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Chew-Harris J, Frampton C, Greer C, Appleby S, Pickering JW, Kuan WS, Ibrahim I, Chan SP, Li Z, Liew OW, Adamson PD, Troughton R, Tan LL, Lin W, Ooi SBS, Richards AM, Pemberton CJ. Prognostic performance of soluble urokinase plasminogen activator receptor for heart failure or mortality in Western and Asian patients with acute breathlessness. Int J Cardiol 2024; 406:132071. [PMID: 38643805 DOI: 10.1016/j.ijcard.2024.132071] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
AIMS The performance of circulating soluble urokinase plasminogen activator receptor (suPAR) for predicting the composite endpoint of subsequent heart failure (HF) hospitalisation and/or death at 1 year was assessed in (i) patients with undifferentiated breathlessness, and generalisability was compared in (ii) disparate Western versus Asian sub-cohorts, and in (iii) the sub-cohort adjudicated with HF. METHODS AND RESULTS Patients with acute breathlessness were recruited from the emergency departments in New Zealand (NZ, n = 612) and Singapore (n = 483). suPAR measured in the presentation samples was higher in patients incurring the endpoint (n = 281) compared with survivors (5.2 ng/mL vs 3.1 ng/mL, P < 0.0001). The discriminative power of suPAR for endpoint prediction was c-statistic of 0.77 in the combined population, but was superior in Singapore than NZ (c-statistic: 0.83 vs 0.71, P < 0.0001). Although the highest suPAR tertile (>4.37 ng/mL) was associated with risks of >4-fold in NZ, >20-fold in Singapore, and ≥3-fold in HF for incurring the outcome, there was no interaction between country and suPAR levels after adjustment. Multivariable analysis indicated suPAR to be robust in predicting HF/death at 1-year [hazard ratio: 1.9 (95% CI:1.7 to 2.0) per SD increase] and improved risk discrimination for outcome prediction in HF (∆0.06) and for those with NT-proBNP >1000 pg/mL (∆0.02). CONCLUSION suPAR is a strong independent predictor of HF and/or death at 1 year in acutely breathless patients, in both Asian and Western cohorts, and in HF. suPAR may improve stratification of acutely breathless patients, and in acute HF, for risk of later onset of heart failure or mortality.
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Affiliation(s)
- Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
| | - Chris Frampton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Charlotte Greer
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Sarah Appleby
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Emergency Care Foundation, Emergency Department, Christchurch Hospital, New Zealand
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Pang Chan
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Geriatrics & Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Oi Wah Liew
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Richard Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Li Ling Tan
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Weiqin Lin
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirley Beng Suat Ooi
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiology Department, National University Heart Centre, National University Hospital, Singapore
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Greer CE, Chew-Harris J, Adamson PD, Pemberton CJ, Pickering JW, Pilbrow AP, Frampton CM, Troughton RW, Doughty RN, Richards AM. Convalescent Growth Differentiation Factor-15 and Long-Term Outcomes after an Acute Coronary Syndrome. J Appl Lab Med 2024:jfae032. [PMID: 38635817 DOI: 10.1093/jalm/jfae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15) has been shown to be associated with adverse clinical outcomes in patients after an acute coronary syndrome when measured soon after an event. Although dynamic in the acute phase after myocardial injury, GDF-15 has been shown to remain stable during convalescence. In this study, we aimed to assess the value of GDF-15 as a long-term prognostic marker for clinical outcomes when measured in the convalescent phase following an acute coronary syndrome. METHODS GDF-15 concentrations were measured in 1945 patients who were recruited between 2002 and 2009 to the Coronary Disease Cohort Study. For this analysis, follow-up was curtailed at 10 years and association of GDF-15 with all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure hospitalizations were assessed with multivariate Cox proportional hazard regression analysis. RESULTS After 10 years of follow-up, there were 648 deaths (348 from cardiovascular causes), 500 admissions for myocardial infarction, and 436 for heart failure. Four-month convalescent GDF-15 demonstrated a robust independent association with all endpoints, which remained after adjustment for Global Registry of Acute Coronary Events score and other convalescent biomarkers. When compared to the lowest quartile of GDF-15 concentrations, those in the highest quartile had a 3-fold increased risk of all-cause death. CONCLUSIONS Convalescent plasma GDF-15 is a strong and independent predictor of 10-year all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure admission following an acute coronary syndrome. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY TRIAL ID ACTRN12605000431628.
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Affiliation(s)
- Charlotte E Greer
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris J Pemberton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Anna P Pilbrow
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Chris M Frampton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Robert N Doughty
- Greenlane Cardiovascular Service, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
- Heart Health Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
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Otto CM, Adamson PD, van Gelder I, Karthikeyan G, Newby DE, Rahimi K, Ribeiro ALP, Song JK. Asynchronous communication for medical journal editorial teams in a diverse global research community. Heart 2023; 109:1802-1804. [PMID: 37827556 PMCID: PMC10715466 DOI: 10.1136/heartjnl-2023-323454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Isabelle van Gelder
- Department of Cardiology, University Medical Centre Groningen Thoraxcentre, Groningen, The Netherlands
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Kazem Rahimi
- Cardiovascular Medicine and Population Health, University of Oxford, Oxford, UK
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, The Republic of Korea
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Kerr AJ, Choi Y, Williams MJ, Stewart RA, White HD, Devlin G, Selak V, Lee MAW, El-Jack S, Adamson PD, Fairley S, Jackson RT, Poppe K. Paired risk scores to predict ischaemic and bleeding risk twenty-eight days to one year after an acute coronary syndrome. Heart 2023; 109:1827-1836. [PMID: 37558394 DOI: 10.1136/heartjnl-2023-322830] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision. METHODS New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score). FINDINGS In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell's c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified. CONCLUSION We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.
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Affiliation(s)
- Andrew J Kerr
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Yeunhyang Choi
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | | | - Ralph Ah Stewart
- Cardiology Department, Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Harvey D White
- Cardiology Department, Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Vanessa Selak
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | | | | | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Sarah Fairley
- Cardiology Department, Wellington Hospital, Wellington, New Zealand
| | - Rodney T Jackson
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Katrina Poppe
- Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
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Daghem M, Adamson PD, Wang KL, Doris M, Bing R, van Beek EJR, Forsyth L, Williams MC, Tzolos E, Dey D, Slomka PJ, Dweck MR, Newby DE, Moss AJ. Temporal Changes in Coronary 18F-Fluoride Plaque Uptake in Patients with Coronary Atherosclerosis. J Nucl Med 2023; 64:1478-1486. [PMID: 37591540 PMCID: PMC10478818 DOI: 10.2967/jnumed.122.264331] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/12/2022] [Indexed: 08/19/2023] Open
Abstract
Coronary 18F-sodium fluoride (18F-fluoride) uptake is a marker of both atherosclerotic disease activity and disease progression. It is currently unknown whether there are rapid temporal changes in coronary 18F-fluoride uptake and whether these are more marked in those with clinically unstable coronary artery disease. This study aimed to determine the natural history of coronary 18F-fluoride uptake over 12 mo in patients with either advanced chronic coronary artery disease or a recent myocardial infarction. Methods: Patients with established multivessel coronary artery disease and either chronic disease or a recent acute myocardial infarction underwent coronary 18F-fluoride PET and CT angiography, which was repeated at 3, 6, or 12 mo. Coronary 18F-fluoride uptake was assessed in each vessel by measuring the coronary microcalcification activity (CMA). Coronary calcification was quantified by measuring calcium score, mass, and volume. Results: Fifty-nine patients had chronic coronary artery disease (median age, 68 y; 93% male), and 52 patients had a recent myocardial infarction (median age, 65 y; 83% male). Reflecting the greater burden of coronary artery disease, baseline CMA values were higher in those with chronic coronary artery disease. Coronary 18F-fluoride uptake (CMA > 0) was associated with higher baseline calcium scores (294 Agatston units [AU] [interquartile range, 116-483 AU] vs. 72 AU [interquartile range, 8-222 AU]; P < 0.001) and more rapid progression of coronary calcification scores (39 AU [interquartile range, 10-82 AU] vs. 12 AU [interquartile range, 1-36 AU]; P < 0.001) than was the absence of uptake (CMA = 0). Coronary 18F-fluoride uptake did not markedly alter over the course of 3, 6, or 12 mo in patients with either chronic coronary artery disease or a recent myocardial infarction. Conclusion: Coronary 18F-fluoride uptake is associated with the severity and progression of coronary artery disease but does not undergo a rapid dynamic change in patients with chronic or unstable coronary artery disease. This finding suggests that coronary 18F-fluoride uptake is a temporally stable marker of established and progressive disease.
