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Hamimi AH, Ghanem AM, Hannah-Shmouni F, Elgarf RM, Matta JR, Gharib AM, Abd-Elmoniem KZ. Ascending Aorta 4D Time to Peak Distention Sexual Dimorphism and Association with Coronary Plaque Burden Severity in Women. J Cardiovasc Transl Res 2024; 17:298-307. [PMID: 37556037 DOI: 10.1007/s12265-023-10422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Coronary artery disease (CAD) risk and plaque scores are often subjective and biased, particularly in mid-age asymptomatic women, whose CAD risk assessment has been historically underestimated. In this study, a new automatic ascending aorta time-to-peak-distention (TPD) analysis was developed for fast screening and as an independent surrogate for subclinical atherosclerosis in asymptomatic women. CCTA was obtained in 50 asymptomatic adults. Plaque burden segment involvement score (SIS) and automatic TPD were obtained from all subjects. Logistic regression analyses were performed to investigate the association between CAD risk scores and TPD with severe coronary plaque burden (SIS>5). TPD, individually, was found to be a significant predictor of SIS>5. Additionally, sex was a significant effect modifier of TPD, with a stronger statistically significant association with women. Four-dimensional aortic time-to-peak distention could supplement conventional CCTA analysis and offer a quick objective screening tool for plaque burden severity and CAD risk stratification, especially in women.
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Affiliation(s)
- Ahmed H Hamimi
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Fady Hannah-Shmouni
- Internal Medicine, Endocrinology, and Genetics, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Reham M Elgarf
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Jatin R Matta
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
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Otsuka K, Ishikawa H, Yamaura H, Hojo K, Kono Y, Shimada K, Kasayuki N, Fukuda D. Thoracic Aortic Plaque Burden and Prediction of Cardiovascular Events in Patients Undergoing 320-row Multidetector CT Coronary Angiography. J Atheroscler Thromb 2024; 31:273-287. [PMID: 37704429 PMCID: PMC10918031 DOI: 10.5551/jat.64251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/20/2023] [Indexed: 09/15/2023] Open
Abstract
AIM Wide volume scan (WVS) coronary computed tomography angiography (CCTA) enables aortic arch visualization. This study assessed whether the thoracic aortic plaque burden (TAPB) score can predict major cardiovascular adverse events (MACE) in addition to and independently of other obstructive coronary artery disease (CAD) attributes. METHODS This study included patients with suspected CAD who underwent CCTA (n=455). CCTA-WVS was used to assess CAD and the prognostic capacity of TAPB scores. Data analysis included the coronary artery calcification score (CACS), CAD status and extent, and TAPB score, calculated as the sum of plaque thickness and plaque angle at five thoracic aortic segments. The primary endpoint was MACE defined as a composite event comprised of ischemic stroke, acute coronary syndrome, and cardiovascular death. RESULTS During a mean follow-up period of 2.8±0.9 years, 40 of 455 (8.8%) patients experienced MACE. In the Cox proportional hazards model adjusted for clinical risks (Suita cardiovascular disease risk score), we identified TAPB score (T3) as a predictor of MACE independent of CACS >400 (hazards ratio [HR], 2.91; 95% confidence interval [CI], 1.26-6.72; p=0.012) or obstructive CAD (HR, 2.83; 95% CI, 1.30-6.18; p=0.009). The area under the curve for predicting MACE improved from 0.75 to 0.795 (p value=0.008) when TAPB score was added to CACS >400 and obstructive CAD. CONCLUSIONS We found that comprehensive non-invasive evaluation of TAPB and CAD has prognostic value in MACE risk stratification for suspected CAD patients undergoing CCTA.
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Affiliation(s)
- Kenichiro Otsuka
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Hirotoshi Ishikawa
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Hiroki Yamaura
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Kana Hojo
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Yasushi Kono
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Kenei Shimada
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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3
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Huang W, Liu X, Cheng P, Li Y, Zhou H, Liu Y, Dong Y, Wang P, Xu C, Xu X. Prognostic value of plaque volume combined with CT fractional flow reserve in patients with suspected coronary artery disease. Clin Radiol 2023; 78:e1048-e1056. [PMID: 37788967 DOI: 10.1016/j.crad.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023]
Abstract
AIM To investigate the prognostic value of quantitative plaque volume on coronary computed tomography (CT) angiography (CTA) combined with CT fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE) in suspected coronary artery disease (CAD) patients. MATERIALS AND METHODS Patients who underwent coronary CTA with clinically suspected CAD were enrolled retrospectively in this study. Patients' baseline, Framingham Risk Score (FRS), coronary CTA plaque assessment, and CT-FFR were analysed retrospectively. Study outcomes included rehospitalisation and MACE (ST-segment elevation myocardial infarction, unstable angina, or non-ST-segment elevation myocardial infarction, revascularisation, and cardiac death). RESULTS There were 251 patients in the study, with a follow-up period of 1-6.58 years. Mean age was 61.16 ± 10.45 years and 146 (58%) patients were male. Higher CT-adapted Leaman score and quantitative plaque volume were found in patients with FRS >0.2 regardless of categorical or continuous variables. Coronary scores, quantitative plaque parameters, and CT-FFR were associated with MACE and rehospitalisation in univariate analysis. In model 1, CT-FFR was associated with MACE in multivariate Cox analysis when adjusted for FRS and CT-adapted Leaman score. Quantitative plaque parameters including calcified plaque volume, fibro-fatty plaque volume, low-attenuation plaque volume, non-calcified plaque volume, and total plaque volume were significantly associated with MACE and improved overall prognostic performance in a model adjusted for CT-FFR. CONCLUSION Additional quantitative plaque volume and CT-FFR further improve the predictive incremental value based on risk factor scores for prognostic prediction in patients. Adding quantitative plaque volume combined with CT-FFR analysis to anatomical and clinical assessment will be further beneficial to predict patients' prognosis of MACE.
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Affiliation(s)
- W Huang
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - X Liu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - P Cheng
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan 430022, China
| | - H Zhou
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Liu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Dong
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - P Wang
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - C Xu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 1037 Luoyu Road, Hongshan District, Wuhan 430070, China
| | - X Xu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China.
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Park S, Jeon YJ, Ann SH, Kim YG, Lee Y, Choi SH, Han S, Park GM. Comprehensive Prediction of Subclinical Coronary Atherosclerosis in Subjects Without Traditional Cardiovascular Risk Factors. Am J Cardiol 2023; 198:64-71. [PMID: 37201233 DOI: 10.1016/j.amjcard.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
It is not uncommon for asymptomatic individuals without identified cardiovascular risk factors to present with atherosclerosis-related adverse events. We aimed to evaluate the predictors of subclinical coronary atherosclerosis in individuals without traditional cardiovascular risk factors. We analyzed 2,061 individuals without identified cardiovascular risk factors who voluntarily underwent coronary computed tomography angiography as part of a general health examination. Subclinical atherosclerosis was defined as the presence of any coronary plaque. Of 2,061 individuals, subclinical atherosclerosis was observed in 337 individuals (16.4%). Clinical variables, such as age, gender, body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were significantly associated with subclinical coronary atherosclerosis. The participants were randomly split into train and validation data sets. In the train set, a prediction model using 6 variables with optimal cutoffs (age >53 years for men and >55 years for women, gender, BMI >22 kg/m2, SBP >120 mm Hg, HDL-C <55 mg/100 ml, and LDL-C >130 mg/100 ml) was derived (area under the curve 0.780, 95% confidence interval 0.751 to 0.809, goodness-of-fit p = 0.693). In the validation set, this model performed well (area under the curve 0.792, 95% confidence interval 0.726 to 0.858, goodness-of-fit p = 0.073). In conclusion, together with nonmodifiable risk factors, such as age and gender, modifiable variables, such as BMI, SBP, LDL-C, and HDL-C, were shown to be associated with subclinical coronary atherosclerosis, even at currently acceptable levels. These results suggest that stricter control of BMI, blood pressure, and cholesterol might be helpful in the primary prevention of future coronary events.
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Affiliation(s)
| | | | | | | | | | - Seong Hoon Choi
- Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.
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Mohammadi T, Mohammadi B. The long-term prognostic value provided by Coronary CT angiography. Eur J Intern Med 2023; 107:37-45. [PMID: 36328870 DOI: 10.1016/j.ejim.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Risk-stratification of patients has a major role in the prevention and treatment of cardiovascular disease. The aim was to find the most informative predictors of cardiovascular events in patients undergoing Coronary CT Angiography. METHODS We carried out a secondary analysis of a large registry dataset. The included population comprises adults aged 18 or older who underwent Coronary CT Angiography of 64-detector rows or greater. We clustered patients based on their characteristics and compared the risk for poor clinical outcomes between the two clusters. RESULTS There were two clusters of patients having different risks for all-cause death, myocardial infarction, and late revascularization [hazard ratios (95%CI) = 2.28 (2.02, 2.57), 1.63 (1.40, 1.89), and 2.46 (2.1, 2.88), all P < 0.001]. The severity of stenosis in the left main coronary artery adjusted for age and sex was the most significant predictor of the high-risk cluster [adjusted odds ratio (95%CI) = 3.35 (2.98, 3.77), P < 0.001]. The severity of stenosis in the first obtuse marginal branch of the left circumflex, distal left circumflex, distal left anterior descending, posterior descending, the first diagonal branch of the left anterior descending, and proximal right coronary artery were important as well (all adjusted odds ratios ≥ 2.52). Cluster profiling showed a higher performance for CT Angiography features (sensitivity = 97.4%, specificity = 85.7%, C-statistic = 98.7%) than calcium, Framingham, and Duke scores in identifying high-risk patients (C-statistic = 82.1, 77.0, and 88.2%, respectively). CONCLUSION Coronary CT Angiography can accurately risk-stratify patients concerning poor clinical outcomes.
