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Hirai K, Imamura S, Hirai A, Misumi K, Ookawara S, Morishita Y. Risk factors and utility of maximum carotid intima-media thickness as a surrogate marker for coronary artery stenosis. Ther Clin Risk Manag 2018; 14:1407-1416. [PMID: 30147324 PMCID: PMC6095113 DOI: 10.2147/tcrm.s168926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study investigated the factors associated with coronary artery stenosis in outpatients. Furthermore, the usefulness of maximum carotid intima–media thickness (maximum-IMT) as a surrogate marker of coronary artery stenosis was evaluated. Methods We conducted a single-center retrospective study. A total of 601 outpatients (338 males; 263 females; mean age, 69.8±10.0 years) who underwent coronary computed tomography angiography between April 2006 and March 2012 were analyzed. The associations between coronary artery stenosis (≥75%) as determined by coronary computed tomography angiography and clinical and laboratory parameters were evaluated by multivariate logistic regression. Validation of maximum-IMT as measured by ultrasonography as a surrogate marker of coronary artery stenosis was analyzed by receiver operating characteristic (ROC) curve analysis. Results The estimated glomerular filtration rate (eGFR: mL/min/1.73 m2) (odds ratio [OR] 0.985, p<0.01), diabetes mellitus (OR 1.98, p<0.05), and maximum-IMT (mm) (OR 1.76, p<0.01) were significantly associated with coronary artery stenosis (≥75%). In analysis of each group categorized by identified factors, such as renal impairment (eGFR <60 mL/min/1.73 m2) and diabetes mellitus, the ROC curve of maximum-IMT was significant in the group of patients with diabetes mellitus without renal impairment (p<0.01) (cutoff value of maximum-IMT, 2.0 mm; sensitivity, 0.74; and specificity, 0.54) but not in other groups. Conclusion Renal impairment, diabetes mellitus, and increased maximum-IMT may be significant risk factors of coronary artery stenosis. Maximum-IMT as measured by ultrasonography may be a useful surrogate marker for coronary artery stenosis in patients with diabetes mellitus without renal impairment but not in other patients.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Shigeki Imamura
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Aizan Hirai
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Kazuo Misumi
- Division of Cardiology, Heart Institute, Chiba-Nishi General Hospital, Chiba, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
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Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department: From Typical Acute Coronary Syndrome to Various Unusual Mimics. J Thorac Imaging 2017; 32:26-35. [PMID: 27819965 DOI: 10.1097/rti.0000000000000241] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is a challenging task for emergency department physicians to establish a precise and rapid diagnosis based only on clinical and laboratory findings in patients who present with nonspecific acute chest pain. In this circumstance, CT angiography can provide important clues to the diagnosis. To provide a rapid diagnosis of acute coronary syndrome (ACS) and its various mimics, the physician should enumerate each possible cause of acute chest pain on the basis of an objective assessment of pretest probability. On the basis of clinical suspicion, the appropriate CT protocol should then be performed. Moreover, radiologists should be familiar with typical CT findings of ACS and its various mimics to assist the emergency department physician in diagnosing patients with nonspecific acute chest pain. This review article presents an overview on choosing an appropriate CT protocol in patients with nonspecific acute chest pain and provides specific CT findings of ACS and various mimics of ACS.
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Matsumoto N, Hirayama A. Clinical value of high duke treadmill score with myocardial perfusion SPECT. J Nucl Cardiol 2016; 23:1301-1303. [PMID: 26122880 DOI: 10.1007/s12350-015-0187-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Naoya Matsumoto
- Nihon University Hospital, Tokyo, Japan.