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Affiliation(s)
- Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom;
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Kang-Ling Wang
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, California; and
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, California; and
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Department of Cardiovascular Science, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom
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Greer C, Williams MC, Newby DE, Adamson PD. Role of computed tomography cardiac angiography in acute chest pain syndromes. Heart 2023; 109:1350-1356. [PMID: 36914247 DOI: 10.1136/heartjnl-2022-321360] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
Use of CT coronary angiography (CTCA) to evaluate chest pain has rapidly increased over the recent years. While its utility in the diagnosis of coronary artery disease in stable chest pain syndromes is clear and is strongly endorsed by international guidelines, the role of CTCA in the acute setting is less certain. In the low-risk setting, CTCA has been shown to be accurate, safe and efficient but inherent low rates of adverse events in this population and the advent of high-sensitivity troponin testing have left little room for CTCA to show any short-term clinical benefit.In higher-risk populations, CTCA has potential to fulfil a gatekeeper role to invasive angiography. The high negative predictive value of CTCA is maintained while also identifying non-obstructive coronary disease and alternative diagnoses in the substantial group of patients presenting with chest pain who do not have type 1 myocardial infarction. For those with obstructive coronary disease, CTCA provides accurate assessment of stenosis severity, characterisation of high-risk plaque and findings associated with perivascular inflammation. This may allow more appropriate selection of patients to proceed to invasive management with no disadvantage in outcomes and can provide a more comprehensive risk stratification to guide both acute and long-term management than routine invasive angiography.
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Affiliation(s)
- Charlotte Greer
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, Canterbury, New Zealand
| | | | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, Canterbury, New Zealand
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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Moss A, Daghem M, Tzolos E, Meah MN, Wang KL, Bularga A, Adamson PD, Kwiecinski J, Fletcher A, Dawson D, Arumugam P, Sabharwal N, Greenwood JP, Townend JN, Calvert PA, Rudd JHF, Berman D, Verjans J, Slomka P, Dey D, Forsyth L, Murdoch L, Lee RJ, Lewis S, Mills NL, van Beek EJR, Williams MC, Dweck MR, Newby DE. Coronary Atherosclerotic Plaque Activity and Future Coronary Events. JAMA Cardiol 2023; 8:755-764. [PMID: 37379010 PMCID: PMC10308296 DOI: 10.1001/jamacardio.2023.1729] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Importance Recurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease activity have the potential to identify individuals at greatest risk. Objective To assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction. Design, Setting, and Participants This prospective, longitudinal, international multicenter cohort study recruited participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020, with a minimum 2 years' follow-up. Intervention Coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography. Main Outcomes and Measures Total coronary atherosclerotic plaque activity was assessed by 18F-sodium fluoride uptake. The primary end point was cardiac death or nonfatal myocardial infarction but was expanded during study conduct to include unscheduled coronary revascularization due to lower than anticipated primary event rates. Results Among 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population. The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]). Total coronary atherosclerotic plaque activity was identified in 421 participants (60%). After a median follow-up of 4 years (IQR, 3-5 years), 141 participants (20%) experienced the primary end point: 9 had cardiac death, 49 had nonfatal myocardial infarction, and 83 had unscheduled coronary revascularizations. Increased coronary plaque activity was not associated with the primary end point (hazard ratio [HR], 1.25; 95% CI, 0.89-1.76; P = .20) or unscheduled revascularization (HR, 0.98; 95% CI, 0.64-1.49; P = .91) but was associated with the secondary end point of cardiac death or nonfatal myocardial infarction (47 of 421 patients with high plaque activity [11.2%] vs 19 of 283 with low plaque activity [6.7%]; HR, 1.82; 95% CI, 1.07-3.10; P = .03) and all-cause mortality (30 of 421 patients with high plaque activity [7.1%] vs 9 of 283 with low plaque activity [3.2%]; HR, 2.43; 95% CI, 1.15-5.12; P = .02). After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction (HR, 1.76; 95% CI, 1.00-3.10; P = .05) but not with all-cause mortality (HR, 2.01; 95% CI, 0.90-4.49; P = .09). Conclusions and Relevance In this cohort study of patients with recent myocardial infarction, coronary atherosclerotic plaque activity was not associated with the primary composite end point. The findings suggest that risk of cardiovascular death or myocardial infarction in patients with elevated plaque activity warrants further research to explore its incremental prognostic implications.
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Affiliation(s)
- Alastair Moss
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
- National Institute for Health and Care Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, England
| | - Marwa Daghem
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Evangelos Tzolos
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Mohammed N. Meah
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Kang-Ling Wang
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Anda Bularga
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Philip D. Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Alison Fletcher
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, Aberdeen, Scotland
| | | | - Nikant Sabharwal
- Oxford University Hospitals, NHS Foundation Trust, Oxford, England
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - Jon N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, England
| | | | - James H. F. Rudd
- Department of Medicine, University of Cambridge, Cambridge, England
| | - Dan Berman
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Johan Verjans
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Lauren Murdoch
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Robert J. Lee
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Nicholas L. Mills
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Edwin J. R. van Beek
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Michelle C. Williams
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Marc R. Dweck
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - David E. Newby
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
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Kwiecinski J, Kolossváry M, Tzolos E, Meah MN, Adamson PD, Joshi NV, Williams MC, van Beek EJR, Berman DS, Maurovich-Horvat P, Newby DE, Dweck MR, Dey D, Slomka PJ. Latent Coronary Plaque Morphology From Computed Tomography Angiography, Molecular Disease Activity on Positron Emission Tomography, and Clinical Outcomes. Arterioscler Thromb Vasc Biol 2023; 43:e279-e290. [PMID: 37165878 PMCID: PMC11006237 DOI: 10.1161/atvbaha.123.319332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Assessments of coronary disease activity with 18F-sodium fluoride positron emission tomography and radiomics-based precision coronary plaque phenotyping derived from coronary computed tomography angiography may enhance risk stratification in patients with coronary artery disease. We sought to investigate whether the prognostic information provided by these 2 approaches is complementary in the prediction of myocardial infarction. METHODS Patients with known coronary artery disease underwent coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography on a hybrid positron emission tomography/computed tomography scanner. Coronary 18F-NaF uptake was determined by the coronary microcalcification activity. We performed quantitative plaque analysis of coronary computed tomography angiography datasets and extracted 1103 radiomic features for each plaque. Using weighted correlation network analysis, we derived latent morphological features of coronary lesions which were aggregated to patient-level radiomics nomograms to predict myocardial infarction. RESULTS Among 260 patients with established coronary artery disease (age, 65±9 years; 83% men), 179 (69%) participants showed increased coronary 18F-NaF activity (coronary microcalcification activity>0). Over 53 (40-59) months of follow-up, 18 patients had a myocardial infarction. Using weighted correlation network analysis, we derived 15 distinct eigen radiomic features representing latent morphological coronary plaque patterns in an unsupervised fashion. Following adjustments for calcified, noncalcified, and low-density noncalcified plaque volumes and 18F-NaF coronary microcalcification activity, 4 radiomic features remained independent predictors of myocardial infarction (hazard ratio, 1.46 [95% CI, 1.03-2.08]; P=0.03; hazard ratio, 1.62 [95% CI, 1.04-2.54]; P=0.02; hazard ratio, 1.49 [95% CI, 1.07-2.06]; P=0.01; and hazard ratio, 1.50 (95% CI, 1.05-2.13); P=0.02). CONCLUSIONS In patients with established coronary artery disease, latent coronary plaque morphological features, quantitative plaque volumes, and disease activity on 18F-sodium fluoride positron emission tomography are additive predictors of myocardial infarction.
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Affiliation(s)
- Jacek Kwiecinski
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.)
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.)
| | - Evangelos Tzolos
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A.)
| | - Nikhil V Joshi
- Bristol Heart Institute, University of Bristol, United Kingdom (N.V.J.)
