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Korosoglou G, Abanador-Kamper N, Tesche C, Renker M, André F, Weichsel L, Hell M, Bönner F, Cramer M, Kelle S, Schulz-Menger J, Fehske W, Rolf A, Frey N, Thiele H, Baldus S. Observer variabilities for the diagnosis of coronary artery disease using anatomical and functional testing: the impact of certification. Clin Res Cardiol 2025:10.1007/s00392-025-02661-0. [PMID: 40338329 DOI: 10.1007/s00392-025-02661-0] [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: 11/01/2024] [Accepted: 04/21/2025] [Indexed: 05/09/2025]
Abstract
AIM To compare the reproducibility in reporting of coronary computed tomography angiography (CCTA) or cardiovascular magnetic resonance imaging (CMR) by certified readers for CCTA and CMR by the German Society of Cardiology (DGK) versus that by non-certified readers. METHODS The study included 40 randomly selected CCTA and vasodilator stress CMR patient datasets. For CCTA, the degree of lumen narrowing, plaque composition, and high-risk plaque features were assessed. For CMR, wall motion and perfusion abnormalities and late gadolinium enhancement (LGE) were rated. All measures were conducted by segments and for individual patients. Intraclass correlation coefficients (ICC) were calculated to assess agreement between non-certified (n = 4) vs. DGK-certified readers (n = 4). RESULTS ICC for assessment of luminal narrowing, plaque composition, and high-risk features were, respectively, 0.65 (95% confidence intervals [CI] 0.59-0.69), 0.64 (95%CI 0.45-0.80), and 0.45 (95%CI 0.22-0.66) for non-certified versus 0.78 (95%CI 0.74-0.81), 0.88 (95%CI 0.79-0.93), and 0.89 (95%CI 0.81-0.95) for DGK-certified readers (p < 0.001 for all). ICC for the assessment of wall motion, perfusion, and LGE were, respectively, 0.41 (95%CI 0.35-0.48), 0.27 (95%CI 0.18-0.38), and 0.48 (95%CI 0.41-0.54) for non-certified versus 0.71 (95%CI 0.67-0.75), 0.71 (95%CI 0.67-0.75) and 0.67 (95%CI 0.62-0.71) for DGK-certified readers (p < 0.001 for all). The agreement was excellent among DGK-certified readers for obstructive CAD (≥ 70% lumen narrowing) assessed by CCTA and high for abnormal perfusion and for LGE by CMR in a per-patient analysis (0.88; 95%CI 0.79-0.94 and 0.84; 95%CI 0.71-0.92), respectively. CONCLUSION Substantially better CCTA and CMR reporting was observed for DGK-certified cardiologists, who achieved high agreement for diagnosing the presence or absence of obstructive CAD by CCTA and abnormal perfusion by CMR. Since important clinical decisions may be based on these readings, our data support quality-controlled education programs for advanced cardiac imaging.
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Affiliation(s)
- Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstr. 1, 69469, Weinheim, Germany.
- Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany.
| | | | - Christian Tesche
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Renker
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhein Main, Bad Nauheim, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120, Heidelberg, Germany
| | - Loris Weichsel
- Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstr. 1, 69469, Weinheim, Germany
- Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany
| | - Michaela Hell
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Florian Bönner
- Department of Cardiology, Pulmonology, and Vascular Medicine, Krankenhaus Düren, Düren, Germany
| | - Mareike Cramer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sebastian Kelle
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Charité, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Wolfgang Fehske
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhein Main, Bad Nauheim, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120, Heidelberg, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
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Nieman K, Chandrashekhar Y. Photon-Counting Detector Coronary CT Angiography: A Confidence Booster for Bloomy Vessels. JACC Cardiovasc Imaging 2025; 18:621-623. [PMID: 40335217 DOI: 10.1016/j.jcmg.2025.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2025]
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Ding Y, Shan D, Han T, Liu Z, Wang X, Dou G, Xin R, Guo Z, Chen G, Jing J, He B, Chen Y, Yang J. Incremental Prognostic Value of Perivascular Fat Attenuation Index in Patients with Diabetes with Coronary Artery Disease. Radiol Cardiothorac Imaging 2025; 7:e240242. [PMID: 40042997 DOI: 10.1148/ryct.240242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
