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Moradi A, Olanisa OO, Nzeako T, Shahrokhi M, Esfahani E, Fakher N, Khazeei Tabari MA. Revolutionizing Cardiac Imaging: A Scoping Review of Artificial Intelligence in Echocardiography, CTA, and Cardiac MRI. J Imaging 2024; 10:193. [PMID: 39194982 DOI: 10.3390/jimaging10080193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND AND INTRODUCTION Cardiac imaging is crucial for diagnosing heart disorders. Methods like X-rays, ultrasounds, CT scans, and MRIs provide detailed anatomical and functional heart images. AI can enhance these imaging techniques with its advanced learning capabilities. METHOD In this scoping review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar using related keywords on 16 April 2024. From 3679 articles, we first screened titles and abstracts based on the initial inclusion criteria and then screened the full texts. The authors made the final selections collaboratively. RESULT The PRISMA chart shows that 3516 articles were initially selected for evaluation after removing duplicates. Upon reviewing titles, abstracts, and quality, 24 articles were deemed eligible for the review. The findings indicate that AI enhances image quality, speeds up imaging processes, and reduces radiation exposure with sensitivity and specificity comparable to or exceeding those of qualified radiologists or cardiologists. Further research is needed to assess AI's applicability in various types of cardiac imaging, especially in rural hospitals where access to medical doctors is limited. CONCLUSIONS AI improves image quality, reduces human errors and radiation exposure, and can predict cardiac events with acceptable sensitivity and specificity.
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Affiliation(s)
- Ali Moradi
- Internal Medicine, HCA Florida, Blake Hospital, Morsani College of Medicine, University of South Florida, Bradenton, FL 34209, USA
- Center for Translational Medicine, Semmelweis University, 1428 Budapest, Hungary
| | - Olawale O Olanisa
- Internal Medicine, Adjunct Clinical Faculty, Michigan State University College of Human Medicine, Trinity Health Grand Rapids, Grand Rapids, MI 49503, USA
| | - Tochukwu Nzeako
- Internal Medicine, Christiana Care Hospital, Newark, DE 19718, USA
| | - Mehregan Shahrokhi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| | - Eman Esfahani
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Nastaran Fakher
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
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Power DA, Hemetsberger R, Farhan S, Abdel-Wahab M, Yasumura K, Kini A, Sharma SK. Calcified coronary lesions: Imaging, prognosis, preparation and treatment state of the art review. Prog Cardiovasc Dis 2024:S0033-0620(24)00095-1. [PMID: 38925256 DOI: 10.1016/j.pcad.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this State Of The Art Review, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.
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Affiliation(s)
- David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Rayyan Hemetsberger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Keisuke Yasumura
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America.
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Patel C, Gerstenfeld EP, Gupta SK, Winterfield J, Woods C, Natale A, Schneider CW, Achyutha AB, Holland SK, Richards E, Albrecht EM, Lehmann JW, Mansour M, Reddy VY. Comparison of cerebral safety after atrial fibrillation using pulsed field and thermal ablation: Results of the neurological assessment subgroup in the ADVENT trial. Heart Rhythm 2024:S1547-5271(24)02661-4. [PMID: 38823667 DOI: 10.1016/j.hrthm.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) ablation carries the risk of silent cerebral event (SCE) and silent cerebral lesion (SCL). Although "silent," these may have long-term clinical implications and are challenging to study as postprocedural magnetic resonance imaging (MRI) is not standard of care. OBJECTIVE The neurological assessment subgroup (NAS) of ADVENT compared cerebral effects of pulsed field ablation (PFA) with standard-of-care thermal ablation. METHODS The NAS included consecutive randomized PFA and thermal ablation patients who received postprocedural brain MRI 12-48 hours after ablation. Patients with apparent SCE or SCL findings underwent a modified Rankin scale assessment. MRI images were subsequently reviewed by a blinded brain imaging core laboratory. RESULTS In total, 77 patients with paroxysmal AF were enrolled at 6 centers; 71 had analyzable scans (34 PFA; 37 thermal ablation). Through individual center review, 6 PFA and 4 thermal scans were identified as SCE/SCL positive, of which 3 PFA and 0 thermal SCE/SCL findings were confirmed by a blinded core laboratory. MRI findings revealed 1 patient with 2- to 4-mm SCEs, 1 patient with a 3-mm SCE, and 1 patient with 2 SCLs (5.5 mm and 11 mm). All modified Rankin scale and National Institutes of Health Stroke Scale scores were 0 before discharge and at 90-day follow-up. There were only 2 neurological safety events (1 transient ischemic attack [PFA] and 1 stroke [thermal ablation]) in the ADVENT study, neither of which was part of the NAS. CONCLUSION The ADVENT trial provides the first prospective, randomized data on the cerebral impact of PFA and thermal ablation of AF. Incidence of SCE/SCL after ablation in the NAS was low.
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Affiliation(s)
| | | | - Sanjaya K Gupta
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Dahl JN, Rasmussen LD, Ding D, Tu S, Westra J, Wijns W, Christiansen EH, Eftekhari A, Li G, Winther S, Bøttcher M. Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2024; 18:162-169. [PMID: 38242777 DOI: 10.1016/j.jcct.2024.01.004] [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: 09/12/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). METHODS Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. RESULTS In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73-86) vs. 77 % (95%CI: 69-83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67-78) vs. 80 % (95%CI: 75-85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). CONCLUSION Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.
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Affiliation(s)
- Jonathan N Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Daixin Ding
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China; Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Jelmer Westra
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - William Wijns
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland.
| | - Evald Høj Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Guanyu Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Parsons M, Tong Y, Valenti SC, Gorelik V, Bhatnagar S, Boily M, Gorelik N. Reporting of Participant Demographics in Clinical Trials Published in General Radiology Journals. Curr Probl Diagn Radiol 2024; 53:81-91. [PMID: 37741699 DOI: 10.1067/j.cpradiol.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES The reporting of research participant demographics provides insights into study generalizability. Our study aimed to determine the frequency at which participant age, sex/gender, race/ethnicity, and socioeconomic status (SES) are reported and used for subgroup analyses in radiology randomized controlled trials (RCTs) and their secondary analyses; as well as the study characteristics associated with, and the classification systems used for demographics reporting. METHODS RCTs and their secondary analyses published in 8 leading radiology journals between 2013 and 2021 were included. Associations between study characteristics and demographic reporting were tested with the chi-square goodness of fit test for categorical variables, Wilcoxon-Mann-Whitney test for impact factor, and logistic regression for publication year. RESULTS Among 432 included articles, 89.4% (386) reported age, 90.3% (390) sex/gender, 5.6% (24) race/ethnicity, and 3.0% (13) SES. Among articles that reported these demographics and were not specific to a subgroup, results were analyzed by age in 14.2% (55/386), sex/gender in 19.4% (66/340), race/ethnicity in 13.6% (3/22), and SES in 46.2% (6/13). Journal, impact factor, and last author continent were predictors of race/ethnicity and SES reporting. Funding was associated with race/ethnicity reporting. No study reported sex and gender separately, or documented transgender, nonbinary gender spectrum or intersex participants. A single category for race/ethnicity was used in 37.5% (9/24) of studies, consisting of either "White" or "Caucasian." CONCLUSION The reporting of participant demographics in radiology trials is variable and not always representative of the population diversity. Editorial guidelines on the reporting and analysis of participant demographics could help standardize practices.
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Affiliation(s)
- Marlee Parsons
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Yi Tong
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Sahir Bhatnagar
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Mathieu Boily
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Natalia Gorelik
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada.
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Chen Q, Zhou F, Xie G, Tang CX, Gao X, Zhang Y, Yin X, Xu H, Zhang LJ. Advances in Artificial Intelligence-Assisted Coronary Computed Tomographic Angiography for Atherosclerotic Plaque Characterization. Rev Cardiovasc Med 2024; 25:27. [PMID: 39077649 PMCID: PMC11262402 DOI: 10.31083/j.rcm2501027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 07/31/2024] Open
Abstract
Coronary artery disease is a leading cause of death worldwide. Major adverse cardiac events are associated not only with coronary luminal stenosis but also with atherosclerotic plaque components. Coronary computed tomography angiography (CCTA) enables non-invasive evaluation of atherosclerotic plaque along the entire coronary tree. However, precise and efficient assessment of plaque features on CCTA is still a challenge for physicians in daily practice. Artificial intelligence (AI) refers to algorithms that can simulate intelligent human behavior to improve clinical work efficiency. Recently, cardiovascular imaging has seen remarkable advancements with the use of AI. AI-assisted CCTA has the potential to facilitate the clinical workflow, offer objective and repeatable quantitative results, accelerate the interpretation of reports, and guide subsequent treatment. Several AI algorithms have been developed to provide a comprehensive assessment of atherosclerotic plaques. This review serves to highlight the cutting-edge applications of AI-assisted CCTA in atherosclerosis plaque characterization, including detecting obstructive plaques, assessing plaque volumes and vulnerability, monitoring plaque progression, and providing risk assessment. Finally, this paper discusses the current problems and future directions for implementing AI in real-world clinical settings.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 210002 Nanjing, Jiangsu, China
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 210002 Nanjing, Jiangsu, China
| | - Guanghui Xie
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 210002 Nanjing, Jiangsu, China
| | - Xiaofei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
| | - Yamei Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
| | - Hui Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 210002 Nanjing, Jiangsu, China
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Dundas J, Leipsic JA, Sellers S, Blanke P, Miranda P, Ng N, Mullen S, Meier D, Akodad M, Sathananthan J, Collet C, de Bruyne B, Muller O, Tzimas G. Artificial Intelligence-based Coronary Stenosis Quantification at Coronary CT Angiography versus Quantitative Coronary Angiography. Radiol Cardiothorac Imaging 2023; 5:e230124. [PMID: 38166336 PMCID: PMC11163244 DOI: 10.1148/ryct.230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 01/04/2024]
Abstract
Purpose To evaluate the performance of a new artificial intelligence (AI)-based tool by comparing the quantified stenosis severity at coronary CT angiography (CCTA) with a reference standard derived from invasive quantitative coronary angiography (QCA). Materials and Methods This secondary, post hoc analysis included 120 participants (mean age, 59.7 years ± 10.8 [SD]; 73 [60.8%] men, 47 [39.2%] women) from three large clinical trials (AFFECTS, P3, REFINE) who underwent CCTA and invasive coronary angiography with QCA. Quantitative analysis of coronary stenosis severity at CCTA was performed using an AI-based coronary stenosis quantification (AI-CSQ) software service. Blinded comparison between QCA and AI-CSQ was measured on a per-vessel and per-patient basis. Results The per-vessel AI-CSQ diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 80%, 88%, 86%, 65%, and 94%, respectively, for diameter stenosis (DS) 50% or greater; and 78%, 92%, 91%, 47%, and 98%, respectively, for DS 70% or greater. The areas under the receiver operating characteristic curve (AUCs) to predict DS of 50% or greater and 70% or greater on a per-vessel basis were 0.92 (95% CI: 0.88, 0.95; P < .001) and 0.93 (95% CI: 0.89, 0.97; P < .001), respectively. The AUCs to predict DS of 50% or greater and 70% or greater on a per-patient basis were 0.93 (95% CI: 0.88, 0.97; P < .001) and 0.88 (95% CI: 0.81, 0.94; P < .001), respectively. Conclusion AI-CSQ at CCTA demonstrated a high diagnostic performance compared with QCA both on a per-patient and per-vessel basis, with high sensitivity for stenosis detection. Keywords: CT Angiography, Cardiac, Coronary Arteries Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- James Dundas
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Jonathon A Leipsic
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Stephanie Sellers
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Patricia Miranda
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Nicholas Ng
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Sarah Mullen
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - David Meier
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Mariama Akodad
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Janarthanan Sathananthan
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Carlos Collet
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Bernard de Bruyne
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Olivier Muller
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
| | - Georgios Tzimas
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.D., J.A.L., P.B., G.T.); Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, British Columbia, Canada (S.S.); HeartFlow, Mountain View, Calif (P.M., N.N., S.M.); Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (D.M., J.S.); Interventional Cardiology Department, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France (M.A.); OLV Clinic, Cardiovascular Center Aalst, Aalst, Belgium (C.C., B.d.B.); and Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland (O.M., G.T.)
