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Lee SN, Lin A, Dey D, Berman DS, Han D. Application of Quantitative Assessment of Coronary Atherosclerosis by Coronary Computed Tomographic Angiography. Korean J Radiol 2024; 25:518-539. [PMID: 38807334 PMCID: PMC11136945 DOI: 10.3348/kjr.2023.1311] [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: 12/06/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 05/30/2024] Open
Abstract
Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool for diagnosing and risk-stratifying patients with suspected coronary artery disease (CAD). Recent advancements in image analysis and artificial intelligence (AI) techniques have enabled the comprehensive quantitative analysis of coronary atherosclerosis. Fully quantitative assessments of coronary stenosis and lumen attenuation have improved the accuracy of assessing stenosis severity and predicting hemodynamically significant lesions. In addition to stenosis evaluation, quantitative plaque analysis plays a crucial role in predicting and monitoring CAD progression. Studies have demonstrated that the quantitative assessment of plaque subtypes based on CT attenuation provides a nuanced understanding of plaque characteristics and their association with cardiovascular events. Quantitative analysis of serial CCTA scans offers a unique perspective on the impact of medical therapies on plaque modification. However, challenges such as time-intensive analyses and variability in software platforms still need to be addressed for broader clinical implementation. The paradigm of CCTA has shifted towards comprehensive quantitative plaque analysis facilitated by technological advancements. As these methods continue to evolve, their integration into routine clinical practice has the potential to enhance risk assessment and guide individualized patient management. This article reviews the evolving landscape of quantitative plaque analysis in CCTA and explores its applications and limitations.
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Affiliation(s)
- Su Nam Lee
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Australia
| | - Damini Dey
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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2
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Rymer JA, Ng N, Takagi H, Koweek LM, Douglas PS, De Bruyne B, Norgaard BL, Patel MR, Leipsic JA, Daubert MA. Anatomic and Functional Discordance Among Patients With Nonobstructive Coronary Disease. JACC Cardiovasc Imaging 2024; 17:705-707. [PMID: 38456878 DOI: 10.1016/j.jcmg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
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3
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Omaygenc MO, Kadoya Y, Small GR, Chow BJW. Cardiac CT: Competition, complimentary or confounder. J Med Imaging Radiat Sci 2024; 55:S31-S38. [PMID: 38433089 DOI: 10.1016/j.jmir.2024.01.005] [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: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
Coronary CT angiography (CCTA) has been gradually adopted into clinical practice over the last two decades. CCTA has high diagnostic accuracy, prognostic value, and unique features such as assessment of plaque composition. CCTA-derived functional assessment techniques such as fractional flow reserve and CT perfusion are also available and can increase the diagnostic specificity of the modality. These properties propound CCTA as a competitor of functional testing in diagnosis of obstructive CAD, however, utilizing CCTA in a concomitant fashion to potentiate the performance of the latter can lead to better patient care and may provide more accurate prognostic information. Although multiple diagnostic challenges such as evaluation of calcified segments, stents, and small distal vessels still exist, the technologic developments in hardware as well as growing incorporation of artificial intelligence to daily practice are all set to augment the diagnostic and prognostic role of CCTA in cardiovascular disorders.
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Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Yoshito Kadoya
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Gary Robert Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Benjamin Joe Wade Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
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Nurmohamed NS, Cole JH, Budoff MJ, Karlsberg RP, Gupta H, Sullenberger LE, Quesada CG, Rahban H, Woods KM, Uzzilia JR, Purga SL, Aquino M, Hoffmann U, Min JK, Earls JP, Choi AD. Impact of atherosclerosis imaging-quantitative computed tomography on diagnostic certainty, downstream testing, coronary revascularization, and medical therapy: the CERTAIN study. Eur Heart J Cardiovasc Imaging 2024; 25:857-866. [PMID: 38270472 PMCID: PMC11139521 DOI: 10.1093/ehjci/jeae029] [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: 11/05/2023] [Revised: 12/26/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. METHODS AND RESULTS In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. CONCLUSION The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Jason H Cole
- Cardiology Associates of Mobile, Mobile, AL, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | - Himanshu Gupta
- Division of Cardiac Imaging, Valley Heart and Vascular Institute, Valley Health System, Ridgewood, NJ, USA
| | | | - Carlos G Quesada
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart Institute, Beverly Hills, CA
| | | | | | | | | | | | | | - James P Earls
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
- Cleerly Inc., Denver, CO, USA
| | - Andrew D Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
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5
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Manubolu VS, Ichikawa K, Budoff MJ. Innovations in cardiac computed tomography: Imaging in coronary artery disease. Prog Cardiovasc Dis 2024:S0033-0620(24)00073-2. [PMID: 38754532 DOI: 10.1016/j.pcad.2024.05.005] [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: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool in the non-invasive evaluation of coronary artery disease (CAD). Recent advancements in imaging techniques, quantitative plaque assessment methods, assessment of coronary physiology, and perivascular coronary inflammation have propelled CCTA to the forefront of CAD management, enabling precise risk stratification, disease monitoring, and evaluation of treatment response. However, challenges persist, including the need for cardiovascular outcomes data for therapy modifications based on CCTA findings and the lack of standardized quantitative plaque assessment techniques to establish universal guidelines for treatment strategies. This review explores the current utilization of CCTA in clinical practice, highlighting its clinical impact and discussing challenges and opportunities for future development. By addressing these nuances, CCTA holds promise for revolutionizing coronary imaging and improving CAD management in the years to come. Ultimately, the goal is to provide precise risk stratification, optimize medical therapy, and improve cardiovascular outcomes while ensuring cost-effectiveness for healthcare systems.
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Mortensen MB, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Thomsen KK, Bøtker HE, Leipsic J, Sand NPR. Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study. J Cardiovasc Comput Tomogr 2024; 18:243-250. [PMID: 38246785 DOI: 10.1016/j.jcct.2024.01.010] [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: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFRCT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. METHODS Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 % coronary stenosis. A per-patient lowest FFRCT-value ≤0.80 represented an abnormal test result. Patients with FFRCT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFRCT) ≥1 vessels with FFRCT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. RESULTS Amongst 769 patients (619 [80 %] stenosis ≥50 %, 510 [66 %] FFRCT ≤0.80), 174 (23 %) reported recurrent angina at follow-up. An FFRCT ≤0.80 vs > 0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 % CI: 1.31-2.52, p < 0.001. Risk of recurrent angina in CR-FFRCT (n = 135) was similar to patients with FFRCT >0.80, 13 % vs 15 %, RR: 0.93; 95 % CI: 0.62-1.40, p = 0.72, while IR-FFRCT (n = 90) and non-revascularized patients with FFRCT ≤0.80 (n = 285) had increased risk, 37 % vs 15 % RR: 2.50; 95 % CI: 1.68-3.73, p < 0.001 and 30 % vs 15 %, RR: 2.03; 95 % CI: 1.44-2.87, p < 0.001, respectively. Use of antianginal medication was similar across study groups. CONCLUSION In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFRCT provides information regarding risk of recurrent angina.
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Affiliation(s)
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | | | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - 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
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Lee E, Amadi C, Williams MC, Agarwal PP. Coronary Artery Disease: Role of Computed Tomography and Recent Advances. Radiol Clin North Am 2024; 62:385-398. [PMID: 38553176 DOI: 10.1016/j.rcl.2023.12.017] [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: 04/02/2024]
Abstract
In this review, the authors summarize the role of coronary computed tomography angiography and coronary artery calcium scoring in different clinical presentations of chest pain and preventative care and discuss future directions and new technologies such as pericoronary fat inflammation and the growing footprint of artificial intelligence in cardiovascular medicine.
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Affiliation(s)
- Elizabeth Lee
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, TC B1-148, Ann Arbor, MI 48109-5030, USA.
