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Sato Y, Kawai H, Hoshino M, Matsumoto S, Hayakawa M, Sadato A, Sarai M, Motoyama S, Takahashi H, Naruse H, Ishii J, Toyama H, Ozaki Y, Nakahara I, Hirose Y, Izawa H. Relationship between epicardial adipose tissue and coronary artery stenoses on computed tomography in patients scheduled for carotid artery revascularization. J Cardiol 2021; 79:588-595. [PMID: 34974941 DOI: 10.1016/j.jjcc.2021.12.008] [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: 09/06/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to clarify the relationship between epicardial adipose tissue (EAT) volume and the presence of severe stenoses (SS) on coronary computed tomography angiography (CTA) for risk stratification of the patients with carotid artery stenoses. METHODS We prospectively performed CTA for 125 consecutive patients (72.4 ± 8.1 years, 85% men) without a history of coronary artery disease (CAD), who were scheduled for carotid artery revascularization from 2014 to 2020. SS was defined as ≥70% luminal stenosis on CTA. EAT was quantified automatically as the total volume of tissue with -190 to -30 HU. RESULTS Of 125 patients, 76 had SS. Between the patients with and without SS, there were significant differences in coronary artery calcium score (CACS), left ventricular ejection fraction (LVEF), dyslipidemia, and EAT, despite no differences in carotid echocardiography findings. After adjustment for age, gender, and dyslipidemia, EAT was an independent factor associated with SS (p=0.011), as well as CACS and LVEF. The addition of EAT to a baseline model including age, gender, dyslipidemia, LVEF, and CACS achieved both net reclassification improvement (0.505, p=0.003) and integrated discrimination improvement (0.059, p=0.003). CONCLUSIONS In patients with carotid stenoses, EAT is associated with CAD and is useful for additional risk stratification. Epicardial fat may have a specific role in the development of CAD in patients with suspected systemic atherosclerosis.
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Affiliation(s)
- Yoshihiro Sato
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, Aichi, Japan.
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan
| | | | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University, Aichi, Japan
| | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Junnichi Ishii
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Aichi, Japan
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Kawai H, Motoyama S, Sarai M, Nagahara Y, Hattori K, Sato Y, Miyajima K, Hoshino M, Matsuyama T, Ohta M, Takahashi H, Shiino K, Sugiura A, Muramatsu T, Naruse H, Ishii J, Toyama H, Ozaki Y, Izawa H. Association of computed tomography-derived myocardial mass with fractional flow reserve-verified ischemia or subsequent therapeutic strategy. Heart Vessels 2021; 36:1099-1108. [PMID: 33533973 DOI: 10.1007/s00380-021-01789-z] [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: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
The aim of the present study was to examine the association of myocardial mass verified by computed tomography (CT) and invasive fractional flow reserve (FFR)-verified myocardial ischemia, or subsequent therapeutic strategy for the targeted vessels after FFR examination. We examined 333 vessels with intermediate stenoses in 297 patients (mean age 69.0 ± 9.5, 228 men) undergoing both coronary CT angiography and invasive FFR, and reviewed the therapeutic strategy after FFR. Of 333 vessels, FFR ≤ 0.80 was documented in 130 (39.0%). Myocardial volume supplied by the target vessel (MVT) was larger in those with FFR-verified ischemia than those without (53.4 ± 19.5 vs. 42.9 ± 22.2 cm3, P < 0.001). Addition of MVT to a model including patient characteristics (age, gender), visual assessment (≥ 70% stenosis, high-risk appearance), and quantitative CT vessel parameters [minimal lumen area (MLA), plaque burden at MLA, percent aggregate plaque volume] improved C-index (from 0.745 to 0.778, P = 0.020). Furthermore, of 130 vessels with FFR ≤ 0.80, myocardial volume exposed to ischemia (MVI) was larger in the vessels with early revascularization after FFR examination than those without (37.2 ± 20.0 vs. 26.8 ± 15.0 cm3, P = 0.003), and was independently associated with early revascularization [OR = 1.03, 95% confidence interval (1.02-1.11), P < 0.001]. Using an on-site CT workstation, MVT identified coronary arteries with FFR-verified ischemia easily and non-invasively, and MVI was associated with subsequent therapeutic strategy after FFR examinations.