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8
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Zarei M, Abadi E, Segars WP, Samei E. Coronary stenosis quantification in cardiac computed tomography angiography: multi-factorial optimization of image quality and radiation dose. J Med Imaging (Bellingham) 2023; 10:063502. [PMID: 38156332 PMCID: PMC10752565 DOI: 10.1117/1.jmi.10.6.063502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/18/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023] Open
Abstract
Background The accuracy and variability of quantification in computed tomography angiography (CTA) are affected by the interplay of imaging parameters and patient attributes. The assessment of these combined effects has been an open engineering challenge. Purpose In this study, we developed a framework that optimizes imaging parameters for accurate and consistent coronary stenosis quantification in cardiac CTA while accounting for patient-specific variables. Methods The framework utilizes a task-specific image quality index, the estimability index (e ' ), approximated by a surrogate estimability polynomial function (EPF) capable of finding the optimal protocol that (1) maximizes image quality with an upper bound for desired radiation dose or (2) minimizes the dose level with a lower bound of acceptable image quality. The optimization process was formulated with the decision variables being subject to a set of constraints. The methodology was verified using CTA data from a prior clinical trial (prospective multi-center imaging study for evaluation of chest pain) by assessing the concordance of its prediction with the trial results. Further, the framework was used to derive an optimum protocol for each case based on the patient attributes, gauging how much improvement would have been possible if the derived optimized protocol would have been deployed. Results The framework produced results consistent with imaging physics principles with approximated EPFs of 97% accuracy. The feature importance evaluation demonstrated a close match with earlier studies. The verification study found e ' scores closely predicting the cardiologist scores to within 95% in terms of the area under the receiver operating characteristic curve and predicting potential for either an average of fourfold increase in e ' within a targeted dose or a reduction in radiation dose by an average of 57% without reducing the image quality. Conclusions The protocol optimization framework provides means to assess and optimize CTA in terms of either image quality or radiation dose objectives with its results predicting prior clinical trial findings.
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Affiliation(s)
- Mojtaba Zarei
- Duke University, Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
| | - Ehsan Abadi
- Duke University, Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
- Duke University School of Medicine, Department of Radiology, Durham, North Carolina, United States
| | - William Paul Segars
- Duke University, Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States
- Duke University School of Medicine, Department of Radiology, Durham, North Carolina, United States
| | - Ehsan Samei
- Duke University, Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
- Duke University School of Medicine, Department of Radiology, Durham, North Carolina, United States
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9
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Meng Q, Yu P, Yin S, Li X, Chang Y, Xu W, Wu C, Xu N, Zhang H, Wang Y, Shen H, Zhang R, Zhang Q. Coronary computed tomography angiography analysis using artificial intelligence for stenosis quantification and stent segmentation: a multicenter study. Quant Imaging Med Surg 2023; 13:6876-6886. [PMID: 37869330 PMCID: PMC10585569 DOI: 10.21037/qims-23-423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 10/24/2023]
Abstract
Background Accurate interpretation of coronary computed tomography angiography (CCTA) is a labor-intensive and expertise-driven endeavor, as inexperienced readers may inadvertently overestimate stenosis severity. Recent artificial intelligence (AI) advances in medical imaging present compelling prospects for auxiliary diagnostic tools in CCTA. This study aimed to externally validate an AI-assisted analysis system capable of rapidly evaluating stenosis severity, exploring its potential integration into routine clinical workflows. Methods This multicenter study consisted of an internal and external cohort of patients who underwent CCTA scans between April 2017 and February 2023. CCTA scans were evaluated using Coronary Artery Disease Reporting and Data System (CAD-RADS) scores to determine stenosis severity, while ground-truth stents were manually annotated by expert readers. The InferRead CT Heart (version 1.6; Infervision Medical Technology Co., Ltd., Beijing, China), which incorporates AI-assisted coronary artery stenosis quantification and automatic stent segmentation, was employed for CCTA scan analysis. AI-based stenosis assessment performance was determined using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while the AI-based stent segmentation overlap was assessed using the Dice similarity coefficient (DSC). Results For ≥50% stenosis diagnoses, the AI system attained per-patient sensitivity, specificity, PPV, and NPV surpassing 90.0% for the internal dataset; for the external dataset, the per-patient values were 88.0% [95% confidence interval (CI): 81.0-94.4%], 94.5% (95% CI: 90.7-97.6%), 90.0% (95% CI: 83.3-95.6%), and 93.4% (95% CI: 89.2-96.8%), respectively. For ≥70% stenosis diagnoses, the per-patient values on the internal dataset were 94.2% (95% CI: 89.2-98.1%), 95.8% (95% CI: 94.1-97.4%), 80.8% (95% CI: 73.5-87.7%), and 98.9% (95% CI: 97.9-99.6%), respectively; for the external dataset, the per-patient values were 91.9% (95% CI: 82.6-100.0%), 97.3% (95% CI: 94.9-99.1%), 85.0% (95% CI: 72.5-94.6%), and 98.6% (95% CI: 96.8-100.0%), respectively. Regarding CAD-RADS categorization, the Cohen kappa was 0.75 and 0.81 for the internal per-patient and per-vessel basis, respectively, and 0.72 and 0.76 for the external per-patient and per-vessel basis, respectively. The DSC for stent segmentation was 0.96±0.06. Conclusions The AI-assisted analysis system for CCTA interpretation exhibited exceptional proficiency in stenosis quantification and stent segmentation, indicating that AI holds considerable potential in advancing CCTA postprocessing techniques.
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Affiliation(s)
- Qingtao Meng
- Department of Radiology, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, China
| | - Pengxin Yu
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Siyuan Yin
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Xiaofeng Li
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Yitong Chang
- Department of Radiology, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, China
| | - Wei Xu
- Department of Radiology, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, China
| | - Chunmao Wu
- Department of Radiology, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, China
| | - Na Xu
- Department of Radiology, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, China
| | - Huan Zhang
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Yu Wang
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Hong Shen
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Rongguo Zhang
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Qingyue Zhang
- Infervision Medical Technology Co., Ltd., Beijing, China
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10
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Wu H, Xiao Z. A knowledge graph-based analytical model for mining clinical value of drug stress echocardiography for diagnosis, risk stratification and prognostic evaluation of coronary artery disease. Int J Cardiol 2023; 387:131107. [PMID: 37271285 DOI: 10.1016/j.ijcard.2023.05.057] [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: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
The three major techniques for clinically diagnosing coronary heart disease, including angina associated with myocardial ischemia, are coronary angiography, myocardial perfusion imaging, and drug stress echocardiography. Compared to the first two methods, which are invasive or involve the use of radionuclides, drug stress echocardiography is increasingly used in clinical practice due to its non-invasive, low-risk, and controllable nature, and wide applicability. We developed a novel methodology to demonstrate knowledge graph-based efficacy analysis of drug stress echocardiography as a complement to traditional meta-analysis. By measuring coronary flow reserve (CFR), we discovered that regional ventricular wall abnormalities (RVWA) and drug-loaded cardiac ultrasound can be used to detect coronary artery disease. Additionally, drug-loaded cardiac ultrasound can be used to identify areas of cardiac ischemia, stratify risks, and determine prognosis. Furthermore, adenosine stress echocardiography(ASE) can determine atypical symptoms of coronary heart disease with associated cardiac events through CFR and related quantitative indices for risk stratification. Using a knowledge graph-based approach, we investigated the positive and negative effects of three drugs - Dipyridamole, Dobutamine, and Adenosine - for coronary artery disease analysis. Our findings show that Adenosine has the highest positive effect and the lowest negative effect among the three drugs. Due to its minimal and controlled side effects, and high sensitivity for diagnosing coronary microcirculation disorders and multiple lesions, adenosine is frequently used in clinical practice.
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Affiliation(s)
- Hongyi Wu
- Department of Cardiology, Zhongshan Hospital affiliated to Fudan University, Shanghai, China.
| | - Zhifeng Xiao
- School of Engineering, Penn State Erie, The Behrend College, Erie, 16563, PA, USA.