Purpose To investigate whether pericoronary adipose tissue attenuation (PCATa) provides incremental prognostic value over commonly used coronary CT angiography (CCTA) parameters for predicting major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with diabetes mellitus (DM). Materials and Methods This prospective study included consecutive patients with type 2 DM who underwent CCTA due to suspected coronary artery disease between January 2015 and December 2017. PCATa of three coronary arteries was measured and evaluated. Cox proportional hazards regression was performed to investigate the prognostic value of PCATa for predicting MACCE. The incremental prognostic value of PCATa for MACCE was evaluated by comparing area under the receiver operating characteristic curve (AUC) values of four models (model 1: clinical characteristics, model 2: model 1 + conventional CCTA findings [coronary artery calcium score, Leiden score], model 3: model 2 + advanced CCTA findings [high-risk plaque, CT fractional flow reserve], model 4: model 3 + PCATa). Results Of the 1029 participants (mean age, 60.2 years ± 9.9 [SD]; 539 male) included in the study, 152 (14.8%) experienced MACCE during a median follow-up of 56.5 months. PCATa independently predicted MACCE after adjustment for clinical characteristics and commonly used CCTA findings (hazard ratio, 1.86 [95% CI: 1.24, 2.80]; P = .003). The model incorporating PCATa improved predictive performance for MACCE compared with the model including clinical characteristics and conventional and advanced CCTA parameters (AUC, 0.75 [95% CI: 0.71, 0.79] vs 0.73 [95% CI: 0.68, 0.77]; P = .009). Conclusion PCATa provided incremental prognostic value beyond clinical characteristics and other CCTA findings for prediction of MACCE in individuals with DM. Keywords: CT Angiography, Cardiac, Coronary Arteries, Inflammation, Outcomes Analysis, Coronary Computed Tomography Angiography, Diabetes Mellitus, Coronary Inflammation, Pericoronary Adipose Tissue Attenuation Supplemental material is available for this article. © RSNA, 2025.
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Affiliation(s)
- Yipu Ding
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- School of Medicine, Nankai University, Tianjin, China
| | - Dongkai Shan
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
| | - Tianwen Han
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
| | - Zinuan Liu
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Medical School of Chinese PLA, Beijing, China
| | - Xi Wang
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Guanhua Dou
- Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ran Xin
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- School of Medicine, Nankai University, Tianjin, China
| | - Ziqiang Guo
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Medical School of Chinese PLA, Beijing, China
| | - Guanxi Chen
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Medical School of Chinese PLA, Beijing, China
| | - Jing Jing
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Bai He
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Yundai Chen
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Junjie Yang
- Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China
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Mastrodicasa D, van Assen M, Huisman M, Leiner T, Williamson EE, Nicol ED, Allen BD, Saba L, Vliegenthart R, Hanneman K, Atzen S. Use of AI in Cardiac CT and MRI: A Scientific Statement from the ESCR, EuSoMII, NASCI, SCCT, SCMR, SIIM, and RSNA. Radiology 2025; 314:e240516. [PMID: 39873607 PMCID: PMC11783164 DOI: 10.1148/radiol.240516] [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: 02/22/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 01/30/2025]
Abstract
Artificial intelligence (AI) offers promising solutions for many steps of the cardiac imaging workflow, from patient and test selection through image acquisition, reconstruction, and interpretation, extending to prognostication and reporting. Despite the development of many cardiac imaging AI algorithms, AI tools are at various stages of development and face challenges for clinical implementation. This scientific statement, endorsed by several societies in the field, provides an overview of the current landscape and challenges of AI applications in cardiac CT and MRI. Each section is organized into questions and statements that address key steps of the cardiac imaging workflow, including ethical, legal, and environmental sustainability considerations. A technology readiness level range of 1 to 9 summarizes the maturity level of AI tools and reflects the progression from preliminary research to clinical implementation. This document aims to bridge the gap between burgeoning research developments and limited clinical applications of AI tools in cardiac CT and MRI.
