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Chan J, Thakur U, Tan S, Muthalaly RG, Thakkar H, Goel V, Cheen YC, Dey D, Brown AJ, Wong DTL, Nerlekar N. Inter-software and inter-scan variability in measurement of epicardial adipose tissue: a three-way comparison of a research-specific, a freeware and a coronary application software platform. Eur Radiol 2023; 33:8445-8453. [PMID: 37369831 PMCID: PMC10667389 DOI: 10.1007/s00330-023-09878-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/26/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) is a proposed marker of cardiovascular risk; however, clinical application may be limited by variability in post-processing software platforms. We assessed inter-vendor agreement of EAT volume (EATv) and attenuation on both contrast-enhanced (CE) and non-contrast CT (NCT) using a standard coronary CT reporting software (Vitrea), an EAT research-specific software (QFAT) and a freeware imaging software (OsiriX). METHODS Seventy-six consecutive patients undergoing simultaneous CE and NCT had complete volumetric EAT measurement. Between-software, within-software NCT vs. CE, and inter- and intra-observer agreement were evaluated with analysis by ANOVA (with post hoc adjustment), Bland-Altman with 95% levels of agreement (LoA) and intraclass correlation coefficient (ICC). RESULTS Mean EATv (freeware 53 ± 31 mL vs. research 93 ± 43 mL vs. coronary 157 ± 64 mL) and attenuation (freeware - 72 ± 25 HU vs. research - 75 ± 3 HU vs. coronary - 61 ± 10 HU) were significantly different between all vendors (ANOVA p < 0.001). EATv was consistently higher in NCT vs. CE for all software packages, with most reproducibility found in research software (bias 26 mL, 95% LoA: 2 to 56 mL), compared to freeware (bias 11 mL 95% LoA: - 46 mL to 69 mL) and coronary software (bias 10 mL 95% LoA: - 127 to 147 mL). Research software had more comparable NCT vs. CE attenuation (- 75 vs. - 72 HU) compared to freeware (- 72 vs. - 57 HU) and coronary (- 61 vs. - 39 HU). Excellent inter-observer agreement was seen with research (ICC 0.98) compared to freeware (ICC 0.73) and coronary software (ICC 0.75) with narrow LoA on Bland-Altman analysis. CONCLUSION There are significant inter-vendor differences in EAT assessment. Our study suggests that research-specific software has better agreement and reproducibility compared to freeware or coronary software platforms. KEY POINTS • There are significant differences between EAT volume and attenuation values between software platforms, regardless of scan type. • Non-contrast scans routinely have higher mean EAT volume and attenuation; however, this finding is only consistently seen with research-specific software. • Of the three analyzed packages, research-specific software demonstrates the highest reproducibility, agreement, and reliability for both inter-scan and inter-observer agreement.
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Affiliation(s)
- Jasmine Chan
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Sean Tan
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Harsh Thakkar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Vinay Goel
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Yeong-Chee Cheen
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Damini Dey
- Cedars Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Yuvaraj J, Lim E, Vo T, Huynh D, Rocco C, Nerlekar N, Cheng K, Lin A, Dey D, Nicholls SJ, Kangaharan N, Wong DTL. Pericoronary adipose tissue attenuation on coronary computed tomography angiography associates with male sex and Indigenous Australian status. Sci Rep 2023; 13:15509. [PMID: 37726291 PMCID: PMC10509231 DOI: 10.1038/s41598-023-41341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
To evaluate if Indigenous Australians have higher coronary inflammation demonstrated non-invasively using pericoronary adipose tissue attenuation on coronary computed tomography angiography (CCTA). We retrospectively obtained a cohort 54 Indigenous patients age- and sex-matched to 54 non-Indigenous controls (age: 46.5 ± 13.1 years; male: n = 66) undergoing CCTA at the Royal Darwin Hospital and Monash Medical Centre. Patient groups were defined to investigate the interaction of ethnicity and sex: Indigenous + male, Indigenous + female, control + male, control + female. Semi-automated software was used to assess pericoronary adipose tissue attenuation (PCAT-a) and volume (PCAT-v). Males had significantly higher PCAT-a (- 86.7 ± 7.8 HU vs. - 91.3 ± 7.1 HU, p = 0.003) than females. Indigenous patients had significantly higher PCAT-v (1.5 ± 0.5cm3 vs. 1.3 ± 0.4cm3, p = 0.032), but only numerically higher PCAT-a (p = 0.133) than controls. There was a significant difference in PCAT-a and PCAT-v across groups defined by Indigenous status and sex (p = 0.010 and p = 0.030, respectively). Among patients with matching CCTA contrast density, multivariable linear regression analysis showed an independent association between Indigenous status and PCAT-a. Indigenous men have increased PCAT-a in an age- and sex-matched cohort. Male sex is strongly associated with increased PCAT-a. Coronary inflammation may contribute to adverse cardiovascular outcomes in Indigenous Australians, but larger studies are required to validate these findings.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Egynne Lim
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Tony Vo
- Division of Medicine, Royal Darwin Hospital, Tiwi, NT, Australia
- Department of Cardiology, Gold Coast University Hospital, Southport, QLD, Australia
| | - David Huynh
- Division of Medicine, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Cheniqua Rocco
- Division of Medicine, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew Lin
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
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3
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Cheng K, Lin A, Stecher X, Bernstein T, Zuñiga P, Mazzon E, Brunser A, Diaz V, Martinez G, Cameron W, Nicholls S, Patel S, Dey D, Wong DTL, Munoz Venturelli P. Association Between Spontaneous Internal Carotid Artery Dissection and Perivascular Adipose Tissue Attenuation on Computed Tomography Angiography. Int J Stroke 2023:17474930231158538. [PMID: 36748981 DOI: 10.1177/17474930231158538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spontaneous cervical artery dissection (sCAD) is a leading cause of ischemic stroke in young patients. Studies using high-resolution magnetic resonance imaging and positron emission tomography have suggested vessel wall inflammation to be a pathogenic factor in sCAD. Computed tomography (CT) attenuation of perivascular adipose tissue (PVAT) is an established non-invasive imaging biomarker of inflammation in coronary arteries, with higher attenuation values reflecting a greater degree of vascular inflammation. OBJECTIVES We evaluate the CT attenuation of PVAT surrounding the internal carotid artery (PVATcarotid) with and without spontaneous dissection. METHODS Single-centre prospective observational study of 56 consecutive patients with CT-verified spontaneous dissection of the internal carotid artery (ICA) admitted between 2011 and 2018. Of these patients, 6 underwent follow-up CTA. 22 patients who underwent CTA for acute neurological symptoms but did not have dissection formed the control group. Using semiautomated research software, PVATcarotid was measured as the mean Hounsfield Unit (HU) attenuation of adipose tissue within a defined volume of interest surrounding the ICA. RESULTS PVATcarotid was significantly higher around dissected ICA compared with non-dissected contralateral ICA in the same patients (-58.7±10.2 vs. -68.9±8.1 HU, P<0.0001) and ICA of patients without dissection (-58.7±10.2 vs. -69.3±9.3 HU, P<0.0001). After a median follow-up of 89 days, there was a significant reduction in PVATcarotid around dissected ICA (from -57.5±13.4 to -74.3±10.5 HU, P<0.05); while no change was observed around non-dissected contralateral ICA (from -71.0±4.4 to -74.1±4.1 HU, P=0.19). ICA dissection was an independent predictor of PVATcarotid following multivariable adjustment for age and the presence of ICA occlusion. CONCLUSION PVATcarotid is elevated in the presence of sCAD and may decrease following the acute event.
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Affiliation(s)
- Kevin Cheng
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Australia 589478.,Department of Medicine, Monash University, Clayton, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Australia 589478.,Department of Medicine, Monash University, Clayton, Australia.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Ximena Stecher
- Departamento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile 441184
| | - Tomas Bernstein
- Departamento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile 441184
| | - Paulo Zuñiga
- Departamento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile 441184
| | - Enrico Mazzon
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Chile 441184.,Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Alejandro Brunser
- Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile 441184
| | - Violeta Diaz
- Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile 441184
| | - Gonzalo Martinez
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile. Millennium Nucleus for Cardiovascular Magnetic Resonance, Chile 28033.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - William Cameron
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Australia 589478
| | - Stephen Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Australia 589478.,Department of Medicine, Monash University, Clayton, Australia
| | - Sanjay Patel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia 2205
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA 22494
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Australia 589478.,Department of Medicine, Monash University, Clayton, Australia
| | - Paula Munoz Venturelli
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Chile 211065.,Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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4
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Dowling C, Nelson AJ, Lim RY, Zhang JM, Cheng K, Smith JA, Seneviratne S, Malaiapan Y, Zaman S, Wong DTL. Quantitative flow ratio to predict long-term coronary artery bypass graft patency in patients with left main coronary artery disease. Int J Cardiovasc Imaging 2022; 38:2811-2818. [DOI: 10.1007/s10554-022-02699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
Fractional flow reserve (FFR) has been demonstrated in some studies to predict long-term coronary artery bypass graft (CABG) patency. Quantitative flow ratio (QFR) is an emerging technology which may predict FFR. In this study, we hypothesised that QFR would predict long-term CABG patency and that QFR would offer superior diagnostic performance to quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).