| | - Chiemezie Amadi
- Department of Radiology, Michigan Medicine, 1500 Medical Center Drive, Room 5481, Ann Arbor, MI 48109-5868, USA
| | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, The Queen's Medical Research Institute, Edinburg BioQuarter, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Prachi P Agarwal
- Department of Radiology, Division of Cardiothoracic Radiology, Michigan Medicine, 1500 East Medical Center Drive SPC 5868, Ann Arbor, MI 48109, USA
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Yang S, Chung J, Lesina K, Doh JH, Jegere S, Erglis A, Leipsic JA, Fearon WF, Narula J, Koo BK. Long-term prognostic implications of CT angiography-derived fractional flow reserve: Results from the DISCOVER-FLOW study. J Cardiovasc Comput Tomogr 2024; 18:251-258. [PMID: 38378313 DOI: 10.1016/j.jcct.2024.01.016] [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: 11/05/2023] [Revised: 01/08/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND & OBJECTIVES The long-term prognostic implications of CT angiography-derived fractional flow reserve (FFRCT) remains unclear. We aimed to explore the long-term outcomes of FFRCT in the first-in-human study of it. MATERIALS & METHODS A total of 156 vessels from 102 patients with stable coronary artery disease, who underwent coronary CT angiography (CCTA) and invasive FFR measurement, were followed. The primary endpoint was target vessel failure (TVF), including cardiovascular death, target vessel myocardial infarction, and target vessel revascularization. Outcome analysis with FFRCT was performed on a per-vessel basis using a marginal Cox proportional hazard model. RESULTS During median 9.9 years of follow-up, TVF occurred in 20 (12.8%) vessels. FFRCT ≤0.80 discriminated TVF (hazard ratio [HR] 2.61, 95% confidence interval [CI] 1.06, 6.45). Among 94 vessels with deferral of percutaneous coronary intervention (PCI), TVF risk was inversely correlated with FFRCT (HR 0.62 per 0.1 increase, 95% CI 0.44, 0.86), with the cumulative incidence of TVF being 2.6%, 15.2%, and 28.6% for vessels with FFRCT >0.90, 0.81-0.90, and ≤0.80, respectively (p-for-trend 0.005). Predictive value for clinical outcomes of FFRCT was similar to that of invasive FFR (c-index 0.79 vs 0.71, P = 0.28). The estimated TVF risk was higher in the deferral of PCI group than the PCI group for vessels with FFRCT ≤0.81. CONCLUSION FFRCT showed improved long-term risk stratification and displayed a risk continuum similar to invasive FFR. CLINICAL TRIAL REGISTRATION NCT01189331.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jaewook Chung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Krista Lesina
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Sanda Jegere
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrejs Erglis
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William F Fearon
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jagat Narula
- The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
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9
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Bär S, Nabeta T, Maaniitty T, Saraste A, Bax JJ, Earls JP, Min JK, Knuuti J. Prognostic value of a novel artificial intelligence-based coronary computed tomography angiography-derived ischaemia algorithm for patients with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:657-667. [PMID: 38084894 PMCID: PMC11057943 DOI: 10.1093/ehjci/jead339] [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: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 05/01/2024] Open
Abstract
AIMS Coronary computed tomography angiography (CTA) imaging is used to diagnose patients with suspected coronary artery disease (CAD). A novel artificial intelligence-guided quantitative computed tomography ischaemia algorithm (AI-QCTischaemia) aims to identify myocardial ischaemia directly from CTA images and may be helpful to improve risk stratification. The aims were to investigate (i) the prognostic value of AI-QCTischaemia amongst symptomatic patients with suspected CAD entering diagnostic imaging with coronary CTA and (ii) the prognostic value of AI-QCTischaemia separately amongst patients with no/non-obstructive CAD (≤50% visual diameter stenosis) and obstructive CAD (>50% visual diameter stenosis). METHODS AND RESULTS For this cohort study, AI-QCTischaemia was calculated by blinded analysts amongst patients with suspected CAD undergoing coronary CTA. The primary endpoint was the composite of death, myocardial infarction (MI), or unstable angina pectoris (uAP) (median follow-up 6.9 years). A total of 1880/2271 (83%) patients had conclusive AI-QCTischaemia result. Patients with an abnormal AI-QCTischaemia result (n = 509/1880) vs. patients with a normal AI-QCTischaemia result (n = 1371/1880) had significantly higher crude and adjusted rates of the primary endpoint [adjusted hazard ratio (HRadj) 1.96, 95% confidence interval (CI) 1.46-2.63, P < 0.001; covariates: age/sex/hypertension/diabetes/smoking/typical angina]. An abnormal AI-QCTischaemia result was associated with significantly higher crude and adjusted rates of the primary endpoint amongst patients with no/non-obstructive CAD (n = 1373/1847) (HRadj 1.81, 95% CI 1.09-3.00, P = 0.022), but not amongst those with obstructive CAD (n = 474/1847) (HRadj 1.26, 95% CI 0.75-2.12, P = 0.386) (P-interaction = 0.032). CONCLUSION Amongst patients with suspected CAD, an abnormal AI-QCTischaemia result was associated with a two-fold increased adjusted rate of long-term death, MI, or uAP. AI-QCTischaemia may be useful to improve risk stratification, especially amongst patients with no/non-obstructive CAD on coronary CTA.
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Affiliation(s)
- Sarah Bär
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Takeru Nabeta
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital, Hämeentie 11, 20540 Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital, Hämeentie 11, 20540 Turku, Finland
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Noblé HJ, Mühlbauer N, Ehling J, Bansmann PM. The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance. ROFO-FORTSCHR RONTG 2024. [PMID: 38631371 DOI: 10.1055/a-2271-0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The aim of our work was to demonstrate the importance of artificial intelligence-based analysis of fractional flow reserves of computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance in patients with unclear chest pain and suspected stable coronary heart disease with a low to medium pre-test probability.The collective of our retrospective analysis includes 63 patients in whom coronary artery stenosis was detected by volume computed tomographic examination in "one beat, whole heart" mode in the period from March to October 2022. In these patients, the fractional flow reserve was also determined by computed tomography, which was modulated by the use of artificial intelligence.The calculated values of the fractional flow reserve and the degrees of stenosis determined by computed tomography showed a moderate and significant negative correlation for all three coronary vascular territories (LAD/CX/RCA) (correlation coefficient rho = 0.54/0.54/0.6; p < 0.01 respectively). In just over a third (37.6 %) of all stenoses classified as high-grade by computed tomography, the assessment of hemodynamic relevance by calculating the fractional flow reserve deviated from the severity of the stenosis diagnosed by computed tomography, while the results in the peripheral areas "no stenosis/vascular occlusion" were 100 % consistent in each case.The present results of this work illustrate that the calculation of the fractional flow reserve based on artificial intelligence as a supplement to volume computed tomography of the heart can make a decisive contribution to further therapy planning by increasing the specificity of the purely morphological method by the physiological aspect. · Calculation of fractional flow reserve is a useful addition to computed tomography of the heart.. · It provides possibility to dispense with unnecessary further diagnostics by increasing specificity.. · The combination of both procedures leads to therapy optimization for patients.. · Noblé H, Mühlbauer N, Ehling J et al. The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2271-0887.
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Affiliation(s)
- Hans-Jürgen Noblé
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Nadine Mühlbauer
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Josef Ehling
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Paul Martin Bansmann
- Institute for Diagnostic and Interventional Radiology, Hospital Porz am Rhein, Cologne, Germany
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11
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Natanzon SS, Han D, Kuronuma K, Gransar H, Miller RJH, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. Self-reported exercise activity influences the relationship between coronary computed tomography angiographic finding and mortality. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00070-4. [PMID: 38589269 DOI: 10.1016/j.jcct.2024.03.011] [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: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
AIM Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n = 1643, 17%), mild exercise (n = 3156, 32%), moderate exercise (n = 3542, 36%), and high exercise (n = 1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p < 0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p < 0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p = 0.912). CONCLUSION Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.
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Affiliation(s)
- Sharon Shalom Natanzon
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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12
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Fernández-Martínez D, González-Fernández MR, Nogales-Asensio JM, Ferrera C. Impact of minimal lumen segmentation uncertainty on patient-specific coronary simulations: A look at FFR CT. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3822. [PMID: 38566253 DOI: 10.1002/cnm.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
We examined the effect of minimal lumen segmentation uncertainty on Fractional Flow Reserve obtained from Coronary Computed Tomography AngiographyFFR CT $$ \left({\mathrm{FFR}}_{\mathrm{CT}}\right) $$ . A total of 14 patient-specific coronary models with different stenosis locations and degrees of severity were enrolled in this study. The optimal segmented coronary lumens were disturbed using intra± 6 % $$ \left(\pm 6\%\right) $$ and inter-operator± 15 % $$ \left(\pm 15\%\right) $$ variations on the segmentation threshold.FFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ was evaluated in each case by 3D-OD CFD simulations. The findings suggest that the sensitivity ofFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ to this type of uncertainty increases distally and with the stenosis severity. Cases with moderate or severe distal coronary lesions should undergo either exact and thorough segmentation operations or invasive FFR measurements, particularly if theFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ is close to the cutoff (0.80). Therefore, we conclude that it is crucial to consider the lesion's location and degree of severity when evaluatingFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ results.
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Affiliation(s)
- Daniel Fernández-Martínez
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Badajoz, Spain
| | | | | | - Conrado Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Badajoz, Spain
- Instituto de Computación Científica Avanzada, Universidad de Extremadura, Badajoz, Spain
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13
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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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14
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Jabbour RJ, Curzen N. How will coronary physiology, plaque vulnerability and ischemia be integrated in future patient pathways with chest pain? Expert Rev Cardiovasc Ther 2024; 22:141-143. [PMID: 38679907 DOI: 10.1080/14779072.2024.2347224] [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: 01/07/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Richard J Jabbour
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Curzen
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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15
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Randhawa MK, Takigami AK, Thondapu V, Ranganath PG, Zhang E, Parakh A, Goiffon RJ, Baliyan V, Foldyna B, Lu MT, Tower-Rader A, Meyersohn NM, Hedgire S, Ghoshhajra BB. Selective Use of CT Fractional Flow at a Large Academic Medical Center: Insights from Clinical Implementation after 1 Year of Practice. Radiol Cardiothorac Imaging 2024; 6:e230073. [PMID: 38573127 PMCID: PMC11056747 DOI: 10.1148/ryct.230073] [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: 03/16/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician's discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Vikas Thondapu
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Praveen G. Ranganath
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Eric Zhang
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Anushri Parakh
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Reece J. Goiffon
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Vinit Baliyan
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Borek Foldyna
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Michael T. Lu
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Albree Tower-Rader
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Nandini M. Meyersohn
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Sandeep Hedgire
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
| | - Brian B. Ghoshhajra
- From the Department of Radiology, Division of Cardiovascular Imaging,
Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB-295,
Boston, MA 02114
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16
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Wang S, Shi Z, Pan H, Yan T, Liu L, Xu J, Wang W, Zhang T. Triglyceride glucose index is associated with functional coronary artery stenosis in hypertensive patients. Front Endocrinol (Lausanne) 2024; 15:1323722. [PMID: 38590821 PMCID: PMC10999614 DOI: 10.3389/fendo.2024.1323722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Background The triglyceride glucose (TyG) index is an effective method for determining insulin resistance (IR). Limited research has explored the connection between the TyG index and functionally significant stenosis in hypertensive patients. Furthermore, the connections between the TyG index, fat attenuation index (FAI) and atherosclerotic plaque characteristics are also worth exploring. Methods The study screened 1622 hypertensive participants without coronary artery disease history who underwent coronary computed tomography angiography. The TyG index was calculated as ln (fasting glucose [mg/dL] * fasting TG [mg/dL]/2). Adverse plaque characteristics (HRPCs), high-risk plaques (HRPs), FAI, and CT-derived fractional flow reserve (FFRCT) were analyzed and measured for all patients. Functionally significant stenosis causing ischemia is defined as FFRCT ≤ 0.80. Two patient groups were created based on the FFRCT: the FFRCT < 0.80 group and the FFRCT > 0.80 group. In hypertensive patients, the association between the TyG index and FFRCT was examined applying a logistic regression model. Results The TyG index was higher for people with FFRCT ≤ 0.80 contrast to those with FFRCT > 0.80. After controlling for additional confounding factors, the logistic regression model revealed a clear connection between the TyG index and FFRCT ≤ 0.80 (OR = 1.718, 95% CI 1.097-2.690, p = 0.018). The restricted cubic spline analysis displayed a nonlinear connection between the TyG index and FFRCT ≤ 0.80 (p for nonlinear = 0.001). The TyG index increased the fraction of individuals with HRPs and HRPCs, FAI raised, and FFRCT decreased (p < 0.05). The multivariate linear regression analysis illustrated a powerfulcorrelation between high TyG index levels and FAI, FFRCT, positive remodeling (PR), and low-attenuation plaque (LAPs) (standardized regression coefficients: 0.029 [p = 0.007], -0.051 [p < 0.001], 0.029 [p = 0.027], and 0.026 [p = 0.046], separately). Conclusion In hypertensive patients, the TyG index showed an excellent association with a risk of FFRCT ≤ 0.80. Additionally, the TyG index was also linked to FAI, FFRCT, PR, and LAPs.