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queens Medical Research Institute (E.J.R.v.B.), University of Edinburgh, United Kingdom
| | - Daniel S Berman
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary (P.M.-H.)
| | - David E Newby
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Piotr J Slomka
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
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9
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Figtree GA, Adamson PD, Antoniades C, Blumenthal RS, Blaha M, Budoff M, Celermajer DS, Chan MY, Chow CK, Dey D, Dwivedi G, Giannotti N, Grieve SM, Hamilton-Craig C, Kingwell BA, Kovacic JC, Min JK, Newby DE, Patel S, Peter K, Psaltis PJ, Vernon ST, Wong DT, Nicholls SJ. Noninvasive Plaque Imaging to Accelerate Coronary Artery Disease Drug Development. Circulation 2022; 146:1712-1727. [PMID: 36441819 DOI: 10.1161/circulationaha.122.060308] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Coronary artery disease (CAD) remains the leading cause of adult mortality globally. Targeting known modifiable risk factors has had substantial benefit, but there remains a need for new approaches. Improvements in invasive and noninvasive imaging techniques have enabled an increasing recognition of distinct quantitative phenotypes of coronary atherosclerosis that are prognostically relevant. There are marked differences in plaque phenotype, from the high-risk, lipid-rich, thin-capped atheroma to the low-risk, quiescent, eccentric, nonobstructive calcified plaque. Such distinct phenotypes reflect different pathophysiologic pathways and are associated with different risks for acute ischemic events. Noninvasive coronary imaging techniques, such as computed tomography, positron emission tomography, and coronary magnetic resonance imaging, have major potential to accelerate cardiovascular drug development, which has been affected by the high costs and protracted timelines of cardiovascular outcome trials. This may be achieved through enrichment of high-risk phenotypes with higher event rates or as primary end points of drug efficacy, at least in phase 2 trials, in a manner historically performed through intravascular coronary imaging studies. Herein, we provide a comprehensive review of the current technology available and its application in clinical trials, including implications for sample size requirements, as well as potential limitations. In its effort to accelerate drug development, the US Food and Drug Administration has approved surrogate end points for 120 conditions, but not for CAD. There are robust data showing the beneficial effects of drugs, including statins, on CAD progression and plaque stabilization in a manner that correlates with established clinical end points of mortality and major adverse cardiovascular events. This, together with a clear mechanistic rationale for using imaging as a surrogate CAD end point, makes it timely for CAD imaging end points to be considered. We discuss the importance of global consensus on these imaging end points and protocols and partnership with regulatory bodies to build a more informed, sustainable staged pathway for novel therapies.
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Affiliation(s)
- Gemma A Figtree
- Kolling Institute of Medical Research, Sydney, Australia (G.A.F., S.T.V.)
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia (G.A.F., S.T.V.)
- Charles Perkins Centre (G.A.F., C.K.C.), University of Sydney, Australia
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, New Zealand (P.D.A.)
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (P.D.A., D.E.N.)
| | - Charalambos Antoniades
- Acute Vascular Imaging Centre (C.A.), Radcliffe Department of Medicine, University of Oxford, UK
- Division of Cardiovascular Medicine (C.A.), Radcliffe Department of Medicine, University of Oxford, UK
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., M. Blaha)
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., M. Blaha)
| | | | - David S Celermajer
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
- Departments of Cardiology (D.S.C., S.P.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore (M.Y.C.)
| | - Clara K Chow
- Westmead Applied Research Centre (C.K.C.), University of Sydney, Australia
- Charles Perkins Centre (G.A.F., C.K.C.), University of Sydney, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research, University of Western Australia (G.D.)
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia (G.D.)
| | - Nicola Giannotti
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory (S.M.G.), University of Sydney, Australia
- Radiology (S.M.G.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Christian Hamilton-Craig
- Faculty of Medicine and Centre for Advanced Imaging, University of Queensland and School of Medicine, Griffith University Sunshine Coast, Australia (C.H.-C.)
| | | | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (J.C.K.)
- St Vincent's Clinical School, University of NSW, Australia (J.C.K.)
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C.K.)
| | | | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (P.D.A., D.E.N.)
| | - Sanjay Patel
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
- Departments of Cardiology (D.S.C., S.P.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Karlheinz Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia (K.P.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia (K.P.)
| | - Peter J Psaltis
- Lifelong Health, South Australian Health and Medical Research Institute, Adelaide (P.J.P.)
- Department of Cardiology, Royal Adelaide Hospital, Australia (P.J.P.)
| | - Stephen T Vernon
- Kolling Institute of Medical Research, Sydney, Australia (G.A.F., S.T.V.)
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia (G.A.F., S.T.V.)
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Dennis T Wong
- Monash Heart, Clayton, Australia (D.T.W., S.J.N.)
- Victorian Heart Institute, Monash University, Melbourne, Australia (D.T.W., S.J.N.)
| | - Stephen J Nicholls
- Monash Heart, Clayton, Australia (D.T.W., S.J.N.)
- Victorian Heart Institute, Monash University, Melbourne, Australia (D.T.W., S.J.N.)
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10
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Affiliation(s)
- Charlotte Greer
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand .,Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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11
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Greer C, Daly M, Troughton R, Adamson PD. SARS-CoV-2 vaccination and myocarditis in a highly vaccinated New Zealand population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A higher incidence of myocarditis has been reported in those who have recently received mRNA SARS – CoV-2 vaccination.1 Canterbury District Health Board (CDHB) serves 578,290 people, including 441,852 adults, with one large tertiary referral hospital offering specialist cardiology services. In 2021 97% of eligible adults received at least one dose and 92% two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). During this time only 21 community cases of COVID-19 infection were reported. We investigated the incidence of myocarditis during the BNT162b2 mRNA vaccine rollout in comparison to the preceding 5 years assuming a stable population size.
Methods
All adult patients admitted to our hospital who received a diagnostic code of acute myocarditis (ICD10 codes I40, I41 and I51.4) during admission between 2016 and 2021 were included. Demographics and peak troponin concentration (hsTnI) were recorded. Vaccine-associated myocarditis was defined as that leading to admitted within 28 days of BNT162b2 vaccination. Myocarditis-associated mortality was defined as death occurring within 28 days of hospital admission. Incidence of myocarditis before and during COVID-19 vaccination was tested using ANOVA.
Results
Between 2016 and 2020 there were 178 total hospital admissions (annualised mean 35.6 [SD6.3] range 28–44) with myocarditis. The mean age was 47.8 [SD15.9] years, 38% were women, and median peak hsTnI 641 (IQR 95.25–8526) ng/L. One patient died within 28 days of admission. In 2021 there were 43 myocarditis admissions, mean age 49.7 [SD18] years, 42% women, with a median hsTnI 355 (IQR 106.5–1876.5) ng/L. Nine of these admissions were within 28 days of vaccination. They were 78% female, mean age 52.6 [SD24.8] years, median peak hsTnI 179 (IQR 52–528) ng/L. One patient died during admission. There was no variance in annual incidence of myocarditis during vaccine rollout (p=0.342).
Conclusion
In a highly vaccinated adult population largely free of COVID-19 infection there were few cases of myocarditis within 28 days of vaccination and no increase in incidence overall compared to the preceding 5 years.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Heart Foundation of New Zealand grant to C Greer
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Affiliation(s)
- C Greer
- University of Otago Christchurch , Christchurch , New Zealand
| | - M Daly
- Christchurch Hospital , Christchurch , New Zealand
| | - R Troughton
- University of Otago Christchurch , Christchurch , New Zealand
| | - P D Adamson
- University of Otago Christchurch , Christchurch , New Zealand
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12
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Kwiecinski J, Kolossvary M, Tzolos E, Meah MN, Adamson PD, Joshi NV, Williams MC, Van Beek EJR, Berman DS, Maurovich-Horvat P, Newby DE, Dweck MR, Dey D, Slomka P. 18F-sodium fluoride positron emission tomography and coronary plaque radiomics derived from computed tomography angiography for prediction of myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Assessments of coronary disease activity with 18F-sodium fluoride positron emission tomography (18F-NaF PET) and radiomics-based precision coronary plaque phenotyping derived from contrast-enhanced computed tomography (CT) have both been shown to enhance risk stratification in patients with coronary artery disease (CAD). To date, no study has investigated whether these two promising methods (which can be obtained during a single imaging session on a hybrid PET/CT scanner) are interchangeable or can provide superior predictive performance when used in combination.