Methods
A prospective study was performed on patients with left main coronary artery disease who were undergoing CABG. QFR, QCA and IVUS assessment was performed. Follow-up computed tomography coronary angiography and invasive coronary angiography was undertaken to assess graft patency.
Results
A total of 22 patients, comprising of 65 vessels were included in the analysis. At a median follow-up of 3.6 years post CABG (interquartile range, 2.3 to 4.8 years), 12 grafts (18.4%) were occluded. QFR was not statistically significantly higher in occluded grafts (0.81 ± 0.19 vs. 0.69 ± 0.21; P = 0.08). QFR demonstrated a discriminatory power to predict graft occlusion (area under the receiver operating characteristic curve, 0.70; 95% confidence interval [CI], 0.52 to 0.88; P = 0.03). At long-term follow-up, the risk of graft occlusion was higher in vessels with a QFR > 0.80 (58.6% vs. 17.0%; hazard ratio, 3.89; 95% CI, 1.05 to 14.42; P = 0.03 by log-rank test). QCA (minimum lumen diameter, lesion length, diameter stenosis) and IVUS (minimum lumen area, minimum lumen diameter, diameter stenosis) parameters were not predictive of long-term graft patency.
Conclusions
QFR may predict long-term graft patency in patients undergoing CABG.
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5
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Munnur RK, Cheng K, Laggoune J, Talman A, Muthalaly R, Nerlekar N, Baey YW, Nogic J, Lin A, Cameron JD, Seneviratne S, Wong DTL. Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2022; 12:415-425. [PMID: 36033222 PMCID: PMC9412217 DOI: 10.21037/cdt-21-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022]
Abstract
Background Computed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up. Methods Retrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up. Results A total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (−) patients and patients with no plaques (20.5% vs. 1.6% vs. 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (−) patients (8.6%), HRP (−)/OS (+) patients (1.8%) and HRP (−)/OS (−) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008). Conclusions The presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.
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Affiliation(s)
- Ravi K Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jordan Laggoune
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Rahul Muthalaly
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Yi-Wei Baey
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia.,South Australian Health Medical Research Institute (SAHMRI), Adelaide, Australia
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6
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Yuvaraj J, Isa M, Che ZC, Lim E, Nerlekar N, Nicholls SJ, Seneviratne S, Lin A, Dey D, Wong DTL. Atherogenic index of plasma is associated with epicardial adipose tissue volume assessed on coronary computed tomography angiography. Sci Rep 2022; 12:9626. [PMID: 35688850 PMCID: PMC9187675 DOI: 10.1038/s41598-022-13479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
The atherogenic index of plasma (AIP) is a novel biomarker of atherogenic dyslipidaemia (AD), but its relationship with cardiac adipose tissue depots is unknown. We aimed to assess the association of AD with cardiac adipose tissue parameters on coronary computed tomography angiography (CCTA). We studied 161 patients who underwent CCTA between 2008 and 2011 (age 59.0 ± 14.0 years). AD was defined as triglyceride (TG) > 1.7 mmol/L and HDL < 1.0 mmol/L (n = 34). AIP was defined as the base 10 logarithmic ratio of TG to HDL. Plaque burden was assessed using the CT-Leaman score (CT-LeSc). We studied volume and attenuation of epicardial adipose tissue (EAT-v and EAT-a) and pericoronary adipose tissue (PCAT-v and PCAT-a) on CCTA using semi-automated software. Patients with AD had higher PCAT-v (p = 0.042) and EAT-v (p = 0.041). AIP was associated with EAT-v (p = 0.006), type II diabetes (p = 0.009) and male sex (p < 0.001) and correlated with CT-LeSc (p = 0.040). On multivariable analysis, AIP was associated with EAT-v ≥ 52.3 cm3, age, male sex and type II diabetes when corrected for traditional risk factors and plaque burden. AIP is associated with increased EAT volume, but not PCAT-a, after multivariable adjustment. These findings indicate AIP is associated with adverse adipose tissue changes which may increase coronary risk.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Mourushi Isa
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Zhu Chung Che
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Egynne Lim
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, MonashHeart and Monash University, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia. .,School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
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7
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Lin A, Kolossváry M, Cadet S, McElhinney P, Goeller M, Han D, Yuvaraj J, Nerlekar N, Slomka PJ, Marwan M, Nicholls SJ, Achenbach S, Maurovich-Horvat P, Wong DTL, Dey D. Radiomics-Based Precision Phenotyping Identifies Unstable Coronary Plaques From Computed Tomography Angiography. JACC Cardiovasc Imaging 2022; 15:859-871. [PMID: 35512957 PMCID: PMC9072980 DOI: 10.1016/j.jcmg.2021.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to precisely phenotype culprit and nonculprit lesions in myocardial infarction (MI) and lesions in stable coronary artery disease (CAD) using coronary computed tomography angiography (CTA)-based radiomic analysis. BACKGROUND It remains debated whether any single coronary atherosclerotic plaque within the vulnerable patient exhibits unique morphology conferring an increased risk of clinical events. METHODS A total of 60 patients with acute MI prospectively underwent coronary CTA before invasive angiography and were matched to 60 patients with stable CAD. For all coronary lesions, high-risk plaque (HRP) characteristics were qualitatively assessed, followed by semiautomated plaque quantification and extraction of 1,103 radiomic features. Machine learning models were built to examine the additive value of radiomic features for discriminating culprit lesions over and above HRP and plaque volumes. RESULTS Culprit lesions had higher mean volumes of noncalcified plaque (NCP) and low-density noncalcified plaque (LDNCP) compared with the highest-grade stenosis nonculprits and highest-grade stenosis stable CAD lesions (NCP: 138.1 mm3 vs 110.7 mm3 vs 102.7 mm3; LDNCP: 14.2 mm3 vs 9.8 mm3 vs 8.4 mm3; both Ptrend < 0.01). In multivariable linear regression adjusted for NCP and LDNCP volumes, 14.9% (164 of 1,103) of radiomic features were associated with culprits and 9.7% (107 of 1,103) were associated with the highest-grade stenosis nonculprits (critical P < 0.0007) when compared with highest-grade stenosis stable CAD lesions as reference. Hierarchical clustering of significant radiomic features identified 9 unique data clusters (latent phenotypes): 5 contained radiomic features specific to culprits, 1 contained features specific to highest-grade stenosis nonculprits, and 3 contained features associated with either lesion type. Radiomic features provided incremental value for discriminating culprit lesions when added to a machine learning model containing HRP and plaque volumes (area under the receiver-operating characteristic curve 0.86 vs 0.76; P = 0.004). CONCLUSIONS Culprit lesions and highest-grade stenosis nonculprit lesions in MI have distinct radiomic signatures compared with lesions in stable CAD. Within the vulnerable patient may exist individual vulnerable plaques identifiable by coronary CTA-based precision phenotyping.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Markus Goeller
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Piotr J Slomka
- Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Pál Maurovich-Horvat
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary; MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Yuvaraj J, Cameron W, Andrews J, Lin A, Nerlekar N, Nicholls SJ, Hamilton G, Issa M, Che ZC, Lim E, Wong DTL. Vascular inflammation in patients with obstructive sleep apnoea and coronary artery disease shown on coronary computed tomography angiography attenuation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Obstructive sleep apnoea (OSA) is associated with increased plaque burden in coronary artery disease (CAD), but the role of vascular inflammation in this relationship is unclear. Coronary computed tomography angiography (CTA) enables surrogate assessment of systemic inflammation via subcutaneous adipose tissue attenuation (ScAT-a), and of coronary inflammation via epicardial adipose tissue volume and attenuation (EAT-v and EAT-a) and pericoronary adipose tissue attenuation (PCAT-a).
Purpose
To investigate whether vascular inflammation is increased in patients with severe OSA and high plaque burden.
Methods
Patients with clinically indicated polysomnography and coronary CTA were included. Severe OSA was classified as apnoea/hypopnoea index (AHI) >30. High plaque burden was defined as a CT-Leaman score (CT-LeSc) >8.3. Patients with both severe OSA and high plaque burden were defined as ‘Group 1’, all other patients were classified as ‘Group 2’. ScAT-a, EAT-a, EAT-v and PCAT-a were assessed on semi-automated software.
Results
A total of 91 patients were studied (59.3 ± 11.1 years). Severe OSA was associated with high plaque burden (p = 0.02). AHI correlated with CT-LeSc (r = 0.24, p = 0.023). Group 1 had lower EAT-a and PCAT-a compared to Group 2 (EAT-a: -87.6 vs. -84.0 HU, p = 0.01; PCAT-a: -90.4 vs. -83.4 HU, p < 0.01). However, among patients without high plaque burden, EAT-a was increased in patients with severe OSA versus mild-moderate OSA (-80.3 vs. -84.0 HU, p = 0.020). On multivariable analysis, EAT-a independently associated with severe OSA and high plaque burden (p < 0.02), and PCAT-a associated with severe OSA and high plaque burden, and hypertension (all p < 0.01).
Conclusions
EAT attenuation is decreased in patients with severe OSA and high plaque burden but increased in patients with severe OSA and low plaque burden. These divergent results suggest coronary inflammation may be increased in OSA independent of CAD, but larger studies are required to validate these findings.