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11
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Shah NR, Hulten EA, Tandon S, Murthy VL, Dorbala S, Thompson RC. Recent clinical trials support continued emphasis on patient-first over modality-first approaches to initial test selection in patients with stable ischemic heart disease. J Nucl Cardiol 2023; 30:1739-1744. [PMID: 35149975 DOI: 10.1007/s12350-022-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, 830 Chalkstone Avenue, Providence, RI, 02908, USA.
| | - Edward A Hulten
- Department of Medicine, F. Edward Hebert Medical School Uniformed Services, University of Health Sciences, Bethesda, MD, USA
| | - Suman Tandon
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Venkatesh L Murthy
- Departments of Medicine and Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Harvard Medical School, Boston, MA, USA
| | - Randall C Thompson
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, KS, USA
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12
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Chandra P, Sethuraman S, Roy S, Mohanty A, Parikh K, Charantharalyil Gopalan B, Sahoo PK, Kasturi S, Shah VT, Kumar V, Pinto B, Rath PC, Yerramareddy VR, Davidson D, Navasundi GB, Subban V, Livingston N, Rajaraman DP, Narang M, West NEJ, Mullasari A. Effectiveness and safety of optical coherence tomography-guided PCI in Indian patients with complex lesions: A multicenter, prospective registry. Indian Heart J 2023; 75:236-242. [PMID: 37244397 PMCID: PMC10421993 DOI: 10.1016/j.ihj.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/30/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is reported to be a feasible and safe imaging modality for the guidance of percutaneous coronary intervention (PCI) of complex lesions. METHODS This multicenter, prospective registry assessed the minimum stent area (MSA) achieved under OCT guidance. A performance goal of 24% improvement in MSA over and above the recommendation set by the European Association of Percutaneous Cardiovascular Interventions Consensus 2018 (4.5 mm2 MSA for non-left main and 3.5 mm2 for small vessels). The incidence of contrast-induced nephropathy was also assessed. Core lab analysis was conducted. RESULTS Five hundred patients (average age: 59.4 ± 10.1 years; 83% males) with unstable angina (36.8%), NSTEMI (26.4%), and STEMI (22%) were enrolled. The primary endpoint was achieved in 93% of lesions with stent diameter ≥2.75 mm (average MSA: 6.44 mm2) and 87% of lesions with stent diameter ≤2.5 mm (average MSA: 4.56 mm2). The average MSA (with expansion ≥80% cutoff) was 6.63 mm2 and 4.74 mm2 with a stent diameter ≥2.75 mm and ≤2.5 mm, respectively. According to the core lab analysis, the average MSA achieved with a stent diameter ≥2.75 mm and ≤2.5 mm was 6.23 mm2 and 3.95 mm2, respectively (with expansion ≥80% cutoff). Clinically significant serum creatinine was noted in two patients (0.45%). Major adverse cardiac events at 1 year were noted in 1.2% (n = 6) of the patients; all were cardiac deaths. CONCLUSION PCI under OCT guidance improves procedural and long-term clinical outcomes in patients with complex lesions not just in a controlled trial environment but also in routine clinical practice.
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Affiliation(s)
- Praveen Chandra
- Interventional and Structural Heart Cardiology, Interventional Cardiology Heart Institute, Medanta-The Medicity, Gurgaon, Haryana, India.
| | - Selvamani Sethuraman
- Department of Cardiology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | - Sanjeeb Roy
- Interventional Cardiology, Intervention Cardiology, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Keyur Parikh
- Intervention Cardiology, Marengo CIMS Hospital, Ahmedabad, Gujarat, India
| | | | - Prasant Kumar Sahoo
- Interventional Cardiology, Department of Cardiology, Apollo Hospital, Bhubaneshwar, Odisha, India
| | - Sridhar Kasturi
- Department of Cardiology, Sunshine Hospital, Hyderabad, Telangana, India
| | | | - Viveka Kumar
- Cardiac Sciences, Department of Cardiology, Max Super Specialty Hospital, Saket, New Delhi, Delhi, India
| | - Brian Pinto
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | | | | | - Deepak Davidson
- Intervention Cardiology, Caritas Hospital, Kottayam, Kerala, India
| | - Girish B Navasundi
- Interventional Cardiology, Department of Cardiology, Apollo Hospital, Bangalore, Karnataka, India
| | - Vijayakumar Subban
- Indian Cardiology Research Foundation, Core Lab, Chennai, Tamil Nadu, India
| | | | | | | | | | - Ajit Mullasari
- Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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13
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Serruys PW, Kotoku N, Nørgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, Knuuti J, Narula J, Perera D, Taylor CA, Leipsic JA, Nicol ED, Piazza N, Schultz CJ, Kitagawa K, Bruyne BD, Collet C, Tanaka K, Mushtaq S, Belmonte M, Dudek D, Zlahoda-Huzior A, Tu S, Wijns W, Sharif F, Budoff MJ, Mey JD, Andreini D, Onuma Y. Computed tomographic angiography in coronary artery disease. EUROINTERVENTION 2023; 18:e1307-e1327. [PMID: 37025086 PMCID: PMC10071125 DOI: 10.4244/eij-d-22-00776] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 04/05/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFRCT), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.
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Affiliation(s)
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D Nicol
- Royal Brompton Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Mie, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | | | | | - Darius Dudek
- Szpital Uniwersytecki w Krakowie, Krakow, Poland
| | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - William Wijns
- Department of Cardiology, University of Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, Galway, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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14
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Han X, He Y, Luo N, Zheng D, Hong M, Wang Z, Yang Z. The influence of artificial intelligence assistance on the diagnostic performance of CCTA for coronary stenosis for radiologists with different levels of experience. Acta Radiol 2023; 64:496-507. [PMID: 35389276 DOI: 10.1177/02841851221089263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The interpretation of coronary computed tomography angiography (CCTA) stenosis may be difficult among radiologists of different experience levels. Artificial intelligence (AI) may improve the diagnostic performance. PURPOSE To investigate whether the diagnostic performance and time efficiency of radiologists with different levels of experience in interpreting CCTA images could be improved by using CCTA with AI assistance (CCTA-AI). MATERIAL AND METHODS This analysis included 200 patients with complete CCTA and invasive coronary angiography (ICA) data, using ICA results as the reference. Eighteen radiologists were divided into three levels based on experience (Levels I, II, and III), and the three levels were divided into groups without (Groups 1, 2, and 3) and with (Groups 4, 5, and 6) AI assistance, totaling six groups (to avoid reader recall bias). The average sensitivity, specificity, NPV, PPV, and AUC were reported for the six groups and CCTA-AI at the patient, vessel, and segment levels. The interpretation time in the groups with and without CCTA-AI was recorded. RESULTS Compared to the corresponding group without CCTA-AI, the Level I group with CCTA-AI had improved sensitivity (75.0% vs. 83.0% on patient-based; P = 0.003). At Level III, the specificity was better with CCTA-AI. The median interpretation times for the groups with and without CCTA-AI were 413 and 615 s, respectively (P < 0.001). CONCLUSION CCTA-AI could assist with and improve the diagnostic performance of radiologists with different experience levels, with Level I radiologists exhibiting improved sensitivity and Level III radiologists exhibiting improved specificity. The use of CCTA-AI could shorten the training time for radiologists.
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Affiliation(s)
- Xianjun Han
- Department of Radiology, Beijing Friendship Hospital, 535066Capital Medical University, Beijing, PR China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, 535066Capital Medical University, Beijing, PR China
| | - Nan Luo
- Department of Radiology, Beijing Friendship Hospital, 535066Capital Medical University, Beijing, PR China
| | - Dandan Zheng
- Shukun (Beijing) Technology Co., Ltd., Beijing, PR China
| | - Min Hong
- Department of Computer Software Engineering, 37969Soonchunhyang University, Asan, Republic of Korea
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, 535066Capital Medical University, Beijing, PR China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, 535066Capital Medical University, Beijing, PR China
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15
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AI Evaluation of Stenosis on Coronary CTA, Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve: A CREDENCE Trial Substudy. JACC Cardiovasc Imaging 2023; 16:193-205. [PMID: 35183478 DOI: 10.1016/j.jcmg.2021.10.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical reads of coronary computed tomography angiography (CTA), especially by less experienced readers, may result in overestimation of coronary artery disease stenosis severity compared with expert interpretation. Artificial intelligence (AI)-based solutions applied to coronary CTA may overcome these limitations. OBJECTIVES This study compared the performance for detection and grading of coronary stenoses using artificial intelligence-enabled quantitative coronary computed tomography (AI-QCT) angiography analyses to core lab-interpreted coronary CTA, core lab quantitative coronary angiography (QCA), and invasive fractional flow reserve (FFR). METHODS Coronary CTA, FFR, and QCA data from 303 stable patients (64 ± 10 years of age, 71% male) from the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia) trial were retrospectively analyzed using an Food and Drug Administration-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. RESULTS Disease prevalence was high, with 32.0%, 35.0%, 21.0%, and 13.0% demonstrating ≥50% stenosis in 0, 1, 2, and 3 coronary vessel territories, respectively. Average AI-QCT analysis time was 10.3 ± 2.7 minutes. AI-QCT evaluation demonstrated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94%, 68%, 81%, 90%, and 84%, respectively, for ≥50% stenosis, and of 94%, 82%, 69%, 97%, and 86%, respectively, for detection of ≥70% stenosis. There was high correlation between stenosis detected on AI-QCT evaluation vs QCA on a per-vessel and per-patient basis (intraclass correlation coefficient = 0.73 and 0.73, respectively; P < 0.001 for both). False positive AI-QCT findings were noted in in 62 of 848 (7.3%) vessels (stenosis of ≥70% by AI-QCT and QCA of <70%); however, 41 (66.1%) of these had an FFR of <0.8. CONCLUSIONS A novel AI-based evaluation of coronary CTA enables rapid and accurate identification and exclusion of high-grade stenosis and with close agreement to blinded, core lab-interpreted quantitative coronary angiography. (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia [CREDENCE]; NCT02173275).