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Affiliation(s)
- Tanya Mohammadi
- The University of Tehran, College of Science, School of Mathematics, Statistics, and Computer Science, Tehran, Iran.
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6
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Zuo Y, Han X, Tian X, Chen S, Wu S, Wang A. Association of Impaired Fasting Glucose With Cardiovascular Disease in the Absence of Risk Factor. J Clin Endocrinol Metab 2022; 107:e1710-e1718. [PMID: 34748624 DOI: 10.1210/clinem/dgab809] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The association between impaired fasting glucose and cardiovascular disease (CVD) in participants without atherosclerotic CVD (ASCVD) risk factors based on current definitions is unclear. The study aimed to examine the association of fasting glucose levels with CVD and its subtypes in persons without ASCVD risk factors. METHODS This study included 38 297 participants [men 62.1%; mean age 47.9 (12.9) years] who were free of a history of CVD and absent of ASCVD risk factors and had a fasting plasma glucose (FPG) level between 70 to 125 mg/dL at baseline from Kailuan Study during 2006 and 2007. Participants were followed until new-onset CVD event, death, or December 31, 2017. Cox proportional hazards models were performed to evaluate the associations. RESULTS During a median follow-up of 11.0 years (interquartile range 10.7-11.2 years), we observed 1217 incident CVD events. Compared with participants with FPG 70 to 99 mg/dL, the multivariable adjusted hazard ratios for CVD among participants with FPG 100 to 109 mg/dL and 110 to 125 mg/dL were 1.18 (95% CI 1.02-1.38) and 1.27 (95% CI 1.03-1.55), respectively. Multivariable-adjusted spline regression model showed a J-shaped association between FPG and the risk of CVD. CONCLUSIONS We found that among individuals without diabetes or other traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing abnormal FPG levels. These results highlight the importance of primordial prevention for FPG level increases along with other traditional ASCVD risk factors.
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Affiliation(s)
- Yingting Zuo
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xinsheng Han
- Department of Neurology, Kai Feng Central Hospital, Kaifeng, China
| | - Xue Tian
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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7
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Unbiased plasma proteomics discovery of biomarkers for improved detection of subclinical atherosclerosis. EBioMedicine 2022; 76:103874. [PMID: 35152150 PMCID: PMC8844841 DOI: 10.1016/j.ebiom.2022.103874] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023] Open
Abstract
Background Imaging of subclinical atherosclerosis improves cardiovascular risk prediction on top of traditional risk factors. However, cardiovascular imaging is not universally available. This work aims to identify circulating proteins that could predict subclinical atherosclerosis. Methods Hypothesis-free proteomics was used to analyze plasma from 444 subjects from PESA cohort study (222 with extensive atherosclerosis on imaging, and 222 matched controls) at two timepoints (three years apart) for discovery, and from 350 subjects from AWHS cohort study (175 subjects with extensive atherosclerosis on imaging and 175 matched controls) for external validation. A selected three-protein panel was further validated by immunoturbidimetry in the AWHS population and in 2999 subjects from ILERVAS cohort study. Findings PIGR, IGHA2, APOA, HPT and HEP2 were associated with subclinical atherosclerosis independently from traditional risk factors at both timepoints in the discovery and validation cohorts. Multivariate analysis rendered a potential three-protein biomarker panel, including IGHA2, APOA and HPT. Immunoturbidimetry confirmed the independent associations of these three proteins with subclinical atherosclerosis in AWHS and ILERVAS. A machine-learning model with these three proteins was able to predict subclinical atherosclerosis in ILERVAS (AUC [95%CI]:0.73 [0.70–0.74], p < 1 × 10−99), and also in the subpopulation of individuals with low cardiovascular risk according to FHS 10-year score (0.71 [0.69–0.73], p < 1 × 10−69). Interpretation Plasma levels of IGHA2, APOA and HPT are associated with subclinical atherosclerosis independently of traditional risk factors and offers potential to predict this disease. The panel could improve primary prevention strategies in areas where imaging is not available.
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8
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Martins AMA, Paiva MUB, Paiva DVN, de Oliveira RM, Machado HL, Alves LJSR, Picossi CRC, Faccio AT, Tavares MFM, Barbas C, Giraldez VZR, Santos RD, Monte GU, Atik FA. Innovative Approaches to Assess Intermediate Cardiovascular Risk Subjects: A Review From Clinical to Metabolomics Strategies. Front Cardiovasc Med 2021; 8:788062. [PMID: 35004898 PMCID: PMC8727773 DOI: 10.3389/fcvm.2021.788062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022] Open
Abstract
Current risk stratification strategies for coronary artery disease (CAD) have low predictive value in asymptomatic subjects classified as intermediate cardiovascular risk. This is relevant because not all coronary events occur in individuals with traditional multiple risk factors. Most importantly, the first manifestation of the disease may be either sudden cardiac death or acute coronary syndrome, after rupture and thrombosis of an unstable non-obstructive atherosclerotic plaque, which was previously silent. The inaccurate stratification using the current models may ultimately subject the individual to excessive or insufficient preventive therapies. A breakthrough in the comprehension of the molecular mechanisms governing the atherosclerosis pathology has driven many researches toward the necessity for a better risk stratification. In this Review, we discuss how metabolomics screening integrated with traditional risk assessments becomes a powerful approach to improve non-invasive CAD subclinical diagnostics. In addition, this Review highlights the findings of metabolomics studies performed by two relevant analytical platforms in current use-mass spectrometry (MS) hyphenated to separation techniques and nuclear magnetic resonance spectroscopy (NMR) -and evaluates critically the challenges for further clinical implementation of metabolomics data. We also discuss the modern understanding of the pathophysiology of atherosclerosis and the limitations of traditional analytical methods. Our aim is to show how discriminant metabolites originated from metabolomics approaches may become promising candidate molecules to aid intermediate risk patient stratification for cardiovascular events and how these tools could successfully meet the demands to translate cardiovascular metabolic biomarkers into clinical settings.
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Affiliation(s)
- Aline M. A. Martins
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
- School of Medicine, University of Brasilia, Brasilia, Brazil
- School of Medicine, University Center of Brasilia (UniCeub), Brasilia, Brazil
| | | | | | | | - Henrique L. Machado
- School of Medicine, University Center of Brasilia (UniCeub), Brasilia, Brazil
| | | | - Carolina R. C. Picossi
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Andréa T. Faccio
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Marina F. M. Tavares
- Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil
| | - Coral Barbas
- Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain
| | - Viviane Z. R. Giraldez
- Lipid Clinic, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Raul D. Santos
- Lipid Clinic, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Guilherme U. Monte
- Department of Heart Transplant, Federal District Institute of Cardiology (ICDF), Brasilia, Brazil
| | - Fernando A. Atik
- School of Medicine, University of Brasilia, Brasilia, Brazil
- Department of Heart Transplant, Federal District Institute of Cardiology (ICDF), Brasilia, Brazil
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9
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Chow BJW, Yam Y, Small G, Wells GA, Crean AM, Ruddy TD, Hossain A. Prognostic durability of coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:331-338. [PMID: 33111135 DOI: 10.1093/ehjci/jeaa196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/17/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS This large prospective cohort study sought to confirm the incremental prognostic value of coronary computed tomographic angiography (CCTA) measured over a prolonged follow-up duration. CCTA has diagnostic and prognostic value but data supporting its long-term prognostic value in a large prospectively recruited cohort with suspected coronary artery disease (CAD) has been limited. METHODS AND RESULTS Consecutive patients (without history of myocardial infarction, revascularization, cardiac transplantation, and congenital heart disease) were prospectively enrolled. CCTA was evaluated for CAD severity, total plaque score (TPS), and left ventricular ejection fraction. Patients were followed for major adverse events (MAE) and major adverse cardiac events (MACE).Over a total of 99 months, 8667 consecutive CCTA patients (mean age = 57.1 ± 11.1 years, 52.9% men) were prospectively enrolled and followed for a mean duration of 7.0 ± 2.6 years. At follow-up, there were a total of 723 MAE, 278 MACE, 547 all-cause deaths, 110 cardiac deaths, and 104 non-fatal myocardial infarction. Patients without coronary atherosclerosis at the time of CCTA had a very low annual event rate for both MAE and MACE (0.45%/year and 0.19%/year, respectively). Both MAE and MACE increased with increasing TPS and severity of CAD. In patients with non-obstructive CAD and who were statin-naive, TPS ≥5 had MACE rates >0.75%/year. Patients with high-risk CAD had an annual MAE and MACE rates of 3.52%/year and 2.58%/year, respectively. Adjusted hazard ratio of the severity of CAD based on multivariable analyses indicated that the prognostic values were incremental. CONCLUSION CCTA has independent and incremental prognostic value that is durable over time. The absence of coronary atherosclerosis portends an excellent prognosis. Patients with increasing non-obstructive plaque burden have worse prognosis and a TPS threshold ≥5 may identify a population that may benefit from statin therapy.
