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Ichikawa K, Lim J, McClelland RL, Susarla S, Krishnan S, Benzing T, Kianoush S, Aldana-Bitar J, Manubolu VS, Budoff MJ. Impact of Nonalcoholic Hepatic Steatosis on the Warranty Period of a Coronary Artery Calcium Score of 0: Results From the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2024; 17:e016465. [PMID: 39288206 PMCID: PMC11410342 DOI: 10.1161/circimaging.123.016465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/11/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND For individuals with a coronary artery calcium (CAC) score of 0, CAC rescans at appropriate timings are recommended, depending on individual risk profiles. Although nonalcoholic fatty liver disease, recently redefined as metabolic-associated fatty liver disease, is a risk factor for atherosclerotic cardiovascular disease events, its relationship with the warranty period of a CAC score of 0 has not been elucidated. METHODS A total of 1944 subjects from the MESA (Multi-Ethnic Study of Atherosclerosis) with a baseline CAC score of 0, presence or absence of nonalcoholic hepatic steatosis, and at least 1 follow-up computed tomography scan were included. Nonalcoholic hepatic steatosis was defined using nonenhanced computed tomography and liver/spleen attenuation ratio <1. The association between nonalcoholic hepatic steatosis and new CAC incidence (CAC score >0) was evaluated using a Weibull survival model. RESULTS Nonalcoholic hepatic steatosis was identified in 268 (14%) participants. Participants with nonalcoholic hepatic steatosis had higher CAC incidence than those without nonalcoholic hepatic steatosis. Nonalcoholic hepatic steatosis was independently associated with new CAC incidence after adjustment for atherosclerotic cardiovascular disease risk factors (hazard ratio, 1.28 [95% CI, 1.05-1.57]; P=0.015). Using a 25% testing yield (25% of participants with zero CAC at baseline would be expected to have developed a CAC score >0), the warranty period of a CAC score of 0 in participants with nonalcoholic hepatic steatosis was shorter than in those without nonalcoholic hepatic steatosis (4.7 and 6.3 years). This association was consistent regardless of sex, race/ethnicity, age, and 10-year atherosclerotic cardiovascular disease risk. CONCLUSIONS Nonalcoholic hepatic steatosis had an impact on the warranty period of a CAC score of 0. The study suggests that the time period until a CAC rescan should be shorter in those with nonalcoholic hepatic steatosis and a CAC score of 0.
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Affiliation(s)
- Keishi Ichikawa
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Jaewon Lim
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Shriraj Susarla
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Srikanth Krishnan
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Travis Benzing
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Sina Kianoush
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Matthew J. Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
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Feuchtner GM, Lacaita PG, Barbieri F, Deeg J, Plank F, Beyer C, Senoner T, Friedrich G, Widmann G. Gender differences in the diagnostic efficacy of coronary CTA: Overutilization of coronary CTA in pre- and perimenopausal females? Int J Cardiol 2024; 409:132181. [PMID: 38754587 DOI: 10.1016/j.ijcard.2024.132181] [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: 04/08/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Public campaigns such as the "Go-red-for-women"-initiative have raised heart-disease awareness and may trigger overutilization of coronary computed tomography angiography (CTA). Objective was to investigate the diagnostic efficacy of coronary CTA stratified by age and gender. METHODS 1882 consecutive patients (58.9 ± 11 years;42.5% females) with low-to-intermediate pre-test-probability of coronary artery disease (CAD) referred to coronary CTA according to ESC-2019 guidelines, were included. Diagnostic efficacy was defined by the 1)negative CTA-rate 2)obstructive CAD (>50%stenosis) 3)High-risk-plaque and 4)CAC-score. RESULTS The negative CTA rate was higher in females compared to males with 360/801 vs 292/1081 (45% vs 27%;p < 0.001). Females had a higher likelihood (OR 2.2:95%CI:1.81-2.67) of a negative CTA than males, despite they were older (p < 0.001). Obstructive disease prevalence was 25.6% and acceptable in both sexes (males vs females: 28.4% vs 21.8%;p = 0.0012). Males had more high-risk-plaque (23.6% vs 11.5%;p < 0.001). When stratifying age groups, negative CTA rate was highest in females <47 years (82.8%), but lower in males with 68.1% (p < 0.001), while obstructive disease prevalence was not different (males:6.5% vs females:4.6%:p = 0.874). Above 50 years, negative CTA rate (39.1% vs 17.6%,p < 0.001;OR 3.02:95%CI:2.381-3.823) was higher, and the obstructive disease rate was lower in females (24.8% vs 34.7%,p = 0.0003). SSPSTm(V.25,IBM) was used for statistical analysis. CONCLUSIONS Above 50 years of age, diagnostic efficacy of coronary CTA is high in both males and females. In females <47 years, the negative CTA rate was highest with 82.8% and obstructive disease prevalence was low (4.6%), still justifying testing but recommending the use of specific tools (PROMISE minimal risk score) or other clinical tests for pre-selection.