Purpose
We sought to investigate whether the prognostic information provided by latent morphological radiomic coronary plaque features and assessments of disease activity by 18F-NaF PET are complementary in prediction of myocardial infarction.
Methods
Patients with known CAD underwent coronary 18F-NaF PET and CT angiography on a hybrid PET/CT scanner. Coronary 18F-NaF uptake was determined by the coronary microcalcification activity (CMA). We performed quantitative plaque analysis of coronary CT angiography datasets. Additionally, coronary plaque segmentations on CT angiography were used to extract 1103 radiomic features. Using weighted correlation network analysis we derived latent morphological features of coronary plaques which were aggregated to patient-level radiomic normograms to predict myocardial infarction using univariate and multivariate Cox proportional hazard models.
Results
The study cohort comprised of 260 patients with established CAD (age: 65±9 years; 84% men); 179 (69%) participants showed increased coronary 18F-NaF activity (CMA >0). Over 53 [40–59] months of follow-up 18 patients had a myocardial infarction. Using weighted correlation network analysis, from the 1103 radiomic features we derived 15 distinct eigen radiomic features representing latent morphological coronary plaque patterns. On univariate cox modelling 7 of these emerged as predictors of myocardial infarction (Figure). Following adjustments for calcified, noncalcified and low-density noncalcified plaque volumes and 18F-NaF CMA 4 radiomic features (related to texture and geometry) remained independent predictors of myocardial infarction (Figure).
Conclusion(s)
In patients with established CAD latent morphological features of coronary plaques are predictors of myocardial infarction above and beyond plaque volumes and 18F-NaF uptake. Comprehensive plaque analysis with radiomics may enhance risk stratification of CAD patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH, Wellcome Trust
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Affiliation(s)
- J Kwiecinski
- Institute of Cardiology in Anin , Warsaw , Poland
| | - M Kolossvary
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center , Boston , United States of America
| | - E Tzolos
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - M N Meah
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - P D Adamson
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - N V Joshi
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - M C Williams
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - E J R Van Beek
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - D S Berman
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - P Maurovich-Horvat
- Semmelweis University Heart and Vascular Center, Cardiovascular Imaging Research Group , Budapest , Hungary
| | - D E Newby
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - M R Dweck
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - D Dey
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - P Slomka
- Cedars-Sinai Medical Center , Los Angeles , United States of America
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13
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Osborne-Grinter M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman D, Slomka PJ, Newby DE, Dweck MR, Dey D, Williams MC. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial. Eur Heart J Cardiovasc Imaging 2022; 23:1210-1221. [PMID: 34529050 PMCID: PMC9612790 DOI: 10.1093/ehjci/jeab135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. METHODS AND RESULTS In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1-9 AU), low (10-99 AU), moderate (100-399 AU), high (400-999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS (P < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. CONCLUSION In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque.
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Affiliation(s)
- Maia Osborne-Grinter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Jacek Kwiecinski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- NIHR Leicester Biomedical Research Centre and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Shirjel Alam
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Amanda Hunter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Anoop S V Shah
- Department of non-communicable disease epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tania Pawade
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Chengjia Wang
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | | | - Giles Roditi
- Institute of Cardiovascular & Medical Sciences, Glasgow University, Glasgow, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | | | - Edward D Nicol
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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14
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Gallacher PJ, Miller-Hodges E, Shah ASV, Farrah TE, Halbesma N, Blackmur JP, Chapman AR, Adamson PD, Anand A, Strachan FE, Ferry AV, Lee KK, Berry C, Findlay I, Cruickshank A, Reid A, Gray A, Collinson PO, Apple FS, McAllister DA, Maguire D, Fox KAA, Keerie C, Weir CJ, Newby DE, Mills NL, Dhaun N. High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment. Kidney Int 2022; 102:149-159. [PMID: 35271932 DOI: 10.1016/j.kint.2022.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 01/01/2023]
Abstract
The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61 years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularization (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment.
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Affiliation(s)
- Peter J Gallacher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eve Miller-Hodges
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Tariq E Farrah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - James P Blackmur
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrew R Chapman
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand, Australia
| | - Atul Anand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona E Strachan
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Amy V Ferry
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Anne Cruickshank
- Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alan Reid
- Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alasdair Gray
- Emergency Medicine Research Group Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul O Collinson
- Departments of Clinical Blood Sciences and Cardiology, St. George's, University Hospitals National Health Service Trust and St. George's University of London, London, UK
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Donogh Maguire
- Emergency Medicine Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Keith A A Fox
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Catriona Keerie
- Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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15
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Fletcher AJ, Tew YY, Tzolos E, Joshi SS, Kaczynski J, Nash J, Debono S, Lembo M, Kwiecinski J, Bing R, Syed MBJ, Doris MK, van Beek EJR, Moss AJ, Jenkins WS, Walker NL, Joshi NV, Pawade TA, Adamson PD, Whiteley WN, Wardlaw JM, Slomka PJ, Williams MC, Newby DE, Dweck MR. Thoracic Aortic 18F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease. JACC Cardiovasc Imaging 2022; 15:1274-1288. [PMID: 35183477 PMCID: PMC9252920 DOI: 10.1016/j.jcmg.2021.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aortic atherosclerosis represents an important contributor to ischemic stroke risk. Identifying patients with high-risk aortic atheroma could improve preventative treatment strategies for future ischemic stroke. OBJECTIVES The purpose of this study was to investigate whether thoracic 18F-sodium fluoride positron emission tomography (PET) could improve the identification of patients at the highest risk of ischemic stroke. METHODS In a post hoc observational cohort study, we quantified thoracic aortic and coronary 18F-sodium fluoride activity in 461 patients with stable cardiovascular disease undergoing PET combined with computed tomography (CT). Progression of atherosclerosis was assessed by change in aortic and coronary CT calcium volume. Clinical outcomes were determined by the occurrence of ischemic stroke and myocardial infarction. We compared the prognostic utility of 18F-sodium fluoride activity for predicting stroke to clinical risk scores and CT calcium quantification using survival analysis and multivariable Cox regression. RESULTS After 12.7 ± 2.7 months, progression of thoracic aortic calcium volume correlated with baseline thoracic aortic 18F-sodium fluoride activity (n = 140; r = 0.31; P = 0.00016). In 461 patients, 23 (5%) patients experienced an ischemic stroke and 32 (7%) a myocardial infarction after 6.1 ± 2.3 years of follow-up. High thoracic aortic 18F-sodium fluoride activity was strongly associated with ischemic stroke (HR: 10.3 [95% CI: 3.1-34.8]; P = 0.00017), but not myocardial infarction (P = 0.40). Conversely, high coronary 18F-sodium fluoride activity was associated with myocardial infarction (HR: 4.8 [95% CI: 1.9-12.2]; P = 0.00095) but not ischemic stroke (P = 0.39). In a multivariable Cox regression model including imaging and clinical risk factors, thoracic aortic 18F-sodium fluoride activity was the only variable associated with ischemic stroke (HR: 8.19 [95% CI: 2.33-28.7], P = 0.0010). CONCLUSIONS In patients with established cardiovascular disease, thoracic aortic 18F-sodium fluoride activity is associated with the progression of atherosclerosis and future ischemic stroke. Arterial 18F-sodium fluoride activity identifies localized areas of atherosclerotic disease activity that are directly linked to disease progression and downstream regional clinical atherothrombotic events. (DIAMOND-Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND], NCT02110303; Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis [SALTIRE II], NCT02132026; Novel Imaging Approaches To Identify Unstable Coronary Plaques, NCT01749254; and Role of Active Valvular Calcification and Inflammation in Patients With Aortic Stenosis, NCT01358513).
