; 14:721-40. [PMID: 23847385 DOI: 10.1093/ehjci/jet123] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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Ellims AH, Wong G, Weir JM, Lew P, Meikle PJ, Taylor AJ. Plasma lipidomic analysis predicts non-calcified coronary artery plaque in asymptomatic patients at intermediate risk of coronary artery disease. Eur Heart J Cardiovasc Imaging 2014; 15:908-16. [PMID: 24618657 DOI: 10.1093/ehjci/jeu033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The optimal management of asymptomatic subjects at intermediate risk of coronary artery disease (CAD) is often uncertain. Re-stratification to a high- or low-risk category may enable optimization of preventative strategies. Coronary computed tomographic angiography (CCTA) enables a minimally invasive assessment of coronary artery plaque quantity and composition. Non-calcified plaque by CCTA is lipid-rich and more vulnerable to rupture and resultant acute coronary syndromes. The purpose of this study was to determine whether novel approaches to CAD risk stratification, such as plasma lipid profiling, may predict non-calcified plaque burden in intermediate risk subjects. METHODS AND RESULTS CCTA and several markers of CAD (including plasma lipid profiling, carotid intima-media thickness, aortic pulse wave velocity, and high-sensitivity C-reactive protein) were prospectively performed in 100 asymptomatic patients at intermediate CAD risk according to the Framingham risk score. Segment stenosis scores (SSS) were calculated to evaluate the burden of total, calcified, and non-calcified coronary artery plaque. Non-calcified plaque was observed in 66 subjects and 158 (11%) of 1425 coronary artery segments. Eighteen lipid species demonstrated significant associations with non-calcified plaque burden, but not with total plaque or calcified plaque burden. No other marker of CAD was found to predict coronary artery plaque burden. CONCLUSIONS Plasma lipidomic analysis can predict the burden of non-calcified coronary plaque in asymptomatic subjects at intermediate risk of CAD. Re-stratification of these patients by plasma lipid profiling may enable more appropriate and effective primary prevention management strategies.
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Affiliation(s)
- Andris H Ellims
- Heart Centre, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Gerard Wong
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Jacquelyn M Weir
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Philip Lew
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Peter J Meikle
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Andrew J Taylor
- Heart Centre, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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Liu D, Jia H, Fu Y, He W, Ma D. Prognostic utility of coronary computed tomographic angiography: a 5-year follow-up in type 2 diabetes patients with suspected coronary artery disease. J Diabetes Res 2014; 2014:103459. [PMID: 24772442 PMCID: PMC3964760 DOI: 10.1155/2014/103459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/27/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To analyze the predictive value of coronary computed tomography angiography on acute coronary artery events in patients with type 2 diabetes. METHODS Coronary computed tomography angiography was performed in 250 type 2 diabetic patients. After a follow-up for 5 years, 145 patients were excluded as they did not have any coronary events. The remaining 95 patients were divided into study group and control group. According to their density and shape, the coronary artery plaques were classified into 3 types and 4 types, respectively. RESULTS There is no statistically significant difference in the degree of stenosis between two groups. The proportion of calcified plaques in the study group was lower than in the control group. The proportion of mixed-calcified plaques in the study group was higher than in the other. Type III plaques have a 76.2% sensitivity and negative predictive value was 64.5% for acute coronary events; type IV plaques have a sensitivity of 52.6% and positive predictive value of 63% for chronic coronary events. CONCLUSIONS CCTA may be used as a non-invasive modality for evaluating and predicting vulnerable coronary atherosclerosis plaques in patients with type 2 diabetes.