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Affiliation(s)
- Hideki Kawai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yasuomi Nagahara
- Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Kousuke Hattori
- Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan
| | - Yoshihiro Sato
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keiichi Miyajima
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | | | - Masaya Ohta
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Shiino
- Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Atsushi Sugiura
- Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Junnichi Ishii
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
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Tomizawa N, Yamamoto K, Inoh S, Nojo T, Nakamura S. High-risk Plaque and Calcification Detected by Coronary CT Angiography to Predict Future Cardiovascular Events After Percutaneous Coronary Intervention. Acad Radiol 2018; 25:486-493. [PMID: 29195787 DOI: 10.1016/j.acra.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to investigate whether high-risk plaque (HRP) and calcium assessed by coronary computed tomography (CT) could predict future cardiovascular events after second-generation drug-eluting stent (DES) placement. MATERIALS AND METHODS We analyzed 317 patients from December 2012 to April 2015 who underwent coronary CT followed by DES placement. HRP was defined as a plaque with positive remodeling and low attenuation or a plaque with a napkin-ring sign. Coronary calcium was assessed by Agatston score (AS). Patients were divided into three groups: low risk, HRP negative and AS <400; intermediate risk, HRP positive and AS ≥400; high risk, HRP positive and AS ≥400. The primary end point was a composite of all-cause mortality, myocardial infarction, fatal arrhythmia, or repeated revascularization. Kaplan-Meier analysis was used to estimate the distribution of time to events. RESULTS A total of 74 events (23%) occurred during a median follow-up of 25.8 months. Patients with primary end points had HRP more frequently (70% vs 51%, P = 0.003) and were more calcified (AS, 471 [interquartile range, 143-1614] vs 289 [interquartile range, 63-787]; P = 0.01) than patients without primary end points. The frequency of primary end point increased significantly in the intermediate- and high-risk patients (P = 0.0011). Multivariate analysis showed that the hazard ratio of the intermediate- and high-risk groups was 1.91 (95% confidence interval, 1.04-3.77; P = 0.037) and 2.66 (95% confidence interval, 1.27-5.73; P = 0.009), respectively. CONCLUSION Plaque and calcification analysis by coronary CT could predict future cardiovascular events after second-generation DES placement.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
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Hoshino M, Kawai H, Sarai M, Sadato A, Hayakawa M, Motoyama S, Nagahara Y, Miyajima K, Takahashi H, Ishii J, Nakahara I, Hirose Y, Ozaki Y. Noninvasive Assessment of Stenotic Severity and Plaque Characteristics by Coronary CT Angiography in Patients Scheduled for Carotid Artery Revascularization. J Atheroscler Thromb 2018; 25:1022-1031. [PMID: 29459518 PMCID: PMC6193191 DOI: 10.5551/jat.42176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aims: Coronary artery atherosclerosis in patients needing carotid revascularization has not been fully clarified. The aim of this study was to evaluate the stenotic severity and plaque characteristics of coronary arteries by coronary computed tomography angiography (CTA) in patients scheduled for carotid-artery stenting (CAS) or carotid endarterectomy (CEA). Methods: We performed coronary CTA after carotid ultrasound (US) in 164 patients (81.7% male, aged 68.1 ± 12.2 years) from 2014 to 2016. Of all, 70 were scheduled for CAS or CEA (CAS/CEA group) and 94 were not (non-CAS/CEA group). Carotid US and coronary CTA were compared for the evaluation of stenotic severity and plaque characteristics of each vessel between CAS/CEA and non-CAS/CEA groups. Results: Between the two groups, there were significant differences in the presence of significant stenosis (SS: ≥ 70% stenosis of coronary artery) (55.7% vs. 39.4%, P = 0.038), triple-vessel disease (TVD)/left main trunk (LMT) (SS in each of three epicardial vessels and/or LMT) (24.3% vs. 7.5%, P = 0.0025), and high-risk plaque (HRP: positive remodeling and/or low attenuation) (55.7% vs. 24.5%, P < 0.0001). CAS/CEA was independently associated with TVD/LMT (OR = 2.30, 95%CI: 1.14–8.59, P = 0.026) and HRP (OR = 3.17, 95%CI: 1.57–6.54, P = 0.0012) in multivariable logistic regression analysis. Similarly, vulnerable plaque (78.6% vs. 2.1%, P < 0.0001) as well as severe stenosis of carotid artery (98.6% vs. 0%, P < 0.0001) was seen more often in CAS/CEA than in non-CAS/CEA group. Conclusions: The prevalence of TVD/LMT and HRP determined by coronary CTA is higher in patients needing CAS/CEA than in those without. Management of systemic atherosclerosis is required in the perioperative period of CAS/CEA.
