1
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Kageyama S, Taylor CA, Updegrove A, Garg S, Masuda S, Revaiah PC, Kageyama M, Tsai TY, Miyashita K, Tobe A, Tanaka K, De Mey J, La Meir M, Schneider U, Doenst T, Teichgräber U, Saima M, Pompilio G, Andreini D, Pontone G, Puskas JD, Gupta H, Morel MA, Serruys PW, Onuma Y. Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease. J Cardiovasc Comput Tomogr 2024; 18:478-488. [PMID: 38944640 DOI: 10.1016/j.jcct.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/27/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Coronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium. METHODS The V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD. RESULTS The V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFRCT [43.1 (15.2) vs 41.1 (16.5), p < 0.001]. Mean V, M, and V/M were 2204 mm3, 137 g, and 16.5 mm3/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r = -0.26 and -0.34). V and V/M had a strong correlation (r = 0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]). CONCLUSION Systematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFRCT.
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Affiliation(s)
| | | | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | | | | | | | | | | | | | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Mark La Meir
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, University Hospital Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Germany
| | | | | | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS Monzino, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS Monzino, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - John D Puskas
- Department of Cardiothoracic Surgery, Emory University Hospital Midtown, USA
| | - Himanshu Gupta
- Department of Radiology, The Valley Hospital, Ridgewood, NJ, USA
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2
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Collet C, Sakai K, Mizukami T, Ohashi H, Bouisset F, Caglioni S, van Hoe L, Gallinoro E, Bertolone DT, Pardaens S, Brouwers S, Storozhenko T, Seki R, Munhoz D, Tajima A, Buytaert D, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, De Bruyne B. Vascular Remodeling in Coronary Microvascular Dysfunction. JACC Cardiovasc Imaging 2024:S1936-878X(24)00308-5. [PMID: 39269414 DOI: 10.1016/j.jcmg.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Approximately half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD). OBJECTIVES This study aims to characterize patients with ANOCA by measuring their minimal microvascular resistance and to examine the pattern of vascular remodeling associated with these measurements. METHODS The authors prospectively included patients with ANOCA undergoing continuous thermodilution assessment. Lumen volume and vessel-specific myocardial mass were quantified using coronary computed tomography angiography (CTA). CMD was defined as coronary flow reserve <2.5 and high minimal microvascular resistance as >470 WU. RESULTS A total of 153 patients were evaluated; 68 had CMD, and 22 of them showed high microvascular resistance. In patients with CMD, coronary flow reserve was 1.9 ± 0.38 vs 3.2 ± 0.81 in controls (P < 0.001). Lumen volume was significantly correlated with minimal microvascular resistance (r = -0.59 [95% CI: -0.45 to -0.71]; P < 0.001). In patients with CMD and high microvascular resistance, lumen volume was 40% smaller than in controls (512.8 ± 130.3 mm3 vs 853.2 ± 341.2 mm3; P < 0.001). Epicardial lumen volume assessed by coronary CTA was independently associated with minimal microvascular resistance (P < 0.001). The predictive capacity of lumen volume from coronary CTA for detecting high microvascular resistance showed an area under the curve of 0.79 (95% CI: 0.69-0.88). CONCLUSIONS Patients with CMD and high minimal microvascular resistance have smaller epicardial vessels than those without CMD. Coronary CTA detected high minimal microvascular resistance with very good diagnostic capacity. Coronary CTA could potentially aid in the diagnostic pathway for patients with ANOCA.
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Affiliation(s)
- Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hirofumi Ohashi
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Frederic Bouisset
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; IRCCS Galeazzi-Sant'Ambrogio Hospital, Division of University Cardiology, Milan, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Ruiko Seki
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Atomu Tajima
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
| | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
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3
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Edrisnia H, Sarkhosh MH, Mohebbi B, Parhizgar SE, Alimohammadi M. Non-invasive fractional flow reserve estimation in coronary arteries using angiographic images. Sci Rep 2024; 14:15640. [PMID: 38977740 PMCID: PMC11231276 DOI: 10.1038/s41598-024-65626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
Coronary artery disease is the leading global cause of mortality and Fractional Flow Reserve (FFR) is widely regarded as the gold standard for assessing coronary artery stenosis severity. However, due to the limitations of invasive FFR measurements, there is a pressing need for a highly accurate virtual FFR calculation framework. Additionally, it's essential to consider local haemodynamic factors such as time-averaged wall shear stress (TAWSS), which play a critical role in advancement of atherosclerosis. This study introduces an innovative FFR computation method that involves creating five patient-specific geometries from two-dimensional coronary angiography images and conducting numerical simulations using computational fluid dynamics with a three-element Windkessel model boundary condition at the outlet to predict haemodynamic distribution. Furthermore, four distinct boundary condition methodologies are applied to each geometry for comprehensive analysis. Several haemodynamic features, including velocity, pressure, TAWSS, and oscillatory shear index are investigated and compared for each case. Results show that models with average boundary conditions can predict FFR values accurately and observed errors between invasive FFR and virtual FFR are found to be less than 5%.
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Affiliation(s)
- Hadis Edrisnia
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | | | - Bahram Mohebbi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ehsan Parhizgar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mona Alimohammadi
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
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4
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Bermpeis K, Pauwels FA, Viscusi MM, Mahendiran T, Bertolone DT, Botti G, Brouwers S, Collet C, de Bruyne B, Mizukami T. Quantification and Timing of Epicardial Vasodilation by Sublingual Nitrates. JACC Cardiovasc Imaging 2024:S1936-878X(24)00230-4. [PMID: 39001728 DOI: 10.1016/j.jcmg.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/15/2024]
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5
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Holmes KR, Gulsin GS, Fairbairn TA, Hurwitz-Koweek L, Matsuo H, Nørgaard BL, Jensen JM, Sand NPR, Nieman K, Bax JJ, Pontone G, Chinnaiyan KM, Rabbat MG, Amano T, Kawasaki T, Akasaka T, Kitabata H, Rogers C, Patel MR, Payne GW, Leipsic JA, Sellers SL. Impact of Smoking on Coronary Volume-to-Myocardial Mass Ratio: An ADVANCE Registry Substudy. Radiol Cardiothorac Imaging 2024; 6:e220197. [PMID: 38483246 PMCID: PMC11056751 DOI: 10.1148/ryct.220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/30/2023] [Accepted: 01/26/2024] [Indexed: 04/19/2024]
Abstract
Purpose To examine the relationship between smoking status and coronary volume-to-myocardial mass ratio (V/M) among individuals with coronary artery disease (CAD) undergoing CT fractional flow reserve (CT-FFR) analysis. Materials and Methods In this secondary analysis, participants from the ADVANCE registry evaluated for suspected CAD from July 15, 2015, to October 20, 2017, who were found to have coronary stenosis of 30% or greater at coronary CT angiography (CCTA) were included if they had known smoking status and underwent CT-FFR and V/M analysis. CCTA images were segmented to calculate coronary volume and myocardial mass. V/M was compared between smoking groups, and predictors of low V/M were determined. Results The sample for analysis included 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants). After adjustment for demographic and clinical factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0; P = .002), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5; P = .02). However, both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4; P < .001 [unadjusted] and P = .002 [unadjusted], respectively). Current smoking status (odds ratio [OR], 0.74 [95% CI: 0.59, 0.93]; P = .009), former smoking status (OR, 0.81 [95% CI: 0.68, 0.97]; P = .02), stenosis of 50% or greater (OR, 0.62 [95% CI: 0.52, 0.74]; P < .001), and diabetes (OR, 0.67 [95% CI: 0.56, 0.82]; P < .001) were independent predictors of low V/M. Conclusion Both current and former smoking status were independently associated with low V/M. Keywords: CT Angiography, Cardiac, Heart, Ischemia/Infarction Clinical trial registration no. NCT02499679 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Kenneth R. Holmes
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gaurav S. Gulsin
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Timothy A. Fairbairn
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Lynne Hurwitz-Koweek
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hitoshi Matsuo
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Bjarne L. Nørgaard
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jesper M. Jensen
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Niels-Peter Rønnow Sand
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Koen Nieman
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jeroen J. Bax
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gianluca Pontone
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Kavitha M. Chinnaiyan
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Mark G. Rabbat
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tetsuya Amano
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tomohiro Kawasaki
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Takashi Akasaka
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hironori Kitabata
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Campbell Rogers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Manesh R. Patel
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Geoffrey W. Payne
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jonathon A. Leipsic
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Stephanie L. Sellers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
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6
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Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Cardiol Clin 2024; 42:101-123. [PMID: 37949532 DOI: 10.1016/j.ccl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
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Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
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7
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Liu C, Lin S, Sheng Y, Wang X, Sun J, Wu J, Yu R. The Role of CCTA-derived Cardiac Structure and Function Analysis in the Prediction of Readmission in Nonischemic Heart Failure. J Cardiovasc Transl Res 2024; 17:216-226. [PMID: 38277087 PMCID: PMC10896797 DOI: 10.1007/s12265-023-10467-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/17/2023] [Indexed: 01/27/2024]
Abstract
Cardiac function and structure significantly impact nonischemic heart failure (HF) patient outcomes. This study investigated 236 patients (107 nonischemic heart failure, 129 healthy) to assess the relationship between coronary computed tomography angiography (CCTA)-derived parameters and clinical outcomes. Among the nonischemic heart failure patients, 37.3% experienced readmissions. In this group, specific CCTA measurements were identified as significant predictors of readmission: epicardial adipose tissue (CTEAT) at 54.49 cm3 (HR: 1.05; 95% CI: 1.03-1.07; P < 0.001), cardiac muscle mass to lumen volume (CTV/M) at 20% (HR: 0.59; 95% CI: 0.48-0.72; P < 0.001), peri-coronary adipose (CTPCAT) at -64.68 HU (HR: 1.1; 95% CI: 1.03-1.16; P = 0.002) for the right coronary artery, -81.07 HU (HR: 1.3; 95% CI: 1.1-1.53; P = 0.002) for the left anterior descending artery, and -73.42 HU (HR: 1.33; 95% CI: 1.18-1.51; P < 0.001) for the circumflex branch of the left coronary artery. In patients with nonischemic heart failure, increased CTEAT, CTPCAT, and CTV/M independently predicted rehospitalization.