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Affiliation(s)
- Daliang Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
| | - Huijuan Jia
- Department of Radiology, Liaocheng People's Hospital, 67 West-Dongchang Road, Liaocheng, Shandong 252000, China
| | - Yucun Fu
- Department of Radiology, Liaocheng People's Hospital, 67 West-Dongchang Road, Liaocheng, Shandong 252000, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
| | - Daqing Ma
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
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Accuracy of coronary computed tomography angiography vs intravascular ultrasound for evaluation of vessel area. J Cardiovasc Comput Tomogr 2014; 8:141-8. [DOI: 10.1016/j.jcct.2013.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/12/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
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Benedek T, Jako B, Benedek I. Plaque quantification by coronary CT and intravascular ultrasound identifies a low CT density core as a marker of plaque instability in acute coronary syndromes. Int Heart J 2014; 55:22-8. [PMID: 24463925 DOI: 10.1536/ihj.13-213] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to demonstrate the relationship between the presence and amount of a low-density core (LDC) with a CT density < 30 Hounsfield units (HU) by coronary computed tomography angiography (CCTA) and IVUS-derived markers of vulnerability in the culprit lesions (CL) of patients with acute coronary syndromes (ACS).In 43 patients with ACS, 105 coronary plaques were scanned using CCTA and IVUS for the quantitative and qualitative assessment of vulnerability markers.The presence of a low attenuation plaque (LAP) was identified in 67.4% of the CL and 29.03% of the non-CL (P = 0.0001). The presence of a LDC > 6.0 mm(3) was significantly correlated with the percentage of the necrotic core (NC) (22.08% versus 7.97%, P = 0.001) and the fibro-fatty tissue by IVUS (18.68% versus 15.87%, P = 0.02). LDC volumes showed a good correlation with the percentage of the NC (r = 0.7303, P < 0.0001) and the fibro-fatty tissue in the CL (r = 0.4928, P < 0.0008). Quantitative plaque analysis revealed a significant difference in plaque composition between CL and non-CL in regards to the LDC (18.45 versus 6.5, P < 0.001), the percentage of NC (20.74 versus 18.74, P = 0.02), fibro-fatty tissue (17.77 versus 15.48, P = 0.002), and fibrotic tissue (51.68 versus 54.8, P = 0.01).VH-IVUS and CCTA plaque quantification showed that the presence of a low-density (< 30 HU) core within the CL of patients with ACS represents a marker of vulnerability and correlates well with other CCTA and IVUS-derived features of vulnerability, particularly the NC of the plaque.
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Affiliation(s)
- Theodora Benedek
- Department of Internal Medicine, University of Medicine and Pharmacy of Tîrgu Mures
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Patel J, Blaha MJ, McEvoy JW, Qadir S, Tota-Maharaj R, Shaw LJ, Rumberger JA, Callister TQ, Berman DS, Min JK, Raggi P, Agatston AA, Blumenthal RS, Budoff MJ, Nasir K. All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000. J Cardiovasc Comput Tomogr 2014; 8:26-32. [DOI: 10.1016/j.jcct.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/05/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bergler J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:1013-32. [PMID: 23998694 DOI: 10.1016/j.echo.2013.07.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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Orellana MRM, Bentourkia M, Sarrhini O, Fulop T, Paquet N, Lavallée É, Turcotte É, Khalil A. Assessment of inflammation in large arteries with 18F-FDG-PET in elderly. Comput Med Imaging Graph 2013; 37:459-65. [PMID: 24148785 DOI: 10.1016/j.compmedimag.2013.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 11/24/2022]
Abstract
This paper presents repeated measurements of atherosclerosis using bimodality positron emission tomography and computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) to assess its uptake in aorta, iliac and femoral arteries in three groups of elderly subjects classified as normals (N), hypercholesterolemics (H) and with stable angina (A) in a 12 months follow-up (T0 to T12). The subjects in group H were taking rosuvastatin (20mg/d) for 12 months before the second scan. The calcifications in the arteries were determined by CT imaging and the artery PET images were analyzed slice by slice. The standard uptake values (SUVs) for 18F-FDG uptake were classified in two main groups: calcified and non-calcified arteries and each main group comprises six sub-groups for the three subject groups N, H and A, and for the two measurements 12 months apart. Although the calcifications were present at some portions of the arteries in all subjects (23%, 36% and 44% of calcified sites to total sites analyzed, respectively, in groups N, H and A), the results show the most noticeable SUV changes after 12 months was in group N of non-calcified arteries. In the three groups, the calcified arteries showed no significant differences between T0 and T12 while significant differences were observed for the non-calcified arteries. However, there were no significant changes at T12 between groups N and H following rosuvastatin intake in group H. In conclusion, the quantitative analysis with 18F-FDG-PET/CT could be efficient in the localization of the inflammation and evaluation of its progression in atherosclerosis instead of global evaluations with systemic inflammation biomarkers.
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