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Civieri G, Kerkhof PLM, Montisci R, Iliceto S, Tona F. Sex differences in diagnostic modalities of coronary artery disease: Evidence from coronary microcirculation. Atherosclerosis 2023; 384:117276. [PMID: 37775426 DOI: 10.1016/j.atherosclerosis.2023.117276] [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: 03/24/2023] [Revised: 06/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
Although atherosclerosis is usually considered a disease of the large arteries, risk factors for atherosclerosis also trigger structural and functional abnormalities at a microvascular level. In cardiac disease, microvascular dysfunction is especially relevant in women, among whom the manifestation of ischemic disease due to impaired coronary microcirculation is more common than in men. This sex-specific clinical phenotype has important clinical implications and, given the higher pre-test probability of coronary microvascular dysfunction in females, different diagnostic modalities should be used in women compared to men. In this review, we summarize invasive and non-invasive diagnostic modalities to assess coronary microvascular function, ranging from catheter-based evaluation of endothelial function to Doppler echocardiography and positron emission tomography. Moreover, we discuss different clinical settings in which microvascular disease plays an important role, underlining the importance of choosing the right diagnostic modality depending on the sex of the patients.
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Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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Kujala I, Nammas W, Maaniitty T, Stenström I, Klén R, Bax JJ, Knuuti J, Saraste A. Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men. Eur Heart J Cardiovasc Imaging 2023; 24:1201-1209. [PMID: 37086269 PMCID: PMC10445260 DOI: 10.1093/ehjci/jead072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/19/2023] [Accepted: 04/02/2023] [Indexed: 04/23/2023] Open
Abstract
AIMS Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischaemia. We evaluated sex differences in disease profile and outcomes after combined computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging in patients with suspected obstructive CAD. METHODS AND RESULTS We retrospectively evaluated 1948 patients (59% women) referred for coronary CTA due to suspected CAD during the years 2008-2016. Patients with a suspected obstructive lesion on coronary CTA (n = 657) underwent 15O-water PET to assess stress myocardial blood flow (MBF). During a mean follow-up of 6.8 years, 182 adverse events (all-cause death, myocardial infarction, or unstable angina) occurred. Women had more often normal coronary arteries (42% vs. 22%, P < 0.001) and less often abnormal stress MBF (9% vs. 28%, P < 0.001) than men. The annual adverse event rate was lower in women vs. men (1.2% vs. 1.7%, P = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0- and 5.6-fold adverse event rates in women and men, respectively. There was no interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse events. CONCLUSION Among patients evaluated for chronic chest pain, women have a lower prevalence of ischaemic CAD and a lower rate of adverse events. Combined coronary CTA and PET myocardial perfusion imaging predict outcomes equally in women and men.
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Affiliation(s)
- Iida Kujala
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
| | - Wail Nammas
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520 Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
- Department of clinical physiology, nuclear medicine and PET, Turku University Hospital, Turku, Finland
| | - Iida Stenström
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520 Turku, Finland
| | - Riku Klén
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
| | - Jeroen J Bax
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520 Turku, Finland
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
- Department of clinical physiology, nuclear medicine and PET, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520 Turku, Finland
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Relationship between sexual differences and cardiovascular risk factors in the prevalence of asymptomatic coronary disease. Int J Cardiol 2023; 370:1-7. [PMID: 36414046 DOI: 10.1016/j.ijcard.2022.11.022] [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: 06/26/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study investigated the sexual differences of coronary artery disease (CAD) prevalence and its association with cardiovascular risk factors in the asymptomatic population. METHODS In total 6434 asymptomatic participants without known CAD (1740 women and 4694 men) underwent coronary computed tomography angiography (CCTA). The prevalence of significant CAD (diameter stenosis ≥50%) and other CCTA findings were compared by sex, and its influence on CAD was investigated in groups stratified by the number of cardiovascular risk factors, including age (>55 years), hypertension, diabetes, dyslipidemia, and current smoking. RESULTS The prevalence of current smokers, hypertension, and diabetes were higher in men than women. The mean coronary artery calcium score was 13.1 ± 58.4 for women and 51.1 ± 158.2 for men; the coronary atherosclerosis burden indices were significantly higher in men than women. Significant CAD was identified in 65 women (3.7%) and 429 men (9.1%), showing a significant association (adjusted odds ratio [OR] 2.38, P < 0.001). The relatively higher risk for significant CAD in men was observed in patients with fewer risk factors, and the risk difference was not significant in patients with many risk factors (adjusted ORs: 7.69, 3.37, 1.71, 1.31, and 0.88 in patients with 0, 1, 2, 3, and 4-5 risk factors, respectively). The association between sex and risk factor groups was significant (P < 0.001). CONCLUSIONS In the asymptomatic population, a significantly higher CAD prevalence was noted in men than women. However, women with a high number of cardiovascular risk factors showed a CAD prevalence similar to that of men.