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Affiliation(s)
- Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Gary Small
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Andrew M Crean
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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10
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Novo S, Diana D, Tomasino C, Zambelli G, Mignano A, Scalmato A, Maniscalco L, Galassi A, Matranga D, Novo G. Electrocardiographic abnormalities, preclinical carotid atherosclerosis andcardiovascular risk, in an apparently healthy real-world population: data from the project "No Stroke, No Infarction" of the rotary international - District 2110 "Sicily & Malta". INT ANGIOL 2021; 40:470-477. [PMID: 34282855 DOI: 10.23736/s0392-9590.21.04637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) represent important causes of morbidity and mortality. Our study aimed to evaluate cardiovascular risk using the EUROSCORE, ECG and carotid ultrasound for prevention purpose in a 50-70 years population and companions asymptomatic and without CVD. METHODS History of CVD, risk factors (RFs), ECG and carotid ultrasound were evaluated. Intima-media thickness (IMT) was defined as wall thickness > 0.9 mm, while focal thickening ≥ 1.5 mm protruding into the lumen as asymptomatic carotid plaque (ACP). RESULTS Totally, 1860 subjects were screened. 393 (21.1%) had no RFs, 780 (42%) hypertension, 571 (30.7%) hypercholesterolemia, 557 (29.9%) diabetes, 474 (25.5%) smoking, 648 (34.8%) overweight, 300 (16.1%) obesity and 184 (9.9%) metabolic syndrome. Carotid atherosclerosis was detected in 903 (48.5%) subjects, 821 (44.1%) had IMT and 547 (29.4%) ACP, and was significantly related to diabetes, hypertension and hypercholesterolemia. Atrial fibrillation was found in 29 subjects (1.6%) and Brugada pattern in one. Using EUROSCORE, 220 subjects resulted at low (11.8%), 1338 at moderate (71.9%), 292 at high (15.7%) and 10 at very-high risk (0.5%). Adding ACP, the percentages were: low 159 (8,54%), moderate 1020 (54,83%), high 663 (35,64%) and very-high risk 18 (0,96%). CONCLUSIONS A total of 302 (16.2%) subjects were at least at high risk for CV events according to the EUROSCORE, increasing to 681 (36,61% - p < 0.001) adding ACP. The combination of EUROSCORE with ECG may help to stratify CV risk in primary prevention. Carotid ultrasound furtherly increases the power of stratification of asymptomatic patients suitable for pharmacological treatment.
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Affiliation(s)
- Salvatore Novo
- School of Medicine, University of Palermo, Palermo, Italy - .,Paolo Giaccone University Hospital, Palermo, Italy - .,International School of Cardiology, Ettore Majorana Foundation and Center for Scientific Culture, Erice, Trapani, Italy -
| | - Davide Diana
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Claudio Tomasino
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giulia Zambelli
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Antonino Mignano
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Andrea Scalmato
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Laura Maniscalco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Alfredo Galassi
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Domenica Matranga
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
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11
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Ibanez B, Fernández-Ortiz A, Fernández-Friera L, García-Lunar I, Andrés V, Fuster V. Progression of Early Subclinical Atherosclerosis (PESA) Study: JACC Focus Seminar 7/8. J Am Coll Cardiol 2021; 78:156-179. [PMID: 34238438 DOI: 10.1016/j.jacc.2021.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/24/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022]
Abstract
Atherosclerosis starts early in life and progresses silently for decades. Considering atherosclerosis as a "systemic disease" invites the use of noninvasive methodologies to detect disease in various regions before symptoms appear. The PESA-(Progression of Early Subclinical Atherosclerosis) CNIC-SANTANDER study is an ongoing prospective cohort study examining imaging, biological, and behavioral parameters associated with the presence and progression of early subclinical atherosclerosis. Between 2010 and 2014, PESA enrolled 4,184 asymptomatic middle-aged participants who undergo serial 3-yearly follow-up examinations including clinical interviews, lifestyle questionnaires, sampling, and noninvasive imaging assessment of multiterritorial subclinical atherosclerosis (carotids, iliofemorals, aorta, and coronaries). PESA tracks the trajectories of atherosclerosis and associated disorders from early stages to the transition to symptomatic phases. A joint venture between the CNIC and the Santander Bank, PESA is expected to run until at least 2029, and its significant contributions to date are presented in this review paper.
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Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Universitario HM Montepríncipe-CIEC, Universidad San Pablo CEU, Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Vicente Andrés
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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12
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Abstract
Targeting residual cardiovascular risk in primary and secondary prevention, would allow deployment of novel therapeutic agents, facilitating precision medicine. For example, lowering vascular inflammation is a promising strategy to reduce the residual inflammatory cardiovascular risk in patients already receiving optimal medical therapy, but prescribing novel anti-inflammatory treatments will be problematic due to the lack of specific companion diagnostic tests, to guide their targeted use in clinical practice. Currently available tests for the detection of coronary inflammation are either non-specific for the cardiovascular system (e.g. plasma biomarkers) or expensive and not readily available (e.g. hybrid positron emission tomography imaging). Recent technological advancements in coronary computed tomography angiography (CCTA) allow non-invasive detection of high-risk plaque features (positive remodelling, spotty calcification, low attenuation plaque, and napkin-ring sign) and help identify the vulnerable patient, but they provide only indirectly information about coronary inflammation. Perivascular fat attenuation index (FAI), a novel method for assessing coronary inflammation by analysing routine CCTA, captures changes in the perivascular adipose tissue composition driven by inflammatory signals coming from the inflamed coronary artery, by analysing the three-dimensional gradients of perivascular attenuation, followed by adjustments for technical, anatomical, and biological factors. By detecting vascular inflammation, perivascular FAI enhances cardiovascular risk discrimination which could aid more cost-effective deployment of novel therapeutic agents. In this article, we present the existing non-invasive modalities for the detection of coronary inflammation and provide a practical guide for their use in clinical practice.
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Affiliation(s)
- Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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13
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Koulouri A, Darioli R, Dine Qanadli S, Katz E, Eeckhout E, Mazzolai L, Depairon M. The atherosclerosis burden score. VASA 2021; 50:280-285. [PMID: 33789435 DOI: 10.1024/0301-1526/a000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). Patients and methods: This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Results: Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). Conclusions: ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.
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Affiliation(s)
| | - Roger Darioli
- Lipid and Cardiovascular Prevention Unit, University Hospital CHUV, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Diagnostic and Interventional Radiology, University Hospital CHUV, Lausanne, Switzerland
| | - Eugène Katz
- Cardiology, University Hospital CHUV, Lausanne, Switzerland
| | - Eric Eeckhout
- Cardiology, University Hospital CHUV, Lausanne, Switzerland
| | - Lucia Mazzolai
- Angiology, University Hospital CHUV, Lausanne, Switzerland
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14
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Monocyte subtype counts are associated with 10-year cardiovascular disease risk as determined by the Framingham Risk Score among subjects of the LIFE-Adult study. PLoS One 2021; 16:e0247480. [PMID: 33647042 PMCID: PMC7920341 DOI: 10.1371/journal.pone.0247480] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Coronary heart disease, an inflammatory disease, is the leading cause of death globally. White blood cell counts (including monocytes) are easily available biomarkers of systemic inflammation. Monocyte subtypes can be measured by flow cytometry and classified into classical (CD14high, CD16neg), intermediate (CD14high, CD16+) and non-classical (CD14+, CD16high) with distinct functional properties. The goal of this study was to investigate the association of monocyte total count and its subtypes with cardiovascular risk groups defined by the Framingham Risk Score, which is used to estimate the 10-year risk of developing myocardial infarction or predict mortality following coronary heart disease. We also aimed to investigate whether monocyte counts are associated with relevant cardiovascular risk factors not included in the Framingham Risk Score, such as carotid atherosclerotic plaque and intima-media thickness. Our data came from the LIFE-Adult study, a population-based cohort study of 10,000 randomly selected participants in Leipzig, Germany. Data was gathered using self-administered questionnaires and physical examinations. Carotid plaques and intima-media thickness were measured using carotid artery sonography. Monocyte subtypes in blood were determined by 10-color flow cytometry for a total of 690 individuals. In a multivariate regression analysis adjusting for the risk factors BMI, intima-media thickness, presence of carotid plaques and diabetes mellitus, monocyte subtypes and total count were found to be significantly associated with the dichotomized Framingham Risk Score (≥10% versus <10%): Odds ratios [95% confidence interval] for monocyte subtypes: classical: 11.19 [3.79–34.26]; intermediate: 2.27 [1.11–4.71]; non-classical: 4.18 [1.75–10.20]; total: 14.59 [4.61–47.95]. In absence of prospective data, the FRS was used as a surrogate for CHD. Our results indicate that monocyte counts could provide useful predictive value for cardiovascular disease risk.