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Lee SE, Cho I, Hong GR, Chang HJ, Sung JM, Cho IJ, Shim CY, Choi BW, Chung N. Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects. J Cardiovasc Ultrasound 2015; 23:244-52. [PMID: 26755933 PMCID: PMC4707310 DOI: 10.4250/jcu.2015.23.4.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/05/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.; Severance Biomedical Science Institute, Yonsei University Health System, Seoul, Korea
| | - Ji Min Sung
- Department of Research Affairs, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Byoung Wook Choi
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Li J, Liu R, Ji X, Xue H, Zhang G, Wang C, Chen Q, Xue F, Cui L. Insight into the Spectrum of Coronary Atherosclerosis in Asymptomatic Urban Han Chinese Population by Coronary Computed Tomography Angiography. PLoS One 2015; 10:e0132188. [PMID: 26151132 PMCID: PMC4495057 DOI: 10.1371/journal.pone.0132188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/10/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Highlighted the spectrum of coronary atherosclerosis in asymptomatic population by Computed Tomography Angiography (CTA) and developed a surrogation of expensive CTA to early detect coronary atherosclerosis. METHODS Three hundred and seven self-referred urban Han Chinese asymptomatic individuals underwent coronary CTA were consecutively enrolled. Total plaque score (TPS), Segment stenosis score (SSS) and Coronary Artery Disease severity (CADS) were used to measure and illustrate the spectrum of atherosclerosis burden by mapping their incidence and proportion onto coronary artery tree. Logistic regression model was further used to explore the association between lipid biomarkers and TPS (SSS) for developing a surrogation of CTA to early detect coronary atherosclerosis. RESULTS We found that the incidence of TPS, SSS and CADS were up to 71.34%, 68.08%, and 71.34%; and high-risk individuals reached up to 11.07%, 15.31% and 16.29% respectively. All TPS, SSS and CADS were much higher in male than female, and have trend of increasing with age. The most lesion segment emerged on proximal LAD, followed by proximal RCA, mid LAD, proximal LCX, and mid RCA with mixed plaque as dominant. HDL-C was a predictor to both TPS [OR: 0.12 (0.02-0.82)] and SSS [OR: 0.15 (0.03-0.76)], and could identify the serious atherosclerosis subjects of TPS or SSS score >5 (AUC 0.73 and 0.70). CONCLUSIONS The atherosclerosis plaque burden was about one in ten as high-risk individuals in this specific urban Han Chinese population. As potential surrogation of CTA, HDL-C was recognized as a significant predictor to atherosclerosis burden and revealed a good performance for identifying high-risk individuals.
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Affiliation(s)
- Jiangbing Li
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ruihong Liu
- Division of Biostatistics, School of Public Health, Shandong University, Shandong, China
| | - Xiaokang Ji
- Division of Biostatistics, School of Public Health, Shandong University, Shandong, China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital, Shandong University, Shandong, China
| | - Guang Zhang
- Health Management Center of Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Chunxia Wang
- Health Management Center of Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Qicai Chen
- Health Management Center of Shengli Qilfield Central Hospital, Shandong, China
| | - Fuzhong Xue
- Division of Biostatistics, School of Public Health, Shandong University, Shandong, China
| | - Lianqun Cui
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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Ede H, Erkoç MF, Okur A, Erbay AR. Impaired aortic elasticity and diastolic functions are associated with findings of coronary computed tomographic angiography. Med Sci Monit 2014; 20:2061-8. [PMID: 25348859 PMCID: PMC4214696 DOI: 10.12659/msm.892502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Aortic elasticity and diastolic functions are helpful parameters in assessment of CAD. In this study we aimed to learn whether diastolic function and aortic elastic properties measured by echocardiography are associated with coronary calcium score (CACS), epicardial fat volume (EFV), and plaque area measured by coronary tomographic angiography. MATERIAL AND METHODS We enrolled 106 consecutive patients suspected of CAD undergoing coronary CTA and transthoracic echocardiography in this prospective study. Total CACS, plaque area, and EFV were calculated via CTA. Aortic stiffness index (ASI) and aortic distensibility (AD) were measured via echocardiography. RESULTS The patients with diastolic dysfunctions of any degree had significantly higher ASI, higher CACS, higher plaque area, and EFV. We found that as the ASI increases, the CACS and total coronary plaque area both increase, showing that there is a strong positive correlation between ASI, CACS, and total coronary plaque area. There was a significant correlation between ASI and EFV, but with a lower statistical value. CONCLUSIONS Aortic elasticity was correlated with CACS and plaque area. Diastolic dysfunction was observed more commonly among patients with higher CACS and EFV. Epicardial fat volume was not as strong as CACS in reflecting aortic elasticity.