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Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France
- Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany
- University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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Koopman MY, Reijnders JJW, Willemsen RTA, van Bruggen R, Doggen CJM, Kietselaer B, Oude Wolcherink MJ, van Ooijen PMA, Gratama JWC, Braam R, Oudkerk M, van der Harst P, Dinant GJ, Vliegenthart R. Coronary calcium scoring as first-line test to detect and exclude coronary artery disease in patients presenting to the general practitioner with stable chest pain: protocol of the cluster-randomised CONCRETE trial. BMJ Open 2022; 12:e055123. [PMID: 35440450 PMCID: PMC9020291 DOI: 10.1136/bmjopen-2021-055123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Identifying and excluding coronary artery disease (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). A diagnostic and prognostic tool could help GPs in determining the likelihood of CAD and guide patient management. Studies in outpatient settings have shown that the CT-based coronary calcium score (CCS) has high accuracy for diagnosis and exclusion of CAD. However, the CT CCS test has not been tested in a primary care setting. In the COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain (CONCRETE) study, the impact of direct access of GPs to CT CCS will be investigated. We hypothesise that this will allow for early diagnosis of CAD and treatment, more efficient referral to the cardiologist and a reduction of healthcare-related costs. METHODS AND ANALYSIS CONCRETE is a pragmatic multicentre trial with a cluster randomised design, in which direct GP access to the CT CCS test is compared with standard of care. In both arms, at least 40 GP offices, and circa 800 patients with atypical AP and non-specific thoracic complaints will be included. To determine the increase in detection and treatment rate of CAD in GP offices, the CVRM registration rate is derived from the GPs electronic registration system. Individual patients' data regarding cardiovascular risk factors, expressed chest pain complaints, quality of life, downstream testing and CAD diagnosis will be collected through questionnaires and the electronic GP dossier. ETHICS AND DISSEMINATION CONCRETE has been approved by the Medical Ethical Committee of the University Medical Center of Groningen. TRIAL REGISTRATION NUMBER NTR 7475; Pre-results.
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Affiliation(s)
- Moniek Y Koopman
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorn J W Reijnders
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Robert T A Willemsen
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rykel van Bruggen
- Multicenter General Practitioners Organisation 'HuisartsenOrganisatie Oost-Gelderland', Apeldoorn, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Martijn J Oude Wolcherink
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Peter M A van Ooijen
- Department of Data Science Center in Health, University of Groniningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Richard Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Matthijs Oudkerk
- Department of Medical Science, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tian XW, Ma AL, Zhou RB, Jiang LJ, Hao Y, Zou XG. Advances in Cardiac Computed Tomography Functional Imaging Technology. Cardiology 2020; 145:615-622. [PMID: 32829331 DOI: 10.1159/000505317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among patients in China, and cardiac computed tomography (CT) is one of the most commonly used examination methods for CVD. Coronary artery CT angiography can be used for the morphologic evaluation of the coronary artery. At present, cardiac CT functional imaging has become an important direction of development of CT. At present, common CT functional imaging technologies include transluminal attenuation gradient, stress dynamic CT myocardial perfusion imaging, and CT-fractional flow reserve. These three imaging modes are introduced and analyzed in this review.