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15
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Coronary CT Angiography Guided Medical Therapy in Subclinical Atherosclerosis. J Clin Med 2021; 10:jcm10040625. [PMID: 33562179 PMCID: PMC7914610 DOI: 10.3390/jcm10040625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
The goals of primary prevention in coronary atherosclerosis are to avoid sudden cardiac death, myocardial infarction or the need for revascularization procedures. Successful prevention will rely on accurate identification, effective therapy and monitoring of those at risk. Identification and potential monitoring can be achieved using cardiac computed tomography (CT). Cardiac CT can determine coronary artery calcification (CAC), a useful surrogate of coronary atherosclerosis burden. Cardiac CT can also assess coronary CT angiography (CCTA). CCTA can identify arterial lumen narrowing and highlight mural atherosclerosis hitherto hidden from other anatomical approaches. Herein we consider the role of CCTA and CAC-scoring in subclinical atherosclerosis. We explore the use of these modalities in screening and discuss data that has used CCTA for guiding primary prevention. We examine therapeutic trials using CCTA to determine the effects of plaque-modifying therapies. Finally, we address the role of CCTA and CAC to guide therapy as defined in current primary prevention documents. CCTA has emerged as an essential tool in the detection and management of clinical coronary artery disease. To date, its role in subclinical atherosclerosis is less well defined, yet with modern CT scanners and continued pharmacotherapy development, CCTA is likely to achieve a more prominent place in the primary prevention of coronary atherosclerosis.
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16
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Whelton SP, McEvoy JW, Shaw L, Psaty BM, Lima JAC, Budoff M, Nasir K, Szklo M, Blumenthal RS, Blaha MJ. Association of Normal Systolic Blood Pressure Level With Cardiovascular Disease in the Absence of Risk Factors. JAMA Cardiol 2021; 5:1011-1018. [PMID: 32936272 DOI: 10.1001/jamacardio.2020.1731] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance The risk of atherosclerotic cardiovascular disease (ASCVD) at currently defined normal systolic blood pressure (SBP) levels in persons without ASCVD risk factors based on current definitions is not well defined. Objective To examine the association of SBP levels with coronary artery calcium and ASCVD in persons without hypertension or other traditional ASCVD risk factors based on current definitions. Design, Setting, and Participants A cohort of 1457 participants free of ASCVD from the Multi-Ethnic Study of Atherosclerosis who were without dyslipidemia (low-density lipoprotein cholesterol level ≥160 mg/dL or high-density lipoprotein cholesterol level <40 mg/dL), diabetes (fasting glucose level ≥126 mg/dL), treatment for hyperlipidemia or diabetes, or current tobacco use, and had an SBP level between 90 and 129 mm Hg. Participants receiving hypertension medication were excluded. Coronary artery calcium was classified as absent or present and adjusted hazard ratios (aHRs) were calculated for incident ASCVD. The study was conducted from March 27, 2018, to February 12, 2020. Exposures Systolic blood pressure. Main Outcomes and Measures Presence or absence of coronary artery calcium and incident ASCVD events. Results Of the 1457 participants, 894 were women (61.4%); mean (SD) age was 58.1 (9.8) years and mean (SD) follow-up was 14.5 (3.9) years. There was an increase in traditional ASCVD risk factors, coronary artery calcium, and incident ASCVD events with increasing SBP levels. The aHR for ASCVD was 1.53 (95% CI, 1.17-1.99) for every 10-mm Hg increase in SBP levels. Compared with persons with SBP levels 90 to 99 mm Hg, the aHR for ASCVD risk was 3.00 (95% CI, 1.01-8.88) for SBP levels 100 to 109 mm Hg, 3.10 (95% CI, 1.03-9.28) for SBP levels 110 to 119 mm Hg, and 4.58 (95% CI, 1.47-14.27) for SBP levels 120 to 129 mm Hg. Conclusions and Relevance Beginning at an SBP level as low as 90 mm Hg, there appears to be a stepwise increase in the presence of coronary artery calcium and the risk of incident ASCVD with increasing SBP levels. These results highlight the importance of primordial prevention for SBP level increase and other traditional ASCVD risk factors, which generally seem to have similar trajectories of graded increase in risk within values traditionally considered to be normal.
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Affiliation(s)
- Seamus P Whelton
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - John W McEvoy
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland.,National Institute for Preventive Cardiology and National University of Ireland, Galway Campus, Galway, Ireland
| | - Leslee Shaw
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, and Epidemiology, and Health Services, University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Khurram Nasir
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roger S Blumenthal
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
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17
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Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque. J Hypertens 2020; 39:1210-1220. [PMID: 33323910 DOI: 10.1097/hjh.0000000000002773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. MATERIALS AND METHODS We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. RESULTS Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. CONCLUSION Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. VIDEO ABSTRACT Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
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18
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Noz MP, Bekkering S, Groh L, Nielen TM, Lamfers EJ, Schlitzer A, El Messaoudi S, van Royen N, Huys EH, Preijers FW, Smeets EM, Aarntzen EH, Zhang B, Li Y, Bremmers ME, van der Velden WJ, Dolstra H, Joosten LA, Gomes ME, Netea MG, Riksen NP. Reprogramming of bone marrow myeloid progenitor cells in patients with severe coronary artery disease. eLife 2020; 9:60939. [PMID: 33168134 PMCID: PMC7665893 DOI: 10.7554/elife.60939] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is the major cause of cardiovascular disease (CVD). Monocyte-derived macrophages are the most abundant immune cells in atherosclerotic plaques. In patients with atherosclerotic CVD, leukocytes have a hyperinflammatory phenotype. We hypothesize that immune cell reprogramming in these patients occurs at the level of myeloid progenitors. We included 13 patients with coronary artery disease due to severe atherosclerosis and 13 subjects without atherosclerosis in an exploratory study. Cytokine production capacity after ex vivo stimulation of peripheral blood mononuclear cells (MNCs) and bone marrow MNCs was higher in patients with atherosclerosis. In BM-MNCs this was associated with increased glycolysis and oxidative phosphorylation. The BM composition was skewed towards myelopoiesis and transcriptome analysis of HSC/GMP cell populations revealed enrichment of neutrophil- and monocyte-related pathways. These results show that in patients with atherosclerosis, activation of innate immune cells occurs at the level of myeloid progenitors, which adds exciting opportunities for novel treatment strategies.
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Affiliation(s)
- Marlies P Noz
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Siroon Bekkering
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Laszlo Groh
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Tim Mj Nielen
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Evert Jp Lamfers
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Andreas Schlitzer
- Quantitative Systems Biology, Life & Medical Sciences Institute, University of Bonn, Single Cell Genomics and Epigenomics Unit at the German Center for Neurodegenerative Diseases and the University of Bonn, Bonn, Germany
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Erik Hjpg Huys
- Department of Laboratory Medicine - Laboratory for Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank Wmb Preijers
- Department of Laboratory Medicine - Laboratory for Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther Mm Smeets
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Erik Hjg Aarntzen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bowen Zhang
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine (CiiM) & TWINCORE, joint ventures between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Yang Li
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands.,Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine (CiiM) & TWINCORE, joint ventures between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Manita Ej Bremmers
- Department of Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Harry Dolstra
- Department of Laboratory Medicine - Laboratory for Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leo Ab Joosten
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands.,Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marc E Gomes
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands.,Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Niels P Riksen
- Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
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19
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Shahavandi M, Amini MR, Shahinfar H, Shab-Bidar S. Major dietary patterns and predicted cardiovascular disease risk in an Iranian adult population. Nutr Health 2020; 27:27-37. [PMID: 32867574 DOI: 10.1177/0260106020952591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Limited data are available on the association of major dietary patterns and predicted risk of cardiovascular disease (CVD) using the Framingham Risk Score (FRS). AIM To investigate the association between major dietary patterns and the predicted 10-year CVD risk in an Iranian population. METHODS This cross-sectional study was conducted on 522 apparently healthy adults referred to health centers in Tehran. Usual dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. The association between dietary patterns and the predicted risk of development of CVD was evaluated using linear multiple regression. Principal component analysis was used to identify major dietary patterns. RESULTS In total, 41% of the men (n = 95) and 46% of women (n = 134) were in the low risk (<10%) and 6% of men (n = 14) and 1% of women (n = 3) were in the high risk (> 20%) category of the FRS. A significant decrease was found for body mass index (p < 0.001), systolic blood pressure (SBP) (p = 0.003), diastolic blood pressure (p = 0.005), and triglyceride (p = 0.02) in the higher tertile of healthy dietary pattern. Adherence to an unhealthy dietary pattern was associated with a significant increase in body weight (p = 0.03) and a significant decrease in high-density lipoprotein cholesterol (p < 0.001). The healthy dietary pattern score was negatively associated with SBP (p = 0.04) and FRS (p < 0.001). CONCLUSION Although we observed improvements in CVD risk factors with greater adherence to healthy dietary patterns, there was no association between identified dietary patterns and the predicted risk of 10-year CVD.