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Affiliation(s)
| | | | - Merel Huisman
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | - Tim Leiner
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | - Eric E. Williamson
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | - Edward D. Nicol
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | - Bradley D. Allen
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | - Luca Saba
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
| | | | | | - Sarah Atzen
- From the Department of Radiology, University of Washington, UW
Medical Center-Montlake, Seattle, Wash (D.M.); Department of Radiology,
OncoRad/Tumor Imaging Metrics Core (TIMC), University of Washington, Seattle,
Wash (D.M.); Department of Radiology and Imaging Sciences, Emory University,
Atlanta, Ga (M.v.A.); Department of Radiology and Nuclear Medicine, Radboud
University Medical Center, Nijmegen, the Netherlands (M.H.); Department of
Radiology, Mayo Clinic, Rochester, Minn (T.L., E.E.W.); Departments of
Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom
(E.D.N.); School of Biomedical Engineering and Imaging Sciences, King’s
College, London, United Kingdom (E.D.N.); Department of Radiology, Northwestern
University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of
Radiology, University of Cagliari, Cagliari, Italy (L.S.); Department of
Radiology, University of Groningen, University Medical Center Groningen,
Hanzeplein 1 Postbus 30 001, 9700 RB Groningen, the Netherlands (R.V.);
Department of Medical Imaging, University Medical Imaging Toronto, University of
Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research
Institute, University Health Network, University of Toronto, Toronto, Ontario,
Canada (K.H.)
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Nicol E, Shaw LJ. Cardiac CT in the context of value-based care. J Cardiovasc Comput Tomogr 2025; 19:126-131. [PMID: 39168770 DOI: 10.1016/j.jcct.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 08/23/2024]
Abstract
Cardiac computed tomography (CCT) is often used synonymously with coronary CT angiography (CCTA) and coronary artery calcium scoring (CACS), but also encompasses the use of CT for the assessment of structural, valvular, and congenital heart disease, and other cardiovascular pathology. This paper looks at the role of cardiac CT in the context of value-based care and predominantly focuses on the role of cardiac CT in the assessment of coronary artery disease (CAD), as this is where most of the clinical use and evidence of value can be found. Critical questions as to the defining of quality health care using cardiac CT are highllighted and the wider use of CT for the assessment of non-coronary disease is commented on towards the end of the manuscript but does not yet have the same level of health economic and value-based evidence.
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Affiliation(s)
- Ed Nicol
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology and Radiology, Royal Brompton Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
| | - Leslee J Shaw
- Blavatnik Family Research Institute, Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Marwick TH, Chandrashekhar Y. Imaging and Precision Medicine: The End of the Road for "Lumpers?". JACC Cardiovasc Imaging 2024; 17:1518-1520. [PMID: 39632046 DOI: 10.1016/j.jcmg.2024.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
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Iraqi N, Mortensen MB, Sand NPR, Busk M, Grove EL, Dey D, Pedersen KB, Kanstrup H, Pedersen AU, Madsen KT, Parner E, Jensen JM, Nørgaard BL. Interscan reproducibility of computed tomography derived coronary plaque volume measurements. J Cardiovasc Comput Tomogr 2024; 18:583-592. [PMID: 39379201 DOI: 10.1016/j.jcct.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility. METHODS CCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level. RESULTS Median plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93-0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74-0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p = 0.003), or lowest image reconstructive iteration level (p < 0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p ≤ 0.001). CONCLUSION Overall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location.
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Affiliation(s)
- Nadia Iraqi
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Martin Bødtker Mortensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Martin Busk
- Department of Cardiology, Little Belt Hospital, Vejle-Kolding, Denmark
| | - Erik Lerkevang Grove
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, USA
| | | | - Helle Kanstrup
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Alexandra Uglebjerg Pedersen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Erik Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jesper Møller Jensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Linde Nørgaard
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Chen YC, Zheng J, Zhou F, Tao XW, Chen Q, Feng Y, Su YY, Zhang Y, Liu T, Zhou CS, Tang CX, Weir-McCall J, Teng Z, Zhang LJ. Coronary CTA-based vascular radiomics predicts atherosclerosis development proximal to LAD myocardial bridging. Eur Heart J Cardiovasc Imaging 2024; 25:1462-1471. [PMID: 38781436 DOI: 10.1093/ehjci/jeae135] [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: 01/14/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS Cardiac cycle morphological changes can accelerate plaque growth proximal to myocardial bridging (MB) in the left anterior descending artery (LAD). To assess coronary computed tomography angiography (CCTA)-based vascular radiomics for predicting proximal plaque development in LAD MB. METHODS AND RESULTS Patients with repeated CCTA scans showing LAD MB without proximal plaque in index CCTA were included from Jinling Hospital as a development set. They were divided into training and internal testing in an 8:2 ratio. Patients from four other tertiary hospitals were set as external validation set. The endpoint was proximal plaque development of LAD MB in follow-up CCTA. Four vascular radiomics models were built: MB centreline (MB CL), proximal MB CL (pMB CL), MB cross-section (MB CS), and proximal MB CS (pMB CS), whose performances were evaluated using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). In total, 295 patients were included in the development (n = 192; median age, 54 ± 11 years; 137 men) and external validation sets (n = 103; median age, 57 ± 9 years; 57 men). The pMB CS vascular radiomics model exhibited higher AUCs in training, internal test, and external sets (AUC = 0.78, 0.75, 0.75) than the clinical and anatomical model (all P < 0.05). Integration of the pMB CS vascular radiomics model significantly raised the AUC of the clinical and anatomical model from 0.56 to 0.75 (P = 0.002), along with enhanced NRI [0.76 (0.37-1.14), P < 0.001] and IDI [0.17 (0.07-0.26), P < 0.001] in the external validation set. CONCLUSION The CCTA-based pMB CS vascular radiomics model can predict plaque development in LAD MB.
