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Ayoub C, Scalia IG, Anavekar NS, Arsanjani R, Jokerst CE, Chow BJW, Kritharides L. Computed Tomography Evaluation of Coronary Atherosclerosis: The Road Travelled, and What Lies Ahead. Diagnostics (Basel) 2024; 14:2096. [PMID: 39335775 PMCID: PMC11431535 DOI: 10.3390/diagnostics14182096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to support CCTA diagnostic and prognostic value both for stable and acute symptoms. It enables rapid and cost-effective rule-out of CAD, and permits quantification and characterization of coronary plaque and associated significance. In this comprehensive review, we detail the road traveled as CCTA evolved to include quantitative assessment of plaque stenosis and extent, characterization of plaque characteristics including high-risk features, functional assessment including fractional flow reserve-CT (FFR-CT), and CT perfusion techniques. The state of current guideline recommendations and clinical applications are reviewed, as well as future directions in the rapidly advancing field of CT technology, including photon counting and applications of artificial intelligence (AI).
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Affiliation(s)
- Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Isabel G Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Benjamin J W Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Department of Radiology, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney Local Health District, Concord, NSW 2137, Australia
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Beştemir A, Apaydın Z, Yaşar Kılınç A. Analysis of Coronary Angiography and Revascularization Rates Made Over 5 Years in Public Institutions in Türkiye. Anatol J Cardiol 2023; 27:529-533. [PMID: 37329116 PMCID: PMC10510416 DOI: 10.14744/anatoljcardiol.2023.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/24/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Coronary angiography is currently the gold standard anatomic imaging method used to diagnose obstructive epicardial coronary artery disease. In patients with critical coronary stenosis, surgical or percutaneous revascularization is provided. Normal coronary artery ratio in coronary angiography is an indirect indicator of patient selection quality. The aim of our study is to evaluate the efficiency of coronary angiography by examining the revascularization rates according to years in patients who underwent coronary angiography. METHODS Revascularization rates will be determined by analyzing retrospectively the number of patients who underwent coronary angiography in our country between 2016 and 2021 and were revascularized interventionally or surgically. The number of patients who underwent percutaneous, surgical, and total revascularization were proportioned to the number of coronary angiography, and their percentages were determined. RESULTS From 2016 to 2019, there was a continuous increase in the number of coronary angiography. In 2020, the lowest coronary angiography numbers (n = 222.159) of the last 6 years were seen with the effect of the COVID-19 pandemic. In 2021, it was observed that the number of coronary angiography increased again with the relaxation of pandemic measures and the approaching of hospital admissions to old levels. It is seen that revascularization is performed in up to one-third of the patients who underwent coronary angiography. CONCLUSION Similar to the rest of the world, revascularization rates as a result of coronary angiography procedures performed in our country are low. With this result, it should not be concluded that coronary angiography is not used effectively; on the contrary, the efficiency of coronary angiography can be increased by more effective use of noninvasive tests.
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Affiliation(s)
| | - Ziya Apaydın
- Department of Cardiology, Haseki Training and Research Hospital, İstanbul, Türkiye
| | - Ali Yaşar Kılınç
- Department of Cardiology, Arnavutköy State Hospital, İstanbul, Türkiye
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Zhang J, Liu Y, Deng Y, Zhu Y, Sun R, Lu S. Non-invasive Global and Regional Myocardial Work Predicts High-Risk Stable Coronary Artery Disease Patients With Normal Segmental Wall Motion and Left Ventricular Function. Front Cardiovasc Med 2021; 8:711547. [PMID: 34651024 PMCID: PMC8505723 DOI: 10.3389/fcvm.2021.711547] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/01/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Previous studies suggested that myocardial work (MW) may identify abnormalities in the left ventricular (LV) function and establish a more sensitive index for LV dysfunction at the early stage. This study aimed to explore the value of global and regional MW parameters in predicting high-risk stable coronary artery disease (SCAD) patients with normal wall motion and preserved LV function. Patients and Methods: A total of 131 patients, who were clinically diagnosed as SCAD with normal wall motion and LV function, were finally included in this study. Global MW parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE) were measured with non-invasive LV pressure-strain loops constructed from speckle-tracking echocardiography. Regional myocardial work index (RWI) and work efficiency (RWE) were also calculated according to the perfusion territory of each major coronary artery. All patients underwent coronary angiography and were divided into the high-risk SCAD group, the non-high-risk SCAD group, and the No SCAD group according to the range and degrees of coronary arteries stenosis. Results: The global longitudinal strain (GLS), GWI and GCW were statistically different (P < 0.001) among the three groups. In the high-risk SCAD group, GLS, GWI, and GCW were significantly lower than the other two groups (P < 0.05). Receiver operating characteristic analysis demonstrated GWI and GCW could predict high-risk SCAD at a cutoff value of 1,808 mm Hg% (sensitivity, 52.6%; specificity, 87.8%; predictive positive value, 76.3%; predictive negative value, 69.9%) and 2,308 mm Hg% (sensitivity, 80.7%; specificity, 64.9%; predictive positive value, 63.3%; predictive negative value, 80.0%), respectively. Multivariate analyses showed that carotid plaque, decreased GWI, and GCW was independently related to high-risk SCAD. The cutoff values of RWILAD, RWILCX, and RWIRCA were 2,156, 1,929, and 1,983 mm Hg% in predicting high-risk SCAD, respectively (P < 0.001). When we combined RWI in two or three perfusion regions, the diagnostic performance of SCAD was improved (P < 0.001). Conclusions: Both global and regional MW parameters have great potential in non-invasively predicting high-risk SCAD patients with normal wall motion and preserved LV function, contributing to the early identification of high-risk patients who may benefit from revascularization therapy.
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Affiliation(s)
- Jun Zhang
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiying Sun
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shirui Lu
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Esposito A, Francone M, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Pontone G, Carrabba N. SIRM-SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis. LA RADIOLOGIA MEDICA 2021; 126:1236-1248. [PMID: 34160775 PMCID: PMC8370938 DOI: 10.1007/s11547-021-01378-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022]
Abstract
In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric "one-stop-shop" approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.