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16
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Ibrahim MK, Shehata MA, Ghozy S, Bilgin C, Jabal MS, Heiferman DM, Kadirvel R, Kallmes DF. Operator assessment versus core laboratory adjudication of recanalization following endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:133-138. [PMID: 36163347 DOI: 10.1136/jnis-2022-019266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Successful recanalization after endovascular thrombectomy serves as the primary endpoint in clinical trials and is a crucial predictor of long-term outcomes. Radiographic outcomes for various interventions have been shown to vary based on the type of interpreter, including the site interventionalist compared with an independent reader. OBJECTIVE To compare angiographic outcomes in stroke thrombectomy procedures based on the type of reader. METHODS A systematic literature search was conducted in Medline, EMBASE, Scopus, and Web-of-Science through February 2022. We included primary studies that reported core laboratory-read and operator angiographic outcomes after mechanical thrombectomy for ischemic stroke. Furthermore, study-defined successful recanalization data were collected. RESULTS Eight studies were included with 4797 patients, 51.2% of whom were male. Four thousand, four hundred and thirty-one patients had core readings, and 4211 had operator readings. Study-defined successful recanalization was significantly higher for operator (84%, 3543/4211) examinations than for core laboratory-read (78.4%, 3476/4431) examinations (p<0.001; OR=1.462, 95% CI 1.175 to 1.819). The modified Thrombolysis in Cerebral Infarction (mTICI) scale score of ≥2 b was higher for operator (85%, 3341/3929) examinations than for core laboratory-read (78.6%, 3107/3952) examinations (p<0.001; OR=1.349, 95% CI 1.071 to 1.701). mTICI 3 was significantly higher for operator (54.6%, 1000/1832) examinations than for core laboratory-read (39.9%, 731/1832) examinations (p<0.001; OR=1.823, 95% CI 1.598 to 2.081). CONCLUSION Operator angiographic reads are statistically significantly higher than core laboratory-read readings following stroke thrombectomy, especially for complete recanalization. These differences should be considered when interpreting reports of angiographic outcomes after thrombectomy.
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Affiliation(s)
| | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel M Heiferman
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Motwani M, Williams MC, Nieman K, Choi AD. Great debates in cardiac computed tomography: OPINION: "Artificial intelligence is key to the future of CCTA - The great hope". J Cardiovasc Comput Tomogr 2023; 17:18-21. [PMID: 35945132 DOI: 10.1016/j.jcct.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Manish Motwani
- Manchester Heart Institute, Manchester University NHS Foundation Trust, UK; Institute of Cardiovascular Science, University of Manchester, UK
| | - Michelle C Williams
- Center for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
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Newman JD, Douglas PS, Zhbannikov I, Ferencik M, Foldyna B, Hoffmann U, Shah SH, Ginsburg GS, Lu MT, Voora D. Associations of a polygenic risk score with coronary artery disease phenotypes in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. Am Heart J 2022; 252:12-15. [PMID: 35605652 PMCID: PMC9336199 DOI: 10.1016/j.ahj.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
A polygenic risk score (PGS) is associated with obstructive coronary artery disease (CAD) independent of traditional risk factors. Coronary computed tomography angiography (CTA) can characterize coronary plaques, including features of highrisk CAD. However, it is unknown if a PGS is associated with obstructive CAD and high-risk CAD phenotypes in patients with symptoms suggestive of CAD.
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Affiliation(s)
- Jonathan D Newman
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016.
| | - Pamela S Douglas
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Ilya Zhbannikov
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Maros Ferencik
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Borek Foldyna
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Udo Hoffmann
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Svati H Shah
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Geoffrey S Ginsburg
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Michael T Lu
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
| | - Deepak Voora
- The Leon H Charney Division of Cardiology, The Center for the Prevention of Cardiovascular Disease, New York, NY 10016
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Azour L, Ko JP, Toussie D, Gomez GV, Moore WH. Current imaging of PE and emerging techniques: is there a role for artificial intelligence? Clin Imaging 2022; 88:24-32. [DOI: 10.1016/j.clinimag.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
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20
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Allmendinger T, Nowak T, Flohr T, Klotz E, Hagenauer J, Alkadhi H, Schmidt B. Photon-Counting Detector CT-Based Vascular Calcium Removal Algorithm: Assessment Using a Cardiac Motion Phantom. Invest Radiol 2022; 57:399-405. [PMID: 35025834 PMCID: PMC9071027 DOI: 10.1097/rli.0000000000000853] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The diagnostic performance of coronary computed tomography angiography is known to be negatively affected by the presence of severely calcified plaques in the coronary arteries. In this article, the performance of a novel image reconstruction algorithm (PureLumen) based on spectral CT data of a first-generation dual-source photon-counting detector computed tomography (PCD-CT) system was assessed in a phantom study. PureLumen tries to remove only the calcified contributions from the image while leaving the rest unmodified. MATERIALS AND METHODS The study uses 2 iodine contrast filled vessel phantoms (diameter 4 mm) filled with different concentrations of iodine and equipped with calcified stenosis inserts. Each phantom features 2 separate calcified lesions of 25% and 50% percentage diameter stenosis (PDS) size. The vessel phantoms were mounted inside an anthropomorphic thorax phantom attached to an artificial motion device, simulating realistic cardiac motion at heart rates between 50 beats per minute and 100 beats per minute. Acquisitions were performed using a prospectively electrocardiogram triggered dual-source sequence mode on a PCD-CT system (NAEOTOM Alpha, Siemens Healthineers). Images were reconstructed at 80% of the RR interval with virtual monoenergetic images (Mono) and with additional calcium-removal (PureLumen), both at 65 keV. PureLumen is based on a spectral base material decomposition into iodine and calcium, which aims to reconstruct images without calcium contributions, while leaving all other material contribution unchanged. Stenosis grade was assessed individually for each vessel insert in all reconstructed image series by 2 readers. RESULTS The measured median PDS values for the 50% lesion were 56.0% (52.0%, 57.0%) for the Mono case and 50.0% (48.5%, 51.0%) for PureLumen. The 25% lesion median PDS values were 36.0% (29.5%, 39.5%) for Mono and 31.5% (30.5%, 34.0%) for PureLumen. Both lesion sizes demonstrate a significant difference between Mono and PureLumen in their result (P < 0.05) with PureLumen median values being closer to the actual true stenosis size for the 50% and 25% lesion. A visual assessment of the image quality depending on the heart rate yielded good image quality up to a heart rate of 80 beats per minute in the PureLumen case. CONCLUSIONS This phantom study shows that a novel calcium-removal image reconstruction algorithm (PureLumen) using a first-generation dual-source PCD-CT effectively decreases blooming artifacts caused by heavily calcified plaques and improves image interpretability. It also shows that PureLumen retains its performance in the presence of motion with simulated heart rates up to 80 beats per minute. Future in vivo clinical studies are needed to confirm the benefits of this type of reconstruction in terms of coronary computed tomography angiography quality and accuracy.
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Affiliation(s)
| | | | - Thomas Flohr
- From Siemens Healthcare GmbH, Forchheim
- University Tübingen, Tübingen
| | | | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard Schmidt
- From Siemens Healthcare GmbH, Forchheim
- University Erlangen, Erlangen, Germany
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21
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Rasmussen LD, Fordyce CB, Nissen L, Hill CL, Alhanti B, Hoffmann U, Udelson J, Bøttcher M, Douglas PS, Winther S. The PROMISE Minimal Risk Score Improves Risk Classification of Symptomatic Patients With Suspected CAD. JACC Cardiovasc Imaging 2022; 15:1442-1454. [DOI: 10.1016/j.jcmg.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
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22
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Chua A, Ihdayhid AR, Linde JJ, Sørgaard M, Cameron JD, Seneviratne SK, Ko BS. Diagnostic Performance of CT-Derived Fractional Flow Reserve in Australian Patients Referred for Invasive Coronary Angiography. Heart Lung Circ 2022; 31:1102-1109. [PMID: 35501246 DOI: 10.1016/j.hlc.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/16/2021] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-invasive computed tomography (CT)-derived fractional flow reserve (FFRCT) is computed from standard coronary CT angiography (CTA) datasets and provides accurate vessel-specific ischaemia assessment of coronary artery disease (CAD). To date, the technique and its diagnostic performance has not been verified in the Australian clinical context. The aim of this study was to describe and compare the diagnostic performance of FFRCT and CTA for the detection of vessel-specific ischaemia as determined by invasive fractional flow reserve (FFR) in the Australian patient population. METHODS One-hundred-and-nine patients (219 vessels) referred for clinically mandated invasive angiography were retrospectively assessed. Each patient underwent research mandated CTA and FFRCT within 3 months of invasive angiography and invasive FFR assessment. Independent core laboratory assessments were made to determine visual CTA stenosis, FFRCT and invasive FFR values. FFRCT values were matched with the corresponding invasive FFR measurement taken at the given wire position. Visual CTA stenosis ≥50%, FFRCT values ≤0.8 and invasive FFR values ≤0.8 were considered significant for ischaemia. RESULTS Per vessel accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FFRCT were 80.4%, 80.0%, 80.6%, 64.9% and 90.0% respectively. Corresponding values for CTA were 75.1%, 87.1%, 69.2%, 58.1% and 91.7% respectively. In receiver operating characteristic curve analysis, FFRCT demonstrated superior area under the curve (AUC) compared with CTA in both per vessel (0.87 vs 0.77, p=0.004) and per patient analysis (0.86 vs 0.74, p=0.011). Per vessel AUC of combined CTA and FFRCT was superior to CTA alone (0.89 vs 0.77, p<0.0001). CONCLUSION In this cohort of Australian patients, the diagnostic performance of FFRCT was found to be comparable to existing international literature, with demonstrated improvement in performance compared with CTA alone for the detection of vessel-specific ischaemia.
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Affiliation(s)
- Alexander Chua
- Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Abdul-Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia.