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Affiliation(s)
- Mahshid Shahavandi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, 48439Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Mohammad Reza Amini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, 48439Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Hossein Shahinfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, 48439Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, 48439Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
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McPherson R. 2018 George Lyman Duff Memorial Lecture: Genetics and Genomics of Coronary Artery Disease: A Decade of Progress. Arterioscler Thromb Vasc Biol 2019; 39:1925-1937. [PMID: 31462092 PMCID: PMC6766359 DOI: 10.1161/atvbaha.119.311392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies have led to a broader understanding of the genetic architecture of coronary artery disease and demonstrate that it largely derives from the cumulative effect of multiple common risk alleles individually of small effect size rather than rare variants with large effects on coronary artery disease risk. The tools applied include genome-wide association studies encompassing over 200 000 individuals complemented by bioinformatic approaches including imputation from whole-genome data sets, expression quantitative trait loci analyses, and interrogation of ENCODE (Encyclopedia of DNA Elements), Roadmap Epigenetic Project, and other data sets. Over 160 genome-wide significant loci associated with coronary artery disease risk have been identified using the genome-wide association studies approach, 90% of which are situated in intergenic regions. Here, I will describe, in part, our research over the last decade performed in collaboration with a series of bright trainees and an extensive number of groups and individuals around the world as it applies to our understanding of the genetic basis of this complex disease. These studies include computational approaches to better understand missing heritability and identify causal pathways, experimental approaches, and progress in understanding at the molecular level the function of the multiple risk loci identified and potential applications of these genomic data in clinical medicine and drug discovery.
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Affiliation(s)
- Ruth McPherson
- From the Division of Cardiology, Atherogenomics Laboratory, Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada
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Krishnamoorthy P, Gupta S, Lu M, Friend EJ, Pressman GS. Usefulness of the Echocardiographic Calcium Score to Refine Risk of Major Adverse Cardiovascular Events Beyond the Traditional Framingham Risk Score. Am J Cardiol 2019; 123:392-395. [PMID: 30527772 DOI: 10.1016/j.amjcard.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/27/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Echocardiographic calcifications are associated with major adverse cardiovascular events (MACE). A recently described semiquantitative Global Cardiac Calcium Score (GCCS) has been associated with mortality and stroke, with increasing scores associated with increasing risk. This score assigns points for calcium in the aortic root and valve, mitral valve and annulus, and submitral apparatus, with additional points for restricted leaflet mobility. We tested the hypothesis that the GCCS could improve prediction of MACE beyond traditional risk scores. This was a retrospective study of 216 subjects from a general echocardiography database (mean age 59 ± 15; 51% male). Follow-up was 3.8 ± 1.7 years. The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) were applied to each patient. Mean GCCS was 3.2 ± 2. In the total cohort, GCCS predicted MACE (myocardial infarction, stroke, all-cause mortality), even after adjusting for FRS (odd ratio 1.19, p = 0.03). There were 106 subjects (49%) in the low-risk FRS group, 71 (33%) in the intermediate-risk group, and 39 (18%) in the high-risk group. GCCS ≥3 was associated with increased MACE (vs <3) in the low-risk group (p = 0.03), while GCCS <3 was associated with decreased MACE (vs ≥3) in the high-risk group (p = 0.04). When applied to the PCE risk estimate (dichotomized at <7.5% vs ≥7.5%) the GCCS similarly refined risk prediction. In conclusion, the semiquantitative GCCS appears to be a marker of additional unaccounted risk factors; it is easily applied and can further stratify risk of MACE beyond traditional FRS or PCE estimates.
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Cal-Gonzalez J, Li X, Heber D, Rausch I, Moore SC, Schäfers K, Hacker M, Beyer T. Partial volume correction for improved PET quantification in 18F-NaF imaging of atherosclerotic plaques. J Nucl Cardiol 2018; 25:1742-1756. [PMID: 28176255 PMCID: PMC6153866 DOI: 10.1007/s12350-017-0778-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate quantification of plaque imaging using 18F-NaF PET requires partial volume correction (PVC). METHODS PVC of PET data was implemented by the use of a local projection (LP) method. LP-based PVC was evaluated with an image quality (NEMA) and with a thorax phantom with "plaque-type" lesions of 18-36 mL. The validated PVC method was then applied to a cohort of 17 patients, each with at least one plaque in the carotid or ascending aortic arteries. In total, 51 calcified (HU > 110) and 16 non-calcified plaque lesions (HU < 110) were analyzed. The lesion-to-background ratio (LBR) and the relative change of LBR (ΔLBR) were measured on PET. RESULTS Following PVC, LBR of the spheres (NEMA phantom) was within 10% of the original values. LBR of the thoracic lesions increased by 155% to 440% when the LP-PVC method was applied to the PET images. In patients, PVC increased the LBR in both calcified [mean = 78% (-8% to 227%)] and non-calcified plaques [mean = 41%, (-9%-104%)]. CONCLUSIONS PVC helps to improve LBR of plaque-type lesions in both phantom studies and clinical patients. Better results were obtained when the PVC method was applied to images reconstructed with point spread function modeling.
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Affiliation(s)
- Jacobo Cal-Gonzalez
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria.
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Heber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria
| | - Stephen C Moore
- Division of Nuclear Medicine, Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Klaus Schäfers
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria
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Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age. Heart Vessels 2018; 33:1288-1300. [DOI: 10.1007/s00380-018-1188-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
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Chen S, Liu Y, Islam SMS, Yao H, Zhou Y, Chen JY, Li Q. A simple prediction model to estimate obstructive coronary artery disease. BMC Cardiovasc Disord 2018; 18:7. [PMID: 29338684 PMCID: PMC5771201 DOI: 10.1186/s12872-018-0745-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 01/10/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A simple noninvasive model to predict obstructive coronary artery disease (OCAD) may promote risk stratification and reduce the burden of coronary artery disease (CAD). This study aimed to develop pre-procedural, noninvasive prediction models that better estimate the probability of OCAD among patients with suspected CAD undergoing elective coronary angiography (CAG). METHODS We included 1262 patients, who had reliable Framingham risk variable data, in a cohort without known CAD from a prospective registry of patients referred for elective CAG. We investigated pre-procedural OCAD (≥50% stenosis in at least one major coronary vessel based on CAG) predictors. RESULTS A total of 945 (74.9%) participants had OCAD. The final modified Framingham scoring (MFS) model consisted of anemia, high-sensitivity C-reactive protein, left ventricular ejection fraction, and five Framingham factors (age, sex, total and high-density lipoprotein cholesterol, and hypertension). Bootstrap method (1000 times) revealed that the model demonstrated a good discriminative power (c statistic, 0.729 ± 0.0225; 95% CI, 0.69-0.77). MFS provided adequate goodness of fit (P = 0.43) and showed better performance than Framingham score (c statistic, 0.703 vs. 0.521; P < 0.001) in predicting OCAD, thereby identifying patients with high risks for OCAD (risk score ≥ 27) with ≥70% predictive value in 68.8% of subjects (range, 37.2-87.3% for low [≤17] and very high [≥41] risk scores). CONCLUSION Our data suggested that the simple MFS risk stratification tool, which is available in most primary-level clinics, showed good performance in estimating the probability of OCAD in relatively stable patients with suspected CAD; nevertheless, further validation is needed.
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Affiliation(s)
- Shiqun Chen
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100 China
- Guangdong General Hospital Zhuhai Hospital, Guangdong Academy of Medical Sciences, Zhuhai, 519000 China
- The George Institute for Global Health, University of Sydney, Camperdown, NSW 2050 Australia
| | - Yong Liu
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100 China
- The George Institute for Global Health, University of Sydney, Camperdown, NSW 2050 Australia
| | | | - Hua Yao
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100 China
| | - Yingling Zhou
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100 China
- Guangdong General Hospital Zhuhai Hospital, Guangdong Academy of Medical Sciences, Zhuhai, 519000 China
| | - Ji-yan Chen
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100 China
| | - Qiang Li
- The George Institute for Global Health, University of Sydney, Camperdown, NSW 2050 Australia
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? Rev Port Cardiol 2018; 37:77-85. [PMID: 29325803 DOI: 10.1016/j.repc.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
Regular physical exercise is responsible for various health benefits, and is recommended for primary and secondary cardiovascular (CV) prevention. Despite these recognized benefits, various clinical events can occur in athletes, including acute myocardial infarction and sudden cardiac death (SCD); the main cause of SCD in veteran athletes is coronary artery disease (CAD). The relationship between intense exercise training and CAD is controversial, and a U-shaped association has been hypothesized. If this is the case, screening for subclinical CAD in older athletes may be justified, and various different methodologies have been proposed. However, the methodology for screening veteran athletes is not consensual, and several markers of CAD, in addition to clinical CV risk factors, could improve risk stratification in this population. In the present paper we review the published data on CAD in athletes, focusing on the relationship between the dose of exercise and CAD, as well as the implications for pre-participation screening of veteran athletes.