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Affiliation(s)
- Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Yong Y Tew
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shruti S Joshi
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Lembo
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maaz B J Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alistair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - William S Jenkins
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Niki L Walker
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Scottish Adult Congenital Cardiology Service, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Nikhil V Joshi
- Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, United Kingdom
| | - Tania A Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - William N Whiteley
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Cedars-Sinai Medical Centre, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, USA
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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16
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Fletcher AJ, Lembo M, Kwiecinski J, Syed MBJ, Nash J, Tzolos E, Bing R, Cadet S, MacNaught G, van Beek EJR, Moss AJ, Doris MK, Walker NL, Dey D, Adamson PD, Newby DE, Slomka PJ, Dweck MR. Quantifying microcalcification activity in the thoracic aorta. J Nucl Cardiol 2022; 29:1372-1385. [PMID: 33474695 PMCID: PMC8497049 DOI: 10.1007/s12350-020-02458-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Standard methods for quantifying positron emission tomography (PET) uptake in the aorta are time consuming and may not reflect overall vessel activity. We describe aortic microcalcification activity (AMA), a novel method for quantifying 18F-sodium fluoride (18F-NaF) uptake in the thoracic aorta. METHODS Twenty patients underwent two hybrid 18F-NaF PET and computed tomography (CT) scans of the thoracic aorta less than three weeks apart. AMA, as well as maximum (TBRmax) and mean (TBRmean) tissue to background ratios, were calculated by two trained operators. Intra-observer repeatability, inter-observer repeatability and scan-rescan reproducibility were assessed. Each 18F-NaF quantification method was compared to validated cardiovascular risk scores. RESULTS Aortic microcalcification activity demonstrated excellent intra-observer (intraclass correlation coefficient 0.98) and inter-observer (intraclass correlation coefficient 0.97) repeatability with very good scan-rescan reproducibility (intraclass correlation coefficient 0.86) which were similar to previously described TBRmean and TBRmax methods. AMA analysis was much quicker to perform than standard TBR assessment (3.4min versus 15.1min, P<0.0001). AMA was correlated with Framingham stroke risk scores and Framingham risk score for hard cononary heart disease. CONCLUSIONS AMA is a simple, rapid and reproducible method of quantifying global 18F-NaF uptake across the ascending aorta and aortic arch that correlates with cardiovascular risk scores.
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Affiliation(s)
- Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Maria Lembo
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Maaz B J Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jennifer Nash
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Gillian MacNaught
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alistair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Niki L Walker
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Scottish Adult Congenital Cardiology Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Damini Dey
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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17
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Tzolos E, Williams MC, McElhinney P, Lin A, Grodecki K, Flores Tomasino G, Cadet S, Kwiecinski J, Doris M, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman DS, Slomka PJ, Dweck MR, Newby DE, Dey D. Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:1078-1088. [PMID: 35450813 PMCID: PMC9187595 DOI: 10.1016/j.jcmg.2022.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. OBJECTIVES This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. METHODS In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). RESULTS In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was -76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of -70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥-70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037). CONCLUSION Coronary CTA-defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.
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Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Priscilla McElhinney
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Lin
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kajetan Grodecki
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guadalupe Flores Tomasino
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sebastien Cadet
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacek Kwiecinski
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shirjel Alam
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Hunter
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- Department of Non-Communicable Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chengjia Wang
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan R Weir-McCall
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Giles Roditi
- Institute of Clinical Sciences, University of Glasgow, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Leslee J Shaw
- Icahn School of Medicine, Mount Sinai, New York, USA
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Daniel S Berman
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Kwiecinski J, Tzolos E, Fletcher AJ, Nash J, Meah MN, Cadet S, Adamson PD, Grodecki K, Joshi N, Williams MC, van Beek EJR, Lai C, Tavares AAS, MacAskill MG, Dey D, Baker AH, Leipsic J, Berman DS, Sellers SL, Newby DE, Dweck MR, Slomka PJ. Bypass Grafting and Native Coronary Artery Disease Activity. JACC Cardiovasc Imaging 2022; 15:875-887. [PMID: 35216930 PMCID: PMC9246289 DOI: 10.1016/j.jcmg.2021.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis. METHODS Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
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Affiliation(s)
- Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander J Fletcher
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kajetan Grodecki
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nikhil Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Chi Lai
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G MacAskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew H Baker
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie L Sellers
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Carter J, Heseltine TD, Meah MN, Tzolos E, Kwiecinski J, Doris M, McElhinney P, Moss AJ, Adamson PD, Hunter A, Alam S, Shah ASV, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Nicol ED, Shaw LJ, Berman DS, Slomka PJ, Mills NL, Dweck MR, Newby DE, Murray SW, Dey D, Williams MC. Hepatosteatosis and Atherosclerotic Plaque at Coronary CT Angiography. Radiol Cardiothorac Imaging 2022; 4:e210260. [PMID: 35506136 PMCID: PMC9059242 DOI: 10.1148/ryct.210260] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/01/2022] [Accepted: 03/29/2022] [Indexed: 01/22/2023]
Abstract
Purpose To assess the association between nonalcoholic fatty liver disease (NAFLD) and quantitative atherosclerotic plaque at CT. Materials and Methods In this post hoc analysis of the prospective Scottish Computed Tomography of the HEART trial (November 2010 to September 2014), hepatosteatosis and coronary artery calcium score were measured at noncontrast CT. Presence of stenoses, visually assessed high-risk plaque, and quantitative plaque burden were assessed at coronary CT angiography. Multivariable models were constructed to assess the impact of hepatosteatosis and cardiovascular risk factors on coronary artery disease. Results Images from 1726 participants (mean age, 58 years ± 9 [SD]; 974 men) were included. Participants with hepatosteatosis (155 of 1726, 9%) had a higher body mass index, more hypertension and diabetes mellitus, and higher cardiovascular risk scores (P < .001 for all) compared with those without hepatosteatosis. They had increased coronary artery calcium scores (median, 43 Agatston units [AU] [interquartile range, 0-273] vs 19 AU [0-225], P = .046), more nonobstructive disease (48% vs 37%, P = .02), and higher low-attenuation plaque burden (5.11% [0-7.16] vs 4.07% [0-6.84], P = .04). However, these associations were not independent of cardiovascular risk factors. Over a median of 4.7 years, there was no evidence of a difference in myocardial infarction between those with and without hepatosteatosis (1.9% vs 2.4%, P = .92). Conclusion Hepatosteatosis at CT was associated with an increased prevalence of coronary artery disease at CT, but this was not independent of the presence of cardiovascular risk factors.Keywords: CT, Cardiac, Nonalcoholic Fatty Liver Disease, Coronary Artery Disease, Hepatosteatosis, Plaque QuantificationClinical trial registration no. NCT01149590 Supplemental material is available for this article. © RSNA, 2022See also commentary by Abohashem and Blankstein in this issue.
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Affiliation(s)
- Jessica Carter
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Thomas D. Heseltine
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Mohammed N. Meah
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Evangelos Tzolos
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Jacek Kwiecinski
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Mhairi Doris
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Priscilla McElhinney
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Alastair J. Moss
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Philip D. Adamson
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Amanda Hunter
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Shirjel Alam
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Anoop S. V. Shah
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Tania Pawade
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Chengjia Wang
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Jonathan R. Weir-McCall
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Giles Roditi
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Edwin J. R. van Beek
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Edward D. Nicol
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Leslee J. Shaw
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Daniel S. Berman
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Piotr J. Slomka
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Nicholas L. Mills
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Marc R. Dweck
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - David E. Newby
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Scott W. Murray
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Damini Dey
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
| | - Michelle C. Williams
- From the University/BHF Centre for Cardiovascular Science, University
of Edinburgh, Chancellor’s Building, 49 Little France Crescent,
Edinburgh, Scotland EH16 SUF, (J.C., M.N.M., E.T., J.K., M.D., A.J.M., P.D.A.,
A.H., S.A., A.S.V.S., T.P., C.W., N.L.M., M.R.D., D.E.N., M.C.W.); Liverpool
Centre for Cardiovascular Science, Liverpool, England (T.D.H., S.W.M.);
Department of Interventional Cardiology and Angiology, Institute of Cardiology,
Warsaw, Poland (J.K.); Biomedical Imaging Research Institute and Division of
Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles,
Calif (P.M., D.S.B., P.J.S., D.D.); Christchurch Heart Institute, University of
Otago, Christchurch, New Zealand (P.D.A.); Department of Radiology, University
of Cambridge, Cambridge, England (J.R.W.M.); Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, Scotland (G.R.); Edinburgh
Imaging Facility QMRI, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.,
M.R.D., D.E.N., M.C.W.); Royal Brompton and Harefield NHS Foundation Trust
Departments of Cardiology and Radiology, London, England and the National Heart
and Lung Institute, Faculty of Medicine, Imperial College, London, England
(E.D.N.); and Icahn School of Medicine, Weill Cornell Medical College, New York,
NY (L.J.S.)