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Affiliation(s)
- J Yuvaraj
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - W Cameron
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - J Andrews
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - A Lin
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - N Nerlekar
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - S J Nicholls
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - G Hamilton
- Monash Health, Department of Lung and Sleep Medicine, Melbourne, Australia
| | - M Issa
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - Z C Che
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - E Lim
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - D T L Wong
- Monash Heart, Monash Cardiovascular Research Centre, Melbourne, Australia
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9
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Yuvaraj J, Cameron W, Andrews J, Lin A, Nerlekar N, Nicholls SJ, Hamilton GS, Wong DTL. Coronary computed tomography angiography-based assessment of vascular inflammation in patients with obstructive sleep apnoea and coronary artery disease. Cardiovasc Diagn Ther 2022; 12:123-134. [DOI: 10.21037/cdt-21-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/12/2021] [Indexed: 11/06/2022]
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10
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Montarello NJ, Singh K, Sinhal A, Wong DTL, Alcock R, Rajendran S, Dautov R, Barlis P, Patel S, Nidorf SM, Thompson PL, Salagaras T, Butters J, Nerlekar N, Di Giovanni G, Ottaway JL, Nicholls SJ, Psaltis PJ. Assessing the Impact of Colchicine on Coronary Plaque Phenotype After Myocardial Infarction with Optical Coherence Tomography: Rationale and Design of the COCOMO-ACS Study. Cardiovasc Drugs Ther 2021; 36:1175-1186. [PMID: 34432196 PMCID: PMC8384919 DOI: 10.1007/s10557-021-07240-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 12/31/2022]
Abstract
Introduction Recurrent event rates after myocardial infarction (MI) remain unacceptably high, in part because of the continued growth and destabilization of residual coronary atherosclerotic plaques, which may occur despite lipid-lowering therapy. Inflammation is an important contributor to this ongoing risk. Recent studies have shown that the broad-acting anti-inflammatory agent, colchicine, may reduce adverse cardiovascular events in patients post-MI, although the mechanistic basis for this remains unclear. Advances in endovascular arterial wall imaging have allowed detailed characterization of the burden and compositional phenotype of coronary plaque, along with its natural history and responsiveness to treatment. One such example has been the use of optical coherence tomography (OCT) to demonstrate the plaque-stabilizing effects of statins on both fibrous cap thickness and the size of lipid pools within plaque. Methods The Phase 2, multi-centre, double-blind colchicine for coronary plaque modification in acute coronary syndrome (COCOMO-ACS) study will evaluate the effect of colchicine 0.5 mg daily on coronary plaque features using serial OCT imaging in patients following MI. Recruitment for the trial has been completed with 64 participants with non-ST elevation MI randomized 1:1 to colchicine or placebo in addition to guideline recommended therapies, including high-intensity statins. The primary endpoint is the effect of colchicine on the minimal fibrous cap thickness of non-culprit plaque over an 18-month period. Summary The COCOMO-ACS study will determine whether addition of colchicine 0.5 mg daily to standard post-MI treatment has incremental benefits on high-risk features of coronary artery plaques. If confirmed, this will provide new mechanistic insights into how colchicine may confer clinical benefits in patients with atherosclerotic cardiovascular disease. Trial Registration ANZCTR trial registration number: ACTRN12618000809235. Date of trial registration: 11th of May 2018.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Australia
| | - Ajay Sinhal
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Dennis T L Wong
- Victorian Heart Institute, Monash University, Clayton, Australia
| | | | | | | | | | | | - Stefan M Nidorf
- GenesisCare Western Australia, Perth, Australia.,Heart and Vascular Research Institute of Western Australia, Perth, Australia
| | - Peter L Thompson
- GenesisCare Western Australia, Perth, Australia.,Heart and Vascular Research Institute of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Thalia Salagaras
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Julie Butters
- Victorian Heart Institute, Monash University, Clayton, Australia.,South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Nitesh Nerlekar
- Victorian Heart Institute, Monash University, Clayton, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Giuseppe Di Giovanni
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Juanita L Ottaway
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | | | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia. .,South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia. .,Adelaide Medical School, University of Adelaide, Adelaide, Australia.
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11
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Yuvaraj J, Cheng K, Lin A, Psaltis PJ, Nicholls SJ, Wong DTL. The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation. Cells 2021; 10:1196. [PMID: 34068406 PMCID: PMC8153638 DOI: 10.3390/cells10051196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and 'vulnerable' atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Andrew Lin
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA;
| | - Peter J. Psaltis
- Department of Medicine, University of Adelaide, Adelaide, SA 5005, Australia;
- South Australian Health Medical Research Institute, Adelaide, SA 5000, Australia
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
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12
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Yuvaraj J, Lin A, Nerlekar N, Munnur RK, Cameron JD, Dey D, Nicholls SJ, Wong DTL. Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease. Cells 2021; 10:1143. [PMID: 34068518 PMCID: PMC8150579 DOI: 10.3390/cells10051143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). METHODS Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. RESULTS PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: -80.7 ± 6.50 HU vs. -84.2 ± 8.09 HU, p = 0.03; PCATLesion: -79.6 ± 7.86 HU vs. -84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: -80.5 ± 7.03 HU vs. -86.1 ± 7.08 HU, p < 0.001; PCATLesion: -79.6 ± 9.06 HU vs. -85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (-76.8 ± 5.69 HU vs. -82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. CONCLUSIONS PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Ravi K. Munnur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - James D. Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
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13
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Lin A, Nerlekar N, Yuvaraj J, Fernandes K, Jiang C, Nicholls SJ, Dey D, Wong DTL. Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study. Eur Heart J Cardiovasc Imaging 2021; 22:298-306. [PMID: 33106867 PMCID: PMC7899274 DOI: 10.1093/ehjci/jeaa224] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD). METHODS AND RESULTS Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (-82.3 ± 5.5 HU) compared with patients with stable CAD (-90.6 ± 5.7 HU, P < 0.001) and controls (-95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation. CONCLUSION PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.
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Affiliation(s)
- Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Katrina Fernandes
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Cathy Jiang
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
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14
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Dowling C, Michail M, Zhang JM, Comella A, Thakur U, Gooley R, McCormick L, Brown AJ, Wong DTL. Diagnostic performance of quantitative flow ratio, non-hyperaemic pressure indices and fractional flow reserve for the assessment of coronary lesions in severe aortic stenosis. Cardiovasc Diagn Ther 2021; 12:314-324. [DOI: 10.21037/cdt-21-574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
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15
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Wong DTL. Intracoronary imaging. Cardiovasc Diagn Ther 2020; 10:1356-1357. [PMID: 33224761 DOI: 10.21037/cdt-2019-ici-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Australia
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16
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Abstract
Atherosclerotic coronary artery disease has a complex pathogenesis which extends beyond cholesterol intimal infiltration. It involves chronic inflammation of the coronary artery wall driven by systemic and local activation of both the adaptive and innate immune systems, which can ultimately result in the rupture or erosion of atherosclerotic plaque, leading to thrombosis and myocardial infarction (MI). Despite current best practice care, including the widespread use of cholesterol-lowering statins, atherothrombotic cardiovascular events recur at alarming rates post-MI. To a large extent, this reflects residual inflammation that is not adequately controlled by contemporary treatment. Consequently, there has been increasing interest in the pharmacological targeting of inflammation to improve outcomes in atherosclerotic cardiovascular disease. This has comprised both novel pathway-specific agents, most notably the anti-interleukin-1 beta monoclonal antibody, canakinumab, and the repurposing of established, broad-acting drugs, such as colchicine, that are already approved for the management of other inflammatory conditions. Here we discuss the importance of inflammation in mediating atherosclerosis and its complications and provide a timely update on "new" and "old" anti-inflammatory therapies currently being investigated to target it.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Mau T Nguyen
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia.