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Affiliation(s)
- Shuting Wang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenzhou Shi
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hong Pan
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tiancai Yan
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ling Liu
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiaheng Xu
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Wang
- The Magnetic Resonance Imaging Room, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tong Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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17
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Zsarnoczay E, Pinos D, Schoepf UJ, Fink N, O'Doherty J, Gnasso C, Griffith J, Vecsey-Nagy M, Suranyi P, Maurovich-Horvat P, Emrich T, Varga-Szemes A. Intra-individual comparison of coronary CT angiography-based FFR between energy-integrating and photon-counting detector CT systems. Int J Cardiol 2024; 399:131684. [PMID: 38151162 DOI: 10.1016/j.ijcard.2023.131684] [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: 10/06/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-based fractional flow reserve (CT-FFR) allows for noninvasive determination of the functional severity of anatomic lesions in patients with coronary artery disease. The aim of this study was to intra-individually compare CT-FFR between photon-counting detector (PCD) and conventional energy-integrating detector (EID) CT systems. METHODS In this single-center prospective study, subjects who underwent clinically indicated CCTA on an EID-CT system were recruited for a research CCTA on PCD-CT within 30 days. Image reconstruction settings were matched as closely as possible between EID-CT (Bv36 kernel, iterative reconstruction strength level 3, slice thickness 0.5 mm) and PCD-CT (Bv36 kernel, quantum iterative reconstruction level 3, virtual monoenergetic level 55 keV, slice thickness 0.6 mm). CT-FFR was measured semi-automatically using a prototype on-site machine learning algorithm by two readers. CT-FFR analysis was performed per-patient and per-vessel, and a CT-FFR ≤ 0.75 was considered hemodynamically significant. RESULTS A total of 22 patients (63.3 ± 9.2 years; 7 women) were included. Median time between EID-CT and PCD-CT was 5.5 days. Comparison of CT-FFR values showed no significant difference and strong agreement between EID-CT and PCD-CT in the per-vessel analysis (0.88 [0.74-0.94] vs. 0.87 [0.76-0.93], P = 0.096, mean bias 0.02, limits of agreement [LoA] -0.14/0.19, r = 0.83, ICC = 0.92), and in the per-patient analysis (0.81 [0.60-0.86] vs. 0.76 [0.64-0.86], P = 0.768, mean bias 0.02, LoA -0.15/0.19, r = 0.90, ICC = 0.93). All included patients were classified into the same category (CT-FFR > 0.75 vs ≤0.75) with both CT systems. CONCLUSIONS CT-FFR evaluation is feasible with PCD-CT and it shows a strong agreement with EID-CT-based evaluation when images are similarly reconstructed.
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Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Siemens Medical Solutions USA Inc, Malvern, USA
| | - Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
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18
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Liu J, Wei H, Zhu X, Liu H, Jin L. Contrasting the relationship of serum uric acid/albumin ratio on quantitative flow ratio with other multiple composite parameters in patients with suspected coronary artery disease. BMC Cardiovasc Disord 2024; 24:146. [PMID: 38443781 PMCID: PMC10913211 DOI: 10.1186/s12872-024-03763-9] [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: 12/01/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the association between quantitative coronary flow reserve (CFR) and the blood uric acid/albumin ratio, as well as multiple clinical parameters, in order to assess the severity of coronary artery functional stenosis. METHODS This retrospective cross-sectional study included 257 suspected coronary artery disease patients who underwent coronary angiography (CAG) and quantitative flow ratio (QFR) examinations in the Department of Cardiovascular Medicine at the First Affiliated Hospital of Yangtze University in Jingzhou City, China, between September 2022 and March 2023. The study subjects were divided into two groups based on their QFR values: QFR ≤ 0.80 group and QFR > 0.80 group. Correlation of uric acid-to-albumin ratio (UAR), high-density lipoprotein ratio (MHR), systemic immune-inflammation index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) with coronary artery QFR was analyzed using univariate and multivariate logistic regression models, considering them as both continuous and binary variables. RESULTS The QFR ≤ 0.80 group consisted of 83 patients, while the QFR > 0.80 group included 174 patients. Significant differences were observed between the QFR ≤ 0.80 and QFR > 0.80 groups in the following parameters: UAR (9.19 ± 2.47 vs 7.61 ± 1.91; p < 0.001), MHR (0.46 ± 0.19 vs 0.37 ± 0.16, p < 0.001), SII (674.98 ± 332.30 vs 571.43 ± 255.82; p = 0.006), SIRI (1.53 ± 0.83 vs 1.29 ± 1.10; p = 0.047), and AISI (340.22 ± 242.10 vs 243.97 ± 151.97; p < 0.001). ROC curve analysis revealed an area under the curve of 0.701 (CI: 0.633-0.770; p < 0.001) for UAR. In the univariate analysis, when treated as binary variables, high levels of UAR, MHR, SII, SIRI, and AISI were found to be significantly associated with the risk of QFR ≤ 0.80 (all P < 0.05). However, in the multivariate regression analysis, only high levels of UAR and AISI remained significantly associated with QFR ≤ 0.80 (all P < 0.05). When treated as continuous variables, the univariate analysis indicated that UAR (OR: 1.412, CI: 1.231-1.620, p < 0.001), e^MHR (OR: 1.394, CI: 1.151-1.687, p < 0.001), lnSII (OR: 1.001, CI: 1.000-1.002, p = 0.008), and lnAISI (OR: 2.695, CI: 1.539-4.719, p = 0.001) were significantly associated with QFR ≤ 0.80. In the multivariate analysis, UAR (OR: 1.373, CI: 1.187-1.587, p < 0.001) and AISI (OR: 2.217, CI: 1.309-3.757, p < 0.001) remained significantly associated with QFR ≤ 0.80. CONCLUSIONS The results of this study indicate a significant association between UAR and AISI with QFR ≤ 0.80, suggesting its potential role in predicting the extent of functional coronary artery stenosis in patients with CAD. Additionally, AIRI, identified as an inflammatory marker in the complete blood count, was found to exert influence on the severity of coronary artery physiology.
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Affiliation(s)
- Jin Liu
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, 434021, China
| | - Han Wei
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, 434021, China
| | - Xuanzhi Zhu
- Department of Anesthesiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
| | - Huangjun Liu
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, 434021, China.
| | - Lijun Jin
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, 434021, China.
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19
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Adnan Z, Panjiyar BK, Mehmood AM, Nanisetty A. Role of non-invasive coronary imaging in stable angina. Glob Cardiol Sci Pract 2024; 2024:e202418. [PMID: 38746064 PMCID: PMC11090183 DOI: 10.21542/gcsp.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Chest pain represents a symptom of significant clinical concern due to the potential for lethal etiologies. Accordingly, it is critical to ascertain the presence of stable angina through various diagnostic tests to inform subsequent therapeutic strategies. Stable angina, while potentially progressing to more severe conditions if left untreated, suffers from a paucity of research regarding its management compared to other more fatal causes of chest pain. Recent advancements in radiological imaging necessitate a re-evaluation of the array and functionality of diagnostic tests, with particular emphasis on prioritizing non-invasive methods such as electrocardiography and echocardiography. This study undertakes a comprehensive review of the literature pertaining to various diagnostic tests for stable angina. We conclude that the management of a patient presenting with chest pain encompasses a continuum of care, beginning with a detailed patient history to estimate pre-test probability and culminating in computed tomography coronary angiography. This continuum is highly individualized, taking into account patient-specific variables, disease burden, and test indications. In an era of rapid research advancement, our findings delineate the optimal sequence of initial diagnostic tests, emphasizing the role of current non-invasive imaging modalities as outlined in standard clinical guidelines.
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Affiliation(s)
- Zahra Adnan
- Foundation University Medical College, Islamabad, Pakistan
| | | | | | - Alekhya Nanisetty
- Kamineni Academy Of Medical Sciences And Research Centre, Hyderabad, India
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20
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Hou C, Lu Y, Ma Y, Li Q, Liu C, Lu M, Cao C, Liu J. Investigation of the predictive value of a novel algorithm based on coronary CT angiography regarding fractional flow reserve and revascularization in patients with stable coronary artery disease. Heart Vessels 2024; 39:195-205. [PMID: 37897523 DOI: 10.1007/s00380-023-02324-y] [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: 04/15/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023]
Abstract
Fractional flow reserve (FFR) has been established as a gold standard for functional coronary ischemia. At present, the FFR can be calculated from coronary computed tomography angiography (CCTA) images (CT-FFR). Previous studies have suggested that CT-FFR outperforms CCTA and invasive coronary angiography (ICA) in determining hemodynamic significance of stenoses. Recently, a novel automatical algorithm of CT-FFR called RuiXin-FFR has been developed. The present study is designed to investigate the predictive value of this algorithm and its value in therapeutic decision making. The present study retrospectively included 166 patients with stable coronary artery disease (CAD) who underwent CCTA screening and diagnostic ICA examination at Peking University People's Hospital, in 73 of whom wire-derived FFR was also measured. CT-FFR analyses were performed with a dedicated software. All patients were followed up for at least 1 year. We validated the accuracy of RuiXin-FFR with invasive FFR as the standard of reference, and investigated the role of RuiXin-FFR in predicting treatment strategy and long-term prognosis. The mean age of the patients was 63.3 years with 63.9% male. The CT-FFR showed a moderate correlation with wire-derived FFR (r = 0.542, p < 0.0001) and diagnostic accuracy of 87.6% to predict myocardial ischemia (AUC: 0.839, 95% CI 0.728-0.950), which was significantly higher than CCTA and ICA. In the multivariate logistic regression analysis, CT-FFR ≤ 0.80 was an independent predictor of undergoing coronary revascularization (OR: 45.54, 95% CI 12.03-172.38, p < 0.0001), whereas CT-FFR > 0.80 was an independent predictor of non-obstructive CAD (OR: 14.67, 95% CI 5.42-39.72, p < 0.0001). Reserving ICA and revascularization for vessels with positive CT-FFR could have reduced the rate of ICA by 29.6%, lowered the rate of ICA in vessels without stenosis > 50% by 11.7%, and increased the rate of revascularization in patients receiving ICA by 21.2%. The average follow-up was 23.7 months, and major adverse cardiovascular events (MACE) occurred in 11 patients. The rate of MACE was significantly lower in patients with CT-FFR > 0.80. The new algorithm of CT-FFR can be used to predict the invasive FFR. The RuiXin-FFR can also provide useful information for the screening of patients in whom further ICA is indeed needed and prognosis evaluation.