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20
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Tzolos E, Kwiecinski J, Lassen ML, Cadet S, Adamson PD, Moss AJ, Joshi N, Williams MC, van Beek EJR, Dey D, Berman DS, Dweck MR, Newby DE, Slomka PJ. Observer repeatability and interscan reproducibility of 18F-sodium fluoride coronary microcalcification activity. J Nucl Cardiol 2022; 29:126-135. [PMID: 32529531 PMCID: PMC7728624 DOI: 10.1007/s12350-020-02221-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aimed to establish the observer repeatability and interscan reproducibility of coronary 18F-sodium-fluoride positron emission tomography (PET) uptake using a novel semi-automated approach, coronary microcalcification activity (CMA). METHODS Patients with multivessel coronary artery disease underwent repeated hybrid PET and computed tomography angiography (CTA) imaging (PET/CTA). CMA was defined as the integrated standardized uptake values (SUV) in the entire coronary tree exceeding 2 standard deviations above the background SUV. Coefficients of repeatability between the same observer (intraobserver repeatability), between 2 observers (interobserver repeatability) and coefficient of reproducibility between 2 scans (interscan reproducibility), were determined at vessel and patient level. RESULTS In 19 patients, CMA was assessed twice in 43 coronary vessels on two PET/CT scans performed 12 ± 5 days apart. There was excellent intraclass correlation for intraobserver and interobserver repeatability as well as interscan reproducibility (all ≥ 0.991). There was 100% intraobserver, interobserver and interscan agreement for the presence (CMA > 0) or absence (CMA = 0) of coronary18F-NaF uptake. Mean CMA was 3.12 ± 0.62 with coefficients of repeatability of ≤ 10% for all measures: intraobserver 0.24 and 0.22, interobserver 0.30 and 0.29 and interscan 0.33 and 0.32 at a per-vessel and per-patient level, respectively. CONCLUSIONS CMA is a repeatable and reproducible global measure of coronary atherosclerotic activity.
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Affiliation(s)
- Evangelos Tzolos
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Martin Lyngby Lassen
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Nikhil Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA.
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21
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Kaiser Y, Daghem M, Tzolos E, Meah MN, Doris MK, Moss AJ, Kwiecinski J, Kroon J, Nurmohamed NS, van der Harst P, Adamson PD, Williams MC, Dey D, Newby DE, Stroes ESG, Zheng KH, Dweck MR. Association of Lipoprotein(a) With Atherosclerotic Plaque Progression. J Am Coll Cardiol 2022; 79:223-233. [PMID: 35057907 PMCID: PMC8784819 DOI: 10.1016/j.jacc.2021.10.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is associated with increased risk of myocardial infarction, although the mechanism for this observation remains uncertain. OBJECTIVES This study aims to investigate whether Lp(a) is associated with adverse plaque progression. METHODS Lp(a) was measured in patients with advanced stable coronary artery disease undergoing coronary computed tomography angiography at baseline and 12 months to assess progression of total, calcific, noncalcific, and low-attenuation plaque (necrotic core) in particular. High Lp(a) was defined as Lp(a) ≥ 70 mg/dL. The relationship of Lp(a) with plaque progression was assessed using linear regression analysis, adjusting for body mass index, segment involvement score, and ASSIGN score (a Scottish cardiovascular risk score comprised of age, sex, smoking, blood pressure, total and high-density lipoprotein [HDL]-cholesterol, diabetes, rheumatoid arthritis, and deprivation index). RESULTS A total of 191 patients (65.9 ± 8.3 years of age; 152 [80%] male) were included in the analysis, with median Lp(a) values of 100 (range: 82 to 115) mg/dL and 10 (range: 5 to 24) mg/dL in the high and low Lp(a) groups, respectively. At baseline, there was no difference in coronary artery disease severity or plaque burden. Patients with high Lp(a) showed accelerated progression of low-attenuation plaque compared with low Lp(a) patients (26.2 ± 88.4 mm3 vs -0.7 ± 50.1 mm3; P = 0.020). Multivariable linear regression analysis confirmed the relation between Lp(a) and low-attenuation plaque volume progression (β = 10.5% increase for each 50 mg/dL Lp(a), 95% CI: 0.7%-20.3%). There was no difference in total, calcific, and noncalcific plaque volume progression. CONCLUSIONS Among patients with advanced stable coronary artery disease, Lp(a) is associated with accelerated progression of coronary low-attenuation plaque (necrotic core). This may explain the association between Lp(a) and the high residual risk of myocardial infarction, providing support for Lp(a) as a treatment target in atherosclerosis.
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Affiliation(s)
- Yannick Kaiser
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Alistair J Moss
- Department of Cardiovascular Science, National Institute of Health Research Biomedical Research Centre Leicester, University of Leicester, Leicester, United Kingdom
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Jeffrey Kroon
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kang H Zheng
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. https://twitter.com/Zheng_KH
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom.
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22
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Kwiecinski J, Tzolos E, Meah MN, Cadet S, Adamson PD, Grodecki K, Joshi NV, Moss AJ, Williams MC, van Beek EJR, Berman DS, Newby DE, Dey D, Dweck MR, Slomka PJ. Machine Learning with 18F-Sodium Fluoride PET and Quantitative Plaque Analysis on CT Angiography for the Future Risk of Myocardial Infarction. J Nucl Med 2022; 63:158-165. [PMID: 33893193 PMCID: PMC8717197 DOI: 10.2967/jnumed.121.262283] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Coronary 18F-sodium fluoride (18F-NaF) PET and CT angiography-based quantitative plaque analysis have shown promise in refining risk stratification in patients with coronary artery disease. We combined both of these novel imaging approaches to develop an optimal machine-learning model for the future risk of myocardial infarction in patients with stable coronary disease. Methods: Patients with known coronary artery disease underwent coronary 18F-NaF PET and CT angiography on a hybrid PET/CT scanner. Machine-learning by extreme gradient boosting was trained using clinical data, CT quantitative plaque analysis, measures and 18F-NaF PET, and it was tested using repeated 10-fold hold-out testing. Results: Among 293 study participants (65 ± 9 y; 84% male), 22 subjects experienced a myocardial infarction over the 53 (40-59) months of follow-up. On univariable receiver-operator-curve analysis, only 18F-NaF coronary uptake emerged as a predictor of myocardial infarction (c-statistic 0.76, 95% CI 0.68-0.83). When incorporated into machine-learning models, clinical characteristics showed limited predictive performance (c-statistic 0.64, 95% CI 0.53-0.76) and were outperformed by a quantitative plaque analysis-based machine-learning model (c-statistic 0.72, 95% CI 0.60-0.84). After inclusion of all available data (clinical, quantitative plaque and 18F-NaF PET), we achieved a substantial improvement (P = 0.008 versus 18F-NaF PET alone) in the model performance (c-statistic 0.85, 95% CI 0.79-0.91). Conclusion: Both 18F-NaF uptake and quantitative plaque analysis measures are additive and strong predictors of outcome in patients with established coronary artery disease. Optimal risk stratification can be achieved by combining clinical data with these approaches in a machine-learning model.
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Affiliation(s)
- Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Kajetan Grodecki
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nikhil V Joshi
- Bristol Heart Institute, University of Bristol, United Kingdom; and
| | - Alastair J Moss
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;
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23
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Cartlidge TRG, Bing R, Kwiecinski J, Guzzetti E, Pawade TA, Doris MK, Adamson PD, Massera D, Lembo M, Peeters FECM, Couture C, Berman DS, Dey D, Slomka P, Pibarot P, Newby DE, Clavel MA, Dweck MR. Contrast-enhanced computed tomography assessment of aortic stenosis. Heart 2021; 107:1905-1911. [PMID: 33514522 PMCID: PMC8600609 DOI: 10.1136/heartjnl-2020-318556] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT. METHODS This was a post hoc analysis of 164 patients (median age 71 (IQR 66-77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight. RESULTS Contrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98-2.38), moderate: 0.87 (1.48-1.72), severe: 0.47 (0.33-0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75-150), moderate: 191 (117-253), severe: 274 (213-344) mm3/cm2). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively). CONCLUSIONS Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction.