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Affiliation(s)
- Chengjia Liu
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuangxiang Lin
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yangyang Sheng
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinghong Wang
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianzhong Sun
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiaxing Wu
- Siemens Healthineers, No.399, West Haiyang Road, Shanghai, 200126, China
| | - Risheng Yu
- Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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8
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Ohashi H, Bouisset F, Buytaert D, Seki R, Sonck J, Sakai K, Belmonte M, Kitslaar P, Updegrove A, Amano T, Andreini D, De Bruyne B, Collet C. Coronary CT Angiography in the Cath Lab: Leveraging Artificial Intelligence to Plan and Guide Percutaneous Coronary Intervention. Interv Cardiol 2023; 18:e26. [PMID: 38125928 PMCID: PMC10731535 DOI: 10.15420/icr.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 12/23/2023] Open
Abstract
The role of coronary CT angiography for the diagnosis and risk stratification of coronary artery disease is well established. However, its potential beyond the diagnostic phase remains to be determined. The current review focuses on the insights that coronary CT angiography can provide when planning and performing percutaneous coronary interventions. We describe a novel approach incorporating anatomical and functional pre-procedural planning enhanced by artificial intelligence, computational physiology and online 3D CT guidance for percutaneous coronary interventions. This strategy allows the individualisation of patient selection, optimisation of the revascularisation strategy and effective use of resources.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Frédéric Bouisset
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Toulouse University HospitalToulouse, France
| | | | | | | | - Koshiro Sakai
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Showa University HospitalTokyo, Japan
| | - Marta Belmonte
- Cardiovascular Center OLVAalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico IINaples, Italy
| | | | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi – Sant’AmbrogioMilan, Italy
- Department of Biomedical and Clinical Sciences, University of MilanMilan, Italy
| | - Bernard De Bruyne
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, University Hospital of LausanneLausanne, Switzerland
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9
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McCarthy CP, Murphy SP, Amponsah DK, Rambarat PK, Lin C, Liu Y, Mohebi R, Levin A, Raghavan A, Miksenas H, Rogers C, Wasfy JH, Blankstein R, Ghoshhajra B, Hedgire S, Januzzi JL. Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction. J Am Coll Cardiol 2023; 82:1676-1687. [PMID: 37777947 DOI: 10.1016/j.jacc.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis. Coronary artery disease (CAD) may predispose some individuals to T2MI and contribute to its high rate of recurrent cardiovascular events. Little is known about the presence and extent of CAD in this population. OBJECTIVES The goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI. METHODS In this prospective study, consecutive eligible individuals with Fourth Universal Definition of Myocardial Infarction criteria for T2MI were enrolled. Participants underwent coronary computed tomography angiography (CTA), fractional flow reserve derived with coronary CTA (FFRCT), and plaque volume analyses. RESULTS Among 50 participants, 25 (50%) were female, and the mean age was 68.0 ± 11.4 years. Atherosclerotic risk factors were common. Coronary CTA revealed coronary plaque in 46 participants (92%). A moderate or greater stenosis (≥50%) was identified in 42% of participants, and obstructive disease (≥50% left main stenosis or ≥70% stenosis in any other epicardial coronary artery) was present in 26%. Prevalence of obstructive CAD did not differ according to T2MI cause (P = 0.54). A hemodynamically significant focal stenosis identified by FFRCT was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFRCT excluded lesion-specific hemodynamically significant stenosis in 8 cases (38%). CONCLUSIONS Among individuals with adjudicated T2MI, CAD was prevalent, but the majority of patients had nonobstructive CAD. Mediators of ischemia are likely multifactorial in this population. (Defining the Prevalence and Characteristics of Coronary Artery Disease Among Patients with Type 2 Myocardial Infarction using CT-FFR [DEFINE TYPE 2 MI]; NCT04864119).
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/CianPMcCarthy
| | - Sean P Murphy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel K Amponsah
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paula K Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Lin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuxi Liu
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reza Mohebi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison Levin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avanthi Raghavan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Miksenas
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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10
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van Rosendael SE, van Rosendael AR, Kuneman JH, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Koweek LMH, Pontone G, Kawasaki T, Sand NPR, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Rogers C, Matsuo H, Leipsic JA, Marsan NA, Jukema JW, Bax JJ, Saraste A, Knuuti J. Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension. Am J Cardiol 2023; 199:100-109. [PMID: 37198076 DOI: 10.1016/j.amjcard.2023.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm3, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI -0.12 to 1.08) mm3/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension.
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Affiliation(s)
| | | | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University, Stanford, California; Department of Radiology, Stanford University, Stanford, California
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, New York
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, Illinois
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Netherlands Heart Institute, Utrecht, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland.
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11
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Mileva N, Ohashi H, Paolisso P, Leipsic J, Mizukami T, Sonck J, Norgaard BL, Otake H, Ko B, Maeng M, Munhoz D, Nagumo S, Belmonte M, Vassilev D, Andreini D, Barbato E, Koo BK, De Bruyne B, Collet C. Relationship between coronary volume, myocardial mass, and post-PCI fractional flow reserve. Catheter Cardiovasc Interv 2023; 101:1182-1192. [PMID: 37102381 DOI: 10.1002/ccd.30664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) carries prognostic information. Yet, myocardial mass subtended by a stenosis influences FFR. We hypothesized that a smaller coronary lumen volume and a large myocardial mass might be associated with lower post-PCI FFR. AIM We sought to assess the relationship between vessel volume, myocardial mass, and post-PCI FFR. METHODS This was a subanalysis with an international prospective study of patients with significant lesions (FFR ≤ 0.80) undergoing PCI. Territory-specific myocardial mass was calculated from coronary computed tomography angiography (CCTA) using the Voronoi's algorithm. Vessel volume was extracted from quantitative CCTA analysis. Resting full-cycle ratio (RFR) and FFR were measured before and after PCI. We assessed the association between coronary lumen volume (V) and its related myocardial mass (M), and the percent of total myocardial mass (%M) with post-PCI FFR. RESULTS We studied 120 patients (123 vessels: 94 left anterior descending arteries, 13 left Circumflex arteries, 16 right coronary arteries). Mean vessel-specific mass was 61 ± 23.1 g (%M 39.6 ± 11.7%). The mean post-PCI FFR was 0.88 ± 0.06 FFR units. Post-PCI FFR values were lower in vessels subtending higher mass (0.87 ± 0.05 vs. 0.89 ± 0.07, p = 0.047), and with lower V/M ratio (0.87 ± 0.06 vs. 0.89 ± 0.07, p = 0.02). V/M ratio correlated significantly with post-PCI RFR and FFR (RFR r = 0.37, 95% CI: 0.21-0.52, p < 0.001 and FFR r = 0.41, 95% CI: 0.26-0.55, p < 0.001). CONCLUSION Post-PCI RFR and FFR are associated with the subtended myocardial mass and the coronary volume to mass ratio. Vessels with higher mass and lower V/M ratio have lower post-PCI RFR and FFR.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Cardiology Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Jonathon Leipsic
- The Centre for Cardiovascular Innovation, UBC, Vancouver, Canada
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Clinical Pharmacology, Showa University, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bjarne L Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromasa Otake
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Sakura Nagumo
- Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Department of Cardiology, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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12
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Sykes R, McFarlane R. Icosapent ethyl and plaque regression: insights from the EVAPORATE-FFRCT study. Eur Heart J Cardiovasc Imaging 2023:7146940. [PMID: 37119308 DOI: 10.1093/ehjci/jead086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, The West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Richard McFarlane
- School of Cardiovascular and Metabolic Health, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, The West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
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13
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Serruys PW, Kotoku N, Nørgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, Knuuti J, Narula J, Perera D, Taylor CA, Leipsic JA, Nicol ED, Piazza N, Schultz CJ, Kitagawa K, Bruyne BD, Collet C, Tanaka K, Mushtaq S, Belmonte M, Dudek D, Zlahoda-Huzior A, Tu S, Wijns W, Sharif F, Budoff MJ, Mey JD, Andreini D, Onuma Y. Computed tomographic angiography in coronary artery disease. EUROINTERVENTION 2023; 18:e1307-e1327. [PMID: 37025086 PMCID: PMC10071125 DOI: 10.4244/eij-d-22-00776] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 04/05/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFRCT), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.
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Affiliation(s)
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D Nicol
- Royal Brompton Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Mie, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | | | | | - Darius Dudek
- Szpital Uniwersytecki w Krakowie, Krakow, Poland
| | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - William Wijns
- Department of Cardiology, University of Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, Galway, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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14
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Takagi H, Ihdayhid AR, Leipsic JA. Integration of fractional flow reserve derived from CT into clinical practice. J Cardiol 2023; 81:577-585. [PMID: 36805489 DOI: 10.1016/j.jjcc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/21/2023]
Abstract
Fractional flow reserve (FFR) is currently considered as the gold standard for revascularization decision-making in patients with stable coronary artery disease (CAD). The application of computational fluid dynamics to coronary computed tomography (CT) angiography (CCTA) enables calculation of FFR without additional testing, radiation exposure, contrast medium injection, and hyperemia (FFRCT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFRCT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFRCT computation, and there are numerous factors impacting on FFRCT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFRCT need to recognize in interpretation of FFRCT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFRCT computation and interpretation to refine the FFRCT strategy in patients with stable CAD.
