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MacLeod MA, Knott KD, Allinson JP, Finney LJ, Wiseman DJ, Ritchie AI, Braddy-Green A, Barlett-Pestell S, Lopez R, Sun L, Webb P, Dalal P, Rubens M, Davies S, Haskard DO, Devaraj A, Donaldson GC, Khamis RY, Nicol ED, Wedzicha JA. Prevalence and Clinical Correlates of Radiologically Detected Coronary Artery Disease in Chronic Obstructive Pulmonary Disease: A Cross-Sectional Observational Study. Am J Respir Crit Care Med 2025; 211:946-956. [PMID: 39680915 DOI: 10.1164/rccm.202404-0838oc] [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: 04/24/2024] [Accepted: 10/30/2024] [Indexed: 12/18/2024] Open
Abstract
Rationale: Unrecognized coronary artery disease (CAD) may contribute to adverse outcomes in chronic obstructive pulmonary disease (COPD). Improved identification of at-risk groups could inform better preventive care. Objectives: We aimed to evaluate the burden and relationships of radiologically detectable CAD in COPD, establish the frequency of occult disease, and examine potential cardiovascular screening methods. Methods: Using computed tomography (CT) coronary angiography, we prospectively evaluated CAD in 50 patients with COPD compared with age- and sex-matched controls. In those with COPD, the relationship of CAD to cardiac symptoms (chest pain, dyspnea), functional capacity (6-minute-walk distance), exacerbations, and inflammation was assessed. The performance of screening tests (cardiovascular risk scores, biomarkers, and thoracic CT-derived coronary artery calcium score) were evaluated using receiver operating characteristic curves. Measurements and Main Results: CAD was present in 88% of patients with COPD (42% had obstructive [⩾50% stenosis of any vessel] and 28% severely obstructive [⩾70%] disease). Rates of obstructive (OR, 3.1; 95% CI, 1.1-8.9; P = 0.037) and severely obstructive CAD (OR, 10.1; 95% CI, 1.9-52.7; P = 0.006) were higher in those with COPD than in controls. In the COPD group, those with CAD had greater functional impairments but not greater dyspnea scores, and 75% reported no chest pain or prior ischemic heart disease. CAD was more extensive in those with increased systemic inflammation (fibrinogen, C-reactive protein, and leukocyte and neutrophil counts), bronchial wall thickening, and sputum bacterial growth but bore no relation to exacerbation frequency. The thoracic CT-derived coronary artery calcium score was an effective screening tool, with areas under the curve of 0.98 (95% CI, 0.95-1.00) for CAD and 0.89 (95% CI, 0.79-1.00) for obstructive CAD. Conclusions: CT coronary angiography-detected CAD is common in patients with COPD but correlates poorly with symptoms and conventional risk scores. Radiological screening with standard (non ECG-gated) CT of the thorax might improve detection and outcome in this patient group.
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Affiliation(s)
- Mairi A MacLeod
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kristopher D Knott
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Lydia J Finney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Dexter J Wiseman
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom; and
| | - Andrew I Ritchie
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Early Respiratory & Immunology Clinical Development, Biopharmaceuticals R&D, AstraZeneca, United Kingdom
| | - Aaron Braddy-Green
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sam Barlett-Pestell
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ralph Lopez
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Logan Sun
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Philippa Webb
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Paras Dalal
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Michael Rubens
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Simon Davies
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Dorian O Haskard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ramzi Y Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Edward D Nicol
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Cappello IA, Pannone L, Della Rocca DG, Sorgente A, Del Monte A, Mouram S, Vetta G, Kronenberger R, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, La Meir M, Belsack D, Sarkozy A, Brugada P, Tanaka K, Chierchia GB, Gharaviri A, de Asmundis C. Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes. Europace 2023; 25:euad328. [PMID: 38064697 PMCID: PMC10751806 DOI: 10.1093/europace/euad328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. METHODS AND RESULTS All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). CONCLUSION In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
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Affiliation(s)
- Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