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Affiliation(s)
- Yan Chun Chen
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Jin Zheng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | | | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China
| | - Yun Feng
- Department of Radiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223001, China
| | - Yun Yan Su
- Department of Radiology, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Gusu District, Suzhou, Jiangsu 215006, China
| | - Yu Zhang
- Outpatient Department of Military, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - Tongyuan Liu
- Department of Radiology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, China
| | - Chang Sheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Jonathan Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Royal Papworth Hospital, Cambridge, UK
| | - Zhongzhao Teng
- Nanjing Jingsan Medical Science and Technology, Ltd., Nanjing, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
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9
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Nurmohamed NS, Min JK, Anthopolos R, Reynolds HR, Earls JP, Crabtree T, Mancini GBJ, Leipsic J, Budoff MJ, Hague CJ, O'Brien SM, Stone GW, Berger JS, Donnino R, Sidhu MS, Newman JD, Boden WE, Chaitman BR, Stone PH, Bangalore S, Spertus JA, Mark DB, Shaw LJ, Hochman JS, Maron DJ. Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial. Eur Heart J 2024; 45:3735-3747. [PMID: 39101625 PMCID: PMC11439108 DOI: 10.1093/eurheartj/ehae471] [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: 09/15/2023] [Revised: 01/19/2024] [Accepted: 07/06/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND AND AIMS The aim of this study was to determine the prognostic value of coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque analysis in ISCHEMIA. METHODS Atherosclerosis imaging quantitative computed tomography (AI-QCT) was performed on all available baseline CCTAs to quantify plaque volume, composition, and distribution. Multivariable Cox regression was used to examine the association between baseline risk factors (age, sex, smoking, diabetes, hypertension, ejection fraction, prior coronary disease, estimated glomerular filtration rate, and statin use), number of diseased vessels, atherosclerotic plaque characteristics determined by AI-QCT, and a composite primary outcome of cardiovascular death or myocardial infarction over a median follow-up of 3.3 (interquartile range 2.2-4.4) years. The predictive value of plaque quantification over risk factors was compared in an area under the curve (AUC) analysis. RESULTS Analysable CCTA data were available from 3711 participants (mean age 64 years, 21% female, 79% multivessel coronary artery disease). Amongst the AI-QCT variables, total plaque volume was most strongly associated with the primary outcome (adjusted hazard ratio 1.56, 95% confidence interval 1.25-1.97 per interquartile range increase [559 mm3]; P = .001). The addition of AI-QCT plaque quantification and characterization to baseline risk factors improved the model's predictive value for the primary outcome at 6 months (AUC 0.688 vs. 0.637; P = .006), at 2 years (AUC 0.660 vs. 0.617; P = .003), and at 4 years of follow-up (AUC 0.654 vs. 0.608; P = .002). The findings were similar for the other reported outcomes. CONCLUSIONS In ISCHEMIA, total plaque volume was associated with cardiovascular death or myocardial infarction. In this highly diseased, high-risk population, enhanced assessment of atherosclerotic burden using AI-QCT-derived measures of plaque volume and composition modestly improved event prediction.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA
| | | | | | | | - James P Earls
- Cleerly, Inc, Denver, CO, USA
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | | | - G B John Mancini
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cameron J Hague
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey S Berger
- New York University Grossman School of Medicine, New York, NY, USA
| | - Robert Donnino
- New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Bernard R Chaitman
- St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St Louis, MO, USA
| | | | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, NY, USA
| | - John A Spertus
- University of Missouri—Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | | | - Leslee J Shaw
- Bronfman Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, NY, USA