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Affiliation(s)
- Hélder Dores
- Hospital das Forças Armadas, Lisbon, Portugal; Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal.
| | - Pedro de Araújo Gonçalves
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal; Hospital de Santa Cruz, CHLO, Lisbon, Portugal
| | - Nuno Cardim
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Nuno Neuparth
- NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fernández-Friera L, Fuster V, López-Melgar B, Oliva B, García-Ruiz JM, Mendiguren J, Bueno H, Pocock S, Ibáñez B, Fernández-Ortiz A, Sanz J. Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors. J Am Coll Cardiol 2017; 70:2979-2991. [PMID: 29241485 DOI: 10.1016/j.jacc.2017.10.024] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Absence of cardiovascular risk factors (CVRFs) is traditionally considered low risk for atherosclerosis; however, individuals without CVRFs, as currently defined, still have events. OBJECTIVES This study sought to identify predictors of subclinical atherosclerosis in CVRF-free individuals. METHODS Participants from the PESA (Progression of Early Subclinical Atherosclerosis) study (n = 4,184) without conventional CVRFs were evaluated (n = 1,779; 45.0 ± 4.1 years, 50.3% women). CVRF freedom was defined as no current smoking and untreated blood pressure <140/90 mm Hg, fasting glucose <126 mg/dl, total cholesterol <240 mg/dl, low-density lipoprotein cholesterol (LDL-C) <160 mg/dl, and high-density lipoprotein cholesterol ≥40 mg/dl. A subgroup with optimal CVRFs (n = 740) was also defined as having blood pressure <120/80 mm Hg, fasting glucose <100 mg/dl, glycosylated hemoglobin <5.7%, and total cholesterol <200 mg/dl. We evaluated ultrasound-detected carotid, iliofemoral, and abdominal aortic plaques; coronary artery calcification; serum biomarkers; and lifestyle. Adjusted odds ratios (with 95% confidence interval) and ordinal logistic regression models were used. RESULTS Subclinical atherosclerosis (plaque or coronary artery calcification) was present in 49.7% of CVRF-free participants. Together with male sex and age, LDL-C was independently associated with atherosclerosis presence and extent, in both the CVRF-free and CVRF-optimal groups (odds ratio [×10 mg/dl]: 1.14 to 1.18; p < 0.01 for all). Atherosclerosis presence and extent was also associated in the CVRF-free group with glycosylated hemoglobin levels. CONCLUSIONS Many CVRF-free middle-aged individuals have atherosclerosis. LDL-C, even at levels currently considered normal, is independently associated with the presence and extent of early systemic atherosclerosis in the absence of major CVRFs. These findings support more effective LDL-C lowering for primordial prevention, even in individuals conventionally considered at optimal risk. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).
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Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain
| | - Belén Oliva
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - José M García-Ruiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; ISPA-Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; i+12 Research Institute and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Stuart Pocock
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
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Type 2 diabetes mellitus is associated with a lower fibrous cap thickness but has no impact on calcification morphology: an intracoronary optical coherence tomography study. Cardiovasc Diabetol 2017; 16:152. [PMID: 29195505 PMCID: PMC5709861 DOI: 10.1186/s12933-017-0635-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background Patients with type 2 diabetes (T2DM) are at high risk for cardiovascular events, which usually arise from the rupture of a vulnerable coronary plaque. The minimal fibrous cap thickness (FCT) overlying a necrotic lipid core is an established predictor for plaque rupture. Recently, coronary calcification has emerged as a relevant feature of plaque vulnerability. However, the impact of T2DM on these morphological plaque parameters is largely unexplored. Therefore, this study aimed to compare differences of coronary plaque morphology in patients with and without T2DM with a particular focus on coronary calcification. Methods In 91 patients (T2DM = 56, non-T2DM = 35) with 105 coronary de novo lesions (T2DM = 56, non-T2DM = 49) plaque morphology and calcification were analyzed using optical coherence tomography (OCT) prior to coronary intervention. Results Patients with T2DM had a lower minimal FCT (80.4 ± 27.0 µm vs. 106.8 ± 27.8 µm, p < 0.001) and a higher percent area stenosis (77.9 ± 8.1% vs. 71.7 ± 11.2%, p = 0.001) compared to non-diabetic subjects. However, patients with and without T2DM had a similar total number of calcifications (4.0 ± 2.6 vs. 4.2 ± 3.1, p = ns) and no significant difference was detected in the number of micro- (0.34 ± 0.79 vs. 0.31 ± 0.71), spotty (2.11 ± 1.77 vs. 2.37 ± 1.89) or macro-calcifications (1.55 ± 1.13 vs. 1.53 ± 0.71, all p = ns). The mean calcium arc (82.3 ± 44.8° vs. 73.7 ± 31.6), the mean thickness of calcification (0.54 ± 0.13 mm vs. 0.51 ± 0.15 mm), the mean calcified area (0.99 ± 0.72 mm2 vs. 0.78 ± 0.49 mm2), the mean depth of calcification (172 ± 192 μm vs. 160 ± 76 μm) and the cap thickness overlying the calcification (50 ± 71 μm vs. 62 ± 61 μm) did not differ between the diabetic and non-diabetic groups (all p = ns). Conclusion T2DM has an impact on the minimal FCT of the coronary target lesion, but not on localization, size, shape or extent of calcification. Thus, the minimal FCT overlying the necrotic lipid core but not calcification is likely to contribute to the increased plaque vulnerability observed in patients with T2DM.
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Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study. Int J Cardiol 2017; 231:18-25. [DOI: 10.1016/j.ijcard.2016.12.137] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
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Ibrahim NE, Januzzi JL, Magaret CA, Gaggin HK, Rhyne RF, Gandhi PU, Kelly N, Simon ML, Motiwala SR, Belcher AM, van Kimmenade RR. A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease. J Am Coll Cardiol 2017; 69:1147-1156. [DOI: 10.1016/j.jacc.2016.12.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 01/09/2023]
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Tomizawa N, Yamamoto K, Hayakawa Y, Inoh S, Nojo T, Nakamura S. A clinical model to identify patients with high-risk plaque by coronary computed tomography angiography. Int J Cardiol 2017; 228:260-264. [PMID: 27865195 DOI: 10.1016/j.ijcard.2016.11.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Current clinical models predict the pre-test probability of obstructive coronary artery disease, but these models do not predict the presence of high-risk plaques. Thus the objective of this study was to propose a model to predict high-risk plaque assessed by coronary computed tomography (CT) angiography. METHODS This study was a retrospective cross-sectional study. A clinical model was derived from 2392 patients and verified by 733 patients who underwent coronary CT suspected of coronary artery disease. High-risk plaque was defined as a plaque with positive remodeling (remodeling index>1.1), low attenuation (<30Hounsfield units) and napkin-ring sign. The risk score was calculated from the following 6 variables with a maximum of 24 points: age, sex, hemoglobin A1c, systolic blood pressure, high-density lipoprotein and smoking status. RESULTS The proportion of patients with high-risk plaque was 11% and 17% in the derivation and validation cohort, respectively. The area under the receiver operation characteristic curve was 0.71 (95% confidence interval (CI): 0.68 to 0.74) in the derivation cohort and 0.75 (95% CI: 0.70 to 0.79) in the validation cohort. The frequency of high-risk plaques was 4% in the low-risk group (≤8 points) while it was 53% in the high-risk group (≥17 points) of the derivation cohort. CONCLUSIONS We propose a scoring system to detect high-risk plaque assessed by coronary CT. Patients in the high-risk group have a high prevalence of high-risk plaque and might benefit from lipid lowering therapy.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Yayoi Hayakawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
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Associations between the Framingham Risk Score and coronary plaque characteristics as assessed by three-vessel optical coherence tomography. Coron Artery Dis 2016; 27:460-6. [PMID: 27218146 DOI: 10.1097/mca.0000000000000383] [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: 11/26/2022]
Abstract
OBJECTIVES This study sought to explore the association between the Framingham Risk Score (FRS) and coronary plaque characteristics assessed by optical coherence tomography (OCT) imaging. BACKGROUND Clinical prediction models are useful for identifying high-risk patients. However, coronary events often occur in individuals estimated to be at low risk. METHODS A total of 254 patients with coronary artery disease who underwent three-vessel OCT were divided into tertiles according to FRS. Nonculprit plaque characteristics were compared among the three groups. RESULTS A total of 663 plaques were analyzed. FRS was significantly associated with calcification [37% (low FRS) vs. 46% (intermediate FRS) vs. 70% (high FRS); P<0.001] and neovascularization [39% (low FRS) vs. 41% (intermediate FRS) vs. 56% (high FRS); P<0.001], but not with lipid-rich plaques or thin-cap fibroatheroma (TCFA). On multivariate analysis, FRS was an independent predictor of the presence of both calcification and neovascularization. There were no deaths, two acute myocardial infarctions, and 15 nontarget lesion revascularizations at the 1-year follow-up. The event rate increased progressively across FRS tertiles [2.4% (low FRS) vs. 7.1% (intermediate FRS) vs. 8.6% (high FRS); P=0.186]. The c-statistic for FRS to predict future clinical events was 0.628 (95% confidence interval, 0.500-0.757). The addition of both calcification and TCFA to FRS provided incremental prognostic value [c-statistics: 0.761 (95% confidence interval, 0.631-0.890)]. CONCLUSION The present study showed significant associations between FRS and the presence of coronary calcification and neovascularization in nonculprit plaques. The combination of FRS and OCT-detected calcifications and TCFA provides improved prognostic ability in identifying patients with known coronary artery disease who are at risk of recurrent events.