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Affiliation(s)
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University
| | | | | | | | | | | | | | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
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Okahara A, Sadamatsu K, Matsuura T, Koga Y, Mine D, Yoshida K. Coronary Artery Disease Screening With Carotid Ultrasound Examination by a Primary Care Physician. Cardiol Res 2016; 7:9-16. [PMID: 28197263 PMCID: PMC5295529 DOI: 10.14740/cr456w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 01/18/2023] Open
Abstract
Background In this study, we investigated the feasibility of primary care physicians using carotid ultrasound to perform coronary artery disease screening in asymptomatic patients with multiple coronary risk factors. Methods We retrospectively collected the data of 135 consecutive asymptomatic patients (mean age: 68.5 ± 8.4 years; male, 75%) who were referred to our institution due to abnormal findings on a carotid ultrasound performed by a primary care physician and who underwent coronary computed tomography angiography. Results The mean number of risk factors was 4.1 ± 1.2 and the mean intima-media thickness was 2.00 ± 0.63 mm. Mild (≤ 50%), moderate (51-75%), and severe (> 76%) coronary stenosis was observed in 54 (40%), 27 (20%), and 25 patients (19%), respectively, while no plaque was found in 24 patients (18%), and five patients (4%) could not be evaluated due to calcification. Consequently, coronary angiography was performed in 56 (41%) patients and coronary intervention was required in 31 patients (23%). A multivariate logistic regression analysis demonstrated that the ratio of low-density lipoprotein cholesterol levels to high-density lipoprotein cholesterol levels, the use of calcium channel blockers and the value of the diastolic blood pressure were related to > 50% coronary stenosis. Conclusions The use of carotid ultrasound in the coronary artery disease screening by primary care physicians resulted in a high prevalence of coronary artery disease and high probabilities of coronary angiography and revascularization, and thus it is considered to be a useful and feasible strategy for the screening of asymptomatic patients.
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Affiliation(s)
- Arihide Okahara
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kenji Sadamatsu
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Taku Matsuura
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yasuaki Koga
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Daigo Mine
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Keiki Yoshida
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
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Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Taguchi H, Yoshikawa J, Shimada K. Epicardial Adipose Tissue Accumulation Is Associated With Renal Dysfunction and Coronary Plaque Morphology on Multidetector Computed Tomography. Circ J 2016; 80:196-201. [DOI: 10.1253/circj.cj-15-0477] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koki Nakanishi
- Department of Cardiovascular Medicine, Baba Memorial Hospital
| | - Shota Fukuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | | | | | - Kenei Shimada
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine
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Ong P, Aziz A, Hansen HS, Prescott E, Athanasiadis A, Sechtem U. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris. Circ J 2015; 79:1431-1438. [DOI: 10.1253/circj.cj-15-0520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert Bosch Krankenhaus
| | - Ahmed Aziz
- Department of Cardiology, Odense University Hospital
- Department of Cardiology, Robert Bosch Krankenhaus
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen
| | | | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krankenhaus
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Motoyama S, Ito H, Ozaki Y. Can Lipid Tissues Including Epicardial Adipose Tissue (EAT), Visceral Adipose Tissue (VAT) and Coronary Plaque Be Moving in the Same Direction? Circ J 2015; 79:969-71. [DOI: 10.1253/circj.cj-15-0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sadako Motoyama
- Division of Cariology, Mount Sinai Hospital
- Department of Cardiology, Fujita Health University
| | - Hajime Ito
- Department of Cardiology, Fujita Health University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
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