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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10
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Jie P, Fan M, Zhang H, Wang O, Lv J, Liu Y, Zhang C, Liu Y, Zhao J. Diagnostic value of artificial intelligence-assisted CTA for the assessment of atherosclerosis plaque: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1398963. [PMID: 39290212 PMCID: PMC11405224 DOI: 10.3389/fcvm.2024.1398963] [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: 03/12/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
Background Artificial intelligence (AI) has increasingly been applied to computed tomography angiography (CTA) images to aid in the assessment of atherosclerotic plaque. Our aim was to explore the diagnostic accuracy of AI-assisted CTA for plaque diagnosis and classification through a systematic review and meta-analysis. Methods A systematic literature review was performed by searching PubMed, EMBASE, and the Cochrane Library according to PRISMA guidelines. Original studies evaluating the diagnostic accuracy of radiomics, machine-learning, or deep-learning techniques applied to CTA images for detecting stenosis, calcification, or plaque vulnerability were included. The quality and risk of bias of the included studies were evaluated using the QUADAS-2 tool. The meta-analysis was conducted using STATA software (version 17.0) to pool sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) to determine the overall diagnostic performance. Results A total of 11 studies comprising 1,484 patients were included. There was low risk of bias and substantial heterogeneity. The overall pooled AUROC for atherosclerotic plaque assessment was 0.96 [95% confidence interval (CI) 0.94-0.97] across 21 trials. Of these, for ≥50% stenosis detection, the AUROC was 0.95 (95% CI 0.93-0.96) in five studies. For identifying ≥70% stenosis, the AUROC was 0.96 (95% CI 0.94-0.97) in six studies. For calcium detection, the AUROC was 0.92 (95% CI 0.90-0.94) in six studies. Conclusion Our meta-analysis demonstrates that AI-assisted CTA has high diagnostic accuracy for detecting stenosis and characterizing plaque composition, with optimal performance in detecting ≥70% stenosis. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO, identifier (CRD42023431410).
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Affiliation(s)
- Pingping Jie
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Min Fan
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Haiyi Zhang
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Oucheng Wang
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Jun Lv
- Department of Comprehensive Internal Medicine, The Affiliated Chinese Traditional Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Yingchun Liu
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Chunyin Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Yong Liu
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Jie Zhao
- Department of Magnetic Resonance Imaging, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
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11
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Davidson MH, Hsieh A, Dicklin MR, Maki KC. The Imperative to Enhance Cost-Effectiveness for Cardiovascular Therapeutic Development. JACC Basic Transl Sci 2024; 9:1029-1040. [PMID: 39297137 PMCID: PMC11405807 DOI: 10.1016/j.jacbts.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 09/21/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Therapeutic agents, such as those that lower low-density lipoprotein cholesterol, have been a critical factor in mitigating CVD event risk and demonstrate the important role that drug discovery plays in reducing morbidity and mortality. However, rapidly rising development costs, diminishing returns, and an increasingly challenging regulatory environment have all contributed to a declining number of cardiovascular (CV) therapeutic agents entering the health care marketplace. For pharmaceutical companies, a traditional cardiovascular outcomes trial (CVOT) can be a major financial burden and impediment to CV agent development. They can take as long as a decade to conduct, delaying potential investment return while carrying risk of failure. For patients, lengthy CVOTs delay drug accessibility. Without cost-effective CVOTs, drug innovation may be compromised, with CV patients bearing the consequences. This paper reviews potential approaches for making CV drug development more cost-effective.