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23
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Coronary CTA With AI-QCT Interpretation: Comparison With Myocardial Perfusion Imaging for Detection of Obstructive Stenosis UsingInvasive Angiography as Reference Standard. AJR Am J Roentgenol 2022; 219:407-419. [PMID: 35441530 DOI: 10.2214/ajr.21.27289] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Deep learning frameworks have been applied to interpretation of coronary CTA performed for coronary artery disease (CAD) evaluation. Objective: To compare the diagnostic performance of myocardial perfusion imaging (MPI) and coronary CTA with artificial intelligence-quantitative CT (AI-QCT) interpretation for detection of obstructive CAD on invasive angiography, and to assess downstream impact of including coronary CTA with AI-QCT in diagnostic algorithms. Methods: This study entailed a retrospective post-hoc analysis of the derivation cohort of the prospective 23-center CREDENENCE trial. The study included 301 patients [mean age 64.4±10.2 years; 88 female, 213 male] recruited from 2014 to 2017 with stable symptoms of myocardial ischemia referred for nonemergent invasive angiography. Patients underwent coronary CTA and MPI before angiography with quantitative coronary angiography (QCA) measurements and fractional flow reserve (FFR). CTA examinations were analyzed using an FDA-cleared cloud-based software that performs AI-QCT for stenosis determination. Diagnostic performance was evaluated. Diagnostic algorithms were compared. Results: Among 102 patients with no ischemia on MPI, AI-QCT identified obstructive (≥50%) stenosis in 54%, including severe (≥70%) stenosis in 20%. Among 199 patients with ischemia on MPI, AI-QCT identified non-obstructive (1-49%) stenosis in 23%. AI-QCT had significantly higher AUC (all p<.001) than MPI for predicting ≥50% stenosis by QCA (0.88 vs 0.66), ≥70% stenosis by QCA (0.92 vs 0.81), and FFR <0.80 (0.90 vs 0.71). AI-QCT ≥50% and ischemia on stress MPI had sensitivity of 95% versus 74% and specificity of 63% versus 43% for detecting ≥50% stenosis by QCA measurement. Compared with performing MPI in all patients and those showing ischemia undergoing invasive angiography, a scenario of performing coronary CTA with AI-QCT in all patients and those showing ≥70% stenosis undergoing invasive angiography would reduce invasive angiography utilization by 39%; a scenario of performing MPI in all patients and those showing ischemia undergoing coronary CTA with AI-QCT and those with ≥70% stenosis on AI-QCT undergoing invasive angiography would reduce invasive angiography utilization by 49%. Conclusion: Coronary CTA with AI-QCT had higher diagnostic performance than MPI for detecting obstructive CAD. Clinical impact: A diagnostic algorithm incorporating AI-QCT could substantially reduce unnecessary downstream invasive testing. Trial Registration: ClinicalTrials.gov NCT02173275.
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24
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Covas P, De Guzman E, Barrows I, Bradley AJ, Choi BG, Krepp JM, Lewis JF, Katz R, Tracy CM, Zeman RK, Earls JP, Choi AD. Artificial Intelligence Advancements in the Cardiovascular Imaging of Coronary Atherosclerosis. Front Cardiovasc Med 2022; 9:839400. [PMID: 35387447 PMCID: PMC8977643 DOI: 10.3389/fcvm.2022.839400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice.
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Affiliation(s)
- Pedro Covas
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Eison De Guzman
- Department of Internal Medicine, The George Washington University School of Medicine, Washington, DC, United States
| | - Ian Barrows
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Andrew J. Bradley
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Brian G. Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Joseph M. Krepp
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Jannet F. Lewis
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Richard Katz
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Cynthia M. Tracy
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Robert K. Zeman
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | - James P. Earls
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Andrew D. Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
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Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry). Eur Radiol 2022; 32:5246-5255. [PMID: 35267087 PMCID: PMC9283210 DOI: 10.1007/s00330-022-08639-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/28/2022] [Accepted: 02/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. METHODS We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010-01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. RESULTS Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010-2014 (52%), while non-academic sites dominated in 2015-2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46-6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). CONCLUSIONS Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. KEY POINTS • Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease. • Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe. • Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.
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Zhang L, Olalere D, Mayrhofer T, Bittner DO, Emami H, Meyersohn NM, Puchner SB, Abidov A, Moloo J, Dolor RJ, Mark DB, Ferencik M, Hoffmann U, Douglas PS, Lu MT. Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial. JAMA Cardiol 2022; 7:259-267. [PMID: 34935857 PMCID: PMC8696694 DOI: 10.1001/jamacardio.2021.5340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Race and ethnicity have been studied as risk factors in cardiovascular disease. How risk factors, epicardial coronary artery disease, and cardiac events differ between Black and White individuals undergoing noninvasive testing for coronary artery disease is not known. OBJECTIVE To assess differences in cardiovascular risk burden, coronary plaque, and major adverse cardiac events between Black and White individuals assigned to receive coronary computed tomography angiography (CCTA) or functional testing for stable chest pain. DESIGN, SETTING, AND PARTICIPANTS A nested observational cohort study within the PROMISE trial was conducted at 193 outpatient sites in North America. A total of 1071 non-Hispanic Black (hereafter Black) and 7693 non-Hispanic White (hereafter White) participants with stable chest pain undergoing noninvasive cardiovascular testing were included. This analysis was conducted from February 13, 2015, to November 2, 2021. MAIN OUTCOMES AND MEASURES The primary end point was the composite of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 24.4 months. RESULTS Among 1071 Black individuals (12.2%) (women, 646 [60.3%]; mean [SD] age, 59 [8] years) and 7693 White individuals (87.8%) (women, 4029 [52.4%]; mean [SD] age, 61.1 [8.4] years), Black participants had a higher cardiovascular risk burden (more hypertension and diabetes), yet there was a similarly low major adverse cardiovascular events rate over a median 2-year follow-up (32 [3.0%] vs 243 [3.2%]; P = .84). Sensitivity analyses restricted to the 79.8% (6993 of 8764) individuals with a normal or mildly abnormal noninvasive testing result and the 54.3% (4559 of 8396) not receiving statin therapy yielded similar findings. In comparison of Black and White individuals in the CCTA group (n = 3323), significant coronary stenosis (hazard ratio [HR], 7.21; 95% CI, 1.94-26.76 vs HR, 4.30; 95% CI, 2.62-7.04) and high-risk plaque (HR, 3.47; 95% CI, 1.00-12.06 vs HR, 2.21; 95% CI, 1.37-3.57) were associated with major adverse cardiovascular events in both Black and White patients. However, with respect to epicardial coronary artery disease burden, Black individuals had a less-prevalent coronary artery calcium score greater than 0 (45.1% vs 63.2%; P < .001), coronary stenosis greater than or equal to 50% (32 [8.7%] vs 430 [14.6%]; P = .001), and high-risk plaque (139 [37.6%] vs 1547 [52.4%]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that, despite a greater cardiovascular risk burden in Black persons, rates of coronary artery calcium, stenosis, and high-risk plaque observed via CCTA were lower in Black persons than White persons. This result suggests differences in cardiovascular risk burden and coronary plaque in Black and White individuals with stable chest pain.
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Affiliation(s)
- Lili Zhang
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Devvora Olalere
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Daniel O. Bittner
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Hamed Emami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,University of Michigan Cardiovascular Center, Ann Arbor
| | - Nina M. Meyersohn
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stefan B. Puchner
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Aiden Abidov
- Division of Cardiology, Department of Internal Medicine, John D Dingell VAMC, Detroit, Michigan
| | | | - Rowena J. Dolor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Maros Ferencik
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Channon KM, Newby DE, Nicol ED, Deanfield J. Cardiovascular computed tomography imaging for coronary artery disease risk: plaque, flow and fat. Heart 2022; 108:1510-1515. [PMID: 35022211 PMCID: PMC9484394 DOI: 10.1136/heartjnl-2021-320265] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac imaging is central to the diagnosis and risk stratification of coronary artery disease, beyond symptoms and clinical risk factors, by providing objective evidence of myocardial ischaemia and characterisation of coronary artery plaque. CT coronary angiography can detect coronary plaque with high resolution, estimate the degree of functional stenosis and characterise plaque features. However, coronary artery disease risk is also driven by biological processes, such as inflammation, that are not fully reflected by severity of stenosis, myocardial ischaemia or by coronary plaque features. New cardiac CT techniques can assess coronary artery inflammation by imaging perivascular fat, and this may represent an important step forward in identifying the ‘residual risk’ that is not detected by plaque or ischaemia imaging. Coronary artery disease risk assessment that incorporates clinical factors, plaque characteristics and perivascular inflammation offers a more comprehensive individualised approach to quantify and stratify coronary artery disease risk, with potential healthcare benefits for prevention, diagnosis and treatment recommendations. Furthermore, identifying new biomarkers of cardiovascular risk has the potential to refine early-life prevention strategies, before atherosclerosis becomes established.
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Affiliation(s)
- Keith M Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - John Deanfield
- Departments of Cardiology and Radiology, Centre for Cardiovascular Prevention and Outcomes, University College London, London, UK
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Abstract
The development of cardiovascular toxicity attributable to anticancer drugs is a pivotal event that is associated with cardiovascular morbidity as well as with worse cancer-specific and overall outcomes. Although broad consensus exists regarding the importance of cardiovascular safety assessment in cancer drug development, real-world data suggest that cardiovascular events are significantly underestimated in oncology trials. This drug safety discrepancy has profound implications on drug development decisions, risk-benefit evaluation, formulation of surveillance and prevention protocols, and survivorship. In this article, we review the contemporary cardiovascular safety evaluation of new pharmaceuticals in hematology and oncology, spanning from in vitro pharmacodynamic testing to randomized clinical trials. We argue that cardiovascular safety assessment of anticancer drugs should be reformed and propose practical strategies, including development and validation of preclinical assays, expansion of oncology trial eligibility, incorporation of cardiovascular end points in early-phase studies, and design of longitudinal multi-institutional cardiotoxicity registries.
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Affiliation(s)
- Ohad Oren
- Division of CardiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Tomas G. Neilan
- Cardio‐Oncology ProgramDivision of CardiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Michael G. Fradley
- Cardio‐Oncology Center of ExcellenceDivision of CardiologyDepartment of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical SchoolBostonMA
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Schwartz FR, Roth CJ, Boardwine B, Hardister L, Thomas-Campbell S, Lander K, Montoya C, Jaffe TA. Electronic Health Record Closed-Loop Communication Program for Unexpected Nonemergent Findings. Radiology 2021; 301:123-130. [PMID: 34374592 DOI: 10.1148/radiol.2021210057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Reliance on examination reporting of unexpected imaging findings does not ensure receipt of findings or appropriate follow-up. A closed-loop communication system should include provider and patient notifications and be auditable through the electronic health record (EHR). Purpose To report the initial design of and results from using an EHR-integrated unexpected findings navigator (UFN) program that ensures closed-loop communication of unexpected nonemergent findings. Materials and Methods An EHR-integrated UFN program was designed to enable identification and communication of unexpected findings and aid in next steps in findings management. Three navigators (with prior training as radiologic technologists and sonographers) facilitated communication and documentation of results to providers and patients. Twelve months (October 2019 to October 2020) of results were retrospectively reviewed to evaluate patient demographics and program metrics. Descriptive statistics and correlation analysis were performed by using commercially available software. Results A total of 3542 examinations were reported within 12 months, representing 0.5% of all examinations performed (total of 749 649); the median patient age was 62 years (range, 1 day to 98 years; interquartile range, 23 years). Most patients were female (2029 of 3542 [57%]). Almost half of the examinations submitted were from chest radiography and CT (1618 of 3542 [46%]), followed by MRI and CT of the abdomen and pelvis (1123 of 3542 [32%]). The most common unexpected findings were potential neoplasms (391 of 3542 [11%]). The median time between examination performance and patient notification was 12 days (range, 0-136 days; interquartile range, 13 days). A total of 2127 additional imaging studies were performed, and 1078 patients were referred to primary care providers and specialists. Most radiologists (89%, 63 of 71 respondents) and providers (65%, 28 of 43 respondents) found the system useful and used it most frequently during regular business hours. Conclusion An electronic health record-integrated, navigator-facilitated, closed-loop communication program for unexpected radiologic findings led to near-complete success in notification of providers and patients and facilitated the next steps in findings management. © RSNA, 2021 See also the editorial by Safdar in this issue.