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
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17
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Lin A, Kolossváry M, Yuvaraj J, Cadet S, McElhinney PA, Jiang C, Nerlekar N, Nicholls SJ, Slomka PJ, Maurovich-Horvat P, Wong DTL, Dey D. Myocardial Infarction Associates With a Distinct Pericoronary Adipose Tissue Radiomic Phenotype: A Prospective Case-Control Study. JACC Cardiovasc Imaging 2020; 13:2371-2383. [PMID: 32861654 DOI: 10.1016/j.jcmg.2020.06.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to determine whether coronary computed tomography angiography (CCTA)-based radiomic analysis of pericoronary adipose tissue (PCAT) could distinguish patients with acute myocardial infarction (MI) from patients with stable or no coronary artery disease (CAD). BACKGROUND Imaging of PCAT with CCTA enables detection of coronary inflammation. Radiomics involves extracting quantitative features from medical images to create big data and identify novel imaging biomarkers. METHODS In a prospective case-control study, 60 patients with acute MI underwent CCTA within 48 h of admission, before invasive angiography. These subjects were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, sex, risk factors, medications, and CT tube voltage. PCAT was segmented around the proximal right coronary artery (RCA) in all patients and around culprit and nonculprit lesions in patients with MI. PCAT segmentations were analyzed using Radiomics Image Analysis software. RESULTS Of 1,103 calculated radiomic parameters, 20.3% differed significantly between MI patients and controls, and 16.5% differed between patients with MI and stable CAD (critical p < 0.0006); whereas none differed between patients with stable CAD and controls. On cluster analysis, the most significant radiomic parameters were texture or geometry based. At 6 months post-MI, there was no significant change in the PCAT radiomic profile around the proximal RCA or nonculprit lesions. Using machine learning (XGBoost), a model integrating clinical features (risk factors, serum lipids, high-sensitivity C-reactive protein), PCAT attenuation, and radiomic parameters provided superior discrimination of acute MI (area under the receiver operator characteristic curve [AUC]: 0.87) compared with a model with clinical features and PCAT attenuation (AUC: 0.77; p = 0.001) or clinical features alone (AUC: 0.76; p < 0.001). CONCLUSIONS Patients with acute MI have a distinct PCAT radiomic phenotype compared with patients with stable or no CAD. Using machine learning, a radiomics-based model outperforms a PCAT attenuation-based model in accurately identifying patients with MI.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sebastien Cadet
- Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - Priscilla A McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cathy Jiang
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Piotr J Slomka
- Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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18
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Mehta OH, Hay M, Lim RY, Ihdayhid AR, Michail M, Zhang JM, Cameron JD, Wong DTL. Comparison of diagnostic performance between quantitative flow ratio, non-hyperemic pressure indices and fractional flow reserve. Cardiovasc Diagn Ther 2020; 10:442-452. [PMID: 32695624 DOI: 10.21037/cdt-20-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Quantitative flow ratio (QFR) is an estimate of fractional flow reserve (FFR) and is derived from 3-dimensional quantitative coronary angiography. The DILEMMA score is an angiographic technique developed to predict FFR. Unlike other diastolic indices such as instantaneous wave-free ratio (iFR), diastolic pressure ratio (dPR) and dPR25-75, neither QFR nor DILEMMA score require pressure wires. This study sought to compare the diagnostic performance of QFR, diastolic indices and DILEMMA score to predict FFR. Methods Between January 2010 and December 2013, patients who underwent invasive coronary angiography and FFR assessments were retrospectively studied. iFR and dPR were derived from FFR pressure tracings. QFR was computed using commercial software. Results Eighty-five lesions (25% FFR significant) were included in this study. Median FFR was 0.88 (0.81-0.92). QFR (rs=0.801), iFR (rs=0.710), dPR (rs=0.716), dPR25-75 (rs=0.715) and DILEMMA score (rs=-0.623) significantly correlated with FFR (P<0.001). QFR ≤0.8 had a specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 86%, 86% and 95% respectively of predicting significant FFR (P<0.001). Receiver-operating characteristic (ROC) analysis revealed the AUC to predict significant FFR for QFR (0.947), iFR (0.880), dPR (0.883), dPR25-75 (0.880) and DILEMMA score (0.916) were not significantly different. However, QFR was a better predictor of FFR than iFR (0.947 vs. 0.770, P<0.01). Conclusions QFR had excellent correlation and accuracy as measured against FFR. When compared to other diastolic indices and DILEMMA score, QFR performed at least as well as the other indices. QFR predicts FFR better than it predicts iFR. QFR is a convenient tool to assess significance of coronary stenosis and a reliable alternative to pressure-wire based indices. Prospective studies are required to investigate the performance and cost-effectiveness of QFR when independently used to guide clinical decision making.
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Affiliation(s)
- Ojas Hrakesh Mehta
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Michael Hay
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Ren Yik Lim
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Michael Michail
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Jun Michael Zhang
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
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19
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Nerlekar N, Thakur U, Lin A, Koh JQS, Potter E, Liu D, Muthalaly RG, Rashid HN, Cameron JD, Dey D, Wong DTL. The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study. Sci Rep 2020; 10:7109. [PMID: 32346001 PMCID: PMC7188860 DOI: 10.1038/s41598-020-63135-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/04/2020] [Indexed: 12/11/2022] Open
Abstract
Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline −76 ± 6 HU vs. −86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Ji Quan Samuel Koh
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Elizabeth Potter
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - David Liu
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul N Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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20
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Yuvaraj J, Lin A, Nerlekar N, Rashid H, Cameron JD, Seneviratne S, Nicholls S, Psaltis PJ, Wong DTL. Is spontaneous coronary artery dissection (SCAD) related to vascular inflammation and epicardial fat? -insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2020; 10:239-241. [PMID: 32420105 DOI: 10.21037/cdt.2020.01.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Stephen Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Peter J Psaltis
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
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21
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Nerlekar N, Muthalaly RG, Wong N, Thakur U, Wong DTL, Brown AJ, Marwick TH. Association of Volumetric Epicardial Adipose Tissue Quantification and Cardiac Structure and Function. J Am Heart Assoc 2019; 7:e009975. [PMID: 30571602 PMCID: PMC6405553 DOI: 10.1161/jaha.118.009975] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Epicardial adipose tissue ( EAT ) is in immediate apposition to the underlying myocardium and, therefore, has the potential to influence myocardial systolic and diastolic function or myocardial geometry, through paracrine or compressive mechanical effects. We aimed to review the association between volumetric EAT and markers of myocardial function and geometry. Methods and Results PubMed, Medline, and Embase were searched from inception to May 2018. Studies were included only if complete EAT volume or mass was reported and related to a measure of myocardial function and/or geometry. Meta-analysis and meta-regression were used to evaluate the weighted mean difference of EAT in patients with and without diastolic dysfunction. Heterogeneity of data reporting precluded meta-analysis for systolic and geometric associations. In the 22 studies included in the analysis, there was a significant correlation with increasing EAT and presence of diastolic dysfunction and mean e' (average mitral annular tissue Doppler velocity) and E/e' (early inflow / annular velocity ratio) but not E/A (ratio of peak early (E) and late (A) transmitral inflow velocities), independent of adiposity measures. There was a greater EAT in patients with diastolic dysfunction (weighted mean difference, 24.43 mL; 95% confidence interval, 18.5-30.4 mL; P<0.001), and meta-regression confirmed the association of increasing EAT with diastolic dysfunction ( P=0.001). Reported associations of increasing EAT with increasing left ventricular mass and the inverse correlation of EAT with left ventricular ejection fraction were inconsistent, and not independent from other adiposity measures. Conclusions EAT is associated with diastolic function, independent of other influential variables. EAT is an effect modifier for chamber size but not systolic function.
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Affiliation(s)
- Nitesh Nerlekar
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia.,2 Baker Heart and Diabetes Institute Melbourne Australia
| | - Rahul G Muthalaly
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Nathan Wong
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Udit Thakur
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Dennis T L Wong
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia.,3 South Australian Health and Medical Research Institute Adelaide Australia
| | - Adam J Brown
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
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22
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Mo L, Gupta V, Modi R, Munnur K, Cameron JD, Seneviratne S, Edwards BA, Landry SA, Joosten SA, Hamilton GS, Wong DTL. Severe obstructive sleep apnea is associated with significant coronary artery plaque burden independent of traditional cardiovascular risk factors. Int J Cardiovasc Imaging 2019; 36:347-355. [PMID: 31637622 DOI: 10.1007/s10554-019-01710-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 01/27/2023]
Abstract
Obstructive Sleep Apnea (OSA) is strongly associated with adverse cardiovascular events. In these patients, increased oxidative stress has been associated with accelerated coronary atherosclerosis. However, it is unclear if OSA is associated with significant coronary artery plaque burden. Our aim is to determine whether OSA and/or markers of hypoxemia are associated with coronary plaque burden (CPB). Patients who had coronary computed tomography angiography (CCTA) and a polysomnogram within 1 year of each other between 2011 and 2016 were analyzed. Apnea-Hypopnea Index (AHI) and hypoxemic burden (ODI3%, ODI4%, nadir SpO2, average spO2 and time of spO2 < 88%) were obtained from the polysomnogram. Total CPB was assessed using the prognostically validated CT-Leaman score (CT-LeSc). Significant CPB was defined as CT-LeSc ≥ 8.3. There were 119 patients with mean (± SD) age of 59 ± 12 years. Using logistical regression analysis; AHI, ODI4% and ODI3% were the only parameters associated with significant CPB. Severe OSA (AHI ≥ 30 events/h) was associated with significant CPB with adjusted OR of 3.21 (p = 0.010) independent of traditional cardiovascular risk factors. Mechanisms associated with apnea and hypopnea events (as measured by AHI, ODI3% and ODI4%), but not the severity of arterial desaturation (nadir SpO2, burden of SpO2 < 88%) were associated with significant CPB.
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Affiliation(s)
- Lin Mo
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Vivek Gupta
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Rohan Modi
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - Kiran Munnur
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Sujith Seneviratne
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Shane A Landry
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Simon A Joosten
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Garun S Hamilton
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia. .,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia. .,South Australian Health & Medical Research Institute, Adelaide, Australia.