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Affiliation(s)
| | - Rong Bing
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Tania A Pawade
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Mhairi K Doris
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK,Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Daniele Massera
- Leon H Charney Division of Cardiology, New York University, New York City, New York, USA
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | | | | | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - David E Newby
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Marc R Dweck
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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24
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Osborne-Grinter M, Kwiecinski J, Cadet S, Adamson PD, Mills NL, Roditi G, Van Beek EJR, Shaw LJ, Nicol ED, Berman D, Slomka PJ, Newby DE, Dweck MR, Dey DE, Williams M. Association of coronary artery calcium score groups with qualitative and quantitatively assessed adverse plaque. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes on coronary computed tomography (CT) angiography (CCTA) is unknown.
Methods
In this post-hoc analysis, CT images and clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1 to 9AU), low (10 to 99AU), moderate (100 to 399AU), high (400 to 999AU) and very high (≥1000AU). Adverse plaques were investigated with qualitative (visual categorisation of positive remodelling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation and total plaque burden) methods.
Results
Images of 1769 patients were assessed (mean age 58±9 years, 56% male, median Agatston score 21 [interquartile range 0 to 230] AU). Of these 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high and 8% very high CACS. Amongst patients with a zero CACS, 14% had nonobstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques and 13% had quantitative low-attenuation plaque (LAP) burden >4% (Figure 1). Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal and low CACS (p<0.001), but there was no difference between those with medium, high and very high CACS. Over a median follow-up of 4.8 [4.1 to 5.7] years, fatal or non-fatal myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS ≥1000AU (Hazard ratio (HR) 4.55 [1.20 to 17.3], p=0.026) and low-attenuation plaque burden (HR 1.74 [1.19 to 2.54], p=0.004) were the only predictors of myocardial infarction, independent of obstructive disease and cardiovascular risk score. Figure 2 shows example CCTA images in a patient with zero CACS, non-calcified plaque (red), low attenuation plaque (orange) burden >4% and obstructive disease in the left anterior descending coronary artery.
Conclusions
In patients with stable chest pain, a zero CACS is associated with a good prognosis, but 1 in 6 have coronary artery disease, including the presence of adverse plaques.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute
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Affiliation(s)
- M Osborne-Grinter
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J Kwiecinski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - S Cadet
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - P D Adamson
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - G Roditi
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom
| | - E J R Van Beek
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - L J Shaw
- Weill Cornell Medical College, New York, United States of America
| | - E D Nicol
- Royal Brompton Hospital, London, United Kingdom
| | - D Berman
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - P J Slomka
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - D E Newby
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Dey
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - M Williams
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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25
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Andrews JPM, MacNaught G, Moss AJ, Doris MK, Pawade T, Adamson PD, van Beek EJR, Lucatelli C, Lassen ML, Robson PM, Fayad ZA, Kwiecinski J, Slomka PJ, Berman DS, Newby DE, Dweck MR. Cardiovascular 18F-fluoride positron emission tomography-magnetic resonance imaging: A comparison study. J Nucl Cardiol 2021; 28:1-12. [PMID: 31792913 PMCID: PMC8616877 DOI: 10.1007/s12350-019-01962-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND 18F-Fluoride uptake denotes calcification activity in aortic stenosis and atherosclerosis. While PET/MR has several advantages over PET/CT, attenuation correction of PET/MR data is challenging, limiting cardiovascular application. We compared PET/MR and PET/CT assessments of 18F-fluoride uptake in the aortic valve and coronary arteries. METHODS AND RESULTS 18 patients with aortic stenosis or recent myocardial infarction underwent 18F-fluoride PET/CT followed immediately by PET/MR. Valve and coronary 18F-fluoride uptake were evaluated independently. Both standard (Dixon) and novel radial GRE) MR attenuation correction (AC) maps were validated against PET/CT with results expressed as tissue-to-background ratios (TBRs). Visually, aortic valve 18F-fluoride uptake was similar on PET/CT and PET/MR. TBRMAX values were comparable with radial GRE AC (PET/CT 1.55±0.33 vs. PET/MR 1.58 ± 0.34, P = 0.66; 95% limits of agreement - 27% to + 25%) but performed less well with Dixon AC (1.38 ± 0.44, P = 0.06; bias (-)14%; 95% limits of agreement - 25% to + 53%). In native coronaries, 18F-fluoride uptake was similar on PET/MR to PET/CT regardless of AC approach. PET/MR identified 28/29 plaques identified on PET/CT; however, stents caused artifact on PET/MR making assessment of 18F-fluoride uptake challenging. CONCLUSION Cardiovascular PET/MR demonstrates good visual and quantitative agreement with PET/CT. However, PET/MR is hampered by stent-related artifacts currently limiting clinical application.
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Affiliation(s)
- Jack P M Andrews
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK.
| | - Gillian MacNaught
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alastair J Moss
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Mhairi K Doris
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tania Pawade
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Philip D Adamson
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, PA, USA
| | - Jacek Kwiecinski
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | | | | | - David E Newby
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Sciences, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, UK
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26
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Affiliation(s)
- Peter McLeod
- Department of Medicine - HeartOtago, University of Otago Dunedin School of Medicine, Dunedin, New Zealand.,Department of Cardiology, Southern District Health Board, Dunedin, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand.,British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Sean Coffey
- Department of Medicine - HeartOtago, University of Otago Dunedin School of Medicine, Dunedin, New Zealand .,Department of Cardiology, Southern District Health Board, Dunedin, New Zealand
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27
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Williams MC, Kwiecinski J, Doris M, McElhinney P, D'Souza MS, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Bonnici-Mallia M, Murrills C, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman DS, Slomka PJ, Newby DE, Dweck MR, Dey D. Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction. JACC Cardiovasc Imaging 2021; 14:1804-1814. [PMID: 33865779 PMCID: PMC8435010 DOI: 10.1016/j.jcmg.2021.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. BACKGROUND Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. METHODS Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. RESULTS Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. CONCLUSIONS Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
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Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom.
| | - Jacek Kwiecinski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Michelle S D'Souza
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alastair J Moss
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shirjel Alam
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Hunter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tania Pawade
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chengjia Wang
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Giles Roditi
- Institute of Clinical Sciences, University of Glasgow, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | - Leslee J Shaw
- Weill Cornell Medical College, New York, New York, USA
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, United Kingdom, and the National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom
| | | | - Piotr J Slomka
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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28
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Meah MN, Singh T, Williams MC, Dweck MR, Newby DE, Slomka P, Adamson PD, Moss AJ, Dey D. Reproducibility of quantitative plaque measurement in advanced coronary artery disease. J Cardiovasc Comput Tomogr 2021; 15:333-338. [PMID: 33423941 PMCID: PMC8236495 DOI: 10.1016/j.jcct.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The ability to characterize and to quantify the extent of coronary artery disease has the potential to improve the prognostic capability of coronary computed tomography angiography. Although reproducible techniques have been described in those with mild coronary disease, this has yet to be assessed in patients with advanced disease. METHODS Twenty patients with known multivessel disease underwent repeated computed tomography coronary angiography, 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility. RESULTS Overall, 149 coronary arterial segments were analysed. There was excellent intraobserver and interobserver agreement for all plaque volume measurements (Lin's coefficient 0.95 to 1.0). There were no substantial interscan differences (P > 0.05 for all) for total (2063 ± 1246 mm3, mean of differences -35.6 mm3), non-calcified (1795 ± 910 mm3, mean of differences -4.3 mm3), calcified (298 ± 425 mm3, mean of differences -31.3 mm3) and low-attenuation (13 ± 13 mm3, mean of differences -2.6 mm3) plaque volumes. Interscan agreement was highest for total and noncalcified plaque volumes. Calcified and low-attenuation plaque (-236.6 to 174 mm3 and -15.8 to 10.5 mm3 respectively) had relatively wider 95% limits of agreement reflecting the lower absolute plaque volumes. CONCLUSION In the presence of advanced coronary disease, semi-automated plaque quantification provides excellent reproducibility, particularly for total and non-calcified plaque volumes. This approach has major potential to assess change in disease over time and optimize risk stratification in patients with established coronary artery disease.