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Affiliation(s)
- Chang Hou
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Yahui Lu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Yuliang Ma
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Qi Li
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Chuanfen Liu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Mingyu Lu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Chengfu Cao
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China.
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21
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Sato Y, Motoyama S, Miyajima K, Kawai H, Sarai M, Muramatsu T, Takahashi H, Naruse H, Ahmadi A, Ozaki Y, Izawa H, Narula J. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. JACC Cardiovasc Imaging 2024; 17:284-297. [PMID: 37768240 DOI: 10.1016/j.jcmg.2023.07.013] [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: 07/27/2022] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) followed by computed tomography angiography-derived fractional flow reserve (FFRCT) is now commonly used for the management of chronic coronary syndrome (CCS). CTA-verified high-risk plaque (HRP) characteristics have also been reported to be associated with a greater likelihood of adverse cardiac events but have not been used for management decisions. OBJECTIVES The aim of this study was to evaluate clinical outcomes based on a combination of point-of-care computed tomography angiography-derived fractional flow reserve (POC-FFRCT) and the presence of HRP in CCS patients initially treated medically or with revascularization based on invasive coronary angiography findings. METHODS CTA was performed as the initial test in 5,483 patients presenting with CCS between September 2015 and December 2020 followed by invasive coronary angiography and revascularization as necessary. POC-FFRCT assessment and HRP characterization were obtained subsequently in 745 consecutive patients. We investigated how HRP and POC-FFRCT, which were not available during the original clinical decision making, correlated with the endpoint defined as a composite of cardiac death, acute coronary syndrome, and a need for unplanned revascularization. RESULTS Cardiac events occurred in 20 patients (2.7%) during a median follow-up of 744 days. The event rate was significantly higher in patients with POC-FFRCT <0.80 compared with POC-FFRCT ≥0.8 (5.4 vs 0.5 per 100 vessel years; log-rank P < 0.0001) and in patients with HRP compared to those without HRP (3.6 vs 0.8 per 100 vessel years; log-rank P = 0.0001). POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events (HR: 16.67; 95% CI: 2.63-105.39; P = 0.002) compared with POC-FFRCT ≥0.8 and absent HRP. For the vessels with POC-FFRCT <0.80 and HRP, a significantly higher rate of adverse events was observed in patients who did not undergo revascularization compared with those revascularized (16.4 vs 1.4 per 100 vessel years; log-rank P = 0.006). CONCLUSIONS POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events, and revascularization of HRP lesions with abnormal POC-FFRCT was associated with a lower event rate.
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Affiliation(s)
- Yoshihiro Sato
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, Aichi, Japan.
| | - Keiichi Miyajima
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | | | | | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Amir Ahmadi
- Department of Medicine, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Jagat Narula
- University of Texas Health Sciences Center, Houston, Texas, USA
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22
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Leipsic JA, Tzimas G. CT-Derived Plaque Physiology and Characterization: Complimentary Tools for Risk Stratification. JACC Cardiovasc Imaging 2024; 17:298-300. [PMID: 37855800 DOI: 10.1016/j.jcmg.2023.08.018] [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: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Georgios Tzimas
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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23
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Chen Z, Zhang J, Cai Y, Zhao H, Wang D, Li C, He Y. Diagnostic performance of angiography-derived fractional flow reserve and CT-derived fractional flow reserve: A systematic review and Bayesian network meta-analysis. J Evid Based Med 2024; 17:119-133. [PMID: 38205918 DOI: 10.1111/jebm.12573] [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: 01/16/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Accumulating evidence has demonstrated that fractional flow reserves (FFRs) derived from invasive coronary angiograms (CA-FFRs) and coronary computed tomography angiography-derived FFRs (CT-FFRs) are promising alternatives to wire-based FFRs. However, it remains unclear which method has better diagnostic performance. This systematic review and meta-analysis aimed to compare the diagnostic performances of the two approaches. METHODS The Cochrane Library, PubMed, Embase, Medline (Ovid), the Chinese China National Knowledge Infrastructure Database (CNKI), VIP, and WanFang Data databases were searched for relevant studies that included comparisons between CA-FFR and CT-FFR, from their respective database inceptions until January 1, 2023. Studies where both noninvasive FFR (including CA-FFR and CT-FFR) and invasive FFR (as a reference standard) were performed for the diagnosis of ischemic coronary artery disease and were designed as prospective, paired diagnostic studies, were pulled. The diagnostic test accuracy method and Bayesian hierarchical summary receiver operating characteristic (ROC) model for network meta-analysis (NMA) of diagnostic tests (HSROC-NMADT) were both used to perform a meta-analysis on the data. RESULTS Twenty-six studies were included in this NMA. The results from both the diagnostic test accuracy and HSROC-NMADT methods revealed that the diagnostic accuracy of CA-FFR was higher than that of CT-FFR, in terms of sensitivity (Se; 0.86 vs. 0.84), specificity (Sp; 0.90 vs. 0.78), positive predictive value (PPV; 0.83 vs. 0.70), and negative predictive value (NPV; 0.91 vs. 0.89) for the detection of myocardial ischemia. A cumulative ranking curve analysis indicated that CA-FFR had a higher diagnostic accuracy than CT-FFR in the context of this study, with a higher area under the ROC curve (AUC; 0.94 vs. 0.87). CONCLUSIONS Although both of these two commonly used virtual FFR methods showed high levels of diagnostic accuracy, we demonstrated that CA-FFR had a better Se, Sp, PPV, NPV, and AUC than CT-FFR. However, this study provided only indirect comparisions; therefore, larger studies are warranted to directly compare the diagnostic performances of these two approaches.
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Affiliation(s)
- Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junyan Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yujia Cai
- Chinese Evidence-based Medicine Center and MAGIC-China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongsen Zhao
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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24
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Dundas J, Leipsic J, Fairbairn T, Ng N, Sussman V, Guez I, Rosenblatt R, Hurwitz Koweek LM, Douglas PS, Rabbat M, Pontone G, Chinnaiyan K, de Bruyne B, Bax JJ, Amano T, Nieman K, Rogers C, Kitabata H, Sand NPR, Kawasaki T, Mullen S, Huey W, Matsuo H, Patel MR, Norgaard BL, Ahmadi A, Tzimas G. Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFR CT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry. Circ Cardiovasc Imaging 2024; 17:e016143. [PMID: 38469689 DOI: 10.1161/circimaging.123.016143] [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: 09/20/2023] [Accepted: 12/12/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Luminal stenosis, computed tomography-derived fractional-flow reserve (FFRCT), and high-risk plaque features on coronary computed tomography angiography are all known to be associated with adverse clinical outcomes. The interactions between these variables, patient outcomes, and quantitative plaque volumes have not been previously described. METHODS Patients with coronary computed tomography angiography (n=4430) and one-year outcome data from the international ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry underwent artificial intelligence-enabled quantitative coronary plaque analysis. Optimal cutoffs for coronary total plaque volume and each plaque subtype were derived using receiver-operator characteristic curve analysis. The resulting plaque volumes were adjusted for age, sex, hypertension, smoking status, type 2 diabetes, hyperlipidemia, luminal stenosis, distal FFRCT, and translesional delta-FFRCT. Median plaque volumes and optimal cutoffs for these adjusted variables were compared with major adverse cardiac events, late revascularization, a composite of the two, and cardiovascular death and myocardial infarction. RESULTS At one year, 55 patients (1.2%) had experienced major adverse cardiac events, and 123 (2.8%) had undergone late revascularization (>90 days). Following adjustment for age, sex, risk factors, stenosis, and FFRCT, total plaque volume above the receiver-operator characteristic curve-derived optimal cutoff (total plaque volume >564 mm3) was associated with the major adverse cardiac event/late revascularization composite (adjusted hazard ratio, 1.515 [95% CI, 1.093-2.099]; P=0.0126), and both components. Total percent atheroma volume greater than the optimal cutoff was associated with both major adverse cardiac event/late revascularization (total percent atheroma volume >24.4%; hazard ratio, 2.046 [95% CI, 1.474-2.839]; P<0.0001) and cardiovascular death/myocardial infarction (total percent atheroma volume >37.17%, hazard ratio, 4.53 [95% CI, 1.943-10.576]; P=0.0005). Calcified, noncalcified, and low-attenuation percentage atheroma volumes above the optimal cutoff were associated with all adverse outcomes, although this relationship was not maintained for cardiovascular death/myocardial infarction in analyses stratified by median plaque volumes. CONCLUSIONS Analysis of the ADVANCE registry using artificial intelligence-enabled quantitative plaque analysis shows that total plaque volume is associated with one-year adverse clinical events, with incremental predictive value over luminal stenosis or abnormal physiology by FFRCT. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02499679.
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Affiliation(s)
- James Dundas
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom (J.D.)
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | | | - Nicholas Ng
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | - Vida Sussman
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Ilana Guez
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Rachael Rosenblatt
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Lynne M Hurwitz Koweek
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | - Mark Rabbat
- Loyola University Medical Center, Maywood, IL (M.R.)
| | | | | | | | - Jeroen J Bax
- Leiden University Medical Centre, the Netherlands (J.J.B.)
| | | | - Koen Nieman
- Stanford University Medical Centre, CA (K.N.)
| | | | | | | | | | - Sarah Mullen
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | - Whitney Huey
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | | | - Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | | | | | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
- Division of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland (G.T.)