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Affiliation(s)
- Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Andrea Igoren Guaricci
- Cardiothoracic Department, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo, AOUP P. Giaccone, Palermo, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Reggio Emilia University, Modena, Italy
- Radiology Department, AOU of Modena, Modena, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare- A.S.LNa1-Centro, Naples, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia E Le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nazario Carrabba
- Cardiothoracovascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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van Rosendael AR, Bax AM, Smit JM, van den Hoogen IJ, Ma X, Al'Aref S, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Min JK, Bax JJ. Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry. Eur Heart J Cardiovasc Imaging 2021; 21:479-488. [PMID: 32065624 DOI: 10.1093/ehjci/jez322] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/01/2019] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. METHODS AND RESULTS Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). CONCLUSION Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medical College, 402 East 67th St, New York, NY 10065, USA
| | - Subhi Al'Aref
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030, USA
| | - Daniele Andreini
- Department of Radiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea 4, Milan, Lombardy 20138, Italy
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd, Taper 1258, Los Angeles, CA 90048, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, 10833 Le Conte Ave, Torrance, Los Angeles, CA 90095, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Via Emanuele Gianturco 113, Naples, 80143 NA, Italy
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd, Ste 300C, Hendersonville, TN 37075, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Augustin DeLago
- Department of Cardiology, Capitol Cardiology Associates, 7 Southwoods Blvd, Albany, NY 12211, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52A, 6020 Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Joerg Hausleiter
- Department of Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, BC V6T 1Z4, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Via Ceccarini, Urbino, 61302 Fano PU, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea 4, Milan, Lombardy 20138, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Ronen Rubinshtein
- Department of Cardiology, Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Mikhal St 7, Haifa, 3436212, Israel
| | - Todd C Villines
- Department of Medicine, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medical College, 402 East 67th St, New York, NY 10065, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Cademartiri F, Casolo G, Clemente A, Seitun S, Mantini C, Bossone E, Saba L, Sverzellati N, Nistri S, Punzo B, Cavaliere C, La Grutta L, Gentile G, Maffei E. Coronary CT angiography: a guide to examination, interpretation, and clinical indications. Expert Rev Cardiovasc Ther 2021; 19:413-425. [PMID: 33884942 DOI: 10.1080/14779072.2021.1915132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The introduction of Cardiac Computed Tomography (CCT) has changed the paradigm in the field of diagnostic cardiovascular medicine. CCT is the primary tool in the assessment of suspected Coronary Artery Disease (CAD) and should be followed by functional assessment when needed to stratify disease and to plan potential interventional or surgical therapy. AREAS COVERED We provided the current state of the knowledge on the main aspects of technique of examination, image interpretation and clinical indications. We have focused our attention on the basic routine applications and activities. EXPERT OPINION The primary role of CCT in suspected CAD will progressively become the standard approach. In general, any situation in which anatomy of the heart and thoracic vessels/structures is mandatory must be approached using CT first, whenever possible. The quantity and quality of information that can be provided by CCT is big and the operators should learn how to deal with this information. On the other hand, CCT is only apparently a straightforward and simple examination. It is actually the most complex diagnostic procedure that can be performed on CT and requires highly skilled operators and state-of-art-technology.
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Affiliation(s)
| | - Giancarlo Casolo
- Department of Cardiology, Ospedale Della Versilia, Viareggio, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Sara Seitun
- Department of Radiology, Ospedale San Martino, Genova, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | | | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino, Italy
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Maffei E, Punzo B, Cavaliere C, Bossone E, Saba L, Cademartiri F. Coronary atherosclerosis as the main endpoint of non-invasive imaging in cardiology: a narrative review. Cardiovasc Diagn Ther 2021; 10:1897-1905. [PMID: 33381433 DOI: 10.21037/cdt-20-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of paradigm determined by the introduction of cardiac computed tomography (CCT) in the field of cardiovascular medicine has allowed new evidence to emerge. These evidences point towards a major role, probably the most important one in terms of prognostic impact, in the detection, characterization and quantification of atherosclerosis as the main driver and endpoint for the management of coronary artery disease (CAD). Extensive literature has been published in the last decade with large numbers and patients' populations, investigating several aspects and correlations between atherosclerotic plaque features and risk factors; also, the relationship between plaque features, both with qualitative and quantitative approaches, and cardiovascular events has been investigated. More recent studies have also pointed out the relationship between the knowledge and classification of sub-clinical atherosclerosis and the induced modification of medical therapy (both aggressiveness and compliance) that is most likely able to increase the effect of anti-atherosclerotic drugs, hence significantly improving prognosis. Non-invasive assessment of CAD by means of CCT is becoming the primary tool for management and also the most important parameter for the comprehension of natural history of CAD and how the therapies we adopt are affecting plaque burden as a whole. In this review we will address the modern concepts of CAD driven understanding and management of cardiovascular disease.
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Affiliation(s)
- Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
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Cademartiri F, Maffei E. Pivotal role of cardiac computed tomography in chronic coronary syndrome. Eur Heart J Cardiovasc Imaging 2020; 21:1363-1365. [DOI: 10.1093/ehjci/jeaa231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Filippo Cademartiri
- Advanced Cardiovascular Imaging, SDN IRCCS, via Gianturco 113, 80143, Naples, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, via Comandino 70, 61029, Urbino, Italy
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Nissen L, Winther S, Schmidt M, Rønnow Sand NP, Urbonaviciene G, Zelechowski MW, Christensen MK, Busk M, Lambrechtsen J, Diederichsen A, Elpert FP, Grove EL, Bøtker HE, Bøttcher M. Implementation of coronary computed tomography angiography as nationally recommended first-line test in patients with suspected chronic coronary syndrome: impact on the use of invasive coronary angiography and revascularization. Eur Heart J Cardiovasc Imaging 2020; 21:1353-1362. [PMID: 32888290 DOI: 10.1093/ehjci/jeaa197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS To investigate the impact of applying coronary computed tomography angiography (CCTA), as the recommended first-line diagnostic test in patients with suspected chronic coronary syndrome (CCS) on the use of invasive coronary angiography (ICA) and revascularization practice. METHODS AND RESULTS We included all patients undergoing a first-time CCTA (n = 53555) and first-time ICA (n = 41451) from 2008 to 2017 due to suspected CCS in Western Denmark (3.3 million inhabitants). The number of CCTA procedures increased from 352 (2008) to 7739 (2017) (2098%), ICA examinations declined from 4538 to 3766 (17%). The average proportion of no- or non-obstructive coronary artery disease by CCTA was 77.5%. Referral to ICA after CCTA occurred in 16.9% of patients in 2008-10 vs. 13.9% in 2014-17 (P < 0.0001). Revascularization in patients referred to ICA after CCTA increased from 33.8% in 2008-10 vs. 44.4% in 2014-17 (P < 0.0001). The revascularization proportion in patients undergoing ICA with no preceding CCTA was 32.3% in 2008-10 vs. 33.3% in (2014-17) (P = 0.1063). Stratified by age, the overall revascularization proportion increased in the younger age groups and was unchanged or decreased in older age groups: <50 years: 60% increase, 50-59 years: 33% increase, 60-69 years: 0%, and >70 years: 9.5% decrease. CONCLUSION The introduction of CCTA as a first-line diagnostic test in patients with suspected CCS does not associate with increased use of invasive angiography and seems to have facilitated a more appropriate revascularization practice.
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Affiliation(s)
- Louise Nissen
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark
| | - Simon Winther
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Schmidt
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | | | - Martin Kirk Christensen
- Department of Cardiology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark
| | - Martin Busk
- Department of Cardiology, Regional Hospital of Vejle, Beriderbakken 4, 7100 Vejle, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark
| | - Frank-Peter Elpert
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Morten Bøttcher
- Department of Cardiology, Regional Hospital West Jutland, Gl. landevej 61, 7400 Herning, Denmark
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10
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Kim YG, Park GM, Lee SB, Yang DH, Kang JW, Lim TH, Kim HK, Choe J, Lee SW, Kim YH. Association of gamma-glutamyl transferase with subclinical coronary atherosclerosis and cardiac outcomes in non-alcoholics. Sci Rep 2020; 10:17994. [PMID: 33093619 PMCID: PMC7581814 DOI: 10.1038/s41598-020-75078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
In an asymptomatic population, we determined the relationship between serum gamma-glutamyl transferase (GGT) and subclinical atherosclerosis, using coronary computed tomography angiography (CCTA). This was a retrospective observational cohort study which analyzed 5120 consecutive asymptomatic individuals with no prior history of coronary artery disease or significant alcohol intake who voluntarily underwent CCTA as part of a general health examination. All subjects were stratified into tertiles based on GGT levels. Degree and extent of subclinical coronary atherosclerosis were evaluated using CCTA. Cardiac events were a composite of all-cause death, myocardial infarction, unstable angina, and coronary revascularization. After adjustment for cardiovascular risk factors, there were no significant differences among GGT tertiles in terms of adjusted odds ratios for non-calcified and mixed plaques. The risk of any atherosclerotic and calcified plaques, significant stenosis, multi-vessel disease, and significant stenosis in the left main or proximal left anterior descending artery was higher in the third GGT tertile than in the first tertile (all p < 0.05). Over a median 5.4-year follow-up, the third GGT tertile had significant adjusted hazards ratios for cardiac events than did the first GGT tertile, even after stepwise adjustment for cardiovascular risk factors (all p < 0.01). In asymptomatic individuals, elevated GGT was independently associated with high-risk feature atherosclerosis and poorer cardiac outcomes.