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Fiz F, Morbelli S, Bauckneht M, Piccardo A, Ferrarazzo G, Nieri A, Artom N, Cabria M, Marini C, Canepa M, Sambuceti G. Correlation between thoracic aorta 18F-natrium fluoride uptake and cardiovascular risk. World J Radiol 2016; 8:82-89. [PMID: 26834946 PMCID: PMC4731351 DOI: 10.4329/wjr.v8.i1.82] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigating the relationship between thoracic and cardiac 18F-Natrium-Fluoride (18F-NaF) uptake, as a marker of ongoing calcification and cardiovascular risk factors.
METHODS: Seventy-eight patients (44 females, mean age 63, range 44-83) underwent whole body 18F-NaF positron emission tomography/computed tomography. Cardiovascular risk (CVR) was used to divide these patients in three categories: Low (LR), medium (MR) and high risk (HR). 18F-NaF uptake was measured by manually drawing volumes of interest on the ascending aorta, on the aortic arch, on the descending aorta and on the myocardium; average standardized uptake value was normalized for blood-pool, to obtain target-to-background ratio (TBR). Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.
RESULTS: A significant difference in whole thoracic aorta TBR was detected between HR and LR (1.84 ± 0.76 vs 1.07 ± 0.3, P < 0.001), but also between MR and HR-LR (1.4 ± 0.4, P < 0.02 and P < 0.01, respectively). Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta (P < 0.01). Myocardial uptake provided an effective CVR classes stratification (P < 0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered (R = 0.67), but it peaked when correlating the descending thoracic segment (R = 0.75), in comparison with the aortic arch and the ascending segment (R = 0.55 and 0.53, respectively).
CONCLUSION: Fluoride uptake within the thoracic aorta wall effectively depicts patients’ risk class and correlates with cardiovascular risk. Descending aorta is the most effective in CVR determination.
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Brown RE, Kuk JL. Composite Risk Scores. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Caselli C, De Graaf MA, Lorenzoni V, Rovai D, Marinelli M, Del Ry S, Giannessi D, Bax JJ, Neglia D, Scholte AJ. HDL cholesterol, leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain. Atherosclerosis 2015; 241:55-61. [DOI: 10.1016/j.atherosclerosis.2015.04.811] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 12/18/2022]
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Association between Aspirin Therapy and Clinical Outcomes in Patients with Non-Obstructive Coronary Artery Disease: A Cohort Study. PLoS One 2015; 10:e0129584. [PMID: 26035823 PMCID: PMC4452779 DOI: 10.1371/journal.pone.0129584] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/11/2015] [Indexed: 01/06/2023] Open
Abstract
Background Presence of non-obstructive coronary artery disease (CAD) is associated with increased prescription of cardiovascular preventive medications including aspirin. However, the association between aspirin therapy with all-cause mortality and coronary revascularization in this population has not been investigated. Methods and Findings Among the cohort of individuals who underwent coronary computed tomography angiography (CCTA) from 2007 to 2011, 8372 consecutive patients with non-obstructive CAD (1-49% stenosis) were identified. Patients with statin or aspirin prescription before CCTA, and those with history of revascularization before CCTA were excluded. We analyzed the differences of all-cause mortality and a composite of mortality and late coronary revascularization (>90 days after CCTA) between aspirin users (n=3751; 44.8%) and non-users. During a median of 828 (interquartile range 385–1,342) days of follow-up, 221 (2.6%) mortality cases and 295 (3.5%) cases of composite endpoint were observed. Annualized mortality rates were 0.97% in aspirin users versus 1.28% in non-users, and annualized rates of composite endpoint were 1.56% versus 1.48%, respectively. Aspirin therapy was associated with significantly lower risk of all-cause mortality (adjusted HR 0.649; 95% CI 0.492–0.857; p=0.0023), but not with the composite endpoint (adjusted HR 0.841; 95% CI 0.662–1.069; p=0.1577). Association between aspirin and lower all-cause mortality was limited to patients with age ≥65 years, diabetes, hypertension, decreased renal function, and higher levels of coronary artery calcium score, low-density lipoprotein cholesterol and high-sensitivity C-reactive protein. Conclusions Among the patients with non-obstructive CAD documented by CCTA, aspirin is associated with lower all-cause mortality only in those with higher risk.
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Fiz F, Morbelli S, Piccardo A, Bauckneht M, Ferrarazzo G, Pestarino E, Cabria M, Democrito A, Riondato M, Villavecchia G, Marini C, Sambuceti G. ¹⁸F-NaF Uptake by Atherosclerotic Plaque on PET/CT Imaging: Inverse Correlation Between Calcification Density and Mineral Metabolic Activity. J Nucl Med 2015; 56:1019-23. [PMID: 25952737 DOI: 10.2967/jnumed.115.154229] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/25/2015] [Indexed: 01/13/2023] Open
Abstract
UNLABELLED Several studies have highlighted the role of vascular (18)F-NaF uptake as a marker of ongoing calcium deposition. However, accumulation of (18)F-NaF is often inconsistent with localization of arterial plaque. Calcification activity and thus (18)F-NaF uptake might prevail in the earlier plaque stages. To test this hypothesis, we evaluated (18)F-NaF uptake in plaque of 3 different densities, using density as a marker of calcification progression. We also tested whether attenuation-weighted image reconstruction affects (18)F-NaF uptake in the different plaque stages. METHODS Sixty-four oncologic patients (14 men and 50 women; mean age, 65.3 ± 8.2 y; range, 26-81 y) underwent (18)F-NaF PET/CT. A volume of interest was drawn on each plaque within the infrarenal aorta to assess mean standardized uptake value and attenuation (in Hounsfield units [HU]). Plaque was then categorized as light (<210 HU), medium (211-510 HU), or heavy (>510 HU). Standardized uptake value was normalized for blood (18)F-NaF activity to obtain the plaque target-to-background ratio (TBR). During this process, several focal, noncalcified areas of (18)F-NaF were identified (hot spots). The TBR of the hot spots was computed after isocontour thresholding. The TBR of a noncalcified control region was also calculated. In 35 patients, the TBR of non-attenuation-corrected images was calculated. RESULTS The average TBR was highest in light plaque (2.21 ± 0.88), significantly lower in medium plaque (1.59 ± 0.63, P < 0.001), and lower still in heavy plaque (1.14 ± 0.37, P < 0.0001 with respect to both light and medium plaque). The TBR of the control region was not significantly different from that of heavy plaque but was significantly lower than that of light and medium plaque (P < 0.01). Hot spots had the highest absolute TBR (3.89 ± 1.87, P < 0.0001 vs. light plaque). TBRs originating from non-attenuation-corrected images did not significantly differ from those originating from attenuation-corrected images. CONCLUSION Our results support the concept that (18)F-NaF is a feasible option in imaging molecular calcium deposition in the early stages of plaque formation, when active uptake mechanisms are the main determinants of calcium presence, but that retention of (18)F-NaF progressively decreases with increasing calcium deposition in the arterial wall. Our data suggest that non-attenuation-corrected reconstruction does not significantly affect evaluation of plaque of any thickness.