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25
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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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26
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Lyu L, Pan J, Li D, Yu D, Li X, Yang W, Dong M, Han Y, Liang Y, Zhang P, Zhang M. A stepwise strategy integrating dynamic stress CT myocardial perfusion and deep learning-based FFR CT in the work-up of stable coronary artery disease. Eur Radiol 2024:10.1007/s00330-023-10562-x. [PMID: 38214735 DOI: 10.1007/s00330-023-10562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/08/2023] [Accepted: 10/29/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To validate a novel stepwise strategy in which computed tomography-derived fractional flow reserve (FFRCT) is restricted to intermediate stenosis on coronary computed tomography angiography (CCTA) and computed tomography myocardial perfusion imaging (CT-MPI) was reserved for vessels with gray zone FFRCT values. MATERIALS AND METHODS This retrospective study included 87 consecutive patients (age, 58 ± 10 years; 70% male) who underwent CCTA, dynamic CT-MPI, interventional coronary angiography (ICA), and fractional flow reserve (FFR) for suspected or known coronary artery disease. FFRCT was computed using a deep learning-based platform. Three stepwise strategies (CCTA + FFRCT + CT-MPI, CCTA + FFRCT, CCTA + CT-MPI) were constructed and their diagnostic performance was evaluated using ICA/FFR as the reference standard. The proportions of vessels requiring further ICA/FFR measurement based on different strategies were noted. Furthermore, the net reclassification index (NRI) was calculated to ascertain the superior model. RESULTS The CCTA + FFRCT + CT-MPI strategy yielded the lowest proportion of vessels requiring additional ICA/FFR measurement when compared to the CCTA + FFRCT and CCTA + CT-MPI strategies (12%, 22%, and 24%). The CCTA + FFRCT + CT-MPI strategy exhibited the highest accuracy for ruling-out (91%, 84%, and 85%) and ruling-in (90%, 85%, and 85%) functionally significant lesions. All strategies exhibited comparable sensitivity for ruling-out functionally significant lesions and specificity for ruling-in functionally significant lesions (p > 0.05). The NRI indicated that the CCTA + FFRCT + CT-MPI strategy outperformed the CCTA + FFRCT strategy (NRI = 0.238, p < 0.001) and the CCTA + CT-MPI strategy (NRI = 0.233%, p < 0.001). CONCLUSIONS The CCTA + FFRCT + CT-MPI stepwise strategy was superior to the CCTA + FFRCT strategy and CCTA+ CT-MPI strategy by minimizing unnecessary invasive diagnostic catheterization without compromising the agreement rate with ICA/FFR. CLINICAL RELEVANCE STATEMENT Our novel stepwise strategy facilitates greater confidence and accuracy when clinicians need to decide on interventional coronary angiography referral or deferral, reducing the burden of invasive investigations on patients. KEY POINTS • A stepwise CCTA + FFRCT + CT-MPI strategy holds promise as a viable method to reduce the need for invasive diagnostic catheterization, while maintaining a high level of agreement with ICA/FFR. • The CCTA + FFRCT + CT-MPI strategy performed better than the CCTA + FFRCT and CCTA + CT-MPI strategies. • A stepwise CCTA + FFRCT + CT-MPI strategy allows to minimize unnecessary invasive diagnostic catheterization and helps clinicians to referral or deferral for ICA/FFR with more confidence.
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Affiliation(s)
- Lijuan Lyu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Jichen Pan
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Dumin Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xinhao Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Wei Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Mei Dong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yeming Han
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yongfeng Liang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Sun Z, Silberstein J, Vaccarezza M. Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment. J Cardiovasc Dev Dis 2024; 11:22. [PMID: 38248892 PMCID: PMC10816599 DOI: 10.3390/jcdd11010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring images with high spatial and temporal resolution. The recent emergence of photon-counting CT has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor-patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease. With the widespread use of artificial intelligence, machine learning, and deep learning in cardiovascular disease, the diagnostic performance of cardiovascular CT has significantly improved, with promising results being presented in terms of both disease diagnosis and prediction. This review article provides an overview of the applications of cardiovascular CT, covering its performance from the perspective of its diagnostic value based on traditional lumen assessment to the identification of vulnerable lesions for the prediction of disease outcomes with the use of these advanced technologies. The limitations and future prospects of these technologies are also discussed.
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Affiliation(s)
- Zhonghua Sun
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
| | - Jenna Silberstein
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
| | - Mauro Vaccarezza
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
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28
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Gabara L, Hinton J, Kira M, Saunders A, Shambrook J, Abbas A, Leipsic JA, Rogers C, Mullen S, Ng N, Wilding S, Douglas PS, Patel M, Fairbairn TA, Hlatky MA, Curzen N. Derivation and validation of a novel functional FFR CT score incorporating the burden of coronary stenosis severity and flow impairment to predict clinical events. J Cardiovasc Comput Tomogr 2024; 18:33-42. [PMID: 37872028 DOI: 10.1016/j.jcct.2023.10.005] [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: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND A score combining the burden of stenosis severity on coronary computed tomography angiography (CCTA) and flow impairment by fractional flow reserve derived from computed tomography (FFRCT) may be a better predictor of clinical events than either parameter alone. METHODS The Functional FFRCT Score (FFS) combines CCTA and FFRCT parameters in an allocated point-based system. The feasibility of the FFS was assessed in cohort of 72 stable chest pain patients with matched CCTA and FFRCT datasets. Validation was performed using 2 cohorts: (a) 4468 patients from the ADVANCE Registry to define its association with revascularization and major adverse cardiovascular events (MACE); (b) 212 patients from the FORECAST trial to determine predictors of MACE. RESULTS The median calculation time for the FFS was 10 (interquartile range 6-17) seconds, with strong intra-operator and inter-operator agreement (Cohen's Kappa 0.89 (±0.37, p < 0.001) and 0.83 (±0.04, p < 0.001, respectively). The FFS correlated strongly with both the CT-SYNTAX and the Functional CT-SYNTAX scores (rS = 0.808 for both, p < 0.001). In the ADVANCE cohort the FFS had good discriminatory abilities for revascularization with an area under the curve of 0.82, 95 % confidence interval (CI) 0.81-0.84, p < 0.001. Patients in the highest FFS tertile had significantly higher rates of revascularization (61 % vs 5 %, p < 0.001) and MACE (1.9 % vs 0.5 %, p = 0.001) compared with the lowest FFS tertile. In the FORECAST cohort the FFS was an independent predictor of MACE at 9-month follow-up (hazard ratio 1.04, 95 % CI 1.01-1.08, p < 0.01). CONCLUSION The FFS is a quick-to-calculate and reproducible score, associated with revascularization and MACE in two distinct populations of stable symptomatic patients.
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Affiliation(s)
- Lavinia Gabara
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Kira
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK
| | - Alec Saunders
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK
| | - James Shambrook
- Department of Cardiothoracic Radiology, Wessex Cardiac Centre, University Hospital Southampton NHS FT, Southampton, UK
| | - Ausami Abbas
- Department of Cardiothoracic Radiology, Wessex Cardiac Centre, University Hospital Southampton NHS FT, Southampton, UK
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - Sam Wilding
- Clinical Trials Unit, University of Southampton, UK
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Centre, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Manesh Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Centre, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Mark A Hlatky
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA; Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK.
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Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Miyashita K, Masuda S, Kageyama S, Garg S, Leipsic JA, Mushtaq S, Andreini D, Tanaka K, de Mey J, Wijns W, Tu S, Piazza N, Onuma Y, Serruys PW. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters. Int J Cardiovasc Imaging 2024; 40:195-206. [PMID: 37870715 PMCID: PMC10774209 DOI: 10.1007/s10554-023-02974-z] [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: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1-95.6) and 84.8% (71.1-93.7), and specificity was 96.8% (93.8-98.6) and 97.2% (94.4-98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.
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Affiliation(s)
- Nozomi Kotoku
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Saima Mushtaq
- Departments of Cardiovascular Imaging and Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - 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
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
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Gohmann RF, Schug A, Pawelka K, Seitz P, Majunke N, El Hadi H, Heiser L, Renatus K, Desch S, Leontyev S, Noack T, Kiefer P, Krieghoff C, Lücke C, Ebel S, Borger MA, Thiele H, Panknin C, Abdel-Wahab M, Horn M, Gutberlet M. Interrater variability of ML-based CT-FFR during TAVR-planning: influence of image quality and coronary artery calcifications. Front Cardiovasc Med 2023; 10:1301619. [PMID: 38188259 PMCID: PMC10768187 DOI: 10.3389/fcvm.2023.1301619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To compare machine learning (ML)-based CT-derived fractional flow reserve (CT-FFR) in patients before transcatheter aortic valve replacement (TAVR) by observers with differing training and to assess influencing factors. Background Coronary computed tomography angiography (cCTA) can effectively exclude CAD, e.g. prior to TAVR, but remains limited by its specificity. CT-FFR may mitigate this limitation also in patients prior to TAVR. While a high reliability of CT-FFR is presumed, little is known about the reproducibility of ML-based CT-FFR. Methods Consecutive patients with obstructive CAD on cCTA were evaluated with ML-based CT-FFR by two observers. Categorization into hemodynamically significant CAD was compared against invasive coronary angiography. The influence of image quality and coronary artery calcium score (CAC) was examined. Results CT-FFR was successfully performed on 214/272 examinations by both observers. The median difference of CT-FFR between both observers was -0.05(-0.12-0.02) (p < 0.001). Differences showed an inverse correlation to the absolute CT-FFR values. Categorization into CAD was different in 37/214 examinations, resulting in net recategorization of Δ13 (13/214) examinations and a difference in accuracy of Δ6.1%. On patient level, correlation of absolute and categorized values was substantial (0.567 and 0.570, p < 0.001). Categorization into CAD showed no correlation to image quality or CAC (p > 0.13). Conclusion Differences between CT-FFR values increased in values below the cut-off, having little clinical impact. Categorization into CAD differed in several patients, but ultimately only had a moderate influence on diagnostic accuracy. This was independent of image quality or CAC.