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Affiliation(s)
- Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, Republic of Korea.
| | - Seung Bum Lee
- Department of Gastroenterology and Hepatology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Hwan Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaewon Choe
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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Gaba P, Gersh BJ, Ali ZA, Moses JW, Stone GW. Complete versus incomplete coronary revascularization: definitions, assessment and outcomes. Nat Rev Cardiol 2020; 18:155-168. [PMID: 33067581 DOI: 10.1038/s41569-020-00457-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
Coronary artery disease is the leading cause of morbidity and mortality worldwide. Selected patients with obstructive coronary artery disease benefit from revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Many (but not all) studies have demonstrated increased survival and greater freedom from adverse cardiovascular events after complete revascularization (CR) than after incomplete revascularization (ICR) in patients with multivessel disease. However, achieving CR after PCI or CABG surgery might not be feasible owing to patient comorbidities, anatomical factors, and technical or procedural considerations. These factors also mean that comparisons between CR and ICR are subject to multiple confounders and are difficult to understand or apply to real-world clinical practice. In this Review, we summarize and critically appraise the evidence linking various types of ICR to adverse outcomes in patients with multivessel disease and stable ischaemic heart disease, non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction, with or without cardiogenic shock. In addition, we provide practical recommendations for revascularization in patients with high-risk multivessel disease to optimize their long-term clinical outcomes and identify areas requiring future clinical investigation.
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Affiliation(s)
- Prakriti Gaba
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ziad A Ali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffrey W Moses
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA. .,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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12
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Benz DC, Giannopoulos AA. Fractional flow reserve as the standard of reference: All that glistens is not gold. J Nucl Cardiol 2020; 27:1314-1316. [PMID: 31175624 DOI: 10.1007/s12350-019-01771-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland.
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13
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Park GM, Lee CH, Lee SW, Yun SC, Kim YH, Kim YG, Won KB, Ann SH, Kim SJ, Yang DH, Kang JW, Lim TH, Koh EH, Lee WJ, Kim MS, Park JY, Kim HK, Choe J, Lee SG. Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry. Diabetes Metab J 2020; 44:470-479. [PMID: 31769239 PMCID: PMC7332335 DOI: 10.4093/dmj.2019.0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis. METHODS We analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively. RESULTS Compared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; P=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; P=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; P<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; P<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (P=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (P=0.023). CONCLUSION Asymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.
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Affiliation(s)
- Gyung Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chang Hoon Lee
- Department of Cardiology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sung Cheol Yun
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ki Bum Won
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Shin Jae Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hwan Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Koh
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Je Lee
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Seon Kim
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Yeol Park
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Kyu Kim
- The Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- The Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Gon Lee
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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14
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Nomura CH, Assuncao-Jr AN, Guimarães PO, Liberato G, Morais TC, Fahel MG, Giorgi MCP, Meneghetti JC, Parga JR, Dantas-Jr RN, Cerri GG. Association between perivascular inflammation and downstream myocardial perfusion in patients with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2020; 21:599-605. [DOI: 10.1093/ehjci/jeaa023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/14/2019] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
Aims
To investigate the association between pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary computed tomography angiography (CTA) and coronary flow reserve (CFR) by positron emission tomography (PET) in patients with suspected coronary artery disease (CAD).
Methods and results
PCAT CT attenuation was measured in proximal segments of all major epicardial coronary vessels of 105 patients with suspected CAD. We evaluated the relationship between PCAT CT attenuation and other quantitative/qualitative CT-derived anatomic parameters with CFR by PET. Overall, the mean age was 60 ± 12 years and 93% had intermediate pre-test probability of obstructive CAD. Obstructive CAD (≥50% stenosis) was detected in 37 (35.2%) patients and impaired CFR (<2.0) in 32 (30.5%) patients. On a per-vessel analysis (315 vessels), obstructive CAD, non-calcified plaque volume, and PCAT CT attenuation were independently associated with CFR. In patients with coronary calcium score (CCS) <100, those with high-PCAT CT attenuation presented significantly lower CFR values than those with low-PCAT CT attenuation (2.47 ± 0.95 vs. 3.13 ± 0.89, P = 0.003). Among those without obstructive CAD, CFR was significantly lower in patients with high-PCAT CT attenuation (2.51 ± 0.95 vs. 3.02 ± 0.84, P = 0.021).
Conclusion
Coronary perivascular inflammation by CTA was independently associated with downstream myocardial perfusion by PET. In patients with low CCS or without obstructive CAD, CFR was lower in the presence of higher perivascular inflammation. PCAT CT attenuation might help identifying myocardial ischaemia particularly among patients who are traditionally considered non-high risk for future cardiovascular events.
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Affiliation(s)
- Cesar H Nomura
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
- Department of Radiology, Institute of Radiology, InRad, University of Sao Paulo Medical School, R. Dr. Ovidio Pires de Campos 75, Cerqueira Cesar, Sao Paulo - SP, 05403-010, Brazil
| | - Antonildes N Assuncao-Jr
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Patricia O Guimarães
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Gabriela Liberato
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Thamara C Morais
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Mateus G Fahel
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Maria C P Giorgi
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - José C Meneghetti
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Jose R Parga
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Roberto N Dantas-Jr
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
| | - Giovanni G Cerri
- Heart Institute, InCor, Cardiovascular Imaging Department, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo – SP, 05403-000, Brazil
- Department of Radiology, Institute of Radiology, InRad, University of Sao Paulo Medical School, R. Dr. Ovidio Pires de Campos 75, Cerqueira Cesar, Sao Paulo - SP, 05403-010, Brazil
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15
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Czarnecki A, Qiu F, Elbaz-Greener G, Cohen EA, Ko DT, Roifman I, Wijeysundera HC. Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease. JACC Cardiovasc Interv 2019; 12:232-241. [PMID: 30660456 DOI: 10.1016/j.jcin.2018.10.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/19/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to assess variation in revascularization of asymptomatic patients with stable ischemic heart disease, identify the predictors of variation, and determine if it was associated with clinical outcomes. BACKGROUND Management of stable ischemic heart disease in asymptomatic patients with obstructive coronary artery disease is controversial, potentially leading to practice variation. METHODS A retrospective observational cohort study was performed using population-based data from Ontario, Canada, in patients with asymptomatic stable ischemic heart disease and obstructive coronary artery disease. The cohort was divided on the basis of treatment strategy: revascularization or medical therapy. Hospitals were allocated into tertiles of their revascularization ratio. Outcomes included death and nonfatal myocardial infarction. Hierarchical logistic regression was used to assess the predictors of revascularization, with median odds ratios used to quantify variation. Proportional hazards models were used to determine the association between management strategy and outcomes. RESULTS The cohort included 9,897 patients, 47% treated with medical therapy and 53% with revascularization. Between hospitals, 2-fold variation existed in the ratio of revascularized to medically treated patients. However, the variation across hospitals was not explained by patient, physician, or hospital factors (median odds ratio in null model: 1.25; median odds ratio in full model: 1.31). Revascularization was associated with a hazard ratio of 0.81 (95% confidence interval: 0.69 to 0.96) for death and a hazard ratio of 0.58 (95% confidence interval: 0.46 to 0.73) for myocardial infarction, with this benefit consistent across tertiles of revascularization ratio. CONCLUSIONS Wide variation was observed in revascularization practice that was not explained by known factors. Despite this variation, a clinical benefit was observed with revascularization that was consistent across hospitals.