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Affiliation(s)
- Xu-Wei Tian
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ai-Lin Ma
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ren-Bing Zhou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Liu-Jiang Jiang
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Yue Hao
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Xiao-Guang Zou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China,
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Mangion K, Adamson PD, Williams MC, Hunter A, Pawade T, Shah ASV, Lewis S, Boon NA, Flather M, Forbes J, McLean S, Roditi G, van Beek EJR, Timmis AD, Newby DE, McAllister DA, Berry C. Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain. Eur Heart J 2020; 41:1337-1345. [PMID: 31883330 PMCID: PMC7109601 DOI: 10.1093/eurheartj/ehz903] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/20/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. METHODS AND RESULTS In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7-8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3-8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24-1.04], and men (HR 0.63, 95% CI 0.42-0.95; Pinteraction = 0.572). CONCLUSION Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
- Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Amanda Hunter
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Stephanie Lewis
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Nicholas A Boon
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - John Forbes
- Graduate Entry School, University of Limerick, Limerick, St Nessan's Rd, Dooradoyle, Co. Limerick, V94 F858, Ireland
| | - Scott McLean
- National Health Service, Hayfield House, Hayfield Rd, Kirkcaldy KY2 5AH, Fife, UK
| | - Giles Roditi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Adam D Timmis
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, University Ave, Glasgow G12 8QQ, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
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Weir-McCall JR, Nicol E, Abbara S, Branch K, Choi AD, Ghoshhajra BB, Leipsic J, Nieman K, Shaw LJ, Blankstein R. Highlights of the fourteenth annual scientific meeting of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2020; 14:118-123. [DOI: 10.1016/j.jcct.2019.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 01/29/2023]
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Coronary Computed Tomography Angiography: Enhancing Risk Stratification and Diagnosis of Cardiovascular Disease in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:62. [DOI: 10.1007/s11936-019-0760-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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10
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Baumann S, Renker M, Schoepf UJ, De Cecco CN, Coenen A, De Geer J, Kruk M, Kim YH, Albrecht MH, Duguay TM, Jacobs BE, Bayer RR, Litwin SE, Weiss C, Akin I, Borggrefe M, Yang DH, Kepka C, Persson A, Nieman K, Tesche C. Gender differences in the diagnostic performance of machine learning coronary CT angiography-derived fractional flow reserve -results from the MACHINE registry. Eur J Radiol 2019; 119:108657. [PMID: 31521876 DOI: 10.1016/j.ejrad.2019.108657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study investigated the impact of gender differences on the diagnostic performance of machine-learning based coronary CT angiography (cCTA)-derived fractional flow reserve (CT-FFRML) for the detection of lesion-specific ischemia. METHOD Five centers enrolled 351 patients (73.5% male) with 525 vessels in the MACHINE (Machine leArning Based CT angiograpHy derIved FFR: a Multi-ceNtEr) registry. CT-FFRML and invasive FFR ≤ 0.80 were considered hemodynamically significant, whereas cCTA luminal stenosis ≥50% was considered obstructive. The diagnostic performance to assess lesion-specific ischemia in both men and women was assessed on a per-vessel basis. RESULTS In total, 398 vessels in men and 127 vessels in women were included. Compared to invasive FFR, CT-FFRML reached a sensitivity, specificity, positive predictive value, and negative predictive value of 78% (95%CI 72-84), 79% (95%CI 73-84), 75% (95%CI 69-79), and 82% (95%CI: 76-86) in men vs. 75% (95%CI 58-88), 81 (95%CI 72-89), 61% (95%CI 50-72) and 89% (95%CI 82-94) in women, respectively. CT-FFRML showed no statistically significant difference in the area under the receiver-operating characteristic curve (AUC) in men vs. women (AUC: 0.83 [95%CI 0.79-0.87] vs. 0.83 [95%CI 0.75-0.89], p = 0.89). CT-FFRML was not superior to cCTA alone [AUC: 0.83 (95%CI: 0.75-0.89) vs. 0.74 (95%CI: 0.65-0.81), p = 0.12] in women, but showed a statistically significant improvement in men [0.83 (95%CI: 0.79-0.87) vs. 0.76 (95%CI: 0.71-0.80), p = 0.007]. CONCLUSIONS Machine-learning based CT-FFR performs equally in men and women with superior diagnostic performance over cCTA alone for the detection of lesion-specific ischemia.