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Affiliation(s)
- Robin F. Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Adrian Schug
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Konrad Pawelka
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Hamza El Hadi
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Linda Heiser
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Katharina Renatus
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Michael A. Borger
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
| | | | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
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Yu Y, Kou J, Guo F, Zhang D, Pan T, Chen Y, Bao W, Sun Y, Zhang H, Li C. Prognostic value of CT-derived fractional flow reserve and fat attenuation index in patients with suspected coronary artery disease: a sex-disaggregated analyses. BMC Cardiovasc Disord 2023; 23:612. [PMID: 38093240 PMCID: PMC10720191 DOI: 10.1186/s12872-023-03650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND There are sex differences in many risk factors associated with coronary artery disease (CAD). CT-derived fractional flow reserve (CT-FFR) and fat attenuation index (FAI) have been shown to independently predict cardiovascular events. We aimed to examine the impact of sex on the prognostic value of CT-FFR and FAI in suspected CAD patients, and to examine the incremental prognostic value of FAI over CT-FFR in both sex. METHODS A total of 1334 consecutive suspected CAD subjects who underwent coronary computed tomographic angiography (CCTA) were retrospectively collected. We divided the patients into males and females and calculated CT-FFR and FAI data from CCTA images. Kaplan-Meier analysis was used to assess the risk of major adverse cardiovascular events (MACE) stratified by CT-FFR and FAI in both sex. Cox regression models were used to assess the incremental prognostic value of FAI by adding the variable to a model that included CT-FFR and clinical variables. RESULTS During a median follow-up of 2.08 years, 212 patients had MACE. CT-FFR ≤ 0.80 was significantly associated with MACE in both sex. FAI value of left anterior descending artery (FAI[LAD]) and FAI value of left circumflex (FAI[LCX]) ≥ 70.1 were significantly associated with MACE in females. FAI[LCX] added incremental prognostic value over clinical and CT-FFR variables in females, with hazard ratio (HR) 3.230 (1.982-5.265, P = 0.000), Harrel's C 0.669 (P < 0.001), net reclassification improvement (NRI) 0.161 (0.073-0.260, P < 0.001), and integrated discrimination index (IDI) 0.036 (0.008-0.090, P = 0.010). FAI[LAD] did not enhance risk prediction in females (Harrel's C 0.643, P = 0.054; NRI 0.041, P = 0.189; IDI 0.005, P = 0.259). The decision curve analysis demonstrated that the model including FAI[LCX] resulted in the highest net benefit. CONCLUSIONS In suspected CAD patients, the prognostic value of CT-FFR is not significantly biased by sex. The prognostic value of FAI[LAD] and FAI[LCX] were significantly associated with MACE in females, but not males. FAI[LCX], not FAI[LAD], added incremental prognostic value over CT-FFR and might enhance CT-FFR risk stratification in females.
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Affiliation(s)
- Yang Yu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Medical Imaging, Cangzhou People's Hospital, Cangzhou, China
| | - Jieli Kou
- Department of Medical Imaging, Cangzhou People's Hospital, Cangzhou, China
| | - Fuqian Guo
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dan Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tong Pan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yicheng Chen
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenjun Bao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhan Sun
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haowen Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Caiying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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Huang W, Liu X, Cheng P, Li Y, Zhou H, Liu Y, Dong Y, Wang P, Xu C, Xu X. Prognostic value of plaque volume combined with CT fractional flow reserve in patients with suspected coronary artery disease. Clin Radiol 2023; 78:e1048-e1056. [PMID: 37788967 DOI: 10.1016/j.crad.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023]
Abstract
AIM To investigate the prognostic value of quantitative plaque volume on coronary computed tomography (CT) angiography (CTA) combined with CT fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE) in suspected coronary artery disease (CAD) patients. MATERIALS AND METHODS Patients who underwent coronary CTA with clinically suspected CAD were enrolled retrospectively in this study. Patients' baseline, Framingham Risk Score (FRS), coronary CTA plaque assessment, and CT-FFR were analysed retrospectively. Study outcomes included rehospitalisation and MACE (ST-segment elevation myocardial infarction, unstable angina, or non-ST-segment elevation myocardial infarction, revascularisation, and cardiac death). RESULTS There were 251 patients in the study, with a follow-up period of 1-6.58 years. Mean age was 61.16 ± 10.45 years and 146 (58%) patients were male. Higher CT-adapted Leaman score and quantitative plaque volume were found in patients with FRS >0.2 regardless of categorical or continuous variables. Coronary scores, quantitative plaque parameters, and CT-FFR were associated with MACE and rehospitalisation in univariate analysis. In model 1, CT-FFR was associated with MACE in multivariate Cox analysis when adjusted for FRS and CT-adapted Leaman score. Quantitative plaque parameters including calcified plaque volume, fibro-fatty plaque volume, low-attenuation plaque volume, non-calcified plaque volume, and total plaque volume were significantly associated with MACE and improved overall prognostic performance in a model adjusted for CT-FFR. CONCLUSION Additional quantitative plaque volume and CT-FFR further improve the predictive incremental value based on risk factor scores for prognostic prediction in patients. Adding quantitative plaque volume combined with CT-FFR analysis to anatomical and clinical assessment will be further beneficial to predict patients' prognosis of MACE.
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Affiliation(s)
- W Huang
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - X Liu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - P Cheng
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan 430022, China
| | - H Zhou
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Liu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - Y Dong
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - P Wang
- Department of Clinical Laboratory, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China
| | - C Xu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, 1037 Luoyu Road, Hongshan District, Wuhan 430070, China
| | - X Xu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China.
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Tao M, Gier C, Al-Sadawi M, Dhaliwal S, Masson R, Rahman T, Gavalas M, Tam E, Mann N. Utility of Fractional Flow Reserve Computed Tomography Angiography in Patients With Stable Coronary Artery Disease. Am J Cardiol 2023; 208:31-36. [PMID: 37812863 DOI: 10.1016/j.amjcard.2023.07.080] [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: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 10/11/2023]
Abstract
Coronary computed tomography angiography is a modality with high negative predictive value for evaluation of coronary artery disease (CAD). However, its diagnostic accuracy for obstructive CAD is limited by multiple factors. Fractional flow reserve (FFR) computed tomography (FFRCT) is an emerging analysis tool for identifying flow-limiting disease; nonetheless, the prognostic value of FFRCT is not well established. This meta-analysis aims to evaluate the association of FFRCT with clinical outcomes in patients with stable CAD. A literature search was conducted for studies reporting the association between FFRCT measurements and all-cause mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), and any need for coronary revascularization. Obstructive disease was defined as a FFR value ≤0.80; nonobstructive disease was defined as an FFR value >0.80. Ten studies were identified to meet the inclusion criteria; mean follow-up was 17 months (range, 3 to 56 months). There was no difference in risk of all-cause mortality between patients with obstructive and those with nonobstructive CAD on FFRCT. However, obstructive lesions were associated with increased risk of MACE, AMI, and any need for revascularization. FFRCT is a useful adjunctive modality for further risk stratification of patients with stable CAD. Obstructive lesions identified by FFRCT are associated with increased risk of MACE, AMI, and any need for revascularization.
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Affiliation(s)
- Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Simrat Dhaliwal
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Ravi Masson
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Tahmid Rahman
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Michael Gavalas
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Edlira Tam
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Noelle Mann
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York..
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Fujimoto S, Nozaki YO, Sakamoto T, Nakanishi R, Asano T, Kadota K, Komiyama K, Taguchi E, Okubo R, Saito A, Ikuta A, Nojiri S, Tanabe K. Clinical impacts of CT-derived fractional flow reserve under insurance reimbursement: Results from multicenter, prospective registry. J Cardiol 2023:S0914-5087(23)00273-3. [PMID: 37949315 DOI: 10.1016/j.jjcc.2023.11.002] [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: 07/02/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Although computed tomography-derived fractional flow reserve (FFRCT) has been reimbursed in a few countries, its impacts on daily practice of coronary artery diseases are not fully elucidated. We evaluated the clinical impacts of FFRCT under the real Japanese insurance reimbursement. METHODS In the multicenter prospective registry: DYNAMIC-FFRCT study, a total of 410 patients who underwent FFRCT analysis under reimbursement were prospectively enrolled at 6 Japanese sites from October 2019 to November 2021. Coronary CT angiography and FFRCT findings, treatment plans, and 90-day outcomes were recorded. The primary endpoint was the redirection rate from the tests that might be expected without FFRCT [invasive coronary angiography (ICA)-selected group, myocardial perfusion single photon emission CT (MPS)-selected group, optimal medical therapy (OMT)-selected group, and others-selected group] to those that were actually performed based on FFRCT. RESULTS ICA could be avoided in 39.5 % in the ICA-selected group (N = 233). In particular, in 94.3 % of patients with an FFRCT value of >0.80, additional examinations, such as ICA, were avoided. In addition, in the MPS-selected group (N = 133), 92.6 % had no additional tests with FFRCT > 0.80, while only 2 cases with FFRCT ≤ 0.80 underwent additional MPS examination. On the contrary, 33.3 % of the OMT-selected group (N = 33) had FFRCT ≤ 0.80. Approximately, 35 % medical cost reduction was also finally expected. CONCLUSION Introduction of FFRCT could not only reduce unnecessary ICA and be a test that replaces the conventional non-invasive functional assessment modality but also result in medical cost reduction even when used under real Japanese insurance reimbursement.