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Affiliation(s)
- Andrew Czarnecki
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Feng Qiu
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Gabby Elbaz-Greener
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric A Cohen
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dennis T Ko
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Idan Roifman
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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van Rosendael AR, Shaw LJ, Xie JX, Dimitriu-Leen AC, Smit JM, Scholte AJ, van Werkhoven JM, Callister TQ, DeLago A, Berman DS, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff G, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Feuchtner G, Lin FY, Jones EC, Pontone G, Andreini D, Marques H, Rubinshtein R, Achenbach S, Dunning A, Gomez M, Hindoyan N, Gransar H, Leipsic J, Narula J, Min JK, Bax JJ. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score. JACC Cardiovasc Imaging 2019; 12:1987-1997. [PMID: 30660516 DOI: 10.1016/j.jcmg.2018.10.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/19/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS). BACKGROUND Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. METHODS A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971). RESULTS The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort. CONCLUSIONS The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).
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Affiliation(s)
- Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joe X Xie
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jeorg Hausleiter
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | | | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Todd C Villines
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Millie Gomez
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Niree Hindoyan
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Jonathon Leipsic
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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17
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Driessen RS, Danad I, Stuijfzand WJ, Raijmakers PG, Schumacher SP, van Diemen PA, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Taylor CA, Knaapen P. Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis. J Am Coll Cardiol 2019; 73:161-173. [DOI: 10.1016/j.jacc.2018.10.056] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023]
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Temporal Trends in Fractional Flow Reserve Use in Patients Undergoing Coronary Angiography: A Population-Based Study. CJC Open 2019. [PMCID: PMC7063660 DOI: 10.1016/j.cjco.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Invasive fractional flow reserve (FFR) has emerged as an important tool to identify a subset of patients in whom coronary revascularization may be beneficial. Our objective was to evaluate temporal trends in FFR use. Methods We identified all coronary angiograms in the CorHealth Ontario Cardiac Registry between the years 2010 and 2015. The primary and secondary outcomes were the age- and sex-adjusted monthly rate of FFR per 100,000 population and per 100 angiograms, respectively. Piecewise regression analyses were used to evaluate the temporal trends in FFR use for the entire cohort, and then stratified by indication (stable coronary artery disease [CAD]) vs acute coronary syndrome [ACS]). Results The study cohort included 379,688 angiograms, of which 122,571 were for stable CAD (32%) and 134,769 were for ACS (36%). Monthly age- and sex-adjusted FFR use rates increased significantly over the study period, from 0.4 to 2.3 per 100,000 people per month. The monthly FFR use rate per 100 angiograms increased from 0.9 to 4.9 per 100 angiograms per month; however, the proportion of positive FFR (< 0.8) results was relatively constant at 28%. There was a more dramatic increase in the use of FFR in the population with stable CAD (1.1 to 8.0 per 100 angiograms/month) compared with the population with ACS (0.6 to 4.5 per 100 angiograms/month). Conclusions There was a > 5-fold increase in the use of FFR in patients across Ontario, which was predominantly driven by use in stable CAD. Case selection for FFR use was relatively unchanged with approximately one-quarter of FFR cases being positive over time.
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Hypertension Is an Independent Predictor of Multivessel Coronary Artery Disease in Young Adults with Acute Coronary Syndrome. Int J Hypertens 2018; 2018:7623639. [PMID: 30538861 PMCID: PMC6260551 DOI: 10.1155/2018/7623639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/18/2018] [Accepted: 11/01/2018] [Indexed: 12/26/2022] Open
Abstract
Background Risk factors of multivessel coronary artery disease (CAD) among young acute coronary syndrome (ACS) patients remain elusive now. Methods This retrospective study analyzed data from 187 consecutive young (age ≤45 years) ACS patients (75 STEMI, 30 NSTEMI, and 72 unstable angina) hospitalized in our hospital from January 2012 to December 2016. Thirty-six young male patients with normal coronary angiography (CAG) findings (no-CAD), who underwent CAG due to suspected chest pain in this period, served as control group. There were 83 patients with single-vessel disease (SVD) and 104 patients with multiple-vessel disease (MVD) among ACS patients. Patients were followed up for a mean of 267±124 days by clinical visit or telephone calls. Results All included patients were male. Prevalence of hypertension (57.2% vs. 30.6%, p=0.002) and smoking (70.6% vs. 52.8%, p=0.049) was significantly higher in ACS patients than in no-CAD patients. Prevalence of hypertension (72.1% vs. 38.6%, p<0.001) and body mass index (BMI) were significantly higher in MVD group than in SVD group. Multivariable analysis revealed that hypertension was an independent risk factor for MVD after adjustment for age, gender, BMI, smoking, family history of premature CAD, hyperlipidemia, left ventricular ejection fraction, and brain natriuretic peptide (odds ratio=3.71, 95% confidence interval=1.84-7.46, p<0.001). Rate of major adverse cardiovascular events (MACE) during follow-up (20.2% vs. 4.8%) was significantly higher in MVD group compared with SVD group. Conclusions Hypertension is an independent predictor of MVD and MVD is associated with increased MACE rate compared to SVD in young ACS patients during the short-term follow-up.
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20
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Lee CH, Lee SW, Park SW. Diabetes and Subclinical Coronary Atherosclerosis. Diabetes Metab J 2018; 42:355-363. [PMID: 30362301 PMCID: PMC6202561 DOI: 10.4093/dmj.2018.0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/20/2018] [Indexed: 12/19/2022] Open
Abstract
It is well known that diabetic patients have a high risk of cardiovascular events, and although there has been a tremendous effort to reduce these cardiovascular risks, the incidence of cardiovascular morbidity and mortality in diabetic patients remains high. Therefore, the early detection of coronary artery disease (CAD) is necessary in those diabetic patients who are at risk of cardiovascular events. Significant medical and radiological advancements, including coronary computed tomography angiography (CCTA), mean that it is now possible to investigate the characteristics of plaques, instead of solely evaluating the calcium level of the coronary artery. Recently, several studies reported that the prevalence of subclinical coronary atherosclerosis (SCA) is higher than expected, and this could impact on CAD progression in asymptomatic diabetic patients. In addition, several reports suggest the potential benefit of using CCTA for screening for SCA in asymptomatic diabetic patients, which might dramatically decrease the incidence of cardiovascular events. For these reasons, the medical interest in SCA in diabetic patients is increasing. In this article, we sought to review the results of studies on CAD in asymptomatic diabetic patients and discuss the clinical significance and possibility of using CCTA to screen for SCA.
