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Stan MV, Mikhaliev КО, Zharinov OJ, Khokhlov AV, Kravchenko AM, Todurov BM. ASSOCIATION OF FRACTIONAL FLOW RESERVE WITH CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE. Wiad Lek 2022; 75:2665-2670. [PMID: 36591751 DOI: 10.36740/wlek202211120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To identify clinical and angiographic factors, associated with fractional flow reserve (FFR), in stable coronary artery disease (CAD) patients. PATIENTS AND METHODS Materials and methods: The study consecutively enrolled 68 patients with stable CAD (mean age (63±8,0) ys) and angiographically intermediate coronary lesions (diameter stenosis 50-90 %), with FFR assessment. Stable angina of CCS classes II and III was diagnosed in 42 (62 %) and 15 (22 %) patients, respectively; left ventricular hypertrophy (LVH) - 27 (40 %); severe coronary stenosis (SCS) (70-90 %) - 46 (68 %). The overall CAD complexity was assessed by SYNTAX score. FFR «negative» group (FFRNEG) included the patients with non-significant FFRs (>0,80) (n=28 [41 %]). In case of at least one significant FFR (≤0,80), a patient was assigned to FFR «positive» group (FFRPOS) (n=40 [59 %]). RESULTS Results: FFRPOS (vs. FFRNEG, respectively) was characterized by the higher frequency of angina class III (32 % vs. 7 %; p<0,001), LVH (53 % vs. 21 %; p=0,010) and SCS (98 % vs. 25 %; p<0,001). The SYNTAX score was strongly associated with FFR ≤0,70 and ≤0,65, and moderately - with FFR ≤0,65. CONCLUSION Conclusions: In patients with stable CAD and intermediate coronary artery stenosis, the presence of at least one functionally significant lesion (FFR ≤0,80) was associated with the higher prevalence of angina class III, LVH and more advanced coronary stenosis (≥70 %). The greater overall CAD complexity increased the probability for the angiographically significant coronary lesions to be more functionally compromised.
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Affiliation(s)
- Mykola V Stan
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
| | - Кyrylo О Mikhaliev
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Oleg J Zharinov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
| | | | - Anatolii M Kravchenko
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Borys M Todurov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
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Zajančkauskienė L, Radionovaitė L, Jankauskas A, Banišauskaitė A, Šakalytė G. Coronary CT Value in Quantitative Assessment of Intermediate Stenosis. Medicina (B Aires) 2022; 58:medicina58070964. [PMID: 35888684 PMCID: PMC9320498 DOI: 10.3390/medicina58070964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Cardiac computed tomography angiography (CCTA) is an excellent non-invasive imaging tool to evaluate coronary arteries and exclude coronary artery disease (CAD). Managing intermediate coronary artery stenosis with negative or inconclusive functional tests is still a challenge. A regular stenosis evaluation together with high-risk plaque features, using semi-automated programs, are becoming promising tools. This case–control study was designed to evaluate the intermediate lesion features’ impact on CAD outcomes, using a semi-automated CCTA atherosclerotic plaque analysis program. Materials and Methods: We performed a single-center, prospective cohort study. A total of 133 patients with low to intermediate risk of CAD, older than 18 years with no previous history of CAD and good quality CCTA images were included in the study, and 194 intermediate stenosis (CAD-RADS 3) were analyzed. For more detailed morphological analysis, we used semi-automated CCTA-dedicated software. Enrolled patients were prospectively followed-up for 2 years. Results: Agatston score was significantly higher in the major adverse cardiovascular events (MACE) group (p = 0.025). Obstruction site analysis showed a significantly lower coronary artery remodeling index (RI) among patients with MACE (p = 0.037); nonetheless RI was negative in both groups. Plaque consistency analysis showed significantly bigger necrotic core area in the MACE group (p = 0.049). In addition, unadjusted multivariate analysis confirmed Agatston score and RI as significant MACE predictors. Conclusions: The Agatston score showes the total area of calcium deposits and higher values are linked to MACE. Higher plaque content of necrotic component is also associated with MACE. Additionally, negatively remodeled plaques are linked to MACE and could be a sign of advanced CAD. The Agatston score and RI are significant in risk stratification for the development of MACE.
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Affiliation(s)
- Laura Zajančkauskienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.R.); (G.Š.)
- Department of Cardiology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
- Correspondence: or ; Tel.: +370-628-13668
| | - Laura Radionovaitė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.R.); (G.Š.)
| | - Antanas Jankauskas
- Department of Radiology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.J.); (A.B.)
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50166 Kaunas, Lithuania
| | - Audra Banišauskaitė
- Department of Radiology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.J.); (A.B.)
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.R.); (G.Š.)