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Affiliation(s)
- Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yui O Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Ryo Okubo
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Akira Saito
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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Han H, Liu M, Yu Y, Chen Y, Xu Y. Predictive value of coronary artery computed tomography-derived fractional flow reserve for cardiovascular events in patients with coronary artery disease. Herz 2023:10.1007/s00059-023-05220-3. [PMID: 37923966 DOI: 10.1007/s00059-023-05220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/23/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Coronary computed tomography-derived fractional flow reserve (FFR-CT) assesses whether coronary artery lesions will result in myocardial ischemia. This study aimed to evaluate the predictive value of FFR-CT for cardiovascular events in patients with coronary artery disease (CAD). METHODS Data were collected retrospectively from patients with CAD who underwent FFR-CT at our hospital from January 2020 to February 2022 (1-year average follow-up). Patients were divided into ischemic (FFR-CT ≤ 0.80) and non-ischemic (FFR-CT > 0.80) groups. The incidence of endpoint events (cardiac death, acute myocardial infarction, unplanned revascularization, unstable angina, and stable angina) was calculated. The FFR-CT value was correlated with endpoint events using Cox regression models and Kaplan-Meier survival curves. RESULTS We recruited 134 patients (93 [69.4%] and 41 [30.6%] patients in the ischemic and non-ischemic groups, respectively). The ischemic group had a higher proportion of men, patients with type 2 diabetes and hypertension, and patients taking antiplatelet drugs and β‑blockers than did the non-ischemic group (all p < 0.05), whereas other parameters were comparable. Multivariate Cox regression analysis revealed no significant differences in cardiac death, acute myocardial infarction, unplanned revascularization, and unstable angina between the groups. The incidence of stable angina events (hazard ratio: 3.092, 95% confidence interval: 1.362-7.022, p = 0.007) was significantly higher in the ischemic group. Kaplan-Meier survival analysis revealed a significant difference in event-free survival for stable angina between the groups (p = 0.002). CONCLUSION In patients with CAD, FFR-CT showed an independent predictive value for stable angina within 1 year of examination.
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Affiliation(s)
- Hongwei Han
- Department of Cardiovascular Medicine, 903 RD Hospital of the Chinese People's Liberation Army, 310000, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, 310000, Hangzhou, Zhejiang, China
| | - Meijun Liu
- Department of Cardiovascular Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Cardiovascular Medicine, 903 RD Hospital of the Chinese People's Liberation Army, 310000, Hangzhou, Zhejiang, China
| | - Yuan Chen
- Department of Cardiovascular Medicine, 903 RD Hospital of the Chinese People's Liberation Army, 310000, Hangzhou, Zhejiang, China
| | - Yizhou Xu
- Department of Cardiovascular Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, Zhejiang, China
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Tomizawa N, Fujimoto S, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kadowaki S, Ikeda F, Kumamaru KK, Watada H, Minamino T, Aoki S. Energy loss is related to CT fractional flow reserve progression in type 2 diabetes mellitus patients. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100328. [PMID: 38511178 PMCID: PMC10945932 DOI: 10.1016/j.ahjo.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 03/22/2024]
Abstract
Background We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 diabetes mellitus. Methods This single-center prospective study included 61 patients with type 2 diabetes mellitus (mean age, 61 years ±9 [SD]; 43 men) showing 20-70 % stenosis who underwent serial coronary CT performed at 2-year interval between October 2015 and March 2020. A mesh-free simulation was performed to calculate the CT-FFR and EL. Functional progression was defined as ≥ 0.05 decrease in CT-FFR on the second coronary CT. Models using baseline CT-FFR and EL were compared by analyzing the receiver operating characteristic (ROC) curve. Results Of the 94 vessels evaluated, 25 vessels (27 %) showed functional progression. EL at distal stenosis (ELdis) of vessels with functional progression was higher than that of vessels without functional progression (27.6 W/m3 [interquartile range (IQR): 15.0, 53.0] vs. 5.7 W/m3 [IQR: 2.3, 10.1], p < 0.001). Multivariable analysis showed that ELdis (per unit Ln(EL); odds ratio, 11.8; 95 % CI: 4.0-34.9; p < 0.001) remained as a predictor of functional progression after adjustment for diameter stenosis and baseline CT-FFR. The area under the ROC curve using ELdis (0.89; 95 % CI: 0.82-0.96) was higher than that using baseline CT-FFR (0.71; 95 % CI: 0.59-0.83; p < 0.001). Conclusion When ELdis and baseline CT-FFR were considered, ELdis was a better predictor of functional progression of coronary stenosis.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yui Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ruiheng Fan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Kadowaki
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fuki Ikeda
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K. Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Machado MF, Felix N, Melo PHC, Gauza MM, Calomeni P, Generoso G, Khatri S, Altmayer S, Blankstein R, Bittencourt MS, Cardoso R. Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography in Stable Chest Pain: A Meta-Analysis of Randomized Controlled Trials. Circ Cardiovasc Imaging 2023; 16:e015800. [PMID: 37988448 DOI: 10.1161/circimaging.123.015800] [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: 06/14/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in several trials with conflicting results. METHODS We performed a systematic review and meta-analysis comparing CCTA first versus direct ICA among patients with stable chest pain, who were initially referred to ICA. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials comparing the 2 strategies. Risk ratios (RRs) and mean differences with 95% CIs were computed for binary and continuous outcomes, respectively. RESULTS Five randomized controlled trials with a total of 5727 patients were included, of whom 51.1% were referred to CCTA and 22.5% of patients had evidence of ischemia on a prior functional test. In the follow-up ranging from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first underwent ICA (23%). Patients who underwent CCTA had lower rates of coronary revascularization (RR, 0.74 [95% CI, 0.66-0.84]; P<0.001) and stroke (RR, 0.50 [95% CI, 0.26-0.98]; P=0.043). Cardiovascular mortality (RR, 0.55 [95% CI, 0.24-1.23]; P=0.146), major adverse cardiovascular events (RR, 0.84 [95% CI, 0.64-1.10]; P=0.198), nonfatal myocardial infarction (RR, 1.09 [95% CI, 0.63-1.88]; P=0.768), and cardiovascular hospitalizations (RR, 0.91 [95% CI, 0.59-1.39]; P=0.669) did not differ significantly between groups. CONCLUSIONS In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. CCTA was associated with a reduction in the rates of coronary revascularization and stroke compared with direct ICA. REGISTRATION URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023383143.
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Affiliation(s)
- Marina F Machado
- Division of Cardiovascular Medicine, Faculdades Integradas Pitágoras de Montes Claros, Brazil (M.F.M.)
| | - Nicole Felix
- Division of Cardiovascular Medicine, Federal University of Campina Grande, Brazil (N.F.)
| | - Pedro H C Melo
- Division of Cardiovascular Medicine, Cardiovascular Research Foundation, New York, NY (P.H.C.M.)
| | - Mateus M Gauza
- Division of Cardiovascular Medicine, University of the Region of Joinville, Brazil (M.M.G.)
| | - Pedro Calomeni
- Division of Cardiovascular Medicine, InCor Heart Institute, University of São Paulo Medical School, Brazil (P.C.)
| | | | - Sourabh Khatri
- Department of Internal Medicine (S.K.), University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stephan Altmayer
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (S.A.)
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., R.C.)
| | - Marcio Sommer Bittencourt
- Division of Cardiology, Department of Internal Medicine (M.S.B.), University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., R.C.)
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Kiso K. The Report of ASNC-JSNC Joint Symposium in JSNC 33 rd Annual Scientific Meeting. ANNALS OF NUCLEAR CARDIOLOGY 2023; 9:74-77. [PMID: 38058575 PMCID: PMC10696144 DOI: 10.17996/anc.23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023]
Abstract
The JSNC-ASNC joint symposium in the 33rd JSNC annual meeting was held on Jun. 24th, and we invited Prof. Mouaz H. Al-Mallah, who was the president of ASNC and requested the lecture entitled "Comparison of MPI and FFRCT". He introduced several cases and evidences reported previously, and summarized the current status of FFRCT, especially about the diagnostic performance, prognostic value, and proper use, compared to MPI.
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Affiliation(s)
- Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
- Sendai Medical Imaging Center, Miyagi, Japan
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Koo BK, Lee JM, Hwang D, Park S, Shiono Y, Yonetsu T, Lee SH, Kawase Y, Ahn JM, Matsuo H, Shin ES, Hu X, Ding D, Fezzi S, Tu S, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1. JACC. ASIA 2023; 3:689-706. [PMID: 38095005 PMCID: PMC10715899 DOI: 10.1016/j.jacasi.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.