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Affiliation(s)
- Chang Hoon Lee
- Department of Cardiology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seong Wook Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Prognosis of anatomic coronary artery disease without myocardial ischemia: Coronary computed tomography angiography detects high-risk patients even in cases of negative single-photon emission computed tomography findings. J Cardiol 2018. [DOI: 10.1016/j.jjcc.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Schulman-Marcus J, Lin FY, Gransar H, Berman D, Callister T, DeLago A, Hadamitzky M, Hausleiter J, Al-Mallah M, Budoff M, Kaufmann P, Achenbach S, Raff G, Chinnaiyan K, Cademartiri F, Maffei E, Villines T, Kim YJ, Leipsic J, Feuchtner G, Rubinshtein R, Pontone G, Andreini D, Marques H, Chang HJ, Chow BJW, Cury RC, Dunning A, Shaw L, Min JK. Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediate- and high-risk coronary artery disease: results from the CONFIRM long-term registry. Eur Heart J Cardiovasc Imaging 2018; 18:841-848. [PMID: 28329294 PMCID: PMC5837582 DOI: 10.1093/ehjci/jew287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/24/2017] [Indexed: 01/10/2023] Open
Abstract
Aims To identify the effect of early revascularization on 5-year survival in patients with CAD diagnosed by coronary-computed tomographic angiography (CCTA). Methods and results We examined 5544 stable patients with suspected CAD undergoing CCTA who were followed a median of 5.5 years in a large international registry. Patients were categorized as having low-, intermediate-, or high-risk CAD based on CCTA findings. Two treatment groups were defined: early revascularization within 90 days of CCTA (n = 1171) and medical therapy (n = 4373). To account for the non-randomized referral to revascularization, we developed a propensity score by logistic regression. This score was incorporated into Cox proportional hazard models to calculate the effect of revascularization on all-cause mortality. Death occurred in 363 (6.6%) patients and was more frequent in medical therapy. In multivariable models, when compared with medical therapy, the mortality benefit of revascularization varied significantly over time and by CAD risk (P for interaction 0.04). In high-risk CAD, revascularization was significantly associated with lower mortality at 1 year (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.11–0.47) and 5 years (HR 0.31, 95% CI 0.18–0.54). For intermediate-risk CAD, revascularization was associated with reduced mortality at 1 year (HR 0.45, 95% CI 0.22–0.93) but not 5 years (HR 0.63, 95% CI 0.33–1.20). For low-risk CAD, there was no survival benefit at either time point. Conclusions Early revascularization was associated with reduced 1-year mortality in intermediate- and high-risk CAD detected by CCTA, but this association only persisted for 5-year mortality in high-risk CAD.
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Affiliation(s)
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tracy Callister
- Tennessee Heart and Vascular Institute, Hendersonville, TN, USA
| | | | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Mouaz Al-Mallah
- King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia
| | - Matthew Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | | | | | | | - Kavitha Chinnaiyan
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
| | - Filippo Cademartiri
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
| | - Erica Maffei
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
| | - Todd Villines
- Department of Medicine, Walter Reed Medical Center, Washington, DC, USA
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Hugo Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, ON, Canada
| | | | | | - Leslee Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, USA
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23
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Impact of cardiac hybrid imaging-guided patient management on clinical long-term outcome. Int J Cardiol 2018; 261:218-222. [DOI: 10.1016/j.ijcard.2018.01.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/22/2017] [Accepted: 01/26/2018] [Indexed: 12/29/2022]
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24
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Hamon M, Lemesle G, Meurice T, Tricot O, Lamblin N, Bauters C. Elective Coronary Revascularization Procedures in Patients With Stable Coronary Artery Disease: Incidence, Determinants, and Outcome (From the CORONOR Study). JACC Cardiovasc Interv 2018; 11:868-875. [PMID: 29747917 DOI: 10.1016/j.jcin.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The authors sought to describe the incidence, determinants, and outcome of elective coronary revascularization (ECR) in patients with stable coronary artery disease (CAD). BACKGROUND Observational data are lacking regarding the practice of ECR in patients with stable CAD receiving modern secondary prevention. METHODS The authors analyzed coronary revascularization procedures performed during a 5-year follow-up in 4,094 stable CAD outpatients included in the prospective multicenter CORONOR (Suivi d'une cohorte de patients COROnariens stables en région NORd-Pas-de-Calais) registry. RESULTS Secondary prevention medications were widely prescribed at inclusion (antiplatelet agents 96.4%, statins 92.2%, renin-angiotensin system antagonists 81.8%). A total of 481 patients underwent ≥1 coronary revascularization procedure (5-year cumulative incidences of 3.6% [0.7% per year] for acute revascularizations and 8.9% [1.8% per year] for ECR); there were 677 deaths during the same period. Seven baseline variables were independently associated with ECR: prior coronary stent implantation (p < 0.0001), absence of prior myocardial infarction (p < 0.0001), higher low-density lipoprotein cholesterol (p < 0.0001), lower age (p < 0.0001), multivessel CAD (p = 0.003), diabetes mellitus (p = 0.005), and absence of treatment with renin-angiotensin system antagonists (p = 0.020). Main indications for ECR were angina associated with a positive stress test (31%), silent ischemia (31%), and angina alone (25%). The use of ECR had no impact on the subsequent risk of death, myocardial infarction, or ischemic stroke (hazard ratio: 1.04; 95% confidence interval: 0.76 to 1.41). CONCLUSIONS These real-life data show that ECR is performed at a rate of 1.8% per year in stable CAD patients widely treated by secondary medical prevention. ECR procedures performed in patients without noninvasive stress tests are not rare. Having an ECR was not associated with the risk of ischemic adverse events.
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Affiliation(s)
- Martial Hamon
- University Hospital of Caen, Caen University, Caen, France
| | - Gilles Lemesle
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1011, Lille, France
| | | | | | - Nicolas Lamblin
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France
| | - Christophe Bauters
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France.
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25
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Ellis AG, Trikalinos TA, Wessler BS, Wong JB, Dahabreh IJ. Propensity Score-Based Methods in Comparative Effectiveness Research on Coronary Artery Disease. Am J Epidemiol 2018; 187:1064-1078. [PMID: 28992207 DOI: 10.1093/aje/kwx214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.
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Affiliation(s)
- Alexandra G Ellis
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts
- Department of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Issa J Dahabreh
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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26
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Clerc OF, Fuchs TA, Stehli J, Benz DC, Gräni C, Messerli M, Giannopoulos AA, Buechel RR, Lüscher TF, Pazhenkottil AP, Kaufmann PA, Gaemperli O. Non-invasive screening for coronary artery disease in asymptomatic diabetic patients: a systematic review and meta-analysis of randomised controlled trials. Eur Heart J Cardiovasc Imaging 2018; 19:838-846. [DOI: 10.1093/ehjci/jey014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/15/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Olivier F Clerc
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Tobias A Fuchs
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Dominik C Benz
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael Messerli
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Andreas A Giannopoulos
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Thomas F Lüscher
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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27
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Dwivedi A, Al'Aref SJ, Lin FY, Min JK. Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging. Korean Circ J 2018; 48:124-133. [PMID: 29441745 PMCID: PMC5861003 DOI: 10.4070/kcj.2017.0392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.