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Affiliation(s)
- Stefan Baumann
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Matthias Renker
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Carlo N De Cecco
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Adriaan Coenen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jakob De Geer
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Mariusz Kruk
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Moritz H Albrecht
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Taylor M Duguay
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Jacobs
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Bayer
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sheldon E Litwin
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christel Weiss
- Medical Faculty Mannheim, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Anders Persson
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Tesche
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
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11
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Sex differences in coronary artery plaque composition detected by coronary computed tomography: quantitative and qualitative analysis. Neth Heart J 2019; 27:272-280. [PMID: 30734147 PMCID: PMC6470243 DOI: 10.1007/s12471-019-1234-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Sex differences in the calculation of coronary heart disease risk have been analysed extensively. However, data on coronary plaque morphology diverge. We analysed plaque characteristics in patients with suspected coronary artery disease (CAD) and defined prognostic factors using coronary computed tomography angiography (CCTA). Methods A total of 6,050 consecutive patients underwent CCTA and were enrolled in the registry. Patients with known CAD were excluded. The patients were propensity score matched (1:1 male:female) for age and known coronary risk factors. Coronary arteries were evaluated for stenosis, plaque types (non-calcified, mixed and calcified) and high-risk plaque features (napkin-ring sign, low-attenuation plaque, spotty calcifications, positive remodelling). Clinical follow-up was performed. Results A total of 1,050 patients (525 female, 525 male) in matched cohorts were selected for analysis. CCTA showed significantly higher calcium scores for males (mean 180.5 vs 67.8 AU, p < 0.0001) and a higher rate of CAD (66.0% vs 34.1%, p < 0.0001). In a total of 16,800 segments, males had significantly more plaques (861 vs 752, p < 0.0001) with a significantly larger proportion of calcified plaques, while females had more mixed and non-calcified plaques (33.5% vs 24.4%, p = 0.006 and 24.1% vs 13.6%, p = 0.22, respectively). After a mean follow-up of 5.6 years, major adverse cardiac event (MACE) rate was 5.3% in male and 1.9% in female patients (p < 0.05). The relative odds ratio for high-risk plaque features to predict MACE was higher in females. Conclusion Based on a higher relative risk for women with high-risk plaque features, the findings of our study support the increased importance of a differentiated qualitative plaque analysis to improve the risk stratification for both sexes.
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12
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Nieman K. Computed tomography myocardial perfusion imaging vs. computed tomography-derived fractional flow reserve, which way forward? Eur Heart J Cardiovasc Imaging 2018; 19:1230-1231. [DOI: 10.1093/ehjci/jey125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Departments of Cardiovascular Medicine and Radiology, Room H2157, 300 Pasteur Drive, Stanford, CA, USA
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13
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Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2018; 12:451-466. [DOI: 10.1016/j.jcct.2018.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
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14
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Shaw LJ, Hachamovitch R, Min JK, Di Carli M, Mieres JH, Phillips L, Blankstein R, Einstein A, Taqueti VR, Hendel R, Berman DS. Evolving, innovating, and revolutionary changes in cardiovascular imaging: We've only just begun! J Nucl Cardiol 2018; 25:758-768. [PMID: 29468466 DOI: 10.1007/s12350-018-1225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/19/2022]
Abstract
In this review, we highlight the need for innovation and creativity to reinvent the field of nuclear cardiology. Revolutionary ideas brought forth today are needed to create greater value in patient care and highlight the need for more contemporary evidence supporting the use of nuclear cardiology practices. We put forth discussions on the need for disruptive innovation in imaging-guided care that places the imager as a central force in care coordination. Value-based nuclear cardiology is defined as care that is both efficient and effective. Novel testing strategies that defer testing in lower risk patients are examples of the kind of innovation needed in today's healthcare environment. A major focus of current research is the evolution of the importance of ischemia and the prognostic significance of non-obstructive atherosclerotic plaque and coronary microvascular dysfunction. Embracing novel paradigms, such as this, can aid in the development of optimal strategies for coronary disease management. We hope that our article will spurn the field toward greater innovation and focus on transformative imaging leading the way for new generations of novel cardiovascular care.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, GA, USA.