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Herczeg S, Simon J, Szegedi N, Karády J, Kolossváry M, Szilveszter B, Balogi B, Nagy VK, Merkely B, Széplaki G, Maurovich-Horvat P, Gellér L. High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation. Coron Artery Dis 2023; 34:18-23. [PMID: 36484216 PMCID: PMC9742003 DOI: 10.1097/mca.0000000000001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is often performed before catheter ablation of atrial fibrillation to map atrial and pulmonary anatomy. Incident coronary artery disease (CAD) may also be diagnosed during cardiac CT angiography (CTA). Our aim was to assess whether coronary CTA might be able to identify a significant proportion of patients with obstructive CAD prior to their catheter ablation procedure event, even in asymptomatic patients. METHODS Consecutive patients undergoing pre-ablation coronary CTA for atrial fibrillation between 2013 and 2020 were retrospectively selected. Patients with previously diagnosed CAD were excluded. Obstructive CAD was defined as ≥50% luminal stenosis. We analyzed the relationship between obstructive CAD, any chest pain, and traditional risk factors. RESULTS Overall, 2321 patients [median age 63.0 (54.4-69.2), 1052/2321 (45.3%) female] underwent coronary CTA and 488/2321 (21.0%) were diagnosed with obstructive CAD. There was no difference regarding the rate of obstructive CAD in patients with any chest pain compared to patients without any chest pain [91/404 (22.5%) vs. 397/1917 (20.7%), P = 0.416, respectively). The following parameters were associated with obstructive CAD: age > 65 years [odds ratio (OR) = 2.51; 95% confidence interval (CI), 2.02-3.13; P < 0.001), male sex (OR = 1.59; 95% CI, 1.28-1.98; P < 0.001), hypertension (OR = 1.40; 95% CI, 1.08-1.81; P = 0.012), diabetes (OR = 1.50; 95% CI, 1.13-1.99; P = 0.006), dyslipidaemia (OR = 1.33; 95% CI, 1.07-1.66; P = 0.011) and history of smoking (OR = 1.34; 95% CI, 1.07-1.68; P = 0.011). CONCLUSIONS The high prevalence of obstructive CAD even in patients without chest pain highlights the importance of additional coronary artery diagnostics in patients undergoing left atrial CTA awaiting catheter ablation for atrial fibrillation. These patients regardless of chest pain thus may require further risk modification to decrease their potential ischemic and thromboembolic risk.
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Affiliation(s)
- Szilvia Herczeg
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Bernadett Balogi
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Vivien K Nagy
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
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4
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Rottländer D, Saal M, Degen H, Gödde M, Horlitz M, Haude M. Diagnostic role of coronary CT angiography in paroxysmal or first diagnosed atrial fibrillation. Open Heart 2021; 8:e001638. [PMID: 34006505 PMCID: PMC8137176 DOI: 10.1136/openhrt-2021-001638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The presence of coronary artery disease (CAD) in patients hospitalised with paroxysmal or first diagnosed atrial fibrillation (AF) has major implications for antithrombotic therapy and cardiovascular event rate. Coronary CT angiography (CCTA) is a feasible tool to identify patients with concealed CAD. We aimed to evaluate the diagnostic role of early CCTA in patients hospitalised with paroxysmal or first diagnosed AF. METHODS In a 5-year single-centre retrospective analysis, 566 patients with paroxysmal or first diagnosed AF who underwent CCTA were enrolled to investigate the presence of CAD. RESULTS In patients with paroxysmal or first diagnosed AF, CCTA revealed CAD (coronary artery stenosis ≥50%) in 39.2%. Cardiac catheterisation was performed in 31.6%, confirming CAD in 13.1% of all patients. In 8.0% percutaneous coronary intervention and in 0.5% coronary artery bypass grafting was performed. In patients with paroxysmal or first diagnosed AF: (1) angina pectoris per se does not predict CAD; (2) multivariable regression analysis revealed age, male sex and diabetes as risk factors for CAD in AF; (3) Framingham Risk Score for coronary heart disease and CHA2DS2-VASc-Score were relevant risk scores of CAD and (4) the classification of Coronary Artery Calcium score reference values according to the Multi-Ethnic Study of Atherosclerosis was a predictor of CAD. CONCLUSION Patients with paroxysmal or first diagnosed AF are at risk for CAD, while CCTA is a feasible diagnostic tool for CAD. We recommend to integrate CT calcium scoring and CCTA into the diagnostic workup of patients with new-onset or paroxysmal AF.
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Affiliation(s)
- Dennis Rottländer
- Cardiology, Rheinland Klinikum Neuss GmbH, Neuss, Germany
- Cardiology, Faculty of Health, University Witten Herdecke, Witten, Germany
| | - Martin Saal
- Cardiology, Rheinland Klinikum Neuss GmbH, Neuss, Germany
| | - Hubertus Degen
- Cardiology, Rheinland Klinikum Neuss GmbH, Neuss, Germany
| | - Miriel Gödde
- Cardiology, Rheinland Klinikum Neuss GmbH, Neuss, Germany
| | - Marc Horlitz
- Cardiology, Faculty of Health, University Witten Herdecke, Witten, Germany
- Cardiology, Krankenhaus Porz am Rhein, Köln, Germany
| | - Michael Haude
- Cardiology, Rheinland Klinikum Neuss GmbH, Neuss, Germany
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