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Affiliation(s)
- Fides R Schwartz
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Christopher J Roth
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Brenda Boardwine
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Lisa Hardister
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Shannon Thomas-Campbell
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Katherine Lander
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Charlene Montoya
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Tracy A Jaffe
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
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Veselova TN, Ternovoy SK, Chepovskiy AM, Borisenko VV, Gavrilov AV, Blagosklonova ER, Dolotova DD, Mironov VM, Arutyunyan GK. Evaluation of the Fractional Flow Reserve by Computer Tomography Data: Comparison of the Calculated Parameters with the Results of Invasive Measurements. ACTA ACUST UNITED AC 2021; 61:28-35. [PMID: 34397339 DOI: 10.18087/cardio.2021.7.n1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
Aim To create a three-dimensional mathematical model of coronary flow in patients with ischemic heart disease based on findings of computed tomography angiography (CTA) with subsequent calculation of the fractional flow reserve (FFRCTA) and comparison of estimated FFRCTA with FFR reference values measured by coronary angiography (CAG).Material and methods The study included 10 patients with borderline stenosis (50-75 %) as determined by CTA performed with a 640‑slice CT-scanner. Based on CTA findings, three-dimensional mathematical models were constructed for further calculation of FFRCTA. Later, an invasive measurement of FFR (FFRINV) was performed for all patients. FFR values <0.8 indicated the hemodynamic significance of stenosis.Results FFRCTA and FFRINV values differed insignificantly in most cases (n=9) and exceeded 5% in only one case. The regression analysis showed a close correlation between estimated and invasively measured FFR values.Conclusion Preliminary results showed a good consistency of calculated and measured FFR values. Therefore, further development of the method for mathematical modeling of three-dimensional blood flow by CTA findings is promising. Noninvasive evaluation of FFR is particularly relevant for analysis of hemodynamic significance of borderline (50-75 %) coronary stenoses.
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Affiliation(s)
- T N Veselova
- National medical research Center of cardiology of the Ministry of Healthcare of Russia, Moscow
| | - S K Ternovoy
- National medical research Center of cardiology of the Ministry of Healthcare of Russia, Moscow; Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - A M Chepovskiy
- Peoples Friendship University of Russia (RUDN University), Moscow
| | | | | | | | | | - V M Mironov
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow
| | - G K Arutyunyan
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow
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CT EvaLuation by ARtificial Intelligence For Atherosclerosis, Stenosis and Vascular MorphologY (CLARIFY): A Multi-center, international study. J Cardiovasc Comput Tomogr 2021; 15:470-476. [PMID: 34127407 DOI: 10.1016/j.jcct.2021.05.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atherosclerosis evaluation by coronary computed tomography angiography (CCTA) is promising for coronary artery disease (CAD) risk stratification, but time consuming and requires high expertise. Artificial Intelligence (AI) applied to CCTA for comprehensive CAD assessment may overcome these limitations. We hypothesized AI aided analysis allows for rapid, accurate evaluation of vessel morphology and stenosis. METHODS This was a multi-site study of 232 patients undergoing CCTA. Studies were analyzed by FDA-cleared software service that performs AI-driven coronary artery segmentation and labeling, lumen and vessel wall determination, plaque quantification and characterization with comparison to ground truth of consensus by three L3 readers. CCTAs were analyzed for: % maximal diameter stenosis, plaque volume and composition, presence of high-risk plaque and Coronary Artery Disease Reporting & Data System (CAD-RADS) category. RESULTS AI performance was excellent for accuracy, sensitivity, specificity, positive predictive value and negative predictive value as follows: >70% stenosis: 99.7%, 90.9%, 99.8%, 93.3%, 99.9%, respectively; >50% stenosis: 94.8%, 80.0%, 97.0, 80.0%, 97.0%, respectively. Bland-Altman plots depict agreement between expert reader and AI determined maximal diameter stenosis for per-vessel (mean difference -0.8%; 95% CI 13.8% to -15.3%) and per-patient (mean difference -2.3%; 95% CI 15.8% to -20.4%). L3 and AI agreed within one CAD-RADS category in 228/232 (98.3%) exams per-patient and 923/924 (99.9%) vessels on a per-vessel basis. There was a wide range of atherosclerosis in the coronary artery territories assessed by AI when stratified by CAD-RADS distribution. CONCLUSIONS AI-aided approach to CCTA interpretation determines coronary stenosis and CAD-RADS category in close agreement with consensus of L3 expert readers. There was a wide range of atherosclerosis identified through AI.
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Hoffmann U, Lu MT, Foldyna B, Zanni MV, Karady J, Taron J, Zhai BK, Burdo T, Fitch KV, Kileel EM, Williams K, Fichtenbaum CJ, Overton ET, Malvestutto C, Aberg J, Currier J, Sponseller CA, Melbourne K, Floris-Moore M, Van Dam C, Keefer MC, Koletar SL, Douglas PS, Ribaudo H, Mayrhofer T, Grinspoon SK. Assessment of Coronary Artery Disease With Computed Tomography Angiography and Inflammatory and Immune Activation Biomarkers Among Adults With HIV Eligible for Primary Cardiovascular Prevention. JAMA Netw Open 2021; 4:e2114923. [PMID: 34185068 PMCID: PMC8243232 DOI: 10.1001/jamanetworkopen.2021.14923] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Cardiovascular disease (CVD) is increased among people with HIV (PWH), but little is known regarding the prevalence and extent of coronary artery disease (CAD) and associated biological factors in PWH with low to moderate traditional CVD risk. OBJECTIVES To determine unique factors associated with CVD in PWH and to assess CAD by coronary computed tomography angiography (CTA) and critical pathways of arterial inflammation and immune activation. DESIGN, SETTING, AND PARTICIPANTS This cohort study among male and female PWH, aged 40 to 75 years, without known CVD, receiving stable antiretroviral therapy, and with low to moderate atherosclerotic cardiovascular disease (ASCVD) risk according to the 2013 American College of Cardiology/American Heart Association pooled cohort equation, was part of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a large, ongoing primary prevention trial of statin therapy among PWH conducted at 31 US sites. Participants were enrolled from May 2015 to February 2018. Data analysis was conducted from May to December 2020. EXPOSURE HIV disease. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence and composition of CAD assessed by coronary CTA and, secondarily, the association of CAD with traditional risk indices and circulating biomarkers, including insulin, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL) 6, soluble CD14 (sCD14), sCD163, lipoprotein-associated phospholipase A2 (LpPLA2), oxidized low-density lipoprotein (oxLDL), and high-sensitivity C-reactive protein (hsCRP). RESULTS The sample included 755 participants, with a mean (SD) age of 51 (6) years, 124 (16%) female participants, 267 (35%) Black or African American participants, 182 (24%) Latinx participants, a low median (interquartile range) ASCVD risk (4.5% [2.6%-6.8%]), and well-controlled viremia. Overall, plaque was seen in 368 participants (49%), including among 52 of 175 participants (30%) with atherosclerotic CVD (ASCVD) risk of less than 2.5%. Luminal obstruction of at least 50% was rare (25 [3%]), but vulnerable plaque and high Leaman score (ie, >5) were more frequently observed (172 of 755 [23%] and 118 of 743 [16%], respectively). Overall, 251 of 718 participants (35%) demonstrated coronary artery calcium score scores greater than 0. IL-6, LpPLA2, oxLDL, and MCP-1 levels were higher in those with plaque compared with those without (eg, median [IQR] IL-6 level, 1.71 [1.05-3.04] pg/mL vs 1.45 [0.96-2.60] pg/mL; P = .008). LpPLA2 and IL-6 levels were associated with plaque in adjusted modeling, independent of traditional risk indices and HIV parameters (eg, IL-6: adjusted odds ratio, 1.07; 95% CI, 1.02-1.12; P = .01). CONCLUSIONS AND RELEVANCE In this study of a large primary prevention cohort of individuals with well-controlled HIV and low to moderate ASCVD risk, CAD, including noncalcified, nonobstructive, and vulnerable plaque, was highly prevalent. Participants with plaque demonstrated higher levels of immune activation and arterial inflammation, independent of traditional ASCVD risk and HIV parameters.