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Affiliation(s)
- Michael H Davidson
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
- NewAmsterdam Pharma, Naarden, the Netherlands
| | | | - Mary R Dicklin
- Midwest Biomedical Research, Addison, Illinois, and Boca Raton, Florida, USA
| | - Kevin C Maki
- Midwest Biomedical Research, Addison, Illinois, and Boca Raton, Florida, USA
- Indiana University School of Public Health, Bloomington, Indiana, USA
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12
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Vatsa N, Faaborg-Andersen C, Dong T, Blaha MJ, Shaw LJ, Quintana RA. Coronary Atherosclerotic Plaque Burden Assessment by Computed Tomography and Its Clinical Implications. Circ Cardiovasc Imaging 2024; 17:e016443. [PMID: 39163370 PMCID: PMC11566462 DOI: 10.1161/circimaging.123.016443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Recent studies have demonstrated that coronary plaque burden carries greater prognostic value in predicting adverse atherosclerotic cardiovascular disease outcomes than myocardial ischemia, thereby challenging the existing paradigm. Advances in plaque quantification through both noncontrast and contrast-enhanced computed tomography (CT) methods have led to earlier and more cost-effective detection of coronary disease compared with traditional stress testing. The 2 principal techniques of noninvasive coronary plaque quantification assessment are coronary artery calcium scoring by noncontrast CT and coronary CT angiography, both of which correlate with disease burden on invasive angiography. Plaque quantification from these imaging modalities has shown utility in risk stratification and prognostication of adverse cardiovascular events, leading to increased incorporation into clinical practice guidelines and preventive care pathways. Furthermore, due to their expanding clinical value, emerging technologies such as artificial intelligence are being integrated into plaque quantification platforms, placing more advanced measures of plaque burden at the forefront of coronary plaque evaluation. In this review, we summarize recent clinical data on coronary artery calcium scoring and coronary CT angiography plaque quantification in the evaluation of adverse atherosclerotic cardiovascular disease in patients with and without chest pain, highlight how these methods compare to invasive quantification approaches, and directly compare the performance characteristics of coronary artery calcium scoring and coronary CT angiography.
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Affiliation(s)
- Nishant Vatsa
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | | | - Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic OH
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD
| | - Leslee J. Shaw
- Blavatnik Family Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raymundo A. Quintana
- Cardiovascular Imaging Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
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13
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Quintana RA, von Knebel Doeberitz P, Vatsa N, Liu C, Ko YA, De Cecco CN, van Assen M, Quyyumi AA. Intra- and inter-reader reproducibility in quantitative coronary plaque analysis on coronary computed tomography angiography. Curr Probl Cardiol 2024; 49:102585. [PMID: 38688396 PMCID: PMC11146670 DOI: 10.1016/j.cpcardiol.2024.102585] [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: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Coronary artery plaque burden, low attenuation non-calcified plaque (LAP), and pericoronary adipose tissue (PCAT) on coronary CT angiography (CCTA), have been linked to future cardiac events. The purpose of this study was to evaluate intra- and inter reader reproducibility in the quantification of coronary plaque burden and its characteristics using an artificial intelligence-enhanced semi-automated software. MATERIALS AND METHODS A total of 10 women and 6 men, aged 52 (IQR 49-58) underwent CCTA using a Siemens Somatom Force, Somatom Definition AS and Somatom Definition Flash scanners. Two expert readers utilized dedicated semi-automatic software (vascuCAP, Elucid Bioimaging, Wenham, MA) to assess calcified plaque, low attenuation plaque and PCAT. Readers were blinded to all clinical information and repeated their analysis at 6 weeks in random order to minimize recall bias. Data analysis was performed on the right and left coronary arteries. Intra- and inter-reader reproducibility was compared using Pearson correlation coefficient, while absolute values between analyses and readers were compared with paired non-parametric tests. This is a sub-study of the Specialized Center of Research Excellence (SCORE) clinical trial (5U54AG062334). RESULTS A total of 64 vessels from 16 patients were analyzed. Intra-reader Pearson correlation coefficients for calcified plaque volume, LAP volume and PCAT volumes were 0.96, 0.99 and 0.92 for reader 1 and 0.94, 0.94 and 0.95 for reader 2, respectively, (all p < 0.0001). Inter-reader Pearson correlation coefficients for calcified plaque volume, LAP and PCAT volumes were 0.92, 0.96 and 0.78, and 0.99, 0.99 and 0.93 on the second analyses, all had a p value <0.0001. There was no significant bias on the corresponding Bland-Altman analyses. CONCLUSION Volume measurement of coronary plaque burden and PCAT volume can be performed with high intra- and inter-reader agreement.