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Affiliation(s)
- Aeshita Dwivedi
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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28
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Abstract
OPINION STATEMENT Coronary CT angiography (CTA) is a highly accurate test for the diagnosis of coronary artery disease (CAD), with its use guided by numerous contemporary appropriate use criteria and clinical guidelines. Unique among non-invasive tests for CAD, coronary CTA provides direct visualization of coronary atherosclerosis for the assessment of angiographic stenosis, as well as validated measures of plaque vulnerability. Long-term studies now clearly demonstrate that the absence of CAD on coronary CTA identifies a patient that is at very low risk for future cardiovascular events. Conversely, the presence, location, and severity of CAD as measured on coronary CTA provide powerful prognostic information that is superior to traditional risk factors and other clinical variables. Observational studies and data obtained from clinical trials suggest that the anatomic information derived from coronary CTA significantly increases the utilization of statins and aspirin. Furthermore, these changes are associated with reductions in the risk for mortality, revascularizations, and incident myocardial infarctions among subjects with coronary atherosclerosis. As a result, current societal consensus statements have attempted to standardize coronary CTA reporting, to include incorporation of vulnerable plaque features and recommendations on the use of preventive therapies, such as statins, so to more consistently link important prognostic findings on coronary CTA to appropriate preventive and therapeutic interventions. Automated measures of total coronary plaque volume, machine learning, and CT-derived fractional flow reserve may further refine the prognostic accuracy of coronary CTA. Herein, we summarize recently published literature that reports the long-term (≥ 5 years of follow-up) prognostic usefulness of coronary CTA.
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29
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Zeltser R, Tortez LM, Druz RS, Kozikowski A, Makaryus AN, Lesser M, Pekmezaris R. Downstream resource utilization following SPECT: Impact of age and gender. J Nucl Cardiol 2017; 24:1657-1661. [PMID: 27324347 DOI: 10.1007/s12350-016-0464-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have identified a downstream referral age and gender bias for invasive coronary anatomy evaluation after single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The present study evaluates if such bias still persists despite advancements in SPECT MPI and angiography. We hypothesized that women and patients ≥80 years old are less likely to undergo invasive coronary angiography after adjusting for clinical and scan variables. METHODS Patients (n = 3824) who referred to a nuclear cardiology laboratory at a tertiary medical center were retrospectively identified. Regression analysis tested age (<55; 55-69; 70-79; ≥80 years) and gender as predictors of diagnostic angiogram at 90 days post-SPECT after adjustment for known CAD, CAD risk equivalent, SSS, SDS, and LVEF. RESULTS Younger patients were more likely to undergo an angiogram as compared to octogenarians (77% more likely if <55 years old, 69% if 55-69 years old, and 52% if 70-79 years old). No effect was found for gender. CONCLUSIONS Older patients were less likely to be referred for angiogram as compared to their younger counterparts. Further study is needed to determine which factors guide this decision-making process in older adults and the influence of these factors on the referral bias.
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Affiliation(s)
- Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Leanne M Tortez
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA.
| | - Regina S Druz
- Integrative Cardiology Center of Long Island, Mineola, NY, USA
| | - Andrzej Kozikowski
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Martin Lesser
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Renee Pekmezaris
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Department of Medicine, Northwell Health, 175 Community Dr., 2nd fl., Manhasset, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
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Durand E, Bauer F, Mansencal N, Azarine A, Diebold B, Hagege A, Perdrix L, Gilard M, Jobic Y, Eltchaninoff H, Bensalah M, Dubourg B, Caudron J, Niarra R, Chatellier G, Dacher JN, Mousseaux E. Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter study. Int J Cardiol 2017; 241:463-469. [DOI: 10.1016/j.ijcard.2017.02.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/10/2016] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
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31
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van Rosendael AR, Bax JJ. Improved risk stratification with computed tomographic coronary angiography in patients with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2017; 18:849-850. [PMID: 28329219 DOI: 10.1093/ehjci/jex029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC Leiden, The Netherlands
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32
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Sechtem U, Mahrholdt H, Ong P, Athanasiadis A, Schäufele T. Testing in Patients With Stable Coronary Artery Disease - The Debate Continues. Circ J 2016; 80:802-10. [PMID: 26984588 DOI: 10.1253/circj.cj-16-0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The major guidelines on stable coronary artery disease recommend revascularizing patients with large areas of myocardium at risk. The algorithms on how to prove that such high risk is present differ considerably. The opinions on the use of coronary CT (calcium scoring and angiography) vary widely. This review aims to summarize the recommendations of the major guidelines, commenting on differences between the guidelines and discussing whether extending the role of coronary CT angiography should be considered in the light of new CT data.
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Long-Term Prognostic Value of Coronary CT Angiography in Asymptomatic Type 2 Diabetes Mellitus. JACC Cardiovasc Imaging 2016; 9:1292-1300. [DOI: 10.1016/j.jcmg.2016.01.040] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/30/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
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34
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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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35
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Bittencourt MS, Hulten EA, Murthy VL, Cheezum M, Rochitte CE, Di Carli MF, Blankstein R. Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis. Circ Cardiovasc Imaging 2016; 9:e004419. [PMID: 27072303 DOI: 10.1161/circimaging.115.004419] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care. METHODS AND RESULTS We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49-0.98; P=0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95-1.84; P=0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14-2.75). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95-1.54). CONCLUSIONS In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.
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Affiliation(s)
- Márcio Sommer Bittencourt
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.).
| | - Edward A Hulten
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Venkatesh L Murthy
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Michael Cheezum
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Carlos E Rochitte
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Marcelo F Di Carli
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
| | - Ron Blankstein
- From the Center for Clinical and Epidemiological Research, University Hospital and State of São Paulo Cancer Institute (ICESP) (M.S.B.) and Heart Institute (C.E.R.), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.); Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.); Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); and Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C., M.D.C., R.B.)
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36
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Sechtem U, Greulich S, Ong P. [Recommendations of the ESC guidelines regarding cardiovascular imaging]. Herz 2016; 41:362-70. [PMID: 27388914 DOI: 10.1007/s00059-016-4453-1] [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] [Indexed: 11/26/2022]
Abstract
Cardiac imaging plays a key role in the diagnosis and risk stratification in the ESC guidelines for the management of patients with stable coronary artery disease. Demonstration of myocardial ischaemia guides the decision which further diagnostic and therapeutic strategy should be followed in these patients. One should, however, not forget that there are no randomised studies supporting this type of management. In patients with a low pretest probability coronary CT angiography is the optimal tool to exclude coronary artery stenoses rapidly and effectively. In the near future, however, better data is needed showing how much cardiac imaging is really necessary and how cost-effective it is in patients with stable coronary artery disease.
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Affiliation(s)
- U Sechtem
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - S Greulich
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - P Ong
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
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37
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Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, Friedman JD, Hayes SW, Thomson LEB, Fish M, Germano G, Abidov A, Shaw L, Rozanski A, Berman DS. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. J Nucl Cardiol 2016; 23:530-41. [PMID: 25971987 PMCID: PMC6377163 DOI: 10.1007/s12350-015-0150-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. METHODS We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. RESULTS Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). CONCLUSION Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.