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Affiliation(s)
| | | | | | | | - Julia Karady
- Massachusetts General Hospital, Boston
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jana Taron
- Massachusetts General Hospital, Boston
- University Hospital Freiburg, Freiburg, Germany
| | - Bingxue K. Zhai
- Massachusetts General Hospital, Boston
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Judith Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Cornelius Van Dam
- Greensboro Clinical Research Site, Cone Health, Greensboro, North Carolina
| | - Michael C. Keefer
- University of Rochester Adult HIV Therapeutic Strategies Network Clinical Research Site, Rochester, New York
| | | | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas Mayrhofer
- Massachusetts General Hospital, Boston
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
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Kolossváry M, Fishman EK, Gerstenblith G, Bluemke DA, Mandler RN, Celentano D, Kickler TS, Bazr S, Chen S, Lai S, Lai H. Cardiovascular risk factors and illicit drug use may have a more profound effect on coronary atherosclerosis progression in people living with HIV. Eur Radiol 2021; 31:2756-2767. [PMID: 33660033 PMCID: PMC9125805 DOI: 10.1007/s00330-021-07755-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/30/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess whether HIV infection directly or indirectly promotes coronary artery disease (CAD) volume progression in a longitudinal study of African Americans. METHODS We randomly selected 300 individuals with subclinical CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV infected, 174 cocaine users) from 1429 cardiovascularly asymptomatic participants of a prospective epidemiological study between May 2004 and August 2015. Individuals underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years). We quantified noncalcified (NCP: -100-350HU), low-attenuation noncalcified (LA-NCP: -100-30HU), and calcified (CP: ≥ 351 HU) plaque volumes. Linear mixed models were used to assess the effects of HIV infection, atherosclerotic cardiovascular disease (ASCVD) risk, and years of cocaine use on plaque volumes. RESULTS There was no significant difference in annual progression rates between HIV-infected and HIV-uninfected regarding NCP (8.7 [IQR: 3.0-19.4] mm3/year vs. 4.9 [IQR: 1.5-18.3] mm3/year, p = 0.14), LA-NCP (0.2 [IQR: 0.0-1.6] mm3/year vs. 0.2 [IQR: 0.0-0.9] mm3/year, p = 0.07) or CP volumes (0.3 [IQR: 0.0-3.4] mm3/year vs. 0.1 [IQR: 0.0-3.2] mm3/year, p = 0.30). Multivariately, HIV infection was not associated with NCP (-6.9mm3, CI: [-32.8-19.0], p = 0.60), LA-NCP (-0.1mm3, CI: [-2.6-2.4], p = 0.92), or CP volumes (-0.3mm3, CI: [-9.3-8.6], p = 0.96). However, each percentage of ASCVD and each year of cocaine use significantly increased total, NCP, and CP volumes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-associated medications had any effect on plaque volumes (p > 0.05 for all). CONCLUSIONS The more profound adverse effect of risk factors in HIV-infected individuals may explain the accelerated progression of CAD in these people, as HIV infection was not independently associated with any coronary plaque volume. KEY POINTS • Human immunodeficiency virus-infected individuals may have similar subclinical coronary artery disease, as the infection is not independently associated with coronary plaque volumes. • However, cardiovascular risk factors and illicit drug use may have a more profound effect on atherosclerosis progression in those with human immunodeficiency virus infection, which may explain the accelerated progression of CAD in these people. • Nevertheless, through rigorous prevention and abstinence from illicit drugs, these individuals may experience similar cardiovascular outcomes as -uninfected individuals.
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Affiliation(s)
- Márton Kolossváry
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor str, Budapest, 1122, Hungary
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA
| | - Gary Gerstenblith
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, 10 Center Dr, Bethesda, MD, 20814, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 614 Wolfe N Wolfe St, Baltimore, MD, 21205, USA
| | - Thomas S Kickler
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Sarah Bazr
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Shaoguang Chen
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Institute of Human Virology, University of Maryland School of Medicine, W Lombard Street, Baltimore, MD, 21201, USA
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 614 Wolfe N Wolfe St, Baltimore, MD, 21205, USA.
- Institute of Human Virology, University of Maryland School of Medicine, W Lombard Street, Baltimore, MD, 21201, USA.
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD, 21201, USA.
| | - Hong Lai
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA
- Institute of Human Virology, University of Maryland School of Medicine, W Lombard Street, Baltimore, MD, 21201, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD, 21201, USA
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Hulten EA, Malhotra S, Tandon S. Patient first versus computed tomography first strategy in testing for stable coronary artery disease: dispelling the prevailing myths and biases. J Nucl Cardiol 2021; 28:735-740. [PMID: 33511561 DOI: 10.1007/s12350-020-02519-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023]
Abstract
We advocate an evidence-based discussion for a patient first philosophy when considering "the right test for the right patient." Numerous test options exist for the evaluation of symptoms of possible stable ischemic heart disease. Major guidelines have traditionally focused on functional testing with or without imaging to clarify symptoms, diagnose ischemia, stratify prognosis, and guide management. Recently, industry advocates have emphasized modality-specific approaches such as computed tomography (CT First) as an initial test strategy for possible stable CAD. We review the key evidence to demonstrate that current best practice would focus on a patient first approach rather than a modality-specific approach.
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Affiliation(s)
- Edward A Hulten
- Departments of Medicine, Cardiology Service, Fort Belvoir Community Hospital, DeWitt Loop 9300, Fort Belvoir, VA, 22060, USA.
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
- F. Edward Hébert Medical School, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, John H. Stroger Hospital, 1901 W. Harrison Street, Suite 3620, Chicago, IL, 60612, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Suman Tandon
- NYU Langone Health and Bellevue Hospital, NYU School of Medicine, 435 East 30th Street, Science Building, Room 713, New York, NY, 10016, USA
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Samei E, Richards T, Segars WP, Daubert MA, Ivanov A, Rubin GD, Douglas PS, Hoffmann U. Task-dependent estimability index to assess the quality of cardiac computed tomography angiography for quantifying coronary stenosis. J Med Imaging (Bellingham) 2021; 8:013501. [PMID: 33447644 PMCID: PMC7797007 DOI: 10.1117/1.jmi.8.1.013501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: Quantifying stenosis in cardiac computed tomography angiography (CTA) images remains a difficult task, as image noise and cardiac motion can degrade image quality and distort underlying anatomic information. The purpose of this study was to develop a computational framework to objectively assess the precision of quantifying coronary stenosis in cardiac CTA. Approach: The framework used models of coronary vessels and plaques, asymmetric motion point spread functions, CT image blur (task-based modulation transfer functions) and noise (noise-power spectrums), and an automated maximum-likelihood estimator implemented as a matched template squared-difference operator. These factors were integrated into an estimability index (e′) as a task-based measure of image quality in cardiac CTA. The e′ index was applied to assess how well it can to predict the quality of 132 clinical cases selected from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain trial. The cases were divided into two cohorts, high quality and low quality, based on clinical scores and the concordance of clinical evaluations of cases by experienced cardiac imagers. The framework was also used to ascertain protocol factors for CTA Biomarker initiative of the Quantitative Imaging Biomarker Alliance (QIBA). Results: The e′ index categorized the patient datasets with an area under the curve of 0.985, an accuracy of 0.977, and an optimal e′ threshold of 25.58 corresponding to a stenosis estimation precision (standard deviation) of 3.91%. Data resampling and training–test validation methods demonstrated stable classifier thresholds and receiver operating curve performance. The framework was successfully applicable to the QIBA objective. Conclusions: A computational framework to objectively quantify stenosis estimation task performance was successfully implemented and was reflective of clinical results in the context of a prominent clinical trial with diverse sites, readers, scanners, acquisition protocols, and patients. It also demonstrated the potential for prospective optimization of imaging protocols toward targeted precision and measurement consistency in cardiac CT images.
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Affiliation(s)
- Ehsan Samei
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Durham, North Carolina, United States
| | - Taylor Richards
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Durham, North Carolina, United States
| | - William P Segars
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Durham, North Carolina, United States
| | - Melissa A Daubert
- Duke University Medical Center, Department of Medicine, Durham, North Carolina, United States
| | - Alex Ivanov
- Massachusetts General Hospital, Department of Radiology, Boston, Massachusetts, United States
| | - Geoffrey D Rubin
- Duke University Medical Center, Department of Radiology, Durham, North Carolina, United States
| | - Pamela S Douglas
- Duke University Medical Center, Department of Medicine, Durham, North Carolina, United States
| | - Udo Hoffmann
- Massachusetts General Hospital, Department of Radiology, Boston, Massachusetts, United States
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Olesen KKW, Riis AH, Nielsen LH, Steffensen FH, Nørgaard BL, Jensen JM, Poulsen PL, Thim T, Bøtker HE, Sørensen HT, Maeng M. Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. Eur Heart J Cardiovasc Imaging 2020; 20:1271-1278. [PMID: 31220229 DOI: 10.1093/ehjci/jez010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/28/2019] [Indexed: 01/18/2023] Open
Abstract
AIMS We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. METHODS AND RESULTS A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71-2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79-3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14-9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. CONCLUSION In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.
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Affiliation(s)
- Kevin K W Olesen
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark
| | - Anders H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark
| | - Lene H Nielsen
- Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark
| | - Flemming H Steffensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark.,Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark
| | - Per L Poulsen
- Departments of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark
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Saraste A, Knuuti J. ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes : Recommendations for cardiovascular imaging. Herz 2020; 45:409-420. [PMID: 32430520 PMCID: PMC7391397 DOI: 10.1007/s00059-020-04935-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of “clinical likelihood of CAD” was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms.
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Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamllynkatu 4-8, 20520, Turku, Finland.,Heart Center, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamllynkatu 4-8, 20520, Turku, Finland.
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38
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Foldyna B, Udelson JE, Karády J, Banerji D, Lu MT, Mayrhofer T, Bittner DO, Meyersohn NM, Emami H, Genders TSS, Fordyce CB, Ferencik M, Douglas PS, Hoffmann U. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging 2020; 20:574-581. [PMID: 30520944 DOI: 10.1093/ehjci/jey182] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/31/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS To update pretest probabilities (PTP) for obstructive coronary artery disease (CAD ≥ 50%) across age, sex, and clinical symptom strata, using coronary computed tomography angiography (CTA) in a large contemporary population of patients with stable chest pain referred to non-invasive testing. METHODS AND RESULTS We included patients enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial and randomized to CTA. Exclusively level III-certified readers, blinded to demographic and clinical data, assessed the prevalence of CAD ≥ 50% in a central core lab. After comparing the recent European Society of Cardiology-Diamond and Forrester PTP (ESC-DF) with the actual observed prevalence of CAD ≥ 50%, we created a new PTP set by replacing the ESC-DF PTP with the observed prevalence of CAD ≥ 50% across strata of age, sex, and type of angina. In 4415 patients (48.3% men; 60.5 ± 8.2 years; 78% atypical angina; 11% typical angina; 11% non-anginal chest pain), the observed prevalence of CAD ≥ 50% was 13.9%, only one-third of the average ESC-DF PTP (40.6; P < 0.001 for difference). The PTP in the new set ranged 2-48% and were consistently lower than the ESC-DF PTP across all age, sex, and angina type categories. Initially, 4284/4415 (97%) patients were classified as intermediate-probability by the ESC-DF (PTP 15-85%); using the PROMISE-PTP, 50.2% of these patients were reclassified to the low PTP category (PTP < 15%). CONCLUSION The ESC-DF PTP overestimate vastly the actual prevalence of CAD ≥ 50%. A new set of PTP, derived from results of non-invasive testing, may substantially reduce the need for non-invasive tests in stable chest pain.