- Department of Cardiology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50166 Kaunas, Lithuania
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Ebaid NY, Khalifa DN, Ragheb AS, Abdelsamie MM, Alsowey AM. Validation of Coronary Artery Disease Reporting and Data System (CAD-RADS) and Application of Coronary Artery Calcium Data and Reporting System (CAC-DRS) as New Standardized Tools in the Management of Coronary Artery Disease Patients. Int J Gen Med 2021; 14:7503-7514. [PMID: 34754223 PMCID: PMC8572090 DOI: 10.2147/ijgm.s336662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives The coronary artery disease reporting and data system (CAD-RADS) is intended to standardize the reporting of CCTA and the subsequent management guidelines of CAD. The present study was conducted to investigate the validation of CAD-RADS and the application of coronary calcium grading in CAD management. Patients and Methods The current study is a single-center prospective study that involved 177 participants with chest pain who were submitted to coronary CT angiography (CCTA). Two reviewers independently assessed CCTA results and gave each patient a CAD-RADS category. The reference standard for determining the clinical utility of CAD-RADS was invasive coronary angiography (ICA). The inter-reviewer agreement (IRA) was tested using the intra-class correlation (ICC). Results The study enrolled 111 cases with non-significant CAD and 66 cases with significant CAD based on ICA findings. According to the reviewer, the CAD-RADS had a sensitivity, specificity, and accuracy of 90.9 to 100%, 89.2 to 94.6%, and 93.16 to 93.2%, respectively, for predicting severe CAD. The IRA for CAD-RADS categories was excellent (ICC = 0.960). The best cut-off value for predicting severe CAD was CAD-RADS > 3. Significant relation between Ca and severe CAD (p<0.001) was detected. Conclusion The current study provides a good understanding of CAD-RADS as a standard tool with high diagnostic accuracy.
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Affiliation(s)
- Noha Yahia Ebaid
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Nabil Khalifa
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmad Sabry Ragheb
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Razek AAKA, Fahmy D. Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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Pradella S, Zantonelli G, Grazzini G, Cozzi D, Danti G, Acquafresca M, Miele V. The Radiologist as a Gatekeeper in Chest Pain. Int J Environ Res Public Health 2021; 18:6677. [PMID: 34205792 PMCID: PMC8296491 DOI: 10.3390/ijerph18126677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.
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Affiliation(s)
- Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Giulia Zantonelli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Manlio Acquafresca
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
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Kim S, Kang W, Cho S, Lim DY, Yoo Y, Park RJ, Lee BC, Moon JD, Park WJ. Associations between Blood Lead Levels and Coronary Artery Stenosis Measured Using Coronary Computed Tomography Angiography. Environ Health Perspect 2021; 129:27006. [PMID: 33621129 PMCID: PMC7901725 DOI: 10.1289/ehp7351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lead exposure is a risk factor for increased blood pressure and cardiovascular disease, even when blood lead levels (BLLs) are within the normal range. OBJECTIVE This study aimed to investigate the association between BLL and coronary artery stenosis (CAS) in asymptomatic adults using 128-slice dual-source coronary computed tomography (CT) angiography. METHODS We analyzed medical records data from 2,193 adults (1,461 men and 732 women) who elected to complete a screening health examination, coronary CT angiography, and BLL measurement during 2011-2018 and had no history of CAS symptoms, cardiovascular disease, or occupational exposure to lead. Logistic regression models were used to estimate associations between moderate-to-severe CAS (≥25% stenosis) and a 1-μg/dL increase in blood lead, with and without adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, regular exercise, smoking status, and alcohol drinking. RESULTS BLLs ranged from 0.12 to 10.14μg/dL, with an arithmetic mean of 2.71±1.26μg/dL. The arithmetic mean was higher for men than for women (2.98±1.26μg/dL vs. 2.18±1.08μg/dL, p<0.001) and higher in the moderate-to-severe CAS group than in the no-CAS or <25% stenosis group (3.02±1.44μg/dL vs. 2.67±1.23μg/dL, p<0.001). Moderate-to-severe CAS was significantly associated with BLL before and after adjustment, with an adjusted odds ratio for a 1-μg/dL increase in BLL of 1.14 (95% CI: 1.02, 1.26), p=0.017. CONCLUSIONS BLL was positively associated with the prevalence of moderate-to-severe CAS in Korean adults who completed an elective screening examination for early cardiovascular disease, 94% of whom had a BLL of <5μg/dL. More efforts and a strict health policy are needed to further reduce BLLs in the general population. https://doi.org/10.1289/EHP7351.
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Affiliation(s)
- Suwhan Kim
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
| | - Wonyang Kang
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
- Institute of Occupational and Environmental Health, Korea Workers’ Compensation & Welfare Service, Incheon, Republic of Korea
| | - Seunghyeon Cho
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
| | - Dae-Young Lim
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
| | - Yeongjae Yoo
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
| | - Ryoung Jin Park
- Department of Occupational and Environmental Medicine, Gwangyang Sarang General Hospital, Gwangyang, Republic of Korea
| | - Byung Chan Lee
- Department of Radiology, CNU Medical School and CNU Hwasun Hospital, Republic of Korea
| | - Jai-Dong Moon
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Hwasun, Republic of Korea
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Basha MAA, Aly SA, Ismail AAA, Bahaaeldin HA, Shehata SM. The validity and applicability of CAD-RADS in the management of patients with coronary artery disease. Insights Imaging 2019; 10:117. [PMID: 31802266 PMCID: PMC6893004 DOI: 10.1186/s13244-019-0806-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. METHODS AND RESULTS A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we have 156 patients with non-significant CAD and 131 patients with significant CAD. On a patient-based analysis, regarding those patients classified as CAD-RADS 4 and CAD-RADS 5 for predicting significant CAD, the CAD-RADS had a sensitivity, specificity, and an accuracy of 100%, 96.8 to 98.7%, and 98.3 to 99.3%, respectively, depending on the reviewer. There was an excellent IRA for CAD-RADS categories (ICC = 0.9862). The best cutoff value for predicting significant CAD was > CAD-RADS 3. Eighty-seven percentage of referring consultants considered CAD-RADS reporting system to be "quite helpful" or "completely helpful" for clinical decision-making in CAD. CONCLUSION CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.
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Affiliation(s)
| | | | - Ahmad Abdel Azim Ismail
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hanan A Bahaaeldin
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Samar Mohamad Shehata
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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