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23
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Munnur RK, Andrews J, Kataoka Y, Nerlekar N, Psaltis PJ, Nicholls SJ, Malaiapan Y, Cameron JD, Meredith IT, Seneviratne S, Wong DTL. Quantitative and Qualitative Coronary Plaque Assessment Using Computed Tomography Coronary Angiography: A Comparison With Intravascular Ultrasound. Heart Lung Circ 2019; 29:883-893. [PMID: 31564511 DOI: 10.1016/j.hlc.2019.06.719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/12/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare computed tomography coronary angiography (CTCA) with intravascular ultrasound (IVUS) in quantitative and qualitative plaque assessment. METHODS Patients who underwent IVUS and CTCA within 3 months for suspected coronary artery disease were retrospectively studied. Plaque volumes on CTCA were quantified manually and with automated-software and were compared to IVUS. High-risk plaque features were compared between CTCA and IVUS. RESULTS There were 769 slices in 32 vessels (27 patients). Manual plaque quantification on CTCA was comparable to IVUS per slice (mean difference of 0.06±0.07, p=0.44; Bland-Altman 95% limits of agreement -2.19-2.08 mm3, bias of -0.06mm3) and per vessel (3.1mm3 ± -2.85mm3, p=0.92). In contrast, there was significant difference between automated-software and IVUS per slice (2.3±0.09mm3, p<0.001; 95% LoA -6.78 to 2.25mm3, bias of -2.2mm3) and per vessel (33.04±10.3 mm3, p<0.01). The sensitivity, specificity, positive and negative predictive value of CTCA to detect plaques that had features of echo-attenuation on IVUS was 93.3%, 99.6%, 93.3% and 99.6% respectively. The association of ≥2 high-risk plaque features on CTCA with echo attenuation (EA) plaque features on IVUS was excellent (86.7%, 99.6%, 92.9% and 99.2%). In comparison, the association of high-risk plaque features on CTCA and plaques with echo-lucency on IVUS was only modest. CONCLUSION Plaque volume quantification by manual CTCA method is accurate when compared to IVUS. The presence of at least two high-risk plaque features on CTCA is associated with plaque features of echo attenuation on IVUS.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia.
| | - Jordan Andrews
- South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Peter J Psaltis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Stephen J Nicholls
- South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Melbourne, Vic, Australia; South Australian Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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24
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Abstract
For over 80 years, spontaneous coronary artery dissection (SCAD) has been recognised as a cause of myocardial infarction. SCAD is described as a non-iatrogenic, non-atherosclerotic coronary artery dissection, resulting in formation of a false lumen or intramural haematoma in the coronary artery wall that compresses the true lumen, often compromising myocardial blood flow. In early literature, the incidence of SCAD in acute coronary syndrome (ACS) was underestimated. Recent advances in awareness and widespread early angiographic investigation in ACS has led to important shifts in our understanding of the prevalence, predisposing causes, natural history, aetiology, clinical and angiographic features, management, and prognosis of SCAD. It is now well understood that SCAD predominantly affects women and is responsible for around 20% of ACS presentations in females below the age of 60. Despite this, SCAD is still often overlooked and misdiagnosed as atherosclerotic disease. Misdiagnosis is multifactorial; with contributing factors including a low clinical index of suspicion, particularly in young females, a lack of clinician familiarity with angiographic variants, and limitations of angiography. Although increasing evidence suggests that optimal management is distinct from atherosclerotic coronary artery disease, many questions remain unanswered regarding the pathogenesis and optimal treatment of SCAD, heralding prospective research to answer these questions. This review aims to give a current clinical perspective on SCAD and highlight the importance of familiarity and vigilance with this condition when diagnosing and treating ACS.
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Affiliation(s)
- Kyle B Franke
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Angus Baumann
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
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25
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Ihdayhid AR, Sakaguchi T, Linde JJ, Sørgaard MH, Kofoed KF, Fujisawa Y, Hislop-Jambrich J, Nerlekar N, Cameron JD, Munnur RK, Crosset M, Wong DTL, Seneviratne SK, Ko BS. Performance of computed tomography-derived fractional flow reserve using reduced-order modelling and static computed tomography stress myocardial perfusion imaging for detection of haemodynamically significant coronary stenosis. Eur Heart J Cardiovasc Imaging 2018; 19:1234-1243. [DOI: 10.1093/ehjci/jey114] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 07/19/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - Takuya Sakaguchi
- Toshiba Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, Japan
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen E, Denmark
| | - Mathias H Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen E, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen E, Denmark
| | - Yasuko Fujisawa
- Toshiba Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, Japan
| | - Jacqui Hislop-Jambrich
- Toshiba Medical Australia and New Zealand, North Ryde, Level 2, Building C, 12-24 Talavera Road, North Ryde NSW, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - Ravi K Munnur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - Marcus Crosset
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
- South Australian Health & Medical Research Institute, North Terrace, Adelaide, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia
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26
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Rajwani A, Nelson AJ, Shirazi MG, Disney PJS, Teo KSL, Wong DTL, Young GD, Worthley SG. CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety. Eur Heart J Cardiovasc Imaging 2018; 18:1361-1368. [PMID: 28013284 DOI: 10.1093/ehjci/jew212] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/16/2016] [Indexed: 11/12/2022] Open
Abstract
Aims We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes. Methods and results Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection. Conclusions In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases.
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Affiliation(s)
- Adil Rajwani
- Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.,Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
| | - Adam J Nelson
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Masoumeh G Shirazi
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Patrick J S Disney
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
| | - Karen S L Teo
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Dennis T L Wong
- MonashHeart and Department of Medicine, Monash University, Melbourne, VIC 3168, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Stephen G Worthley
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
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Munnur RK, Cameron JD, McCormick LM, Psaltis PJ, Nerlekar N, Ko BSH, Meredith IT, Seneviratne S, Wong DTL. Diagnostic accuracy of ASLA score (a novel CT angiographic index) and aggregate plaque volume in the assessment of functional significance of coronary stenosis. Int J Cardiol 2018; 270:343-348. [PMID: 29907444 DOI: 10.1016/j.ijcard.2018.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Visual assessment of diameter-stenosis on Computed Tomography Coronary Angiography (CTCA) lacks specificity to determine functional significance of coronary artery stenosis. Percent-aggregate plaque volume (%APV) and ASLA score, which incorporates Area of Stenosis, Lesion length, and area of myocardium subtended estimated by APPROACH score (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) have been described to predict lesion specific ischaemia in focal lesions with intermediate stenosis. METHODS AND RESULTS Included were 81 patients (mean age 64.7 ± 9 years, 62% male; 94 vessels) who underwent 320- detector-row CTCA, invasive coronary angiography and fractional-flow-reserve (FFR). We examined vessels with wide range of diameter stenosis (mid to severe) and with multiple lesions. Invasive FFR of ≤0.8 was considered functionally significant. The first 54 patients (62 vessels) formed the derivation cohort. ASLA score was the best predictor of FFR ≤ 0.8 (AUC 0.83, p < 0.001) compared to %APV (0.72), CT >50% (0.76), APPROACH score (0.79), area-stenosis (0.73), diameter-stenosis (0.74), minimum-luminal-diameter (0.74), minimal-luminal-area (0.72), and lesion-length (0.67). ASLA score and not %APV, provided incremental predictive value when added to CT > 50 [(NRI 0.71, p = 0.005) vs. (NRI 0.01, p = 0.96)]. In the validation cohort of 27 patients (32 vessels), the ASLA score (AUC 0.85) was again a better predictor of FFR ≤ 0.8 compared to %APV (0.71), CT > 50% (0.66) and other CT indices. The AUC of ASLA score was superior to CTCA>50% (p = 0.001). CONCLUSION ASLA score is a novel predictor of functional significance of coronary stenosis and adds incremental predictive value to CT > 50 but %APV did not.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia.
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Liam M McCormick
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Peter J Psaltis
- South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Brian S H Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia; South Australian Medical Research Institute (SAHMRI), Adelaide, Australia
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Nerlekar N, Brown AJ, Muthalaly RG, Talman A, Hettige T, Cameron JD, Wong DTL. Association of Epicardial Adipose Tissue and High-Risk Plaque Characteristics: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.117.006379. [PMID: 28838916 PMCID: PMC5586465 DOI: 10.1161/jaha.117.006379] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high‐risk plaque (HRP). EAT can be measured by volumetric assessment (EAT‐v) or linear thickness (EAT‐t). We performed a systematic review and random‐effects meta‐analysis to assess the association of EAT with HRP and whether this association is dependent on the measurement method used. Methods and Results Electronic databases were systematically searched up to October 2016. Studies reporting HRP by computed tomography or intracoronary imaging and studies measuring EAT‐v or EAT‐t were included. Odds ratios were extracted from multivariable models reporting the association of EAT with HRP and described as pooled estimates with 95% confidence intervals (CIs). Analysis was stratified by EAT measurement method. Nine studies (n=3772 patients) were included with 7 measuring EAT‐v and 2 measuring EAT‐t. Increasing EAT was significantly associated with the presence of HRP (odds ratio: 1.26 [95% CI, 1.11–1.43]; P<0.001). Patients with HRP had higher EAT‐v than those without (weighted mean difference: 28.3 mL [95% CI, 18.8–37.8 mL]; P<0.001). EAT‐v was associated with HRP (odds ratio: 1.19 [95% CI, 1.06–1.33]; P<0.001); however, EAT‐t was not (odds ratio: 3.09 [95% CI, 0.56–17]; P=0.2). Estimates remained significant when adjusted for small‐study effect bias (odds ratio: 1.13 [95% CI, 1.03–1.28]; P=0.04). Conclusions Increasing EAT is associated with the presence of HRP, and patients with HRP have higher quantified EAT‐v. The association of EAT‐v with HRP is significant compared with EAT‐t; however, a larger scale study is still required, and further evaluation is needed to assess whether EAT may be a potential therapeutic target for novel pharmaceutical agents. Clinical Trial Registration URL: https://www.crd.york.ac.uk/. Unique identifier: CRD42017055473.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Thushan Hettige
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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Wong DTL. The prognostic value of residual coronary stenoses after functionally complete revascularisation. Cardiovasc Diagn Ther 2017; 7:S63-S65. [PMID: 28748149 DOI: 10.21037/cdt.2017.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fractional flow reserve (FFR) has become the gold standard for functional assessment of coronary artery stenosis. Studies have confirmed the superiority of FFR guided percutaneous coronary intervention (PCI) compared to angiography guided PCI. Due to the high cost of FFR, it is not economically viable for FFR to be incorporated into every routine invasive coronary angiography. As a result, visual estimation of diameter stenosis on invasive coronary angiography still remains the cornerstone for decision making regarding revascularisation treatment for patients. This is despite recent studies questioning the "visual functional mismatch" between diameter stenosis and FFR in 57% of patients with non-left main stenosis. In patients with multivessel disease, complete revascularisation leads to improved long term outcomes. However, some lesions classified as significant by angiography may not be functionally significant. Kobayashi and colleagues demonstrated that after functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization.