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Affiliation(s)
- Gudrun M Feuchtner
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Pietro G Lacaita
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Fabian Barbieri
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
| | - Johannes Deeg
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Fabian Plank
- Tyrol Clinicum Hall, Department of Cardiology, Milser Strasse 10, Hall 6060, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Thomas Senoner
- Department of Anaesthesiology and Intensive Care, Innsbruck Medical University, Anichstrasse 35, Innsbruck A 6020, Austria
| | - Guy Friedrich
- Department of Internal Medicine, Cardiology, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
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Abdul-Rahman T, Bliss ZSB, Lizano-Jubert I, Muñoz MJS, Garg N, Pachchipulusu VK, Ashinze P, Miteu GD, Baig R, Omar DA, Badawy MM, Bukhari SMA, Wireko AA, Aborode AT, Atallah O, Mahmoud HA, Aldosoky W, Abohashem S. Beyond symptoms: Unlocking the potential of coronary calcium scoring in the prevention and treatment of coronary artery disease. Curr Probl Cardiol 2024; 49:102378. [PMID: 38185434 DOI: 10.1016/j.cpcardiol.2024.102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
Coronary Artery Disease (CAD) represents a persistent global health menace, particularly prevalent in Eastern European nations. Often asymptomatic until its advanced stages, CAD can precipitate life-threatening events like myocardial infarction or stroke. While conventional risk factors provide some insight into CAD risk, their predictive accuracy is suboptimal. Amidst this, Coronary Calcium Scoring (CCS), facilitated by non-invasive computed tomography (CT), emerges as a superior diagnostic modality. By quantifying calcium deposits in coronary arteries, CCS serves as a robust indicator of atherosclerotic burden, thus refining risk stratification and guiding therapeutic interventions. Despite certain limitations, CCS stands as an instrumental tool in CAD management and in thwarting adverse cardiovascular incidents. This review delves into the pivotal role of CCS in CAD diagnosis and treatment, elucidates the involvement of calcium in atherosclerotic plaque formation, and outlines the principles and indications of utilizing CCS for predicting major cardiovascular events.
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Affiliation(s)
| | | | | | | | - Neil Garg
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, United States
| | | | - Patrick Ashinze
- Department of Medical Services, Saint Francis Catholic Hospital, Okpara Inland, Delta, Nigeria
| | - Goshen David Miteu
- Department of Biomedical Science, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Rusab Baig
- Shadan Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | | | - Wesam Aldosoky
- Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Shady Abohashem
- Massachusetts General Hospital and Harvard Medical School, Boston, United States.
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Hanneman K, Gulsin GS. Significance of a Coronary Artery Calcium Score of 0 in Stable Chest Pain. Radiology 2024; 310:e240073. [PMID: 38441099 DOI: 10.1148/radiol.240073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Kate Hanneman
- From University Medical Imaging Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (K.H.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (K.H.); and Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, United Kingdom (G.S.G.)
| | - Gaurav S Gulsin
- From University Medical Imaging Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (K.H.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (K.H.); and Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, United Kingdom (G.S.G.)
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