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Affiliation(s)
- Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Interv Cardiol Clin 2023; 12:95-117. [PMID: 36372465 DOI: 10.1016/j.iccl.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
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Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
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16
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Piña P, Lorenzatti D, Paula R, Daich J, Schenone AL, Gongora C, Garcia MJ, Blaha MJ, Budoff MJ, Berman DS, Virani SS, Slipczuk L. Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet? Am J Prev Cardiol 2022; 13:100451. [PMID: 36619296 PMCID: PMC9813535 DOI: 10.1016/j.ajpc.2022.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Atherosclerotic cardiovascular disease risk (ASCVD) is an ongoing epidemic, and lipid abnormalities are its primordial cause. Most individuals suffering a first ASCVD event are previously asymptomatic and often do not receive preventative therapies. The cornerstone of primary prevention has been the identification of individuals at risk through risk calculators based on clinical and laboratory traditional risk factors plus risk enhancers. However, it is well accepted that a clinical risk calculator misclassifies a significant proportion of individuals leading to the prescription of a lipid-lowering medication with very little yield or a missed opportunity for lipid-lowering agents with a potentially preventable event. The development of coronary artery calcium scoring (CAC) and CT coronary angiography (CCTA) provide complementary tools to directly visualize coronary plaque and other risk-modifying imaging components that can potentially provide individualized lipid management. Understanding patient selection for CAC or potentially CCTA and the risk implications of the different parameters provided, such as CAC score, coronary stenosis, plaque characteristics and burden, epicardial adipose tissue, and pericoronary adipose tissue, have grown more complex as technologies evolve. These parameters directly affect the shared decision with patients to start or withhold lipid-lowering therapies, to adjust statin intensity or LDL cholesterol goals. Emerging lipid lowering studies with non-invasive imaging as a guide to patient selection and treatment efficacy, plus the evolution of lipid lowering therapies from statins to a diverse armament of newer high-cost agents have pushed these two fields forward with a complex interaction. This review will discuss existing risk estimators, and non-invasive imaging techniques for subclinical coronary atherosclerosis, traditionally studied using CAC and more recently CCTA with qualitative and quantitative measurements. We will also explore the current data, gaps of knowledge and future directions on the use of these techniques in the risk-stratification and guidance of lipid management.
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Affiliation(s)
- Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Rita Paula
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos Gongora
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine. Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Corresponding author.
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17
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Zhang LJ, Tang C, Xu P, Guo B, Zhou F, Xue Y, Zhang J, Zheng M, Xu L, Hou Y, Lu B, Guo Y, Cheng J, Liang C, Song B, Zhang H, Hong N, Wang P, Chen M, Xu K, Liu S, Jin Z, Lu G. Coronary Computed Tomography Angiography-derived Fractional Flow Reserve: An Expert Consensus Document of Chinese Society of Radiology. J Thorac Imaging 2022; 37:385-400. [PMID: 36162081 DOI: 10.1097/rti.0000000000000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the state-of-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.
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Affiliation(s)
- Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Chunxiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Pengpeng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Bangjun Guo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University-Xi'an
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Bin Lu
- Department of Radiology, State Key Laboratory and National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province
| | - Bin Song
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital
| | - Peijun Wang
- Department of Radiology, Tongji Hospital of Tongji University School of Medicine
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Ke Xu
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Shiyuan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhengyu Jin
- Department of Medical Imaging and Nuclear Medicine, Changzheng Hospital of Naval Medical University, Shanghai
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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18
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Brown JM, Zhou W, Weber B, Divakaran S, Barrett L, Bibbo CF, Hainer J, Taqueti VR, Dorbala S, Blankstein R, Di Carli MF. Low coronary flow relative to myocardial mass predicts heart failure in symptomatic hypertensive patients with no obstructive coronary artery disease. Eur Heart J 2022; 43:3323-3331. [PMID: 34491335 PMCID: PMC9470377 DOI: 10.1093/eurheartj/ehab610] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 08/20/2021] [Indexed: 01/14/2023] Open
Abstract
AIMS The transition from hypertension to heart failure (HF) remains poorly understood. We hypothesized that insufficient perfusion to match global metabolic demand, reflected by a low ratio of myocardial blood flow to global myocardial mass, may be a HF risk marker. METHODS AND RESULTS A retrospective cohort (n = 346) of patients with hypertension who underwent clinical positron emission tomography (PET) myocardial perfusion imaging for chest pain and/or dyspnoea at Brigham and Women's Hospital (Boston, MA, USA) were studied. Patients without obstructive coronary artery disease by history or PET perfusion (summed stress score <3), HF, cardiomyopathy, or ejection fraction (EF) <40% were followed for HF hospitalization (primary outcome), all-cause death, and their composite. Myocardial blood flow, left ventricular (LV) mass, volumes, and EF were obtained from PET, and a 'flow/mass ratio' was determined as hyperaemic myocardial blood flow over LV mass indexed to body surface area. A lower flow/mass ratio was independently associated with larger end-diastolic (β = -0.44, P < 0.001) and end-systolic volume (β = -0.48, P < 0.001) and lower EF (β = 0.33, P < 0.001). A flow/mass ratio below the median was associated with an adjusted hazard ratio of 2.47 [95% confidence interval (CI) 1.24-4.93; P = 0.01] for HF hospitalization, 1.95 (95% CI 1.12-3.41; P = 0.02) for death, and 2.20 (95% CI 1.39-3.49; P < 0.001) for the composite. CONCLUSION An integrated physiological measure of insufficient myocardial perfusion to match global metabolic demand identifies subclinical hypertensive heart disease and elevated risk of HF and death in symptomatic patients with hypertension but without flow-limiting coronary artery disease.
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Affiliation(s)
- Jenifer M Brown
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Wunan Zhou
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiology Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Brittany Weber
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sanjay Divakaran
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Leanne Barrett
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Courtney F Bibbo
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sharmila Dorbala
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ron Blankstein
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Marcelo F Di Carli
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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19
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Liu J, Li B, Ma J, Wang X, Zhang L, Mao B, Liu Y. Effect of the ratio of vessel-specific volume to fractional myocardial mass on fractional flow reserve. Exp Biol Med (Maywood) 2022; 247:1630-1638. [PMID: 34238054 PMCID: PMC9597209 DOI: 10.1177/15353702211027119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to examine whether the ratio of vessel-specific coronary arterial lumen volume to the fraction of myocardial mass (VR/MR) affects myocardial ischemia. We proposed a calculation method for VR/MR, and compared the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) with VR/MR in predicting myocardial ischemia. VR/MR and V/M were computed using data from 205 patients with 241 stenosis vessel who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography, and fractional flow reserve. The vessel-specific coronary arterial lumen volume (VR) was obtained from CTA by segmenting the coronary arterial lumen volume, while the vessel-specific fraction of myocardial mass (MR) was obtained by allometric scaling. The VR/MR was then calculated. The cut-off values of V/M (23.55 mm3/g) and VR/MR (12.98 mm3/g) were used to define equal groups of ischemic and non-ischemic patients, respectively. Using these cut-off values, the accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of V/M were 60%, 76%, 45%, 57%, and 66%, and of VR/MR were 87%, 92%, 77%, 89%, and 83%, respectively. Patients have different VR/MR values in different stenotic coronary arteries. Clinically, VR/MR is a quantitative indicator of the risk of myocardial ischemia.
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Affiliation(s)
- Jincheng Liu
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China
| | - Junling Ma
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China
| | - Xue Wang
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China
| | - Boyan Mao
- Beijing University of Chinese Medicine, Beijing 100029,
China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and
Life, Beijing University of Technology, Beijing 100124, China,Youjun Liu.
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20
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Semerdzhieva NE, Denchev SV, Gospodinova MV. Left Ventricular Diastolic Function: Comparison of Slow Coronary Flow Phenomenon and Left Ventricular Hypertrophy in the Absence of Obstructive Coronary Disease. Cureus 2022; 14:e24789. [PMID: 35673304 PMCID: PMC9165915 DOI: 10.7759/cureus.24789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background An interplay of myocardial structural abnormalities and coronary arterial dysfunction underlies the worsening left ventricular compliance. The conventionally used angina drugs have demonstrated a beneficial effect on both angina and coronary flow in cases with microvascular dysfunction and non-obstructive coronary disease. Despite that, vasoactive therapy only partially affects diastolic function in this patient population. Purpose This retrospective study was planned to evaluate the association of myocardial mass, delayed epicardial coronary flow, and vasoactive drugs with parameters of diastolic function in two cohorts with preserved left ventricular function and non-obstructive coronary disease in patients with slow coronary flow phenomenon (SCFP) and patients with the hypertensive disease and left ventricular hypertrophy. Material and methods The epicardial coronary flow was evaluated in 48 patients with unstable angina in the absence of coronary stenosis >50%, by applying the methods of corrected thrombolysis in myocardial infraction frame count (cTFC). The abnormalities in the left ventricular function were assessed by echocardiography using PW-Doppler of the diastolic mitral inflow and tissue Doppler imaging. Twenty-one (43.8%) patients were diagnosed with SCFP, and twelve patients (25%) had slow epicardial coronary flow, hypertensive disease, and ventricular hypertrophy (SFLVH). The remaining 15 (31.3%) were patients with ventricular hypertrophy, hypertension, and non-delayed epicardial coronary flow (NFLVH). Results The patients with SFLVH showed reduced peak early diastolic lateral mitral annular velocity (e'L) when compared to SCFP (7.1±1.9cm/s vs 8.6±2.1 cm/s, p=0.045) and NFLVH (7.1±1.9 cm/s vs 8.7±1.8 cm/s, p=0.018). A borderline significant difference was observed for the peak early diastolic septal mitral annular velocity (e'S) between the patients with SFLVH and SCFP ( 7.0±1.3 cm/s vs 8.3±2.1 cm/s, p=0.057). The ratio of mitral diastolic inflow velocity to early diastolic velocity of the mitral annulus (E/e') in the SFLVH group was a tendency higher than E/e' of the patients with SCFP (9.8±3.1 vs. 8.2±2.1, p=0.084) and NFLVH (9.8±3.1 vs. 7.8±1.5, p=0.051) .In the group with left ventricular hypertrophy, E/e' >10 was more frequently observed in patients with a marked delay in the epicardial flow (33.1 ± 13.1 frames vs. 25.4 ± 11.8 frames, p=0.011) and higher left ventricular mass (146.9 ± 17.7 g/m2 vs. 126.1 ± 121.5 g/m2, p=0.027). Conclusions Patients with microvascular angina represent a diverse population. The echocardiographic parameters of left ventricular relaxation (e') and end-diastolic pressure (E/e') are abnormally altered in the population with left ventricular hypertrophy compared to SCFP. The delayed epicardial flow further impairs diastolic function in hypertensive patients with hypertrophy and non-obstructive coronary disease.