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Affiliation(s)
- Hüseyin Ede
- Department of Cardiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Mustafa Fatih Erkoç
- Department of Radiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Aylin Okur
- Department of Radiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ali Rıza Erbay
- Department of Cardiology, Bozok University School of Medicine, Yozgat, Turkey
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Fujihara K, Suzuki H, Sato A, Ishizu T, Kodama S, Heianza Y, Saito K, Iwasaki H, Kobayashi K, Yatoh S, Takahashi A, Yahagi N, Sone H, Shimano H. Comparison of the Framingham risk score, UK Prospective Diabetes Study (UKPDS) Risk Engine, Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) and maximum carotid intima-media thickness for predicting coronary artery stenosis in patients with asymptomatic type 2 diabetes. J Atheroscler Thromb 2014; 21:799-815. [PMID: 24717757 DOI: 10.5551/jat.20487] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS To compare the efficacy of Framingham Risk Score (FRS), UK Prospective Diabetes Study (UKPDS) risk engine, a risk score based on the Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC), the maximum intima-media thickness (max-IMT) determined on coronary computed tomography angiography (CCTA) and their combination in asymptomatic patients with type 2 diabetes. METHODS A total of 116 Japanese patients with type 2 diabetes underwent CCTA. The risk of coronary heart disease was calculated according to the FRS, UKPDS and JALS-ECC. We evaluated the reclassification of coronary artery stenosis (CAS) based on the risk score categories after adding each IMT related variable. RESULTS Sixty-eight patients had CAS. The areas under the curves (AUCs) in the receiver operating characteristic curve analyses of FRS, UKPDS and JALS-ECC were 0.763 (95% confidence interval [CI]: 0.674-0.853), 0.785 (95% CI: 0.703-0.868) and 0.767 (95% CI: 0.681-0.853), respectively. The AUCs for FRS, UKPDS and JALS-ECC combined with the max-IMT were 0.788 (95% CI: 0.705-0.872), 0.800 (95% CI: 0.720-0.879) and 0.786 (95% CI: 0.703-0.869), respectively. Combining the max-IMT with the risk scores improved the identification of subjects with stenotic lesions, in particular, those in the first, second and third tertiles of the FRS, first and second tertiles of the UKPDS and first and second tertiles of the JALS-ECC (P=0.054, P=0.056, P=0.015, P=0.082, P=0.060, P=0.007, and P=0.080, respectively). The net reclassification improvement increased following the addition of a max-IMT of ≥ 1.9 mm (32.4% in FRS, 19.9% in UKPDS and 51.7% in JALS-ECC). CONCLUSIONS These data suggest that combining a risk score with the max-IMT improves the prediction of CAS in comparison with the risk score alone.