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Affiliation(s)
- Raymundo A Quintana
- Cardiovascular Imaging Section, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Philipp von Knebel Doeberitz
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nishant Vatsa
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA; Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
| | - Marly van Assen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA; Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
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14
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Mostaza JM, Pintó X, Armario P, Masana L, Real JT, Valdivielso P, Arrobas-Velilla T, Baeza-Trinidad R, Calmarza P, Cebollada J, Civera-Andrés M, Cuende Melero JI, Díaz-Díaz JL, Espíldora-Hernández J, Fernández Pardo J, Guijarro C, Jericó C, Laclaustra M, Lahoz C, López-Miranda J, Martínez-Hervás S, Muñiz-Grijalvo O, Páramo JA, Pascual V, Pedro-Botet J, Pérez-Martínez P, Puzo J. SEA 2024 Standards for Global Control of Vascular Risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:133-194. [PMID: 38490888 DOI: 10.1016/j.arteri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
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Affiliation(s)
- José María Mostaza
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España.
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBERobn), Fundación para la Investigación y Prevención de las Enfermedades Cardiovasculares (FIPEC), Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Pedro Armario
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Universitat Rovira i Virgili, Tarragona, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España
| | - Teresa Arrobas-Velilla
- Laboratorio de Nutrición y RCV, UGC de Bioquímica clínica, Hospital Virgen Macarena, Sevilla, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Jesús Cebollada
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Miguel Civera-Andrés
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - José I Cuende Melero
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - José L Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Javier Espíldora-Hernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España; Unidad de Lípidos y Unidad Asistencial de Hipertensión Arterial- Riesgo Vascular (HTA-RV), UGC Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Jacinto Fernández Pardo
- Servicio de Medicina Interna, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Murcia, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorón, España
| | - Carles Jericó
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Martín Laclaustra
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Lahoz
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Ovidio Muñiz-Grijalvo
- Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - José A Páramo
- Servicio de Hematología, Clínica Universidad de Navarra, Navarra, España; Laboratorio Aterotrombosis, CIMA, Universidad de Navarra, Pamplona, España
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - José Puzo
- Servicio de Bioquímica Clínica, Unidad de Lípidos, Hospital General Universitario San Jorge de Huesca, Huesca, España; Departamento de Medicina, Universidad de Zaragoza, Zaragoza, España
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15
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Hondros CAB, Khan I, Solvik M, Hanseth S, Pedersen EKR, Hovland S, Larsen TH, Lønnebakken MT. Compositional plaque progression in women and men with non-obstructive coronary artery disease. IJC HEART & VASCULATURE 2024; 51:101352. [PMID: 38356931 PMCID: PMC10865024 DOI: 10.1016/j.ijcha.2024.101352] [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: 10/25/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
Background In coronary artery disease (CAD), plaque progression and plaque composition are associated with cardiovascular risk. Whether compositional plaque progression in non-obstructive CAD differs between women and men is less studied. Methods We included 31 patients (42% women) with chronic non-obstructive CAD from the Norwegian Registry of Invasive Cardiology, undergoing serial coronary computed tomography angiography (CCTA) on clinical indication (median inter-scan interval 1.8 [1.5-2.2] years). We performed quantitative and qualitative plaque analysis of all coronary artery segments. Results Women were older compared to men (65 ± 8 years vs. 55 ± 12 years, p = 0.019), while there was no difference in the prevalence of hypertension, diabetes, smoking or statin treatment between groups. At baseline, women had a higher total plaque burden, more calcified plaques, and less fibro-fatty and necrotic core plaques compared to men (all p < 0.05). During follow-up, men showed faster progression of fibro-fatty plaques (4.0 ± 5.4 % per year vs. -0.6 ± 3.1 % per year, p = 0.019) and a greater reduction of fibrous plaques (-7.3 ± 6.1 % per year vs. 2.1 ± 7.2 % per year, p = 0.003) compared to women even after age adjustment. At follow-up, total plaque burden remained higher in women compared to men (24.9 ± 3.3 % vs. 21.1 ± 2.6 %, p = 0.001), while men had an increase in fibro-fatty (21.2 ± 9.3 % vs. 28.6 ± 9.8 %, p = 0.004) and necrotic core plaques (5.6 ± 3.6 % vs. 10.8 ± 7.2 %, p = 0.006), and a decrease in fibrous plaques (69.0 ± 11.9 % vs. 54.7 ± 13.7 %, p < 0.001). Women's plaque composition remained unaltered. Conclusion In non-obstructive CAD, serial CCTA demonstrated a higher total plaque burden and a stable plaque composition in women, while men had a faster progression of unstable low-attenuating fibro-fatty plaques.Clinical trial registration: ClinicalTrials.gov: Identifier NCT04009421.