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21
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Ihdayhid AR, Fairbairn TA, Gulsin GS, Tzimas G, Danehy E, Updegrove A, Jensen JM, Taylor CA, Bax JJ, Sellers SL, Leipsic JA, Nørgaard BL. Cardiac computed tomography-derived coronary artery volume to myocardial mass. J Cardiovasc Comput Tomogr 2022; 16:198-206. [PMID: 34740557 DOI: 10.1016/j.jcct.2021.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
In the absence of disease impacting the coronary arteries or myocardium, there exists a linear relationship between vessel volume and myocardial mass to ensure balanced distribution of blood supply. This balance may be disturbed in diseases of either the coronary artery tree, the myocardium, or both. However, in contemporary evaluation the coronary artery anatomy and myocardium are assessed separately. Recently the coronary lumen volume to myocardial mass ratio (V/M), measured noninvasively using coronary computed tomography angiography (CTCA), has emerged as an integrated measure of myocardial blood supply and demand in vivo. This has the potential to yield new insights into diseases where this balance is altered, thus impacting clinical diagnoses and management. In this review, we outline the scientific methodology underpinning CTCA-derived measurement of V/M. We describe recent studies describing alterations in V/M across a range of cardiovascular conditions, including coronary artery disease, cardiomyopathies and coronary microvascular dysfunction. Lastly, we highlight areas of unmet research need and future directions, where V/M may further enhance our understanding of the pathophysiology of cardiovascular disease.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia.
| | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
| | - Gaurav S Gulsin
- University of Leicester and the Leicester NIHR Biomedical Research Centre, Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom; Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Georgios Tzimas
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | | | | | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Jeroen J Bax
- Leiden University, Department of Medicine, Leiden, Netherlands.
| | - Stephanie L Sellers
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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22
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Effect of the Coronary Arterial Diameter Derived From Coronary Computed Tomography Angiography on Fractional Flow Reserve. J Comput Assist Tomogr 2022; 46:397-405. [PMID: 35483102 DOI: 10.1097/rct.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) is considered to be the criterion standard for the clinical diagnosis of functional myocardial ischemia. In this study, we explored the effect of the coronary arterial diameter derived from coronary computed tomography angiography on FFR. METHOD We retrospectively reviewed the clinical information of 131 patients with moderate coronary artery stenosis. To compare the mean diameter of stenotic vessels, patients were divided into ischemic and nonischemic groups. According to the clinical statistics of the diameter of the ischemic group and the nonischemic group, we established 8 ideal models of coronary artery diameter of 4 mm (40%, 50%, 60%, and 70% stenosis) and diameter of 3 mm (40%, 50%, 60%, and 70% stenosis). Two sets of numerical simulation experiments were carried out: experiment 1 evaluated the variation rate of CT-based computation of non-invasive fractional flow reserve (FFRCT) with vessel diameters of 4 mm and 3 mm under different stenosis rates, and experiment 2 explored the variation of FFRCT with vessel diameters of 4 mm and 3 mm under different cardiac outputs. We simulated changes in the flow of narrow blood vessels by changes in cardiac output. RESULTS According to clinical statistics, the mean ± SD diameter of stenotic vessels in the ischemic and nonischemic groups was 3.67 ± 0.77 mm and 3.31 ± 0.64 mm (P < 0.05 for difference), respectively. In experiment 1, the FFRCT of coronary with a diameter of 4 mm was 0.86, 0.80, 0.66, and 0.35, and that with a diameter of 3 mm was 0.90, 0.84, 0.71, and 0.50, respectively. In experiment 2, the FFRCT of the coronary vessel diameter of 4 mm was 0.84, 0.80, 0.76, and 0.72, respectively. The FFRCT coronary vessels with a diameter of 3 mm were 0.87, 0.84, 0.80, and 0.76, respectively. CONCLUSIONS As the stenosis increases, compared with narrow blood vessel of small diameter, the narrow blood vessel with larger diameter is accompanied by faster flow rate changes and is more prone to ischemia.
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23
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
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24
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Garg K, Patel TR, Kanwal A, Villines TC, Aggarwal NR, Nasir K, Blumenthal RS, Blaha MJ, Douglas PS, Shaw LJ, Sharma G. The evolving role of coronary computed tomography in understanding sex differences in coronary atherosclerosis. J Cardiovasc Comput Tomogr 2022; 16:138-149. [PMID: 34654676 PMCID: PMC9358989 DOI: 10.1016/j.jcct.2021.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Our understanding of sex differences in subclinical atherosclerosis and plaque composition and characteristics have greatly improved with the use of coronary computed tomography (CCTA) over the past years. CCTA has emerged as an important frontline diagnostic test for women, especially as we continue to understand the impact of non-obstructive atherosclerosis as well as diffuse, high risk plaque as precursors of acute cardiac events in women. Based on its ability to identify complex plaque morphology such as low attenuation plaque, high risk non calcified plaque, positive remodeling, fibrous cap, CCTA can be used to assess plaque characteristics. CCTA can avoid false positive of other imaging studies, if included earlier in assessment of ischemic symptoms. In the contemporary clinical setting, CCTA will prove useful in further understanding and managing cardiovascular disease in women and those without traditional obstructive coronary disease.
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Affiliation(s)
- Keva Garg
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Toral R Patel
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Arjun Kanwal
- Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Todd C Villines
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Khurram Nasir
- Center for Outcomes Research, Division of Cardiology, Houston Methodist, Houston, TX, USA
| | - Roger S Blumenthal
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslee J Shaw
- Department of Population Health Science, Blavatnik Women's Health Research Institute, Mount Sinai School of Medicine, NY, USA
| | - Garima Sharma
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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25
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Coronary volume to left ventricular mass ratio in patients with diabetes mellitus. J Cardiovasc Comput Tomogr 2022; 16:319-326. [DOI: 10.1016/j.jcct.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
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26
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease. Int J Cardiol 2021; 343:187-193. [PMID: 34454964 DOI: 10.1016/j.ijcard.2021.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Computed-tomography (CT) derived fractional-flow-reserve (FFRCT) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFRCT at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFRCT decline below the pathological value of 0.80 in no-apparent CAD. METHODS A total of 150 consecutive patients who had both CT angiography coupled to FFRCT analysis and invasive angiogram showing < 20% coronary stenosis were included. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT > 0.80 (n = 317) and FFRCT ≤ 0.80 (n = 114). ΔFFRCT was defined as the change in FFRCT from proximal to distal vessel. Vessel morphology (vessel length and lumen volume) and plaque characteristics [low-attenuation plaque volume, intermediate-attenuation (IAP) plaque volume, and calcified plaque volume] were evaluated. RESULTS FFRCT decreased from proximal to distal for the three major vessels in both FFRCT > 0.80 and FFRCT ≤ 0.80. Compared to FFRCT > 0.80, IAP volume was significantly higher in all three major vessels in FFRCT ≤ 0.80. ΔFFRCT was correlated with vessel length and lumen volume in FFRCT > 0.80, whereas ΔFFRCT was correlated with IAP volume in FFRCT ≤ 0.80. IAP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤ 0.80. CONCLUSIONS The presence of IAP is a major predictor of gradual decrease of FFRCT below 0.80 in no-apparent CAD vessels. Vessel morphology and plaque characteristics should be considered when interpreting FFRCT.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Vincent Michiels
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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27
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CT-derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation. Eur Radiol 2021; 32:1843-1852. [PMID: 34523009 PMCID: PMC8831350 DOI: 10.1007/s00330-021-08246-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Invasively measured fractional flow reserve (FFR) is associated with outcome in heart transplant (HTx) patients. Coronary computed tomography angiography (CCTA)-derived FFR (FFRct) provides additional functional information from anatomical CT images. We describe the first use of FFRct in HTx patients. METHODS HTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal to each coronary stenosis > 30% and FFRct ≤ 0.8 indicated hemodynamically significant stenosis. FFRct was also measured at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left, right, and circumflex coronary artery in each patient. RESULTS Seventy-three patients (age 56 (42-65) years, 63% males) at 11 (8-16) years after HTx were included. Eighteen (25%) patients had a focal hemodynamically significant stenosis (stenosis > 30% with FFRct ≤ 0.8). In the 55 patients without a hemodynamically significant focal FFRct stenosis (FFRct > 0.80), the distal left anterior descending artery FFRct was < 0.90 in 74% of the patients and 10 (18%) patients had ≥ 1 coronary artery with a distal FFRct ≤ 0.8, including 1 with a distal FFRct ≤ 0.8 in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86-0.91), 0.87 (0.86-0.90), and 0.88 (0.86-0.91) (median with 25th-75th percentile) at 5-9, 10-14, or ≥ 15 years post-transplantation, respectively (p = 0.93). CONCLUSIONS FFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary stenosis with FFRct ≤ 0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients. KEY POINTS • This is the first report describing the use of FFRct in in heart transplant patients. • FFRct identifies patients after heart transplantation with hemodynamically significant coronary stenosis. • Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.