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Affiliation(s)
- Kazuya Fujihara
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
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Sadigh G, Haft JW, Pagani FD, Prager RL, Kazerooni EA, Carlos RC, Kelly AM. Impact of coronary CT angiography on surgical decision-making for coronary artery bypass graft surgery. Acad Radiol 2013; 20:1083-90. [PMID: 23931421 DOI: 10.1016/j.acra.2013.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/16/2013] [Accepted: 05/20/2013] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the impact of coronary computed tomography angiography (CCTA) on treatment decisions made by cardiac surgeons and to explore barriers to implementation of CCTA as first-line imaging workup before coronary artery bypass. MATERIALS AND METHODS Tertiary academic medical center retrospective cohort study. Questionnaires administered to three cardiac surgeons regarding diagnosis and treatment decisions with level of confidence in decision making for 30 chest pain patients, after reviewing deidentified catheter coronary angiogram (CCA) and CCTA images on the same patients, several weeks apart. RESULTS All surgeons tended to report more severe disease with CCTA than CCA (P < .05). Treatment decisions differed in 12 (40%), 14 (47%), and 18 (60%) patients within each individual surgeon based on CCTA images compared to CCA images (P = .11, .01, and .02, respectively). Confidence levels were significantly higher with CCA for the diagnosis and treatment of coronary artery disease for all three surgeons (P < .05). There was a tendency toward more invasive treatment choices (angioplasty, stent insertion, or coronary artery bypass graft) when making treatment decisions based upon CCTA images. CONCLUSIONS Severity of disease may be overestimated by cardiac surgeons when using CCTA as a decision-making test, tending toward more invasive treatment choices compared to CCA. Additionally, cardiac surgeons may be more confident with their diagnosis and treatment based on CCA. These may be important limitations in the application of CCTA in clinical practice and may reflect the maturation of CCTA use in practice, diffusion of the technology and/or a reflection of the technology itself.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology, Emory University, Atlanta, GA, USA
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Yang X, Gai L, Dong W, Liu H, Sun Z, Tian F, Chen Y. Characterization of culprit lesions in acute coronary syndromes compared with stable angina pectoris by dual-source computed tomography. Int J Cardiovasc Imaging 2012; 29:945-53. [PMID: 23224436 DOI: 10.1007/s10554-012-0165-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
To identify the characterization of culprit lesions in acute coronary syndrome (ACS) compared with stable angina pectoris (SAP) by dual-source computed tomography (DSCT). 65 patients with ACS and 75 controls with SAP and a similar atherosclerotic risk profile were studied. Computed tomography (CT) coronary angiography was performed using a DSCT scanner before invasive catheterization. Using DSCT and quantitative coronary angiography (QCA), lesion characteristics [luminal cross-section area (L-CSA), vascular cross-section area (V-CSA), plaque area and degree of stenosis) were detected. Plaque types, mean and minimum CT density (Hounsfield Unit; HU), remodeling index, and presence of "spotty" calcifications were analyzed using DSCT. A good correlation was observed between DSCT and QCA for all lesion characteristics (P < 0.05). Culprit lesions in ACS had much larger V-CSA (20.5 ± 6.0 vs. 14.8 ± 4.8 mm(2)), plaque area (15.3 ± 5.0 vs. 11.1 ± 3.3 mm(2)) and remodeling index (1.3 ± 0.2 vs. 1.0 ± 0.4) than stable lesions in SAP (P < 0.05). The prevalence of non-calcified/calcified/mixed plaque was 30/0/35 in ACS versus 25/15/35 stable lesions in SAP (P < 0.01). The proportion of "spotty" calcified plaques was 21.5 % in culprit lesions (14 of 65) versus 1.3 % in SAP (1 of 75). The mean/minimum HU of culprit lesions was 88.6 ± 43.2/154.2 ± 98.7 in ACS versus 45.9 ± 34.7/98.2 ± 76.8 in SAP (both P < 0.01). DSCT is a feasible means of detecting coronary stenosis with good accuracy compared with QCA. Culprit lesions in ACS display a greater proportion of non-calcified material with lower CT attenuation, "spotty" calcifications and higher remodeling index compared with SAP lesions.
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Affiliation(s)
- Xia Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Hascoët S, Bongard V, Chabbert V, Marachet MA, Rousseau H, Charpentier S, Bouisset F, Honton B, Lairez O, Marchal P, Berry M, Carrié D, Galinier M, Elbaz M. Early triage of emergency department patients with acute coronary syndrome: Contribution of 64-slice computed tomography angiography. Arch Cardiovasc Dis 2012; 105:338-46. [DOI: 10.1016/j.acvd.2012.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/08/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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