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Affiliation(s)
- Rine Nakanishi
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Reza Arsanjani
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aryeh Shalev
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Yuka Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - John D Friedman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Louise E B Thomson
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Mathews Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aiden Abidov
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Leslee Shaw
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Alan Rozanski
- Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Stone GW, Hochman JS, Williams DO, Boden WE, Ferguson TB, Harrington RA, Maron DJ. Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia: The Case for Community Equipoise. J Am Coll Cardiol 2016; 67:81-99. [PMID: 26616030 PMCID: PMC5545795 DOI: 10.1016/j.jacc.2015.09.056] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Gregg W Stone
- Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
| | - Judith S Hochman
- Department of Medicine, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York
| | - David O Williams
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - William E Boden
- Department of Medicine, Samuel S. Stratton VA Medical Center, Albany Medical Center and Albany Medical College, Albany, New York
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, North Carolina
| | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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40
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Hung CS, Li HY, Kuo CH, Lin MS, Kuo TC, Tsai SJ, Liu PH, Lin CH, Yang CY, Chuang LM, Chen MF, Tseng YJ, Kao HL. Fasting but not changes of plasma metabolome during oral glucose tolerance tests improves the diagnosis of severe coronary arterial stenosis. Clin Endocrinol (Oxf) 2015; 83:483-9. [PMID: 25557422 DOI: 10.1111/cen.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/19/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noninvasive stress tests for the diagnosis of significant coronary arterial stenosis requiring intervention are not perfect. We investigated whether plasma metabolome during the oral glucose tolerance test (OGTT) can improve the diagnosis. METHODS A total of 117 subjects with positive stress test results who received coronary angiography were recruited. After excluding subjects with a history of myocardial infarction and subjects who did not receive OGTT, the 18 subjects without significant stenosis were selected as controls. Another 18 age- and sex-matched subjects with significant stenosis were selected as cases. Plasma metabolome from samples obtained in fasting, 30 and 120 min after OGTT was measured using liquid chromatography combined with time-of-flight mass spectrometry. RESULTS We found five metabolites which can identify patients with significant stenosis independent to clinical risk factors, including diabetes, hypertension, hypercholesterolaemia, smoking and history of percutaneous coronary intervention (all P < 0·05). The area under the receiver operating characteristic (AUROC) curve of these metabolites was 0·799-0·818 at fasting and 30 min after OGTT. The addition of metabolites to clinical factors increases the AUROC (0·616, 95%CI 0·429-0·803 for model with clinical factors only; 0·824, 95%CI 0·689-0·959 for model with four metabolites and clinical factors). The changes of plasma metabolite levels during OGTT did not significantly improve the diagnostic performance. CONCLUSIONS Fasting plasma metabolome, but not change of plasma metabolome during OGTT, can improve the diagnosis of significant stenosis in patients with positive noninvasive stress test results.
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Affiliation(s)
- Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hua Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Chueh Kuo
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Sung-Jeng Tsai
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pi-Hua Liu
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsin Lin
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yi Yang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Fong Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yufeng J Tseng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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41
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Danad I, Min JK. Computed tomography: The optimal imaging method for differentiation of ischemic vs non-ischemic cardiomyopathy. J Nucl Cardiol 2015; 22:961-7. [PMID: 26153260 DOI: 10.1007/s12350-015-0146-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ibrahim Danad
- Department of Radiology, Weill Cornell Medical College and The NewYork-Presbyterian Hospital, New York, NY, USA
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and The NewYork-Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA
| | - James K Min
- Department of Radiology, Weill Cornell Medical College and The NewYork-Presbyterian Hospital, New York, NY, USA.
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and The NewYork-Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA.
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42
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Computed tomography segmental calcium score (SCS) to predict stenosis severity of calcified coronary lesions. Int J Cardiovasc Imaging 2015; 31:1663-75. [DOI: 10.1007/s10554-015-0750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
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43
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Abbott JD. Measuring the Effectiveness of Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2015; 8:e003024. [PMID: 26253736 DOI: 10.1161/circinterventions.115.003024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Dawn Abbott
- From the Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence.
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Levsky JM, Spevack DM, Travin MI, Menegus MA, Huang PW, Clark ET, Kim CW, Hirschhorn E, Freeman KD, Tobin JN, Haramati LB. Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A Randomized Trial. Ann Intern Med 2015; 163:174-83. [PMID: 26052677 PMCID: PMC4703121 DOI: 10.7326/m14-2948] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The role of coronary computed tomography angiography (CCTA) in the management of symptomatic patients suspected of having coronary artery disease is expanding. However, prospective intermediate-term outcomes are lacking. OBJECTIVE To compare CCTA with conventional noninvasive testing. DESIGN Randomized, controlled comparative effectiveness trial. (ClinicalTrials.gov: NCT00705458). SETTING Telemetry-monitored wards of an inner-city medical center. PATIENTS 400 patients with acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; and low socioeconomic status. INTERVENTION CCTA or radionuclide stress myocardial perfusion imaging (MPI). MEASUREMENTS The primary outcome was cardiac catheterization not leading to revascularization within 1 year. Secondary outcomes included length of stay, resource utilization, and patient experience. Safety outcomes included death, major cardiovascular events, and radiation exposure. RESULTS Thirty (15%) patients who had CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not undergo revascularization (difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus 49%), emergency department visit (63% versus 58%), and outpatient cardiology visit (23% versus 21%) did not differ. Long-term, all-cause radiation exposure was lower for the CCTA group (24 versus 29 mSv; P < 0.001). More patients in the CCTA group graded their experience favorably (P = 0.001) and would undergo the examination again (P = 0.003). LIMITATION This was a single-site study, and the primary outcome depended on clinical management decisions. CONCLUSION The CCTA and MPI groups did not significantly differ in outcomes or resource utilization over 40 months. Compared with MPI, CCTA was associated with less radiation exposure and with a more positive patient experience. PRIMARY FUNDING SOURCE American Heart Association.
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Affiliation(s)
- Jeffrey M. Levsky
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Daniel M. Spevack
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mark I. Travin
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mark A. Menegus
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Paul W. Huang
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Elana T. Clark
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Choo-won Kim
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Esther Hirschhorn
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Katherine D. Freeman
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan N. Tobin
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Linda B. Haramati
- From Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
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45
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Park GM, Lee JH, Lee SW, Yun SC, Kim YH, Cho YR, Gil EH, Kim TS, Kim CJ, Cho JS, Park MW, Her SH, Yang DH, Kang JW, Lim TH, Koh EH, Lee WJ, Kim MS, Lee KU, Kim HK, Choe J, Park JY. Comparison of Coronary Computed Tomographic Angiographic Findings in Asymptomatic Subjects With Versus Without Diabetes Mellitus. Am J Cardiol 2015; 116:372-8. [PMID: 26037293 DOI: 10.1016/j.amjcard.2015.04.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
Abstract
There are limited data on the impact of diabetes mellitus (DM) on the risk of subclinical atherosclerosis. Therefore, we sought to investigate the impact of DM on the risk of subclinical atherosclerosis in asymptomatic subjects. We analyzed 2,034 propensity score-matched asymptomatic subjects who underwent coronary computed tomographic angiography (mean age 55.9 ± 8.2 years; men 1,725 [84.8%]). Coronary artery calcium score, degree and extent of coronary artery disease (CAD), and clinical outcomes were assessed. High-risk CAD was defined as at least 2-vessel coronary disease with proximal left anterior descending artery involvement, 3-vessel disease, or left main disease. Compared with subjects without DM, those matched with DM had higher coronary artery calcium score (89.9 ± 240.4 vs 62.8 ± 179.5, p = 0.004) and more significant CAD (≥50% diameter stenosis, 15.2% vs 10.2%, p = 0.001), largely in the form of 1-vessel disease (10.8% vs 7.3%, p = 0.007). However, there were no significant differences between matched pairs in significant CAD in the left main or proximal left anterior descending artery (5.3% vs 3.8%, p = 0.138), multivessel disease (4.4% vs 2.9%, p = 0.101), and high-risk CAD (4.3% vs 2.7%, p = 0.058). During the follow-up period (median 21.8, interquartile range 15.2 to 33.4 months), there was no significant difference in the composite of all-cause death, myocardial infarction, acute coronary syndrome, and coronary revascularization between 2 groups (hazard ratio 1.438, 95% confidence interval 0.844 to 2.449, p = 0.181). In asymptomatic subjects, those matched with DM have more subclinical atherosclerosis, mainly confined to non-high-risk CAD, than those matched without DM, and there are no differences in high-risk CAD and clinical outcomes.