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Long term effects of surgical and transcatheter aortic valve replacement on FFR CT in patients with severe aortic valve stenosis. Int J Cardiovasc Imaging 2021; 38:427-434. [PMID: 34498201 DOI: 10.1007/s10554-021-02401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
The long-term variations of fractional flow reserve derived from coronary computed tomography (FFRCT) after surgical (SAVR) or transcatheter (TAVR) aortic valve replacement in patients with severe aortic valve stenosis (AS) have not been investigated. A total of 25 patients with isolated, severe AS underwent coronary computed tomography with 3-vessel FFRCT analysis (Heartflow Inc.-Redwood City, California, USA) and measurement of total coronary volume (V), left ventricular mass (M) and their ratio (V/M) before and 6 months after SAVR or TAVR. A significant increase in V/M due to a decrease in left ventricular mass 6 months after intervention was observed, whereas total coronary volume did not change (coronary volume pre: 2924.5 ± 867.9 mm3, coronary volume post: 2844.2 ± 792.8 mm3, P = 0.158; LV mass pre: 151.7 ± 40.7 g, LV mass post: 127.3 ± 34.7 g, P < 0.001; V/M pre: 19.5 ± 4.1 mm3/g, V/M post: 22.7 ± 4.28 mm3/g, P = 0.002). FFRCT (expressed as area under the virtual pullback curve) remained constant. This proof-of-concept study showed that FFRCT was not subject to the confounding effect of left ventricular mass regression after SAVR or TAVR. Despite significant left ventricular remodeling at 6 months after AS treatment, FFRCT values remained constant. Further studies are needed comparing the performance of the different invasive and non-invasive coronary physiological indices in this patient cohort.
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Zhang H, Li G, Hou Q, Yang Y, Wei H, Yang Y, Qu Z, Xie J, Qiao A. Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors. Front Physiol 2021; 12:716877. [PMID: 34483970 PMCID: PMC8414807 DOI: 10.3389/fphys.2021.716877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
The use of diameter stenosis (DS), as revealed by coronary angiography, for predicting fractional flow reserve (FFR) usually results in a high error rate of detection. In this study, we investigated a method for predicting FFR in patients with coronary stenosis based on multiple independent risk factors. The aim of the study was to improve the accuracy of detection. First, we searched the existing literature to identify multiple independent risk factors and then calculated the corresponding odds ratios. The improved analytic hierarchy process (IAHP) was then used to determine the weighted value of each independent risk factor, based on the corresponding odds ratio. Next, we developed a novel method, based on the top seven independent risk factors with the highest weighted values, to predict FFR. This model was then used to predict the FFR of 253 patients with coronary stenosis, and the results were then compared with previous methods (DS alone and a simplified scoring system). In addition to DS, we identified a range of other independent risk factors, with the highest weighted values, for predicting FFR, including gender, body mass index, location of stenosis, type of coronary artery distribution, left ventricular ejection fraction, and left myocardial mass. The area under the receiver-operating characteristic curve (AUC) for the newly developed method was 84.3% (95% CI: 79.2–89.4%), which was larger than 65.3% (95% CI: 61.5–69.1%) of DS alone and 74.8% (95% CI: 68.4–81.2%) of the existing simplified scoring system. The newly developed method, based on multiple independent risk factors, effectively improves the prediction accuracy for FFR.
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Affiliation(s)
- Honghui Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,College of Engineering, Inner Mongolia University for Nationalities, Tongliao, China
| | - Gaoyang Li
- Institute of Fluid Science, Tohoku University, Miyagi, Japan
| | - Qianwen Hou
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yinlong Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Hongge Wei
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yujia Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhuoran Qu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jinjie Xie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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30
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Fournier S, Keulards DC, van 't Veer M, Colaiori I, Di Gioia G, Zimmermann F, Mizukami T, Nagumo S, Kodeboina M, El Farissi M, Zelis J, Sonck J, Collet C, Pijls NH, De Bruyne B. Normal values of thermodilution-derived absolute coronary blood flow and microvascular resistance in humans. EUROINTERVENTION 2021; 17:e309-e316. [PMID: 33016881 PMCID: PMC9724861 DOI: 10.4244/eij-d-20-00684] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Absolute hyperaemic coronary blood flow (Q, in mL/min) and resistance (R, in Wood units [WU]) can be measured invasively by continuous thermodilution. AIMS The aim of this study was to assess normal reference values of Q and R. METHODS In 177 arteries (69 patients: 25 controls, i.e., without identifiable coronary atherosclerosis; 44 patients with mild, non-obstructive atherosclerosis), thermodilution-derived hyperaemic Q and total, epicardial, and microvascular absolute resistances (Rtot, Repi, and Rmicro) were measured. In 20 controls and 29 patients, measurements were obtained in all three major coronary arteries, thus allowing calculations of Q and R for the whole heart. In 15 controls (41 vessels) and 25 patients (71 vessels), vessel-specific myocardial mass was derived from coronary computed tomography angiography. RESULTS Whole heart hyperaemic Q tended to be higher in controls compared to patients (668±185 vs 582±138 mL/min, p=0.068). In the left anterior descending coronary artery (LAD), hyperaemic Q was significantly higher (293±102 mL/min versus 228±71 mL/min, p=0.004) in controls than in patients. This was driven mainly by a difference in Repi (43±23 vs 83±41 WU, p=0.048), without significant differences in Rmicro. After adjustment for vessel-specific myocardial mass, hyperaemic Q was similar in the three vascular territories (5.9±1.9, 4.9±1.7, and 5.3±2.1 mL/min/g, p=0.44, in the LAD, left circumflex and right coronary artery, respectively). CONCLUSIONS The present report provides reference values of absolute coronary hyperaemic Q and R. Q was homogeneously distributed in the three major myocardial territories but the large ranges of observed hyperaemic values of flow and of microvascular resistance preclude their clinical use for inter-patient comparison.
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Affiliation(s)
- Stephane Fournier
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Lausanne University Centre Hospital, Lausanne, Switzerland,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Di Gioia
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Sakura Nagumo
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium
| | | | | | - Jo Zelis
- Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands
| | - Jeroen Sonck
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium
| | - Nico H.J. Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands,Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bernard De Bruyne
- Cardiovascular Centre Aalst, OLV-Clinic Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
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31
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Hsieh YF, Lee CK, Wang W, Huang YC, Lee WJ, Wang TD, Chou CY. Coronary CT angiography-based estimation of myocardial perfusion territories for coronary artery FFR and wall shear stress simulation. Sci Rep 2021; 11:13855. [PMID: 34226598 PMCID: PMC8257574 DOI: 10.1038/s41598-021-93237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to apply a CCTA-derived territory-based patient-specific estimation of boundary conditions for coronary artery fractional flow reserve (FFR) and wall shear stress (WSS) simulation. The non-invasive simulation can help diagnose the significance of coronary stenosis and the likelihood of myocardial ischemia. FFR is often regarded as the gold standard to evaluate the functional significance of stenosis in coronary arteries. In another aspect, proximal wall shear stress (\documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox) can also be an indicator of plaque vulnerability. During the simulation process, the mass flow rate of the blood in coronary arteries is one of the most important boundary conditions. This study utilized the myocardium territory to estimate and allocate the mass flow rate. 20 patients are included in this study. From the knowledge of anatomical information of coronary arteries and the myocardium, the territory-based FFR and the \documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox can both be derived from fluid dynamics simulations. Applying the threshold of distinguishing between significant and non-significant stenosis, the territory-based method can reach the accuracy, sensitivity, and specificity of 0.88, 0.90, and 0.80, respectively. For significantly stenotic cases (\documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{FFR}_{m}$$\end{document}FFRm\documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ 0.80), the vessels usually have higher wall shear stress in the proximal region of the lesion.
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Affiliation(s)
- Yu-Fang Hsieh
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, 106, Taiwan
| | - Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan.
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32
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Mehta NN. Epicardial Assessment of Coronary Artery Disease in Inflammatory Diseases: Is it Enough? JACC Cardiovasc Imaging 2021; 14:2221-2225. [PMID: 33865786 DOI: 10.1016/j.jcmg.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Nehal N Mehta
- Lab of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA.
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33
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Semerdzhieva NE, Denchev S. Association of High Density Cholesterol With Hyperemic Epicardial Flow and Frame Count Reserve in Patients With Moderate Coronary Lesions and Slow Coronary Flow. Cureus 2021; 13:e13985. [PMID: 33758725 PMCID: PMC7978158 DOI: 10.7759/cureus.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Patients with microvascular angina and non-obstructive coronary atherosclerotic disease have an elevated risk of adverse events and all-cause mortality compared with individuals without ischaemic heart disease. The diagnosis coronary microvascular dysfunction in this setting relies on the detection of impaired coronary flow at rest or on calculation of coronary flow reserve. Previous studies demonstrate that the coronary flow reserve assessed by the corrected thrombolysis in myocardial infarction method - the frame count reserve is an objective quantitative alternative to other widely used invasive methods for microvascular status evaluation. Purpose We assessed the significance of clinical, hemodynamic, angiographic variables and therapy with reference to FCR in a small group of patients with up to moderate atherosclerotic coronary lesions and slow coronary flow. Materials and methods: Frame count reserve was evaluated in 15 patients without flow-limiting (>50%) coronary stenoses admitted with unstable angina. Frame count reserve was calculated by dividing the baseline corrected thrombolysis in myocardial infarction frame count (cTFC) by the cTFC assessed after intracoronary infusion of 100 µg of the calcium channel blocker - verapamil. Results The values of frame count reserve correlate positively with the levels of high density cholesterol (r= 0.900, p=0.001), inversely coronary flow after the application of verapamil - cTFCv (r= - 0.534, p=0.049). cTFCv was positively related with the levels of high density lipoproteins (r = - 0.645; p= 0.044) and was negatively influenced by the presence of atherosclerotic lesions at quantitative angiography (42.8±19.1 (n=8) vs 23±5.4 (n=7), p=0.029).The therapy with β-blocker and long-acting nitrate was associated with insignificantly higher frame count reserves after intracoronary verapamil compared to the continuous intake only of β-blocker or β-blocker and verapamil (2.1±0.78 vs 1.34±0.14 vs 1.70±0.70, p=NS). Conclusions Higher high-density lipoproteins relate to higher frame count reserves evaluated using verapamil. The improved blood flow after this microvascular vasodilator is consistently positively related to high-density cholesterol and the lack of atherosclerosis at conventional coronary angiography. The combined intake of micro- and macrovascular vasodilator could be associated with higher frame count reserves compared to therapy with β-blocker and one vasodilating drug.