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Affiliation(s)
- Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, Clayton, 3168 VIC, Australia.,South Australian Medical Research Institute (SAHMRI), Adelaide, Australia
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Nerlekar N, Ko BS, Nasis A, Cameron JD, Leung M, Brown AJ, Wong DTL, Ngu PJ, Troupis JM, Seneviratne SK. Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography. Cardiovasc Diagn Ther 2017; 7:296-304. [PMID: 28567355 DOI: 10.21037/cdt.2017.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA). METHODS Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm). A wider phase window was used for the elevated HR group (30-80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score. RESULTS Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61-80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort. CONCLUSIONS In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Philip J Ngu
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - John M Troupis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia.,Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
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Adams DB, Narayan O, Munnur RK, Cameron JD, Wong DTL, Talman AH, Harper RW, Seneviratne SK, Meredith IT, Ko BS. Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography. Int J Cardiovasc Imaging 2016; 33:241-249. [PMID: 27672064 DOI: 10.1007/s10554-016-0982-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023]
Abstract
Epidemiological studies observed a higher prevalence of coronary atherosclerosis in South Asians when compared to Caucasians, but quantitative computed tomography differences in aggregate plaque volume (APV) and epicardial fat volume (EFV) between South Asians, Southeast or East Asians (SEEAs) and Caucasians remain unknown. We aimed to compare APV and EFV quantified on computed-tomographic-coronary-angiography (CTCA) between South Asian, SEEA and Caucasian populations residing in Australia. Age, gender and body-mass-index matched subjects from three ethnic groups who underwent clinically indicated 320-detector CTCA were retrospectively analysed. Percentage APV in the first 5 cm of the left anterior descending artery (LAD) and EFV were quantified using dedicated software (Vital Images, USA). One-hundred-and-fifty subjects (average age = 57.7 years, 56 % male, n = 50 in each ethnic group) were analysed. Mean LAD percentage APV was highest in South Asians (44.5 ± 8.4 % vs. 37.5 ± 6.5 % in SEEAs and 39.5 ± 6.4 % in Caucasians, P = 0.00001). South Asian ethnicity predicted LAD APV above traditional risk factors on multivariate analysis (P = 0.000002). EFV was significantly higher in both South Asians (103.2 ± 41.7 cm3 vs. 85.8 ± 39.4 cm3, P = 0.035) and SEEAs (110.8 ± 36.9 cm3 vs. 85.8 ± 39.4 cm3, P = 0.001) when compared with Caucasians. In this cohort LAD percentage APV and EFV, as quantified on CTCA, differs between South Asians, SEEA and Caucasian populations, with higher LAD APV observed in South Asians and lower EFV in Caucasians. Atherosclerotic volume in LAD was best predicted by South Asian ethnicity above traditional risk factors and EFV. Further research is required to establish whether APV and EFV quantification can improve cardiac risk prediction in the South Asian population.
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Affiliation(s)
- Daniel B Adams
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Om Narayan
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Ravi Kiran Munnur
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - James D Cameron
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Dennis T L Wong
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Andrew H Talman
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Richard W Harper
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Sujith K Seneviratne
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Ian T Meredith
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Brian S Ko
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
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Abstract
Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process. Insights from pathological observations and advances in cellular and molecular biology have helped us understand the process of plaque formation, progression and rupture leading to events. Several intravascular imaging techniques such as intravascular ultrasound (IVUS), Virtual histology IVUS (VH-IVUS) and optical coherence tomography (OCT) allow in vivo assessment of plaque burden, plaque morphology and response to therapy. In addition, non invasive assessment using coronary artery calcium (CAC) score allows risk stratification and plaque burden assessment whilst computed tomography coronary angiography (CTCA) allows evaluation of luminal stenosis, plaque characterisation and quantification. This review aims to summarise the results of invasive and non-invasive imaging studies of coronary atherosclerosis seen in various high-risk populations including DM, metabolic syndrome, obesity, CKD and, gender differences and ethnicity. Understanding the phenotype of plaques in various susceptible groups may allow potential development of personalised therapies.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
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Rajwani A, Shirazi MG, Disney PJS, Wong DTL, Teo KSL, Delacroix S, Chokka RG, Young GD, Worthley SG. Left Atrial Appendage Eccentricity and Irregularity Are Associated With Residual Leaks After Percutaneous Closure. JACC Clin Electrophysiol 2015; 1:478-485. [PMID: 29759401 DOI: 10.1016/j.jacep.2015.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Predictors of residual leak following percutaneous LAA closure were evaluated. BACKGROUND Left atrial appendage (LAA) closure aims to exclude this structure from the circulation, typically using a circular occluder. A noncircular orifice is frequently encountered however, and fibrous remodeling of the LAA in atrial fibrillation may restrict orifice deformation. Noncircularity may thus be implicated in the occurrence of residual leak despite an appropriately oversized device. METHODS Pre-procedural multislice computerized tomography was used to quantify LAA orifice eccentricity and irregularity. Univariate predictors of residual leak were identified with respect to the orifice, device, and relevant clinical variables, with the nature of any correlations then further evaluated. RESULTS Eccentricity and irregularity indexes of the orifice in 31 individuals were correlated with residual leak even where the device was appropriately oversized. An eccentricity index of 0.15 predicted a residual leak with 85% sensitivity and 59% specificity. An irregularity index of 0.05 predicted a significant residual leak ≥3 mm with 100% sensitivity and 86% specificity. Orifice size, device size, degree of device oversize, left atrial volume, and pulmonary artery pressure were not predictors of residual leak. CONCLUSIONS Eccentricity and irregularity of the LAA orifice are implicated in residual leak after percutaneous closure even where there is appropriate device over-size. Irregularity index in particular is a novel predictor of residual leak, supporting a closer consideration of orifice morphology before closure.
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Affiliation(s)
- Adil Rajwani
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia.
| | - Masoumeh G Shirazi
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Division of Medicine, University of Adelaide, Adelaide, Australia
| | - Patrick J S Disney
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Dennis T L Wong
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, Australia; MonashHeart and Department of Medicine, Monash University, Melbourne, Australia
| | - Karen S L Teo
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Division of Medicine, University of Adelaide, Adelaide, Australia
| | - Sinny Delacroix
- Division of Medicine, University of Adelaide, Adelaide, Australia
| | - Ramesh G Chokka
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Division of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Division of Medicine, University of Adelaide, Adelaide, Australia; South Australian Health and Medical Research Institute, North Terrace, Adelaide, Australia
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Ko BS, Wong DTL, Nørgaard BL, Leong DP, Cameron JD, Gaur S, Marwan M, Achenbach S, Kuribayashi S, Kimura T, Meredith IT, Seneviratne SK. Diagnostic Performance of Transluminal Attenuation Gradient and Noninvasive Fractional Flow Reserve Derived from 320-Detector Row CT Angiography to Diagnose Hemodynamically Significant Coronary Stenosis: An NXT Substudy. Radiology 2015; 279:75-83. [PMID: 26444662 DOI: 10.1148/radiol.2015150383] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare the diagnostic performance of 320-detector row computed tomography (CT) coronary angiography-derived computed fractional flow reserve (FFR; FFRCT), transluminal attenuation gradient (TAG; TAG320), and CT coronary angiography alone to diagnose hemodynamically significant stenosis as determined by invasive FFR. MATERIALS AND METHODS This substudy of the prospective NXT study (no. NCT01757678) was approved by each participating institution's review board, and informed consent was obtained from all participants. Fifty-one consecutive patients who underwent 320-detector row CT coronary angiographic examination and invasive coronary angiography with FFR measurement were included. Independent core laboratories determined coronary artery disease severity by using CT coronary angiography, TAG320, FFRCT, and FFR. TAG320 is defined as the linear regression coefficient between luminal attenuation and axial distance from the coronary ostium. FFRCT was computed from CT coronary angiography data by using computational fluid dynamics technology. Diagnostic performance was evaluated and compared on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS Among 82 vessels, 24 lesions (29%) had ischemia by FFR (FFR ≤ 0.80). FFRCT exhibited a stronger correlation with invasive FFR compared with TAG320 (Spearman ρ, 0.78 vs 0.47, respectively). Overall per-vessel accuracy, sensitivity, specificity, and positive and negative predictive values for TAG320 (<15.37) were 78%, 58%, 86%, 64%, and 83%, respectively; and those of FFRCT were 83%, 92%, 79%, 65%, and 96%, respectively. ROC curve analysis showed a significantly larger AUC for FFRCT (0.93) compared with that for TAG320 (0.72; P = .003) and CT coronary angiography alone (0.68; P = .008). CONCLUSION FFRCT computed from 320-detector row CT coronary angiography provides better diagnostic performance for the diagnosis of hemodynamically significant coronary stenoses compared with CT coronary angiography and TAG320.