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Affiliation(s)
- Borek Foldyna
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - James E Udelson
- Tufts University School of Medicine and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street North, Boston, MA, USA
| | - Júlia Karády
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, Hungary
| | - Dahlia Banerji
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Michael T Lu
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Thomas Mayrhofer
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,School of Business Studies, Stralsund University of Applied Sciences, Zur Schwedenschanze 15, Stralsund, Germany
| | - Daniel O Bittner
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Maximilianspl. 2, Erlangen, Germany
| | - Nandini M Meyersohn
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Hamed Emami
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Tessa S S Genders
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada
| | - Maros Ferencik
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Knight Cardiovascular Institute, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
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39
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Achenbach S. Coronary CT Angiography: Moving Up on the Risk Scale. J Am Coll Cardiol 2020; 75:464-466. [PMID: 32029127 DOI: 10.1016/j.jacc.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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40
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Busse A, Cantré D, Beller E, Streckenbach F, Öner A, Ince H, Weber MA, Meinel FG. Cardiac CT: why, when, and how : Update 2019. Radiologe 2019; 59:1-9. [PMID: 31062037 DOI: 10.1007/s00117-019-0530-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to review established and emerging techniques of cardiac computed tomography (CT) and their clinical applications with a special emphasis on new techniques, recent trials, and guidelines. TECHNOLOGICAL INNOVATIONS Cardiac CT has made great strides in recent years to become an ever more robust and safe imaging technique. The improvements in spatial and temporal resolution are equally important as the substantial reduction in radiation exposure, which has been achieved through prospective ECG-triggering, low tube voltage scanning, tube current modulation, and iterative reconstruction techniques. CT-derived fractional flow reserve and CT myocardial perfusion imaging are novel, investigational techniques to assess the hemodynamic significance of coronary stenosis. ESTABLISHED AND EMERGING INDICATIONS In asymptomatic patients at risk for coronary artery disease, CT coronary artery calcium scoring is useful to assess cardiovascular risk and guide the intensity of risk factor modification. Coronary CT angiography is an excellent noninvasive test to rule out obstructive coronary artery disease in patients with stable chest pain. In acute chest pain with normal ECG and normal cardiac enzymes, cardiac CT can safely rule out acute coronary syndrome although its benefit and role in this indication remains controversial. Cardiac CT is the established standard for planning transcatheter aortic valve implantation and-increasingly-minimally invasive mitral valve procedures. PRACTICAL RECOMMENDATIONS Our review makes practical recommendations on when and how to perform cardiac CT and provides templates for structured reporting of cardiac CT examinations.
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Affiliation(s)
- Anke Busse
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Daniel Cantré
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ebba Beller
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix Streckenbach
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Alper Öner
- Department of Internal Medicine, Division of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Hüseyin Ince
- Department of Internal Medicine, Division of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Department of Diagnostic, Interventional, Neuro- and Pediatric Radiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
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41
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Bittner DO, Mayrhofer T, Budoff M, Szilveszter B, Foldyna B, Hallett TR, Ivanov A, Janjua S, Meyersohn NM, Staziaki PV, Achenbach S, Ferencik M, Douglas PS, Hoffmann U, Lu MT. Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc Imaging 2019; 13:1534-1545. [PMID: 31734213 DOI: 10.1016/j.jcmg.2019.09.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/13/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). BACKGROUND The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). METHODS PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants' CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. RESULTS In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. CONCLUSIONS These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.
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Affiliation(s)
- Daniel O Bittner
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany.
| | - Thomas Mayrhofer
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Matt Budoff
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Balint Szilveszter
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Borek Foldyna
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Travis R Hallett
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander Ivanov
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sumbal Janjua
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nandini M Meyersohn
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro V Staziaki
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephan Achenbach
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany
| | - Maros Ferencik
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael T Lu
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Saraste A, Barbato E, Capodanno D, Edvardsen T, Prescott E, Achenbach S, Bax JJ, Wijns W, Knuuti J. Imaging in ESC clinical guidelines: chronic coronary syndromes. Eur Heart J Cardiovasc Imaging 2019; 20:1187-1197. [DOI: 10.1093/ehjci/jez219] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/18/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). The 2019 guideline identified six common clinical scenarios of CCS defined by the different evolutionary phases of coronary artery disease (CAD), excluding the situations in which an acute coronary event, often with coronary thrombus formation, dominates the clinical presentation. This review aims at providing a summary of novel or revised concepts in the guidelines together with the recent data underlying the major changes on the use of cardiac imaging in patients with suspected or known CCS.
Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of CAD based on age, sex and symptoms have been adjusted substantially downward as compared with 2013 ESC guidelines. Further, the impact of various risk factors and modifiers on the pre-test probability was highlighted and a new concept of ‘Clinical likelihood of CAD’ was introduced. Recommendations regarding diagnostic tests to establish or rule-out obstructive CAD have been updated with recent data on their diagnostic performance in different patient groups and impact on patient outcome. As the initial strategy to diagnose CAD in symptomatic patients, non-invasive functional imaging for myocardial ischaemia, coronary computed tomography angiography or invasive coronary angiography combined with functional evaluation may be used, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests instead of the exercise electrocardiogram are recommended when following the non-invasive diagnostic strategy.
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Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamllynkatu 4-8, Turku, Finland
- Heart Center, Turku University Hospital, Hämeentie 11, Turku, Finland
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Via S. Pansini, 5, Naples, Italy
| | - Davide Capodanno
- CardioThoracic-Vascular and Transplant Department, A.O.U. ‘Policlinico-Vittorio Emanuele’, University of Catania, Via Citelli 6, Catania, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamllynkatu 4-8, Turku, Finland
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Litwin SE, Coles A, Hill CL, Alhanti B, Pagidipati N, Lee KL, Pellikka PA, Mark DB, Udelson JE, Cooper L, Tardif JC, Hoffmann U, Douglas PS. Discordances between predicted and actual risk in obese patients with suspected cardiac ischaemia. Heart 2019; 106:273-279. [PMID: 31601728 DOI: 10.1136/heartjnl-2018-314503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To test the relationship between increasing severity of obesity, calculated risk and observed outcomes. METHODS Patients with symptoms suggestive of coronary artery disease (CAD) (n=10 003) were stratified according to body mass index (BMI). We compared risk factors, pooled risk scores and physicians' perception of risk. Cox regression tested the association between BMI and (1) presence of obstructive CAD and (2) composite clinical endpoints (death, cardiovascular death, unstable angina hospitalisation and myocardial infarction). RESULTS BMI was ≥30 kg/m2 in 48% of patients and ≥35 in 20%. Increasingly obese patients were younger, female and non-smoking but with higher prevalence of hypertension, diabetes, black race and sedentary lifestyle. Pooled risk estimates of CAD were highest in those with mid-range BMI. In contrast, physicians' estimation of the likelihood of significant CAD based on clinical impression increased progressively with BMI. For a 10% increase in the Diamond-Forrester probability of CAD, the adjusted OR for obstructive CAD was 1.5 (95% CI 1.4 to 1.5) in patients with BMI <35, but only 1.2 (95% CI 1.1 to 1.3) in those with BMI ≥35 (interaction p<0.001). Framingham Risk Score increased across increasing BMI categories. However, there was a strong and consistent inverse relationship between degree of obesity and all three composite clinical endpoints over a median 25 months of follow-up. CONCLUSIONS Despite perceptions of higher risk and higher risk scores, increasingly obese patients had obstructive CAD less frequently than predicted and had fewer adverse clinical outcomes. There is a need for risk assessment tools and guidelines that account for obesity. TRIAL REGISTRATION NUMBER NCT01174550.
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Affiliation(s)
- Sheldon E Litwin
- Division of Cardiology, Department of Medicine, Ralph H Johnson VA Medical Center, Charleston, South Carolina, USA .,Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Adrian Coles
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neha Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - James E Udelson
- Division of Cardiology, Tufts University Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Lawton Cooper
- National Heart, Lung and Blood institute, Bethesda, MD, United States
| | - Jean-Claude Tardif
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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44
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Affiliation(s)
- Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts.
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45
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Ferencik M, Lu MT, Mayrhofer T, Puchner SB, Liu T, Maurovich-Horvat P, Ghemigian K, Ivanov A, Adami E, Nagurney JT, Woodard PK, Truong QA, Udelson JE, Hoffmann U. Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial. J Cardiovasc Comput Tomogr 2019; 13:196-202. [PMID: 31113728 DOI: 10.1016/j.jcct.2019.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/30/2019] [Accepted: 05/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. METHODS We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. RESULTS We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50-0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78-0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56-10.36) and 3.50 (95% CI 1.12-10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55-9.85, p = 0.004) after adjustment for stenosis severity. CONCLUSION Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.
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Affiliation(s)
- Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael T Lu
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Mayrhofer
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Stefan B Puchner
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ting Liu
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Khristine Ghemigian
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander Ivanov
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth Adami
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Quynh A Truong
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - James E Udelson
- Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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46
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Marwan M. Computational fluid dynamics: can computed tomography imaging compete with cath-lab physiology? Cardiovasc Res 2019; 115:e41-e43. [DOI: 10.1093/cvr/cvz059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohamed Marwan
- Cardiology Department, Friedrich-Alexander Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany
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47
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Masri A, Murthy VL. Clinical Risk Scores to Minimize Low Yield Coronary Artery Disease Testing. Circ Cardiovasc Imaging 2019; 12:e008626. [PMID: 30712365 DOI: 10.1161/circimaging.118.008626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmad Masri
- Division of Cardiovascular Medicine, Department of Medicine and the Heart and Vascular Institute, University of Pittsburgh (A.M.)
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor (V.L.M.)
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48
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Scholtz JE, Hedgire S, Ghoshhajra BB. Technical Aspects, Interpretation, and Body of Evidence for Coronary Computed Tomography Angiography. Radiol Clin North Am 2019; 57:13-23. [DOI: 10.1016/j.rcl.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Quyyumi AA, Tahhan AS. High-Sensitivity Troponin and Coronary Artery Disease Severity: A Bridge Too Far? JACC Cardiovasc Imaging 2018; 12:1056-1057. [PMID: 30448115 DOI: 10.1016/j.jcmg.2018.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Arshed A Quyyumi
- Emory Clinical Cardiovascular Research institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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