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Affiliation(s)
| | - Stefan Denchev
- Department of Cardiology, Medical Center 'Mediva', Sofia, BGR
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34
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Xu F, Johnson EL, Wang C, Jafari A, Yang CH, Sacks MS, Krishnamurthy A, Hsu MC. Computational investigation of left ventricular hemodynamics following bioprosthetic aortic and mitral valve replacement. MECHANICS RESEARCH COMMUNICATIONS 2021; 112:103604. [PMID: 34305195 PMCID: PMC8301225 DOI: 10.1016/j.mechrescom.2020.103604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The left ventricle of the heart is a fundamental structure in the human cardiac system that pumps oxygenated blood into the systemic circulation. Several valvular conditions can cause the aortic and mitral valves associated with the left ventricle to become severely diseased and require replacement. However, the clinical outcomes of such operations, specifically the postoperative ventricular hemodynamics of replacing both valves, are not well understood. This work uses computational fluid-structure interaction (FSI) to develop an improved understanding of this effect by modeling a left ventricle with the aortic and mitral valves replaced with bioprostheses. We use a hybrid Arbitrary Lagrangian-Eulerian/immersogeometric framework to accommodate the analysis of cardiac hemodynamics and heart valve structural mechanics in a moving fluid domain. The motion of the endocardium is obtained from a cardiac biomechanics simulation and provided as an input to the proposed numerical framework. The results from the simulations in this work indicate that the replacement of the native mitral valve with a tri-radially symmetric bioprosthesis dramatically changes the ventricular hemodynamics. Most significantly, the vortical motion in the left ventricle is found to reverse direction after mitral valve replacement. This study demonstrates that the proposed computational FSI framework is capable of simulating complex multiphysics problems and can provide an in-depth understanding of the cardiac mechanics.
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Affiliation(s)
- Fei Xu
- Ansys Inc., Austin, TX 78746, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | | | - Arian Jafari
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Cheng-Hau Yang
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Michael S. Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Adarsh Krishnamurthy
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
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35
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Benetos G, Benz DC, Rampidis GP, Giannopoulos AA, von Felten E, Bakula A, Sustar A, Fuchs TA, Pazhenkottil AP, Gebhard C, Kaufmann PA, Gräni C, Buechel RR. Coronary artery lumen volume index as a marker of flow-limiting atherosclerosis-validation against 13N-ammonia positron emission tomography. Eur Radiol 2021; 31:5116-5126. [PMID: 33454800 PMCID: PMC8213544 DOI: 10.1007/s00330-020-07586-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), has been proposed as an indicator of diffuse atherosclerosis. We investigated the association of CAVi with quantitative flow parameters and its ability to predict ischemia as derived from 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI). METHODS Sixty patients who underwent hybrid CCTA/PET-MPI due to suspected CAD were retrospectively included. CAVi was defined as total coronary artery lumen volume over myocardial mass, both derived from CCTA. From PET-MPI, quantitative stress and rest myocardial blood flow (MBF) and myocardial flow reserve (MFR) were obtained and correlated with CAVi, and semi-quantitative perfusion images were analyzed for the presence of ischemia. Harrell's c-statistic and net reclassification improvement (NRI) analysis were performed to evaluate the incremental value of CAVi over the CCTA model (i.e., stenosis > 50% and > 70%). RESULTS CAVi correlated moderately with stress MBF and MFR (R = 0.50, p < 0.001, and R = 0.39, p = 0.002). Mean stress MBF and MFR were lower in patients with low (i.e., ≤ 20.2 mm3/g, n = 24) versus high (i.e., > 20.2 mm3/g, n = 36) CAVi (p < 0.001 for both comparisons). CAVi was independently associated with abnormal stress MBF (OR 0.90, 95% CI 0.82-0.998, p = 0.045). CAVi increased the predictive ability of the CCTA model for abnormal stress MBF and ischemia (c-statistic 0.763 versus 0.596, pdiff < 0.05 and 0.770 versus 0.645, pdiff < 0.05, NRI 0.84, p = 0.001 and 0.96, p < 0.001, respectively). CONCLUSIONS CAVi exhibits incremental value to predict both abnormal stress MBF and ischemia over CCTA alone. KEY POINTS • Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), is correlated with myocardial blood flow indices derived from 13N-ammonia positron emission tomography myocardial perfusion imaging. • CAVi is independently associated with abnormal stress myocardial blood flow. • CAVi provides incremental diagnostic value over CCTA for both abnormal stress MBF and ischemia.
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Affiliation(s)
- Georgios Benetos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georgios P Rampidis
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Adam Bakula
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aleksandra Sustar
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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36
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Nicol ED, Weir-McCall JR. Using FFR CT to Guide Management Strategy in Women: Two Steps Forward and One Step Back. JACC Cardiovasc Imaging 2020; 13:2588-2590. [PMID: 32861657 DOI: 10.1016/j.jcmg.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Edward D Nicol
- Division of Cardiology, Royal Brompton Hospital, London, United Kingdom.
| | - Jonathan R Weir-McCall
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge, United Kingdom
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Aoshima C, Fujimoto S, Kawaguchi YO, Dohi T, Kamo Y, Takamura K, Hiki M, Kato Y, Okai I, Okazaki S, Kumamaru KK, Aoki S, Daida H. Plaque characteristics on coronary CT angiography associated with the positive findings of fractional flow reserve and instantaneous wave-free ratio. Heart Vessels 2020; 36:461-471. [PMID: 33219413 DOI: 10.1007/s00380-020-01722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are useful in determining indications for revascularization of coronary artery disease (CAD). Although the discordance of FFR and iFR was noted in approximately 20%, this cause has not been well established. We investigated patient background and features on coronary CT angiography (CCTA) showing not only FFR- and iFR-positive findings but also discordance between FFR ≤ 0.8 and iFR ≤ 0.89. METHODS Subjects were consecutively treated in 83 cases with 105 vessels in which stenosis of 30-90% was detected at one vessel of at least 2 mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected CAD which underwent CCTA. The factors affecting not only FFR- and iFR-positive findings, respectively, but also discordance between FFR and iFR was evaluated using logistic regression analysis on per-patient and per-vessel basis. RESULTS FFR- and iFR-positive findings were observed in 42 vessels (40.0%) and 34 vessels (32.3%), respectively. Discordance between FFR ≤ 0.8 and iFR ≤ 0.89 was observed in 22 vessels (21.0%) of 21 patients. In multivariate logistic analysis, LAD (OR 3.55; 95%CI 1.20-11.71; p = 0.0217) and lumen volume/myocardial weight (L/M) ratio (OR 0.93; 0.86-0.99, p = 0.0290) were significant predictors for FFR-positive findings. For iFR-positive findings, LAD (OR 3.86; 95%CI 1.12-13.31; p = 0.0236) was only significant predictor. In FFR ≤ 0.8 and iFR > 0.89 group (15 vessels, 14.3%), positive remodeling (PR) (OR 5.03, 95%CI 1.23-20.48, p = 0.0205) was significant predictor. In FFR > 0.8 and iFR ≤ 0.89 group (7 vessels, 6.7%), there were no significant predictors. CONCLUSION On CCTA characteristics, a relevant predictor for FFR-positive findings included low L/M ratio. PR was significant predictor in FFR-positive, iFR-negative patients among those with discordance between the FFR and iFR.
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Affiliation(s)
- Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yuko O Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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Hoshino M, Yang S, Sugiyama T, Zhang J, Kanaji Y, Yamaguchi M, Hada M, Sumino Y, Horie T, Nogami K, Ueno H, Misawa T, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Peri-coronary inflammation is associated with findings on coronary computed tomography angiography and fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 14:483-489. [DOI: 10.1016/j.jcct.2020.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 01/11/2023]
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Uceda DE, Dey AK, Lateef SS, Abdelrahman K, Aksentijevich M, Reddy AS, Choi H, Rodante JA, Playford MP, Bluemke DA, Zhou W, Chen MY, Gelfand JM, Mehta NN. Impaired Coronary Blood Flow in Patients with Psoriasis: Findings from an Observational Cohort Study. J Invest Dermatol 2020; 141:913-916. [PMID: 33011154 DOI: 10.1016/j.jid.2020.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/01/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Domingo E Uceda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sundus S Lateef
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Khaled Abdelrahman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Milena Aksentijevich
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Aarthi S Reddy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Harry Choi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Wunan Zhou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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40
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Anastasius M, Maggiore P, Huang A, Blanke P, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Raff GL, Hurwitz Koweek LM, Pontone G, Kawasaki T, Rønnow Sand NP, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J. The clinical utility of FFR CT stratified by age. J Cardiovasc Comput Tomogr 2020; 15:121-128. [PMID: 33032976 DOI: 10.1016/j.jcct.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known. METHODS Patients' in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFRCT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFRCT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFRCT was deemed to be ≤ 0.8. RESULTS FFRCT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFRCT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFRCT positivity or stenosis severity <50% or ≥50%. With a negative FFRCT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFRCT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006-1.08, p = 0.02). Amongst patients with a FFRCT > 0.80, there was no effect of age on the odds of revascularisation. CONCLUSION The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFRCT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFRCT are largely constant regardless of age.