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Affiliation(s)
- Brian S Ko
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Dennis T L Wong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Bjarne L Nørgaard
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Darryl P Leong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - James D Cameron
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Sara Gaur
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Mohamed Marwan
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Stephan Achenbach
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Sachio Kuribayashi
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Takeshi Kimura
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Ian T Meredith
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
| | - Sujith K Seneviratne
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Rd, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G.); Department of Cardiology, Erlangen University Hospital, Erlangen, Germany (M.M., S.A.); Department of Diagnostic Radiology, Keio University, Tokyo, Japan (S.K.); and Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T.K.)
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Rashid HNZ, Wong DTL, Wijesekera H, Gutman SJ, Shanmugam VB, Gulati R, Malaipan Y, Meredith IT, Psaltis PJ. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome--A single-centre Australian experience. Int J Cardiol 2015; 202:336-8. [PMID: 26426273 DOI: 10.1016/j.ijcard.2015.09.072] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/21/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Hashrul N Z Rashid
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia; Discipline of Medicine, University of Adelaide & Heart Health Theme, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Harendra Wijesekera
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Sarah J Gutman
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Vimal B Shanmugam
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Yuvaraj Malaipan
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Ian T Meredith
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia
| | - Peter J Psaltis
- Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, VIC, Australia; Discipline of Medicine, University of Adelaide & Heart Health Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.
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Psaltis PJ, Talman AH, Munnur K, Cameron JD, Ko BSH, Meredith IT, Seneviratne SK, Wong DTL. Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography. Int J Cardiovasc Imaging 2015; 32:317-328. [PMID: 26335371 DOI: 10.1007/s10554-015-0762-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/31/2015] [Indexed: 12/12/2022]
Abstract
Epicardial fat volume (EFV) has been suggested to promote atherosclerotic plaque development in coronary arteries, and has been correlated with both coronary stenosis and acute coronary events. Although associated with progression of coronary calcification burden, a relationship with progression of coronary atheroma volume has not been previously tested. We studied patients who had clinically indicated serial 320-row multi-detector computer tomography coronary angiography with a median 25-month interval. EFV was measured at baseline and follow-up. In vessels with coronary stenosis, quantitative analysis was performed to measure atherosclerotic plaque burden, volume and aggregate plaque volume at baseline and follow-up. The study comprised 64 patients (58.4 ± 12.2 years, 27 males, 192 vessels, 193 coronary segments). 79 (41 %) coronary segments had stenosis at baseline. Stenotic segments were associated with greater baseline EFV than those without coronary stenosis (117.4 ± 45.1 vs. 102.3 ± 51.6 cm(3), P = 0.046). 46 (24 %) coronary segments displayed either new plaque formation or progression of adjusted plaque burden at follow-up. These were associated with higher baseline EFV than segments without stenosis or those segments that had stenoses that did not progress (128.7 vs. 101.0 vs. 106.7 cm(3) respectively, P = 0.006). On multivariate analysis, baseline EFV was the only independent predictor of coronary atherosclerotic plaque progression or new development (P = 0.014). High baseline EFV is associated with the presence of coronary artery stenosis and plaque volume progression. Accumulation of EFV may be implicated in the evolution and progression of coronary atheroma.
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Affiliation(s)
- Peter J Psaltis
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia.,Department of Medicine, University of Adelaide and Heart Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Andrew H Talman
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - Kiran Munnur
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - James D Cameron
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - Brian S H Ko
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - Ian T Meredith
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - Sujith K Seneviratne
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Heart, Monash Cardiovascular Research Centre, Monash University, Clayton, VIC, Australia. .,Department of Medicine, University of Adelaide and Heart Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
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Baillie TJ, Scherer DJ, Wong DTL, Steele PM. Kounis syndrome and hypersensitivity myocarditis - One and the same? Insights from cardiac magnetic resonance imaging. J Cardiol Cases 2015; 12:119-122. [PMID: 30546573 DOI: 10.1016/j.jccase.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/01/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022] Open
Abstract
Myocarditis and acute coronary syndrome are both described in the setting of concurrent hypersensitivity reactions to a variety of allergenic triggers (hypersensitivity myocarditis and Kounis syndrome respectively). Mast cell degranulation is thought to be pivotal in the pathogenesis of both clinical entities. Cardiac magnetic resonance imaging (CMR) has assumed a key role in the assessment of chest pain syndromes, providing a useful non-invasive tool to aid clinical decision-making. Despite increasing availability and uptake of CMR, only a small fraction of published Kounis syndrome cases report CMR findings, and confirmation of myocardial infarction remains elusive. We present a case of presumed Kounis syndrome with comprehensive CMR imaging that provides an insight into why these two well-described clinical entities share many clinical features - perhaps they are one and the same. <Learning objective: Myocarditis and acute coronary syndrome (ACS) in the setting of hypersensitivity reactions share similar clinical characteristics. Endomyocardial biopsies are often not undertaken in this patient group, and differentiation has typically been at the clinicians' discretion. Cardiac magnetic resonance imaging can provide an insight into the underlying pathogenesis, with currently available evidence suggesting myocarditis is a prerequisite for ACS, rather than being stand-alone clinical entities.>.
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Ko BS, Wong DTL, Cameron JD, Leong DP, Soh S, Nerlekar N, Meredith IT, Seneviratne SK. The ASLA Score: A CT Angiographic Index to Predict Functionally Significant Coronary Stenoses in Lesions with Intermediate Severity-Diagnostic Accuracy. Radiology 2015; 276:91-101. [PMID: 25710278 DOI: 10.1148/radiol.15141231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To identify computed tomographic (CT) coronary indexes independently associated with a fractional flow reserve (FFR) of 0.8 or less, to derive a score that combines CT indexes most predictive of an FFR of 0.8 or less, and to evaluate the diagnostic accuracy of the score in predicting an FFR of 0.8 or less. MATERIALS AND METHODS This retrospective study had institutional review board approval and waiver of the need to obtain informed consent. Consecutive patients who underwent CT coronary angiography and FFR assessment with one or more discrete lesion(s) of intermediate (30%-70%) severity at CT were included. Quantitative CT measurements were performed by using dedicated software. The CT indexes evaluated included the following: plaque burden, minimal luminal area and diameter, stenosis diameter, area of stenosis, lesion length, remodeling index, plaque morphology, calcification severity, and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score, which approximates the size of the myocardium subtended by a lesion. By using covariates independently associated with an FFR of 0.8 or less, a score was determined on the basis of modified Akaike information criteria, and the C statistics of individual and combined indexes were compared. RESULTS Eighty-five patients (mean age, 64.2 years; range, 48-88 years; 65.9% men; 124 lesions; 38 lesions with an FFR ≤ 0.8) were included. Area of stenosis, lesion length, and APPROACH score were the strongest predictors of an FFR of 0.8 or less and were used to derive the ASLA score. The optimism-adjusted Harrell C statistic for the combined score was 0.82, which was superior to that for area of stenosis (0.74), lesion length (0.75), and the APPROACH score (0.71) (P < .001 for trend). The corresponding incremental discrimination improvement indexes were 0.17, 0.11, and 0.19, respectively (P < .001 for all), suggesting that the score improves reclassification compared with any one angiographic index. The average time required for score derivation was 102.6 seconds. CONCLUSION The ASLA score, which accounts for CT-derived area of stenosis, lesion length, and APPROACH score, may conveniently improve the prediction, beyond individual indexes, of functionally significant intermediate coronary lesions.
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Affiliation(s)
- Brian S Ko
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Dennis T L Wong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - James D Cameron
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Darryl P Leong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Siang Soh
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Ian T Meredith
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Sujith K Seneviratne
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
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Talman AH, Psaltis PJ, Cameron JD, Meredith IT, Seneviratne SK, Wong DTL. Epicardial adipose tissue: far more than a fat depot. Cardiovasc Diagn Ther 2015; 4:416-29. [PMID: 25610800 DOI: 10.3978/j.issn.2223-3652.2014.11.05] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/17/2014] [Indexed: 01/04/2023]
Abstract
Epicardial adipose tissue (EAT) refers to the fat depot that exists on the surface of the myocardium and is contained entirely beneath the pericardium, thus surrounding and in direct contact with the major coronary arteries and their branches. EAT is a biologically active organ that may play a role in the association between obesity and coronary artery disease (CAD). Given recent advances in non-invasive imaging modalities such a multidetector computed tomography (MDCT), EAT can be accurately measured and quantified. In this review, we focus on the evidence suggesting a role for EAT as a quantifiable risk marker in CAD, as well as describe the role EAT may play in the development and vulnerability of coronary artery plaque.