- Emory University Clinical Cardiovascular Research Institute, 1462 Clifton Rd NE, Room 529, Atlanta, GA, 30324, USA.
| | | | - James K Min
- Weill Cornell Medical College, New York, NY, USA
| | - Marcelo Di Carli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Viviany R Taqueti
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Hendel
- Tulane University School of Medicine, New Orleans, LA, USA
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15
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Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women. Can J Cardiol 2018; 34:400-412. [DOI: 10.1016/j.cjca.2018.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/17/2023] Open
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16
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Huang D, Li Z, Chen B, Fang G, Sun X, Li F, Xu H, Chen Y, Ding W. Naringin protects against steroid‑induced avascular necrosis of the femoral head through upregulation of PPARγ and activation of the Notch signaling pathway. Mol Med Rep 2018; 17:3328-3335. [PMID: 29257271 DOI: 10.3892/mmr.2017.8247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/01/2017] [Indexed: 02/05/2023] Open
Abstract
Naringin, a flavonoid, is the effective pharmaceutical ingredient of drynaria, with the effects of healing fractures, strengthening bones and promoting kidney function. The aim of the present study was to investigate the potential effect of naringin on steroid‑induced avascular necrosis of the femoral head (SANFH). Treatment with naringin markedly protected against the steroid‑induced decrease in serum osteocalcin levels, and the rate of osteonecrosis in a model of SANFH. In addition, naringin decreased the total cholesterol and low density lipoprotein/high density lipoprotein ratio in the SANFH rabbit. It was observed that naringin markedly inhibited caspase‑3 activity, increased runt‑related transcription factor 2 and transcription factor sp7 mRNA expression, promoted alkaline phosphatase activity and upregulated collagen I, peroxisome proliferator‑activated receptor (PPAR) γ2, neurogenic locus notch homolog protein (Notch), β‑catenin and phosphorylated‑Rac‑α serine/threonine protein kinase protein expression in the SANFH rabbit. The results of the present study demonstrated that naringin protects against SANFH through upregulation of PPARγ2 and activation of the Notch signaling pathway, and may be a useful addition to the treatment options for diseases of the femoral head.
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Affiliation(s)
- Donghong Huang
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhanchun Li
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Bin Chen
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Guizhen Fang
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Xitao Sun
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Fei Li
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Hairu Xu
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Ying Chen
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
| | - Weihang Ding
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang 310006, P.R. China
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17
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Shaikh K, Budoff MJ. Diagnostic Accuracy of Exercise Electrocardiogram in Women. J Womens Health (Larchmt) 2018; 27:411-412. [PMID: 29356598 DOI: 10.1089/jwh.2017.6864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kashif Shaikh
- Department of Cardiology, Los Angeles Biomedical Research Institute , Harbor-UCLA Medical Center, Torrance, California
| | - Matthew J Budoff
- Department of Cardiology, Los Angeles Biomedical Research Institute , Harbor-UCLA Medical Center, Torrance, California
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18
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Lau ES, Sarma A. Utility of Imaging in Risk Stratification of Chest Pain in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:72. [PMID: 28782082 DOI: 10.1007/s11936-017-0568-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease (CVD) is vital to optimal diagnosis and management, particularly of women (Mosca et al. Circulation 124:2145-54, 2011). There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men (Patel et al. N Engl J Med 362:886-95, 2010). Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men (Bairey Merz et al. J Am Coll Cardiol 47:S21-9, 2006). Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.
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Affiliation(s)
- Emily S Lau
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | - Amy Sarma
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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19
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Pagidipati NJ, Douglas PS. The Puzzle of Noninvasive Testing in Women: Filling in the Pieces With the CRESCENT Trial (Calcium Imaging and Selective CT Angiography in Comparison to Functional Testing for Suspected Coronary Artery Disease). Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006085. [PMID: 28174198 DOI: 10.1161/circimaging.117.006085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neha J Pagidipati
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Pamela S Douglas
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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