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Affiliation(s)
- Malcom Anastasius
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Paul Maggiore
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Alex Huang
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Phillip Blanke
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Gilbert L Raff
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA
| | - Kristian A Øvrehus
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | | | | | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
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Ihdayhid AR, Thakur U, Yap G, Goeller M, Nerlekar N, Adams D, Isa M, Joshi M, Cameron J, Seneviratne S, Dey D, Achenbach S, Leipsic J, Ko BS. Ethnic differences in coronary anatomy, left ventricular mass and CT-derived fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 15:249-257. [PMID: 33041249 DOI: 10.1016/j.jcct.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies have observed higher incidence of cardiovascular mortality in South Asians (SA), and lower prevalence in East Asians (EA), compared with Caucasians. These observations are not entirely explained by ethnic differences in cardiovascular risk factors and mechanistic factors such as variations in cardiac anatomy and physiology may play a role. This study compared ethnic differences in CT-assessed left ventricular (LV) mass, coronary anatomy and non-invasive fractional flow reserve (FFRCT). METHODS Three-hundred symptomatic patients (age 59 ± 7.9, male 51%) underwent clinically-mandated CT-coronary-angiography (CTA) were matched for age, gender, BMI and diabetes (100 each ethnicity). Assessment of coronary stenosis, luminal dimensions and vessel dominance was performed by independent observers. LV mass, coronary luminal volume and FFRCT were quantified by blinded core-laboratory. A sub-analysis was performed on patients (n = 187) with normal/minimal disease (0-25% stenosis). RESULTS Stenosis severity was comparable across ethnic groups. EA demonstrated less left-dominant circulation (2%) compared with SA (8.2%) and Caucasians (10.1%). SA compared with EA and Caucasians demonstrated smallest indexed LV mass, coronary luminal volumes and dimensions. EA compared with Caucasians had comparable indexed LV mass, coronary luminal dimensions and highest luminal volumes. The latter was driven by higher prevalence of right-dominance including larger and longer right posterior left ventricular artery. FFRCT in the left anterior descending artery (LAD) was lowest in SA (0.87) compared with EA (0.89; P = 0.009) and Caucasians (0.89; P < 0.001), with no difference in other vessels. All observed differences were consistent in patients with minimal disease. CONCLUSION This single-centre study identified significant ethnic differences in CT-assessed LV mass, coronary anatomy and LAD FFRCT. These hypotheses generating results may provide a mechanistic explanation for ethnic differences in cardiovascular outcomes and require validation in larger cohorts.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- 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
| | - Grace Yap
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Markus Goeller
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Daniel Adams
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mourushi Isa
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mitwa Joshi
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James 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
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - Jonathan Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
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42
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Fairbairn TA, Dobson R, Hurwitz-Koweek L, Matsuo H, Norgaard BL, Rønnow Sand NP, Nieman K, Bax JJ, Pontone G, Raff G, Chinnaiyan KM, Rabbat M, Amano T, Kawasaki T, Akasaka T, Kitabata H, Binukrishnan S, Rogers C, Berman D, Patel MR, Douglas PS, Leipsic J. Sex Differences in Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Lessons From ADVANCE. JACC Cardiovasc Imaging 2020; 13:2576-2587. [PMID: 32861656 DOI: 10.1016/j.jcmg.2020.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study is to determine the management and clinical outcomes of patients investigated with coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) according to sex. BACKGROUND Women are underdiagnosed with conventional ischemia testing, have lower rates of obstructive coronary artery disease (CAD) at invasive coronary angiography (ICA), yet higher mortality compared to men. Whether FFRCT improves sex-based patient management decisions compared to CCTA alone is unknown. METHODS Subjects with symptoms and CAD on CCTA were enrolled (2015 to 2017). Demographics, symptom status, CCTA anatomy, coronary volume to myocardial mass ratio (V/M), lowest FFRCT values, and management plans were captured. Endpoints included reclassification rate between CCTA and FFRCT management plans, incidence of ICA demonstrating obstructive CAD (≥50% stenosis) and revascularization rates. RESULTS A total of 4,737 patients (n = 1,603 females, 33.8%) underwent CCTA and FFRCT. Women were older (age 68 ± 10 years vs. 65 ± 10 years; p < 0.0001) with more atypical symptoms (41.5% vs. 33.9%; p < 0.0001). Women had less obstructive CAD (65.4% vs. 74.7%; p < 0.0001) at CCTA, higher FFRCT (0.76 ± 0.10 vs. 0.73 ± 0.10; p < 0.0001), and lower likelihood of positive FFRCT ≤ 0.80 for the same degree stenosis (p < 0.0001). A positive FFRCT ≤0.80 resulted in equal referral to ICA (n = 510 [54.5%] vs. n = 1,249 [56.5%]; p = 0.31), but more nonobstructive CAD (n = 208 [32.1%] vs. n = 354 [24.5%]; p = 0.0003) and less revascularization (n = 294 [31.4%] vs. n = 800 [36.2%]; p < 0.0001) in women, unless the FFRCT was ≤0.75 where revascularization rates were similar (n = 253 [41.9%] vs. n = 715 [46.4%]; p = 0.06). Women have a higher V/M ratio (26.17 ± 7.58 mm3/g vs. 24.76 ± 7.22 mm3/g; p < 0.0001) that is associated with higher FFRCT independent of degree stenosis (p < 0.001). Predictors of revascularization included stenosis severity, FFRCT, symptoms, and V/M ratio (p < 0.001) but not female sex (p = 0.284). CONCLUSIONS FFRCT differs between the sexes, as women have a higher FFRCT for the same degree of stenosis. In FFRCT-positive CAD, women have less obstructive CAD at ICA and less revascularization, which is associated with higher V/M ratio. The findings suggest that CAD and FFRCT variations by sex need specific interpretation as these differences may affect therapeutic decision making and clinical outcomes. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care [ADVANCE]; NCT02499679).
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Affiliation(s)
| | - Rebecca Dobson
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Hitoshi Matsuo
- Wakayama Medical University, Wakayama, Japan; Gifu Heart Center, Gifu, Japan
| | | | | | - Koen Nieman
- Stanford University Medical Center, Palo Alto, California, USA
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Gilbert Raff
- William Beaumont Hospital, Royal Oaks, Michigan, USA
| | | | - Mark Rabbat
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | | | | | | | | | - Daniel Berman
- Cedars Sinai Medical Centre, Beverly Hills, California, USA
| | - Manesh R Patel
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Feuchtner GM, Langer C, Senoner T, Barbieri F, Beyer C, Bonaros N, Schachner T, Friedrich G, Baldauf B, Taylor CA, Klauser A, Rauch S, Leipsic J, Dichtl W, Widmann G, De Cecco CN, Plank F. Differences in coronary vasodilatory capacity and atherosclerosis in endurance athletes using coronary CTA and computational fluid dynamics (CFD): Comparison with a sedentary lifestyle. Eur J Radiol 2020; 130:109168. [PMID: 32739779 DOI: 10.1016/j.ejrad.2020.109168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/04/2020] [Accepted: 07/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim was to assess the effect of endurance exercise on coronary vasodilatory capacity and atherosclerosis by coronary computed tomography angiography (CTA) and computational fluid dynamic (CFD) modelling. METHODS 100 subjects (age 56.2y±11, 29 females) who underwent coronary CTA were included into this retrospectively matched cohort study. Endurance athletes (≥1 h per unit and ≥3 times per week training) were compared to controls with a sedentary lifestyle, and within subgroups with and without sublingual nitroglycerin preparation. CTA image analysis included coronary stenosis severity (CADRADS), total (segment involvement score = SIS) and mixed plaque burden (G-score), high-risk plaque criteria, the coronary artery calcium score (CACS) and CFD analysis including Fractional Flow Reserve (FFRCT), myocardial mass (M), total vessel lumen volume (V) and volume-to-mass (V/M) ratio. RESULTS The prevalence of atherosclerosis by CTA was 65.4 % and >50 % coronary stenosis was found in 17.3 % of athletes. Coronary stenosis severity (CADRADS), total and mixed non-calcified plaque burden (SIS and G-score) were lower in athletes (p = 0.003 and p < 0.001) but not CACS (p = 0.055) and less high-risk plaques were found (p < 0.001). The G-score was correlated with distal FFRCT (p = 0.025). V/M-ratio was different between athletes who received nitroglycerin compared with those who did not (V/M: 21.1 vs. 14.8; p < 0.001), but these differences were not observed in the control subjects. CONCLUSION Endurance training improves coronary vasodilatory capacity and reduces high-risk plaque and mixed non-calcifed plaque burden as assessed by coronary CTA angiography. Our study may advocate coronary CTA with FFRCT for evaluation of coronary artery disease in endurance athletes.