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Affiliation(s)
- Andrew H Talman
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Peter J Psaltis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - James D Cameron
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Ian T Meredith
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Sujith K Seneviratne
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Dennis T L Wong
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
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Munnur RK, Cameron JD, Ko BS, Meredith IT, Wong DTL. Cardiac CT: atherosclerosis to acute coronary syndrome. Cardiovasc Diagn Ther 2014; 4:430-48. [PMID: 25610801 PMCID: PMC4278045 DOI: 10.3978/j.issn.2223-3652.2014.11.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA.
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Wong DTL, Soh SY, Ko BSH, Cameron JD, Crossett M, Nasis A, Troupis J, Meredith IT, Seneviratne SK. Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 2014; 4:299-306. [PMID: 25276615 DOI: 10.3978/j.issn.2223-3652.2014.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aims to compare the image quality of second generation versus first generation 320-computed tomography coronary angiography (CTCA) in patients with heart rate ≥65 bpm as it has not been specifically reported. METHODS Consecutive patients who underwent CTCA using second-generation-320-detector-row-CT were prospectively enrolled. A total of 50 patients with elevated (≥65 bpm) heart rate and 50 patients with controlled (<65 bpm) heart rate were included. Age and gender matched patients who were scanned with the first-generation-320-detector-row-CT were retrospectively identified. Image quality in each coronary artery segment was assessed by two blinded CT angiographers using the five-point Likert scale. RESULTS In the elevated heart rate cohorts, while there was no significant difference in heart rate during scan-acquisition (66 vs. 69 bpm, P=0.308), or body mass index (28.5 vs. 29.6, P=0.464), the second generation scanner was associated with better image quality (3.94±0.6 vs. 3.45±0.8, P=0.001), and with lower radiation (2.8 vs. 4.3 mSv, P=0.009). There was no difference in scan image quality for the controlled heart rate cohorts. CONCLUSIONS The second generation CT scanner provides better image quality at lower radiation dose in patients with elevated heart rate (≥65 bpm) compared to first generation CT scanner.
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Affiliation(s)
- Dennis T L Wong
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Siang Y Soh
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Brian S H Ko
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - James D Cameron
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Marcus Crossett
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Arthur Nasis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - John Troupis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Ian T Meredith
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
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Dundon BK, Torpey DK, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. Beneficial cardiovascular remodeling following arterio-venous fistula ligation post-renal transplantation: a longitudinal magnetic resonance imaging study. Clin Transplant 2014; 28:916-25. [DOI: 10.1111/ctr.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin K. Dundon
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - David K. Torpey
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Adam J. Nelson
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Dennis T. L. Wong
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Rae F. Duncan
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Randall J. Faull
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Stephen G. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
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Malaiapan Y, Wong DTL, Psaltis PJ, Meredith IT. Interpretation of optical coherence tomography images - Authors' reply. Lancet 2014; 383:1888. [PMID: 24881992 DOI: 10.1016/s0140-6736(14)60917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, 3168 VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, 3168 VIC, Australia; South Australian Health & Medical Research Institute, Adelaide, Australia.
| | - Peter J Psaltis
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, 3168 VIC, Australia; South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, 3168 VIC, Australia
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Wong DTL, Leong DP, Weightman MJ, Richardson JD, Dundon BK, Psaltis PJ, Leung MCH, Meredith IT, Worthley MI, Worthley SG. Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction. Eur Radiol 2014; 24:1219-28. [PMID: 24723232 DOI: 10.1007/s00330-014-3137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/28/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE). METHODS STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function. RESULTS Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001). CONCLUSION Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI. KEY POINTS Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI. Baseline CS predicts contractile function recovery better than baseline CSR following STEMI. Baseline CS provides incremental value to LGE and MVO following STEMI.
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Affiliation(s)
- Dennis T L Wong
- Discipline of Medicine, University of Adelaide, Adelaide, Australia,
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Affiliation(s)
- Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, VIC, Australia.
| | - Siang Yong Soh
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, VIC, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, VIC, Australia
| | - Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Heart, Southern Health, Clayton, VIC, Australia
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Ko BS, Wong DTL, Cameron JD, Leong DP, Leung M, Meredith IT, Nerlekar N, Antonis P, Crossett M, Troupis J, Harper R, Malaiapan Y, Seneviratne SK. 320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study. Eur Radiol 2013; 24:738-47. [PMID: 24217643 DOI: 10.1007/s00330-013-3059-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/30/2013] [Accepted: 10/14/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the accuracy of 320-row multidetector coronary computed tomography angiography (M320-CCTA) to detect functional stenoses using fractional flow reserve (FFR) as the reference standard and to predict revascularisation in stable coronary artery disease. METHODS One hundred and fifteen patients (230 vessels) underwent M320-CCTA and FFR assessment and were followed for 18 months. Diameter stenosis on invasive angiography (ICA) and M320-CCTA were assessed by consensus by two observers and significant stenosis was defined as ≥50%. FFR ≤0.8 indicated functionally significant stenoses. RESULTS M320-CCTA had 94% sensitivity and 94% negative predictive value (NPV) for FFR ≤0.8. Overall accuracy was 70%, specificity 54% and positive predictive value 65%. On receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for CCTA to predict FFR ≤0.8 was 0.74 which was comparable with ICA. The absence of a significant stenosis on M320-CCTA was associated with a 6% revascularisation rate. M320-CCTA predicted revascularisation with an AUC of 0.71 which was comparable with ICA. CONCLUSIONS M320-CCTA has excellent sensitivity and NPV for functional stenoses and therefore may act as an effective gatekeeper to defer ICA and revascularisation. Like ICA, M320-CCTA lacks specificity for functional stenoses and only has moderate accuracy to predict the need for revascularisation. KEY POINTS • Important information about the heart is provided by 320-row multidetector CT coronary angiography (M320-CCTA). • M320-CCTA accurately detects and excludes functional stenoses determined by fractional flow reserve (FFR). • Non-significant stenoses on M320-CCTA associated with fewer cardiac events and less revascularisation. • M320-CCTA may act as a gatekeeper for invasive angiography and inappropriate revascularisation. • Like ICA, M320-CCTA only has moderate accuracy to predict vessels requiring revascularisation.
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Affiliation(s)
- Brian S Ko
- Monash Cardiovascular Research Centre, MonashHEART, Department of Medicine Monash Medical Centre (MMC), Southern Health and Monash University, Melbourne, Australia,
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Richardson JD, Bertaso AG, Psaltis PJ, Frost L, Carbone A, Paton S, Nelson AJ, Wong DTL, Worthley MI, Gronthos S, Zannettino ACW, Worthley SG. Impact of timing and dose of mesenchymal stromal cell therapy in a preclinical model of acute myocardial infarction. J Card Fail 2013; 19:342-53. [PMID: 23663817 DOI: 10.1016/j.cardfail.2013.03.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/22/2013] [Accepted: 03/26/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although mesenchymal stem/stromal cells (MSC) have shown therapeutic promise after myocardial infarction (MI), the impact of cell dose and timing of intervention remains uncertain. We compared immediate and deferred administration of 2 doses of MSC in a rat model of MI. METHODS AND RESULTS Sprague-Dawley rats were used. Allogeneic prospectively isolated MSC ("low" dose 1 × 10(6) or "high" dose 2 × 10(6) cells) were delivered by transepicardial injection immediately after MI ("early-low," "early-high"), or 1 week later ("late-low," "late-high"). Control subjects received cryopreservant solution alone. Left ventricular dimensions and ejection fraction (EF) were assessed by cardiac magnetic resonance. All 4 MSC-treatment cohorts demonstrated higher EF than control animals 4 weeks after MI (P values <.01 to <.0001), with function most preserved in the early-high group (absolute reduction in EF from baseline: control 39.1 ± 1.7%, early-low 26.5 ± 3.2%, early-high 7.9 ± 2.6%, late-low 19.6 ± 3.5%, late-high 17.9 ± 4.0%). Cell treatment also attenuated left ventricular dilatation and fibrosis and augmented left ventricular mass, systolic wall thickening (SWT), and microvascular density. Although early intervention selectively increased SWT and vascular density in the infarct territory, delayed treatment caused greater benefit in remote (noninfarct) myocardium. All outcomes demonstrated dose dependence for early MSC treatment, but not for later cell administration. CONCLUSIONS The nature and magnitude of benefit from MSC after acute MI is strongly influenced by timing of cell delivery, with dose dependence most evident for early intervention. These novel insights have potential implications for cell therapy after MI in human patients.
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Affiliation(s)
- James D Richardson
- Cardiovascular Research Centre, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, Adelaide, Australia
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and MonashHEART, Clayton Victoria, Australia.
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Wong DTL, Soh SY, Meredith IT, Malaiapan Y. Saphenous vein graft 'arterialization' assessed by optical coherence tomography. Int J Cardiol 2013; 167:e121-2. [PMID: 23628303 DOI: 10.1016/j.ijcard.2013.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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