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Affiliation(s)
- Francesco Fiz
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Matteo Bauckneht
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Giulia Ferrarazzo
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Manlio Cabria
- Nuclear Medicine Unit, Galliera Hospital, Genoa, Italy
| | - Alessia Democrito
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Mattia Riondato
- Nuclear Medicine Unit, S. Andrea Hospital, La Spezia, Italy; and
| | | | - Cecilia Marini
- Institute of Molecular Bioimaging and Physiology, CNR, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
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Mushtaq S, De Araujo Gonçalves P, Garcia-Garcia HM, Pontone G, Bartorelli AL, Bertella E, Campos CM, Pepi M, Serruys PW, Andreini D. Long-Term Prognostic Effect of Coronary Atherosclerotic Burden. Circ Cardiovasc Imaging 2015; 8:e002332. [DOI: 10.1161/circimaging.114.002332] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Saima Mushtaq
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Pedro De Araujo Gonçalves
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Hector M. Garcia-Garcia
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Antonio L. Bartorelli
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Erika Bertella
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Carlos M. Campos
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Mauro Pepi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Patrick W. Serruys
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
| | - Daniele Andreini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University
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Hwang IC, Jeon JY, Kim Y, Kim HM, Yoon YE, Lee SP, Kim HK, Sohn DW, Sung J, Kim YJ. Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease. Atherosclerosis 2015; 239:335-42. [PMID: 25682032 DOI: 10.1016/j.atherosclerosis.2015.01.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/07/2015] [Accepted: 01/25/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Non-obstructive coronary artery disease (CAD) is a frequent clinical condition and is associated with an increase in cardiovascular events. However, appropriate medical therapy for this population is not known. We investigated the association between statin use and risk of all-cause mortality and coronary revascularization in patients with non-obstructive CAD. METHODS From 2007 to 2011, we identified 8372 consecutive patients with non-obstructive CAD (1-49% stenosis) documented by coronary computed tomography angiography (CCTA) from 3 medical centers. Patients with statins or aspirin use before CCTA, and a history of revascularization before initial CCTA were excluded. All-cause mortality and a composite of mortality and late coronary revascularization (>90 days after CCTA) were analyzed according to the use of statins. RESULTS Mean age of the study population was 61.4 ± 10.9 years and 70.3% were male. Statins were prescribed to 1983 (23.7%) patients. During 828 days of follow-up (IQR 385-1342), 221 (2.6%) cases of all-cause mortality and 295 (3.5%) cases of the composite endpoint were observed. Statin therapy was associated with lower risks of all-cause mortality (adjusted HR 0.397; 95% CI 0.262-0.602; p < 0.0001) and composite endpoint (adjusted HR 0.430; 95% CI 0.310-0.597; p < 0.0001). Association between statin therapy and better clinical outcomes was regardless of age, sex, presence of hypertension or diabetes, coronary artery calcium score, low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein levels, or glomerular filtration rate. CONCLUSIONS Statin therapy was associated with a lower risk of all-cause mortality in patients with non-obstructive CAD documented by CCTA, regardless of combined clinical risk factors.
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Affiliation(s)
- In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo-Yeong Jeon
- Department of Statistics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Younhee Kim
- Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae-Won Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jidong Sung
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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McEvoy JW, Diamond GA, Detrano RC, Kaul S, Blaha MJ, Blumenthal RS, Jones SR. Risk and the physics of clinical prediction. Am J Cardiol 2014; 113:1429-35. [PMID: 24581923 DOI: 10.1016/j.amjcard.2014.01.418] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 12/14/2022]
Abstract
The current paradigm of primary prevention in cardiology uses traditional risk factors to estimate future cardiovascular risk. These risk estimates are based on prediction models derived from prospective cohort studies and are incorporated into guideline-based initiation algorithms for commonly used preventive pharmacologic treatments, such as aspirin and statins. However, risk estimates are more accurate for populations of similar patients than they are for any individual patient. It may be hazardous to presume that the point estimate of risk derived from a population model represents the most accurate estimate for a given patient. In this review, we exploit principles derived from physics as a metaphor for the distinction between predictions regarding populations versus patients. We identify the following: (1) predictions of risk are accurate at the level of populations but do not translate directly to patients, (2) perfect accuracy of individual risk estimation is unobtainable even with the addition of multiple novel risk factors, and (3) direct measurement of subclinical disease (screening) affords far greater certainty regarding the personalized treatment of patients, whereas risk estimates often remain uncertain for patients. In conclusion, shifting our focus from prediction of events to detection of disease could improve personalized decision-making and outcomes. We also discuss innovative future strategies for risk estimation and treatment allocation in preventive cardiology.
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Affiliation(s)
- John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - George A Diamond
- Division of Cardiology, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Robert C Detrano
- Department of Radiology, School of Medicine, University of California, Irvine, California
| | - Sanjay Kaul
- Division of Cardiology, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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de Araujo Goncalves P, Campos CAM, Serruys PW, Garcia-Garcia HM. Computed tomography angiography for the interventional cardiologist. Eur Heart J Cardiovasc Imaging 2014; 15:842-54. [DOI: 10.1093/ehjci/jeu053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
As laparoscopic surgery is replacing open surgery, similarly computed tomography angiography is replacing invasive conventional cardiac angiography. In the last century, marvelous efforts in research have improved strategies for cure, diagnosis and prevention of fatal human diseases; however, coronary artery disease, as the most prevalent cause of mortality and morbidity in the world, has remained a great challenge. Due to advancements in technology and research, it has become more simple and robust to diagnose and treat coronary artery disease (CAD) with minimal or no intervention, promising to not only diagnosis at an early stage but potential prevention altogether. While most with obvious CAD can be diagnosed easily and quickly with ECG, those identified as 'low risk' require more extensive testing to diagnose or rule out CAD. For example in emergency departments, low-risk patients with chest pain are diagnosed solely depending on history, ECG and blood testing for biomarkers. This approach has resulted in either delayed or miss-diagnosis of Acute coronary syndrome. To prevent this, many emergency departments now use protocols for low-risk heart patients that include cardiac stress tests and/or CT heart imaging. This review provides an overview of the current literature on the value of Computed tomography angiography and discusses how prognostic information obtained with Computed tomography angiography can be used to further integrate the technique into clinical practice.
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Affiliation(s)
- Muhammad A Latif
- St. John Cardiovascular Research Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Why Global Risk Scores Fail to Detect At-Risk Young Women and Men With Acute Coronary Syndromes. Can J Cardiol 2014; 30:12-3. [DOI: 10.1016/j.cjca.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 11/23/2022] Open
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Shaw LJ, Tandon S, Rosen S, Mieres JH. Evaluation of suspected ischemic heart disease in symptomatic women. Can J Cardiol 2013; 30:729-37. [PMID: 24582723 DOI: 10.1016/j.cjca.2013.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/20/2013] [Accepted: 09/22/2013] [Indexed: 01/22/2023] Open
Abstract
There is a wealth of evidence about the role of a variety of diagnostic testing modalities to define coronary artery disease (CAD) risk in women presenting for evaluation of suspected myocardial ischemia. The exercise electrocardiogram (ECG) is the core index procedure, which can define risk in women capable of performing maximal exercise. Stress imaging, using echocardiography or myocardial perfusion single-photon emission computed tomography/positron emission tomography, is useful for symptomatic women with an abnormal resting ECG or for those who are functionally disabled. For women with low-risk stress imaging findings, there is a very low risk of CAD events, usually < 1%. There is a gradient relationship between the extent and severity of inducible abnormalities and CAD event risk. Women at high risk are those defined as having moderate to severely abnormal wall motion or abnormal perfusion imaging findings. In addition to stress imaging, the evidence of the relationship between CAD extent and severity and prognosis has been clearly defined with coronary computed tomographic angiography. In women, prognosis for those with mild but nonobstructive CAD is higher when compared with those without any CAD. The current evidence base clearly supports that women presenting with chest pain can benefit from one of the commonly applied diagnostic testing modalities.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia, USA.
| | | | - Stacey Rosen
- North Shore Long Island Jewish Hospital, Manhasset, New York, USA
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Keidar S, Gamliel-Lazarovich A. Viewpoint: personalizing statin therapy. Rambam Maimonides Med J 2013; 4:e0008. [PMID: 23908858 PMCID: PMC3678834 DOI: 10.5041/rmmj.10108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular disease (CVD), associated with vascular atherosclerosis, is the major cause of death in Western societies. Current risk estimation tools, such as Framingham Risk Score (FRS), based on evaluation of multiple standard risk factors, are limited in assessment of individual risk. The majority (about 70%) of the general population is classified as low FRS where the individual risk for CVD is often underestimated but, on the other hand, cholesterol lowering with statin is often excessively administered. Adverse effects of statin therapy, such as muscle pain, affect a large proportion of the treated patients and have a significant influence on their quality of life. Coronary artery calcification (CAC), as assessed by computed tomography, carotid artery intima-media thickness (CIMT), and especially presence of plaques as assessed by B-mode ultrasound are directly correlated with increased risk for cardiovascular events and provide accurate and relevant information for individual risk assessment. Absence of vascular pathology as assessed by these imaging methods has a very high negative predictive value and therefore could be used as a method to reduce significantly the number of subjects who, in our opinion, would not benefit from statins and only suffer from their side-effects. In summary, we suggest that in very-low-risk subjects, with the exception of subjects with low FRS with a family history of coronary artery disease (CAD) at young age, if vascular imaging shows no CAC or normal CIMT without plaques, statin treatment need not be administered.
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Affiliation(s)
- Shlomo Keidar
- Internal Medicine A, The Rappaport Family Institute for Research in the Medical Sciences, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Rambam Medical Center, Haifa, Israel; and
- Lipid Research Laboratory, The Rappaport Family Institute for Research in the Medical Sciences, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Rambam Medical Center, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Aviva Gamliel-Lazarovich
- Lipid Research Laboratory, The Rappaport Family Institute for Research in the Medical Sciences, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Rambam Medical Center, Haifa, Israel
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