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Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
| | - Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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40
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Gulsin GS, Tzimas G, Holmes KR, Takagi H, Sellers SL, Blanke P, Koweek LMH, Nørgaard BL, Jensen J, Rabbat MG, Pontone G, Fairbairn TA, Chinnaiyan KM, Douglas PS, Huey W, Matsuo H, Sand NPR, Nieman K, Bax JJ, Amano T, Kawasaki T, Akasaka T, Rogers C, Berman DS, Patel MR, De Bruyne B, Mullen S, Leipsic JA. Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes. Radiol Cardiothorac Imaging 2023; 5:e220276. [PMID: 37908552 PMCID: PMC10613926 DOI: 10.1148/ryct.220276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 11/02/2023]
Abstract
Purpose To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity. Conclusion Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
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Affiliation(s)
- Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kenneth-Royce Holmes
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Stephanie L. Sellers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Lynne M. H. Koweek
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bjarne L. Nørgaard
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jesper Jensen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Mark G. Rabbat
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Gianluca Pontone
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Timothy A. Fairbairn
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kavitha M. Chinnaiyan
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Pamela S. Douglas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Whitney Huey
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hitoshi Matsuo
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Niels P. R. Sand
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Koen Nieman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jeroen J. Bax
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tetsuya Amano
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tomohiro Kawasaki
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Takashi Akasaka
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Campbell Rogers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Daniel S. Berman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Manesh R. Patel
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bernard De Bruyne
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Sarah Mullen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
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Patel KK, Shaw LJ. Defining a Precise Diagnostic Strategy for Suspected Coronary Artery Disease-Lessons Learned From the PRECISE Trial. JAMA Cardiol 2023; 8:902-903. [PMID: 37610732 DOI: 10.1001/jamacardio.2023.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Affiliation(s)
- Krishna K Patel
- Department of Population Health Science and Policy and Medicine (Cardiology), Blavatnik Family Research Institute, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslee J Shaw
- Department of Population Health Science and Policy and Medicine (Cardiology), Blavatnik Family Research Institute, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Douglas PS, Nanna MG, Kelsey MD, Yow E, Mark DB, Patel MR, Rogers C, Udelson JE, Fordyce CB, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Vemulapalli S. Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:904-914. [PMID: 37610731 PMCID: PMC10448364 DOI: 10.1001/jamacardio.2023.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Trials showing equivalent or better outcomes with initial evaluation using coronary computed tomography angiography (cCTA) compared with stress testing in patients with stable chest pain have informed guidelines but raise questions about overtesting and excess catheterization. Objective To test a modified initial cCTA strategy designed to improve clinical efficiency vs usual testing (UT). Design, Setting, and Participants This was a pragmatic randomized clinical trial enrolling participants from December 3, 2018, to May 18, 2021, with a median of 11.8 months of follow-up. Patients from 65 North American and European sites with stable symptoms of suspected coronary artery disease (CAD) and no prior testing were randomly assigned 1:1 to precision strategy (PS) or UT. Interventions PS incorporated the Prospective Multicenter Imaging Study for the Evaluation of Chest Pain (PROMISE) minimal risk score to quantitatively select minimal-risk participants for deferred testing, assigning all others to cCTA with selective CT-derived fractional flow reserve (FFR-CT). UT included site-selected stress testing or catheterization. Site clinicians determined subsequent care. Main Outcomes and Measures Outcomes were clinical efficiency (invasive catheterization without obstructive CAD) and safety (death or nonfatal myocardial infarction [MI]) combined into a composite primary end point. Secondary end points included safety components of the primary outcome and medication use. Results A total of 2103 participants (mean [SD] age, 58.4 [11.5] years; 1056 male [50.2%]) were included in the study, and 422 [20.1%] were classified as minimal risk. The primary end point occurred in 44 of 1057 participants (4.2%) in the PS group and in 118 of 1046 participants (11.3%) in the UT group (hazard ratio [HR], 0.35; 95% CI, 0.25-0.50). Clinical efficiency was higher with PS, with lower rates of catheterization without obstructive disease (27 [2.6%]) vs UT participants (107 [10.2%]; HR, 0.24; 95% CI, 0.16-0.36). The safety composite of death/MI was similar (HR, 1.52; 95% CI, 0.73-3.15). Death occurred in 5 individuals (0.5%) in the PS group vs 7 (0.7%) in the UT group (HR, 0.71; 95% CI, 0.23-2.23), and nonfatal MI occurred in 13 individuals (1.2%) in the PS group vs 5 (0.5%) in the UT group (HR, 2.65; 95% CI, 0.96-7.36). Use of lipid-lowering (450 of 900 [50.0%] vs 365 of 873 [41.8%]) and antiplatelet (321 of 900 [35.7%] vs 237 of 873 [27.1%]) medications at 1 year was higher in the PS group compared with the UT group (both P < .001). Conclusions and Relevance An initial diagnostic approach to stable chest pain starting with quantitative risk stratification and deferred testing for minimal-risk patients and cCTA with selective FFR-CT in all others increased clinical efficiency relative to UT at 1 year. Additional randomized clinical trials are needed to verify these findings, including safety. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology, Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Mehta CR, Naeem A, Patel Y. Cardiac Computed Tomography Angiography in CAD Risk Stratification and Revascularization Planning. Diagnostics (Basel) 2023; 13:2902. [PMID: 37761268 PMCID: PMC10530183 DOI: 10.3390/diagnostics13182902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE OF REVIEW Functional stress testing is frequently used to assess for coronary artery disease (CAD) in symptomatic, stable patients with low to intermediate pretest probability. However, patients with highly vulnerable plaque may have preserved luminal patency and, consequently, a falsely negative stress test. Cardiac computed tomography angiography (CCTA) has emerged at the forefront of primary prevention screening and has excellent agency in ruling out obstructive CAD with high negative predictive value while simultaneously characterizing nonobstructive plaque for high-risk features, which invariably alters risk-stratification and pre-procedural decision making. RECENT FINDINGS We review the literature detailing the utility of CCTA in its ability to risk-stratify patients with CAD based on calcium scoring as well as high-risk phenotypic features and to qualify the functional significance of stenotic lesions. SUMMARY Calcium scores ≥ 100 should prompt consideration of statin and aspirin therapy. Spotty calcifications < 3 mm, increased non-calcified plaque > 4 mm3 per mm of the vessel wall, low attenuation < 30 HU soft plaque and necrotic core with a rim of higher attenuation < 130 HU, and a positive remodeling index ratio > 1.1 all confer additive risk for acute plaque rupture when present. Elevations in the perivascular fat attenuation index > -70.1 HU are a strong predictor of all-cause mortality and can further the risk stratification of patients in the setting of a non-to-minimal plaque burden. Lastly, a CT-derived fractional flow reserve (FFRCT) < 0.75 or values from 0.76 to 0.80 in conjunction with additional risk factors is suggestive of flow-limiting disease that would benefit from invasive testing. The wealth of information available through CCTA can allow clinicians to risk-stratify patients at elevated risk for an acute ischemic event and engage in advanced revascularization planning.
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Affiliation(s)
- Chirag R. Mehta
- Department of Cardiology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA (Y.P.)
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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45
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Fujii Y, Kitagawa T, Ikenaga H, Tatsugami F, Awai K, Nakano Y. The reliability and utility of on-site CT-derived fractional flow reserve (FFR) based on fluid structure interactions: comparison with FFR CT based on computational fluid dynamics, invasive FFR, and resting full-cycle ratio. Heart Vessels 2023; 38:1095-1107. [PMID: 37004540 DOI: 10.1007/s00380-023-02265-6] [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: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
Fractional flow reserve (FFR) derived off-site by coronary computed tomography angiography (CCTA) (FFRCT) is obtained by applying the principles of computational fluid dynamics. This study aimed to validate the overall reliability of on-site CCTA-derived FFR based on fluid structure interactions (CT-FFR) and assess its clinical utility compared with FFRCT, invasive FFR, and resting full-cycle ratio (RFR). We calculated the CT-FFR for 924 coronary vessels in 308 patients who underwent CCTA for clinically suspected coronary artery disease. Of these patients, 35 patients with at least one obstructive stenosis (> 50%) detected on CCTA underwent both CT-FFR and FFRCT for further investigation. Furthermore, 24 and 20 patients underwent invasive FFR and RFR in addition to CT-FFR, respectively. The inter-observer correlation (r) of CT-FFR was 0.93 (95% confidence interval [CI] 0.85-0.97, P < 0.0001) with a mean absolute difference of - 0.0042 (limits of agreement - 0.073, 0.064); 97.3% of coronary arteries without obstructive lesions on CCTA had negative results for ischemia on CT-FFR (> 0.80). The correlation coefficient between CT-FFR and FFRCT for 105 coronary vessels was 0.87 (95% CI 0.82-0.91, P < 0.0001) with a mean absolute difference of - 0.012 (limits of agreement - 0.12, 0.10). CT-FFR correlated well with both invasive FFR (r = 0.66, 95% CI 0.36-0.84, P = 0.0003) and RFR (r = 0.78, 95% CI 0.51-0.91, P < 0.0001). These data suggest that CT-FFR can potentially substitute for FFRCT and correlates closely with invasive FFR and RFR with high reproducibility. Our findings should be proven by further clinical investigation in a larger cohort.
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Affiliation(s)
- Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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46
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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47
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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48
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Alexander M, Lan NSR, Dallo MJ, Briffa TG, Sanfilippo FM, Hooper A, Bartholomew H, Hii L, Hillis GS, McQuillan BM, Dwivedi G, Rankin JM, Ihdayhid AR. Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost-effective alternative care model: a retrospective cross-sectional study. Med J Aust 2023; 219:155-161. [PMID: 37403443 DOI: 10.5694/mja2.52018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year. MAIN OUTCOME MEASURES Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment). RESULTS The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non-ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50-69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed-days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved. CONCLUSION Many rural and remote Western Australians transferred for ICA in Perth have non-obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost-effective strategy for risk stratification of people with suspected CAD.
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Affiliation(s)
| | - Nick S R Lan
- Fiona Stanley Hospital, Perth, WA
- The University of Western Australia, Perth, WA
| | | | | | | | - Andrew Hooper
- Medical Royal Flying Doctor Service Western Australia, Perth, WA
| | | | | | - Graham S Hillis
- Royal Perth Hospital, Perth, WA
- The University of Western Australia, Perth, WA
| | - Brendan M McQuillan
- The University of Western Australia, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
| | - Girish Dwivedi
- Fiona Stanley Hospital, Perth, WA
- Harry Perkins Institute of Medical Research, Perth, WA
| | | | - Abdul Rahman Ihdayhid
- Fiona Stanley Hospital, Perth, WA
- Harry Perkins Institute of Medical Research, Perth, WA
- Curtin Medical School, Curtin University, Perth, WA
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Choi AD. CT-FFR: Real-World Questions, and the New CAD Imaging Triple Aim. JACC Cardiovasc Imaging 2023; 16:1066-1068. [PMID: 37269266 DOI: 10.1016/j.jcmg.2023.03.020] [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: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
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Tavoosi A, Kadoya Y, Chong AY, Small GR, Chow BJW. Utility of FFRCT in Patients with Chest Pain. Curr Atheroscler Rep 2023; 25:427-434. [PMID: 37358803 DOI: 10.1007/s11883-023-01117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The goal of this article is to review the data supporting the use of fractional flow reserve derived from coronary computed tomography angiography (FFRCT) in patients with chest pain. REVIEW FINDINGS Numerous clinical trials have demonstrated that the diagnostic accuracy of coronary computed tomography angiography (CCTA) can be improved with the use of FFRCT, primarily due to its superior specificity when compared to CCTA alone. This promising development may help reduce the need for invasive angiography in patients presenting with chest pain. Furthermore, some studies have indicated that incorporating FFRCT into decision-making is safe, with an FFRCT value of ≥ 0.8 being associated with favorable outcomes. While FFRCT has been shown to be feasible in patients with acute chest pain, further large-scale studies are warranted to confirm its utility. The emergence of FFRCT as a tool for the management of patients with chest pain is promising. However, potential limitations require the interpretation of FFRCT in conjunction with clinical context.
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Affiliation(s)
- Anahita Tavoosi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Yoshito Kadoya
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Aun Yeong Chong
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Gary R Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Benjamin J W Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
- Department of Radiology, University of Ottawa, Ottawa, Canada.
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