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Affiliation(s)
| | | | - Thomas Senoner
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Innsbruck Medical University, Austria
| | - Guy Friedrich
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Benito Baldauf
- ISAG- Institute for Sport and Alpin- and Healthmedicine, Innsbruck, Austria
| | - Charles A Taylor
- Stanford University, Dept. Bioengineering, Palo Alto, San Francisco, USA
| | - Andrea Klauser
- Department of Radiology, Innsbruck Medical University, Austria
| | - Stefan Rauch
- Department of Radiology, Innsbruck Medical University, Austria
| | - Jonathon Leipsic
- University of British Columbia, Vancouver, Dept. Radiology BC Canada
| | - Wolfgang Dichtl
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Austria
| | | | - Fabian Plank
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
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44
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Choi J, Kim E, Kim HY, Lee S, Kim SM. Allometric scaling patterns among the human coronary artery tree, myocardial mass, and coronary artery flow. Physiol Rep 2020; 8:e14514. [PMID: 32725793 PMCID: PMC7387886 DOI: 10.14814/phy2.14514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/09/2023] Open
Abstract
Human coronary artery tree is a physiological transport system for oxygen and vital materials through a hierarchical vascular network to match the energy demands of myocardium, which has the highest oxygen extraction ratio among body organs and heavily depends on the blood flow for its energy supply. Therefore, it would be reasonable to expect that the key design principle of this arterial network is to minimize energy expenditure, which can be described by allometric scaling law. We enrolled patients who underwent coronary computed tomography angiography without obstructive lesion. The cumulative arterial length (L), volume (V), and diameter (D) in relation to the artery-specific myocardial mass (M) were assessed. Flow rate (Q) was computed using quantitative flow ratio (QFR) measurement in patients who underwent invasive angiography. A total of 638 arteries from 43 patients (mean age 61 years, male gender 65%) were analyzed. A significant power-law relationship was found among L-M, V-M, D-M, V-L, D-L, and V-D, and also among Q-M, Q-L, Q-V, and Q-D in 106 arteries interrogated with QFR (p < .001, all). Our results suggest that the fundamental design principle of the human coronary arterial network may follow allometric scaling law.
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Affiliation(s)
- Jin‐Ho Choi
- Department of Emergency MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Eunsoo Kim
- College of Life Science and BiotechnologyKorea UniversitySeoulRepublic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular MedicineChonnam National University HospitalGwangjuRepublic of Korea
| | - Seung‐Hwa Lee
- Department of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Sung Mok Kim
- Depart of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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45
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Keulards DCJ, Fournier S, van 't Veer M, Colaiori I, Zelis JM, El Farissi M, Zimmermann FM, Collet C, De Bruyne B, Pijls NHJ. Computed tomographic myocardial mass compared with invasive myocardial perfusion measurement. Heart 2020; 106:1489-1494. [PMID: 32471907 PMCID: PMC7509389 DOI: 10.1136/heartjnl-2020-316689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
Objective The prognostic importance of a coronary stenosis depends on its functional severity and its depending myocardial mass. Functional severity can be assessed by fractional flow reserve (FFR), estimated non-invasively by a specific validated CT algorithm (FFRCT). Calculation of myocardial mass at risk by that same set of CT data (CTmass), however, has not been prospectively validated so far. The aim of the present study was to compare relative territorial-based CTmass assessment with relative flow distribution, which is closely linked to true myocardial mass. Methods In this exploratory study, 35 patients with (near) normal coronary arteries underwent CT scanning for computed flow-based CTmass assessment and underwent invasive myocardial perfusion measurement in all 3 major coronary arteries by continuous thermodilution. Next, the mass and flows were calculated as relative percentages of total mass and perfusion. Results The mean difference between CTmass per territory and invasively measured myocardial perfusion, both expressed as percentage of total mass and perfusion, was 5.3±6.2% for the left anterior descending territory, −2.0±7.4% for the left circumflex territory and −3.2±3.4% for the right coronary artery territory. The intraclass correlation between the two techniques was 0.90. Conclusions Our study shows a close relationship between the relative mass of the perfusion territory calculated by the specific CT algorithm and invasively measured myocardial perfusion. As such, these data support the use of CTmass to estimate territorial myocardium-at-risk in proximal coronary arteries.
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Affiliation(s)
- Daniëlle C J Keulards
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Iginio Colaiori
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Jo M Zelis
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Frederik M Zimmermann
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Bernard De Bruyne
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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46
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Tanabe Y, Kido T, Kurata A, Uetani T, Kuwahara N, Morikawa T, Kawaguchi N, Kido T, Nishimura K, Ikeda S, Yamaguchi O, Mochizuki T. Combined assessment of subtended myocardial volume and myocardial blood flow for diagnosis of obstructive coronary artery disease using cardiac computed tomography: A feasibility study. J Cardiol 2020; 76:259-265. [PMID: 32359811 DOI: 10.1016/j.jjcc.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/28/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the combined diagnostic performance of coronary artery stenosis-subtended myocardial volume (Vsub) and myocardial blood flow (MBFsub) on computed tomography (CT) for detecting obstructive coronary artery disease (CAD) assessed by invasive coronary angiography (ICA) and fractional flow reserve (FFR). METHODS Thirty-nine patients who underwent coronary CT angiography (CTA) and stress dynamic myocardial CT perfusion (CTP) prior to ICA were enrolled. Obstructive CAD was defined as severe (≥70%) or moderate (30-69%) stenosis with FFR ≤0.8 on ICA. The Vsub was semi-automatically calculated from coronary CTA data using Voronoi diagram-based myocardial segmentation. The standard CT-MBF based on the 17-segment model was calculated using dynamic stress CTP data and deconvolution analysis. The CT-MBFsub was automatically analyzed by integrating the CT-MBF and Voronoi diagram-based myocardial segmentation analyses. The diagnostic performance of combined CT-MBFsub and Vsub assessment was determined using receiver operating characteristic analysis and compared with standard CT-MBF and CT-MBFsub. RESULTS Of 117 vessels in 39 patients, 72 vessels were suspected of significant stenosis on CTA and 33 vessels had obstructive CAD on ICA and FFR. The sensitivity and specificity for identifying obstructive CAD were 67% and 82% for standard CT-MBF, 70% and 77% for CT-MBFsub, and 85% and 82% for combined CT-MBFsub and Vsub assessment. The area under the receiver operating characteristic curve of the combined CT-MBFsub and Vsub assessment was significantly higher than those of standard CT-MBF and CT-MBFsub (0.89 vs. 0.75, 0.77; p<0.05). CONCLUSIONS The Vsub may aid in increasing the diagnostic performance of CT-MBFsub for detecting obstructive CAD.
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Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Natsumi Kuwahara
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Tomoro Morikawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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47
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Choi JW, van Rosendael AR, Bax AM, van den Hoogen IJ, Gianni U, Baskaran L, Andreini D, De Cecco CN, Earls J, Ferencik M, Hecht H, Leipsic JA, Maurovich-Horvat P, Nicol E, Pontone G, Raman S, Schoenhagen P, Arbab-Zadeh A, Choi AD, Feuchtner G, Weir-McCall J, Chinnaiyan K, Whelton S, Min JK, Villines TC, Al’Aref SJ. The Journal of Cardiovascular Computed Tomography year in review – 2019. J Cardiovasc Comput Tomogr 2020; 14:107-117. [DOI: 10.1016/j.jcct.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/20/2022]
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48
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On outflow boundary conditions for CT-based computation of FFR: Examination using PET images. Med Eng Phys 2020; 76:79-87. [DOI: 10.1016/j.medengphy.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/12/2023]
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49
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Benetos G, Buechel RR, Gonçalves M, Benz DC, von Felten E, Rampidis GP, Clerc OF, Messerli M, Giannopoulos AA, Gebhard C, Fuchs TA, Pazhenkottil AP, Kaufmann PA, Gräni C. Coronary artery volume index: a novel CCTA-derived predictor for cardiovascular events. Int J Cardiovasc Imaging 2020; 36:713-722. [PMID: 31894527 DOI: 10.1007/s10554-019-01750-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
Coronary computed tomography angiography (CCTA) provides critical prognostic information on plaque burden and stenosis severity of coronary arteries. We aimed to investigate the long-term prognostic value of coronary artery volume per myocardial mass as a potential new imaging parameter. Consecutive patients with suspected coronary artery disease (CAD) were included. Coronary artery volume index (CAVi) was defined as volume over myocardial mass. Additionally, obstructive CAD (≥ 70% stenosis) and segment severity score (SSS: sum of all segments scored according to lesion severity with 0 = no lesion, 1 = narrowing < 50%, 2 = stenosis 50-69% and 3 = stenosis ≥ 70%) were evaluated. Major adverse cardiovascular events (MACE) were defined as cardiac death, non-fatal myocardial infarction or revascularization. The association of CAVi with MACE was evaluated using Cox regression hazards ratios (HR) and Kaplan Meier curves. In a total of 325 patients, 36 (11.1%) patients experienced MACE during the mean follow-up of 5.4 ± 1.7 years. Patients with low-CAVi (< 27.9 mm3/g) experienced more MACE than patients with high-CAVI (17.2% versus 4.5%, p < 0.001, Kaplan Meier curve p = 0.001). SSS, obstructive CAD and low-CAVi were all significant predictors of MACE in univariable analysis (HR 1.14, 95% CI 1.09-1.19, p < 0.001; HR 5.51, 95% CI 2.86-10.60, p < 0.001; and HR 3.79, 95% CI 1.66-8.65, p = 0.002, respectively). CAVi maintained significant association with MACE when adjusted to SSS (CAVi HR 2.43, 95% CI 1.02-5.75, p = 0.04) or obstructive CAD (CAVi HR 2.4, 95% CI 1.002-5.75, p = 0.049). CAVi could further risk stratify patients without obstructive CAD when stratifying patients according to obstructive CAD (Kaplan-Meier curve p = 0.049). CAVi is a novel CCTA-derived imaging parameter, yielding independent prognostic value over stenosis and plaque burden.
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Affiliation(s)
- Georgios Benetos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Marisa Gonçalves
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georgios P Rampidis
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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50
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Type 2 diabetes mellitus is associated with increased left ventricular mass independent of coronary artery volume. Clin Radiol 2019; 74:972.e17-972.e23. [DOI: 10.1016/j.crad.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 07/18/2019] [Indexed: 11/20/2022]
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