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Affiliation(s)
- Gyung-Min Park
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sung-Cheol Yun
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Eun Ha Gil
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Tae-Seok Kim
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chan Joon Kim
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jung Sun Cho
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Mahn-Won Park
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Sung Ho Her
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Koh
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Je Lee
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seon Kim
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Up Lee
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- The Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- The Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong-Yeol Park
- Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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46
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Bom MJ, van der Zee PM, Cornel JH, van der Zant FM, Knol RJJ. Diagnostic and Therapeutic Usefulness of Coronary Computed Tomography Angiography in Out-Clinic Patients Referred for Chest Pain. Am J Cardiol 2015; 116:30-6. [PMID: 25933737 DOI: 10.1016/j.amjcard.2015.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Coronary computed tomography angiography (CCTA) is widely used to exclude coronary artery disease (CAD) in patients with low-to-intermediate pretest probability (PTP) of obstructive CAD. The aim of our study was to investigate the reclassification by CCTA and the implications of CCTA results on management because limited studies exist on these subjects; 1,560 patients with chest pain without a history of CAD and with low or intermediate PTP of CAD referred for CCTA from the out-patient clinic were prospectively included. PTP was defined by the Duke Clinical Score as either low (<15%), low-intermediate (15% to 50%), or high-intermediate (50% to 85%). Distribution of CCTA results among the categories of PTP of CAD and the influence of CCTA results on management were analyzed. CCTA revealed obstructive CAD in 7%, 15%, and 23% of cases, in patients with low, low-intermediate, and high-intermediate PTP, respectively; 855 of 1,031 patients (83%) with intermediate PTP of CAD showed no obstructive CAD on CCTA and were consequently reclassified. Management changes after CCTA occurred in 689 patients (44%). In 633 patients (41%), medication was altered and 135 (9%) were referred for invasive coronary angiography. Treatment with statin was initiated in 442 (28%) and stopped in 71 patients (5%). Aspirin was initiated in 192 (12%) and stopped in 139 patients (9%). In conclusion, in a routine clinical cohort, CCTA resulted in reclassification in most patients. Furthermore, our study suggests that the Duke Clinical Score overestimates the probability of obstructive CAD compared with CCTA findings. Finally, CCTA results have implications on patient management, with medication changes in 41% of patients.
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Affiliation(s)
- Michiel J Bom
- Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
| | | | - Jan H Cornel
- Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Friso M van der Zant
- Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands
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47
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Marwick TH, Cho I, Ó Hartaigh B, Min JK. Finding the Gatekeeper to the Cardiac Catheterization Laboratory: Coronary CT Angiography or Stress Testing? J Am Coll Cardiol 2015; 65:2747-56. [PMID: 26112200 PMCID: PMC4618380 DOI: 10.1016/j.jacc.2015.04.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022]
Abstract
Functional capacity is a robust predictor of clinical outcomes, and stress testing is used in current practice paradigms to guide referral to invasive coronary angiography. However, invasive coronary angiography is driven by ongoing symptoms, as well as risk of adverse outcomes. The limitations of current functional testing-based paradigms might be avoided by using coronary computed tomographic angiography (CCTA) for exclusion of obstructive coronary artery disease. The growth of CCTA has been supported by comparative prognostic evidence with CCTA and functional testing, as well as radiation dose reduction. Use of CCTA for physiological evaluation of coronary lesion-specific ischemia may facilitate evaluation of moderate stenoses, designation of the culprit lesion, and prediction of benefit from revascularization. The potential of CCTA to serve as an effective gatekeeper to invasive coronary angiography will depend, in part, on the adoption of these new developments, as well as definition of the benefit of detecting high-risk plaque for guiding the management of selected patients.
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Affiliation(s)
- Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Iksung Cho
- Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
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48
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Thomas DM, Divakaran S, Villines TC, Nasir K, Shah NR, Slim AM, Blankstein R, Cheezum MK. Management of Coronary Artery Calcium and Coronary CTA Findings. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015; 8:18. [PMID: 25960825 PMCID: PMC4412516 DOI: 10.1007/s12410-015-9334-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient's risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings.
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Affiliation(s)
- Dustin M. Thomas
- />Department of Medicine (Cardiology Service), San Antonio Military Medical Center, San Antonio, TX USA
| | - Sanjay Divakaran
- />Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Todd C. Villines
- />Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Khurram Nasir
- />Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL USA
| | - Nishant R. Shah
- />Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Ahmad M. Slim
- />Department of Medicine (Cardiology Service), San Antonio Military Medical Center, San Antonio, TX USA
| | - Ron Blankstein
- />Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Michael K. Cheezum
- />Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Boston, MA USA
- />Non-invasive Cardiovascular Imaging Program, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA
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49
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Bilbey N, Blanke P, Leipsic J. Dual-Energy CT of the Heart: Current State and Future Prospects. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0089-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Park GM, An H, Lee SW, Cho YR, Gil EH, Her SH, Kim YH, Lee CW, Koh EH, Lee WJ, Kim MS, Lee KU, Kang JW, Lim TH, Park SW, Park SJ, Park JY. Risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes. Medicine (Baltimore) 2015; 94:e508. [PMID: 25634204 PMCID: PMC4602974 DOI: 10.1097/md.0000000000000508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
No model has been developed to predict significant coronary artery disease (CAD) on coronary computed tomographic angiography (CCTA) in asymptomatic type 2 diabetes. Therefore, we sought to develop a model for the prediction of significant CAD on CCTA in these patients. We analyzed 607 asymptomatic patients with type 2 diabetes who underwent CCTA. The cardiac event was defined as a composite of cardiac death, nonfatal myocardial infarction, acute coronary syndrome, and coronary revascularization. Significant CAD (diameter stenosis ≥50%) in at least one coronary artery on CCTA was observed in 188 (31.0%). During the follow-up period (median 4.3 [interquartile range, 3.7-4.8] years), 71 patients had 83 cardiac events. Clinical risk factors for significant CAD were age, male gender, duration of diabetes, hypertension, current smoking, family history of premature CAD, previous history of stroke, ratio of total cholesterol to high-density lipoprotein cholesterol, and neuropathy. Using these variables, we formulated a risk score model, and the scores ranged from 0 to 17 (area under the curve = 0.727, 95% confidence interval = 0.714-0.739, P < 0.001). Patients were categorized into low (≤3), intermediate (4-6), or high (≥7) risk group. There were significant differences between the risk groups in the probability of significant CAD (12.6% vs 29.4% vs 57.7%, P for all < 0.001) and 5-year cardiac event-free survival rate (96.6% ± 1.5% vs 88.9% ± 1.8% vs 73.8% ± 4.1%, log-rank P for trend < 0.001). This model predicts significant CAD on CCTA and has the potential to identify asymptomatic type 2 diabetes with high risk.
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Affiliation(s)
- Gyung-Min Park
- From the Department of Cardiology (G-MP, EHG, SHH), Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Daejeon; Department of Biostatistics (HA), College of Medicine, Korea University; Departments of Cardiology (S-WL, Y-HK, CWL, S-WP, S-JP); Endocrinology (EHK, WJL, M-SK, K-UL, J-YP); Radiology (J-WK, T-HL), Asan Medical Center, College of Medicine, University of Ulsan, Seoul; and Department of Cardiology (Y-RC), Dong-A University hospital, Busan, Korea
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