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Affiliation(s)
- Caroline Annette Berge Hondros
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Ingela Khan
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Margrete Solvik
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Silja Hanseth
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009 Bergen, Norway
| | - Eva Kristine Ringdal Pedersen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Siren Hovland
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Norwegian Registry of Invasive Cardiology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Terje Hjalmar Larsen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Biomedicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
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16
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Guan H, Tian J, Wang Y, Niu P, Zhang Y, Zhang Y, Fang X, Miao R, Yin R, Tong X. Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review. Eur J Med Res 2024; 29:152. [PMID: 38438934 PMCID: PMC10910816 DOI: 10.1186/s40001-024-01739-1] [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: 12/04/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) poses a significant global health burden. This is particularly due to its macrovascular complications, such as coronary artery disease, peripheral vascular disease, and cerebrovascular disease, which have emerged as leading contributors to morbidity and mortality. This review comprehensively explores the pathophysiological mechanisms underlying these complications, protective strategies, and both existing and emerging secondary preventive measures. Furthermore, we delve into the applications of experimental models and methodologies in foundational research while also highlighting current research limitations and future directions. Specifically, we focus on the literature published post-2020 concerning the secondary prevention of macrovascular complications in patients with T2DM by conducting a targeted review of studies supported by robust evidence to offer a holistic perspective.
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Affiliation(s)
- Huifang Guan
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Jiaxing Tian
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Ying Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Ping Niu
- Rehabilitation Department, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Yuxin Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yanjiao Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xinyi Fang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Runyu Miao
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Ruiyang Yin
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaolin Tong
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
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17
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Leipsic JA, Chandrashekhar Y. Novel Analytics for Coronary CT Angiography: Advancing Our Understanding of Risk and Mechanisms of MI. JACC Cardiovasc Imaging 2024; 17:345-347. [PMID: 38448132 DOI: 10.1016/j.jcmg.2024.02.001] [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: 03/08/2024]
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18
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Lima MR, Lopes PM, Ferreira AM. Use of coronary artery calcium score and coronary CT angiography to guide cardiovascular prevention and treatment. Ther Adv Cardiovasc Dis 2024; 18:17539447241249650. [PMID: 38708947 PMCID: PMC11075618 DOI: 10.1177/17539447241249650] [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: 09/12/2023] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Currently, cardiovascular risk stratification to guide preventive therapy relies on clinical scores based on cardiovascular risk factors. However, the discriminative power of these scores is relatively modest. The use of coronary artery calcium score (CACS) and coronary CT angiography (CCTA) has surfaced as methods for enhancing the estimation of risk and potentially providing insights for personalized treatment in individual patients. CACS improves overall cardiovascular risk prediction and may be used to improve the yield of statin therapy in primary prevention, and possibly identify patients with a favorable risk/benefit relationship for antiplatelet therapies. CCTA holds promise to guide anti-atherosclerotic therapies and to monitor individual response to these treatments by assessing individual plaque features, quantifying total plaque volume and composition, and assessing peri-coronary adipose tissue. In this review, we aim to summarize current evidence regarding the use of CACS and CCTA for guiding lipid-lowering and antiplatelet therapy and discuss the possibility of using plaque burden and plaque phenotyping to monitor response to anti-atherosclerotic therapies.
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Affiliation(s)
- Maria Rita Lima
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, Lisbon 2790-134, Portugal
| | - Pedro M. Lopes
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - António M. Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
- UNICA – Cardiovascular CT and MR Unit, Hospital da Luz, Lisbon, Portugal
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19
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Almeida SO, Winchester DE, Blankstein R, Shaw LJ, Ferencik M, Arbab-Zadeh A, Choi AD. Expanding appropriate use of cardiac CT in chronic coronary disease: Key insights from the 2023 update. J Cardiovasc Comput Tomogr 2023; 17:465-469. [PMID: 37923579 DOI: 10.1016/j.jcct.2023.10.006] [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: 08/08/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Shone O Almeida
- Division of Cardiovascular Sciences, University of South Florida, Tampa, FL, USA
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Ron Blankstein
- Cardiovascular Division (Department of Medicine) and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslee J Shaw
- Blavatnik Family Women's Research Institute, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Armin Arbab-Zadeh
- Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew D Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
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