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Affiliation(s)
- Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Trisha Singh
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; British Heart Foundation Cardiovascular Research Centre. University of Leicester, Leicester, UK
| | - Damini Dey
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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29
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Ho CYC, Lee M, El-Jack S, Barr P, Simmonds M, Devlin G, Adamson PD, Williams M, Kerr AJ. How common are non-acute coronary syndrome (ACS) diagnoses in patients with suspected ACS investigated with coronary angiography in New Zealand? (ANZACS-QI 58). N Z Med J 2021; 134:43-55. [PMID: 34239161] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND AIMS The last two decades in New Zealand have seen increased availability of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and early invasive coronary angiography (ICA) for other high-risk acute coronary syndrome (ACS) patients. One metric to assess the clinical appropriateness of these invasive strategies is to examine the false-positive rate for the investigation (ie, the rate of non-ACS diagnoses). METHODS All patients presenting to New Zealand public hospitals with suspected ACS who underwent ICA between 2015 and 2019 were recorded prospectively in the All New Zealand Acute Coronary Syndrome Quality Improvement registry. The cohort was divided according to clinical impression at presentation: (1) suspected STEMI <24h and (2) other suspected ACS. The final discharge diagnosis for each patient were obtained from the registry. RESULTS There were 6,059 (20%) patients with suspected STEMI <24h and 24,258 (80%) with other suspected ACS. Of the suspected STEMIs <24h, 90.6% had a final diagnosis of STEMI, 3.5% non-ST segment elevation ACS (NSTEACS) and only 5.9% had a non-ACS diagnosis. Of those with other suspected ACS, 80.7% had a final ACS diagnosis. Across all New Zealand district health boards (DHBs), the proportion of non-ACS diagnoses was similar for suspected STEMI presentations. However, for other suspected ACS, the proportions were higher in DHBs with rapid access to coronary interventional facilities than in those without (17.6% vs 7.0%, p<0.001). CONCLUSIONS False-positive catheter laboratory activations for suspected STEMI patients are low across New Zealand. The differences in the proportion of non-ACS diagnoses according to DHB interventional capability for other suspected ACS requires further investigation.
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Affiliation(s)
| | - Mildred Lee
- Department of Cardiology, Counties Manukau District Health Board, New Zealand
| | - Seif El-Jack
- Department of Cardiology, Waitematā District Health Board, New Zealand
| | - Peter Barr
- Department of Cardiology, Auckland District Health Board, New Zealand
| | - Mark Simmonds
- Department of Cardiology, Capital and Coast District Health Board, New Zealand
| | - Gerry Devlin
- Department of Cardiology, Gisborne Hospital, New Zealand
| | - Philip D Adamson
- Department of Cardiology, Canterbury District Health Board, New Zealand; Department of Medicine, University of Otago, New Zealand
| | - Michael Williams
- Department of Cardiology, Southern District Health Board, New Zealand; Department of Medicine, University of Otago, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Counties Manukau District Health Board, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
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30
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Pawade TA, Doris MK, Bing R, White AC, Forsyth L, Evans E, Graham C, Williams MC, van Beek EJ, Fletcher A, Adamson PD, Andrews JP, Cartlidge TR, Jenkins WS, Syed M, Fujisawa T, Lucatelli C, Fraser W, Ralston SH, Boon N, Prendergast B, Newby DE, Dweck MR. Effect of Denosumab or Alendronic Acid on the Progression of Aortic Stenosis: A Double-Blind Randomized Controlled Trial. Circulation 2021; 143:2418-2427. [PMID: 33913339 PMCID: PMC8212878 DOI: 10.1161/circulationaha.121.053708] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Valvular calcification is central to the pathogenesis and progression of aortic stenosis, with preclinical and observational studies suggesting that bone turnover and osteoblastic differentiation of valvular interstitial cells are important contributory mechanisms. We aimed to establish whether inhibition of these pathways with denosumab or alendronic acid could reduce disease progression in aortic stenosis. METHODS In a single-center, parallel group, double-blind randomized controlled trial, patients >50 years of age with calcific aortic stenosis (peak aortic jet velocity >2.5 m/s) were randomized 2:1:2:1 to denosumab (60 mg every 6 months), placebo injection, alendronic acid (70 mg once weekly), or placebo capsule. Participants underwent serial assessments with Doppler echocardiography, computed tomography aortic valve calcium scoring, and 18F-sodium fluoride positron emission tomography and computed tomography. The primary end point was the calculated 24-month change in aortic valve calcium score. RESULTS A total of 150 patients (mean age, 72±8 years; 21% women) with calcific aortic stenosis (peak aortic jet velocity, 3.36 m/s [2.93-3.82 m/s]; aortic valve calcium score, 1152 AU [655-2065 AU]) were randomized and received the allocated trial intervention: denosumab (n=49), alendronic acid (n=51), and placebo (injection n=25, capsule n=25; pooled for analysis). Serum C-terminal telopeptide, a measure of bone turnover, halved from baseline to 6 months with denosumab (0.23 [0.18-0.33 µg/L] to 0.11 µg/L [0.08-0.17 µg/L]) and alendronic acid (0.20 [0.14-0.28 µg/L] to 0.09 µg/L [0.08-0.13 µg/L]) but was unchanged with placebo (0.23 [0.17-0.30 µg/L] to 0.26 µg/L [0.16-0.31 µg/L]). There were no differences in 24-month change in aortic valve calcium score between denosumab and placebo (343 [198-804 AU] versus 354 AU [76-675 AU]; P=0.41) or alendronic acid and placebo (326 [138-813 AU] versus 354 AU [76-675 AU]; P=0.49). Similarly, there were no differences in change in peak aortic jet velocity or 18F-sodium fluoride aortic valve uptake. CONCLUSIONS Neither denosumab nor alendronic acid affected progression of aortic valve calcification in patients with calcific aortic stenosis. Alternative pathways and mechanisms need to be explored to identify disease-modifying therapies for the growing population of patients with this potentially fatal condition. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02132026.
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Affiliation(s)
- Tania A. Pawade
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Mhairi K. Doris
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Audrey C. White
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit (L.F.), University of Edinburgh, United Kingdom
| | - Emily Evans
- Edinburgh Clinical Research Facility (E.E., C.G.), University of Edinburgh, United Kingdom
| | - Catriona Graham
- Edinburgh Clinical Research Facility (E.E., C.G.), University of Edinburgh, United Kingdom
| | - Michelle C. Williams
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Edwin J.R. van Beek
- Edinburgh Imaging (E.J.R.v.B., A.F., C.L.), University of Edinburgh, United Kingdom
| | - Alison Fletcher
- Edinburgh Imaging (E.J.R.v.B., A.F., C.L.), University of Edinburgh, United Kingdom
| | - Philip D. Adamson
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
- Christchurch Heart Institute, University of Otago, New Zealand (P.D.A.)
| | - Jack P.M. Andrews
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Timothy R.G. Cartlidge
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - William S.A. Jenkins
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Christophe Lucatelli
- Edinburgh Imaging (E.J.R.v.B., A.F., C.L.), University of Edinburgh, United Kingdom
| | - William Fraser
- Norwich Medical School, University of East Anglia, United Kingdom (W.F.)
| | - Stuart H. Ralston
- Institute of Genetics and Molecular Medicine (S.H.R.), University of Edinburgh, United Kingdom
| | - Nicholas Boon
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science (T.A.P., M.K.D., R.B., A.C.W., M.C.W., P.D.A., J.P.M.A., T.R.G.C., W.S.A.J., M.S., T.F., N.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe FT, Cadet S, Kwiecinski J, Doris M, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek E, Shaw L, Nicol ED, Berman DS, Slomka P, Dweck M, Newby D, Dey D. 155 Pericoronary adipose tissue attenuation, low attenuation plaque burden and 5-year risk of myocardial infarction. Imaging 2021. [DOI: 10.1136/heartjnl-2021-bcs.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand .,BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Abstract
Preterm birth affects 1 in 10 pregnancies worldwide, with increasing survival rates over the last 30 years. However, as this new generation of long-term survivors approaches middle age, recent studies have revealed increased cardiovascular risk factors and higher rates of ischaemic heart disease and heart failure. Cardiovascular imaging has identified smaller cardiac chamber size, changes in myocardial mass and impaired ventricular function, particularly under physiological stress. Accordingly, this population should be recognised as having a higher risk of heart failure as they age. In this review, we present current evidence for increased rates of heart failure and evidence of alterations in cardiac structure and function in those born preterm. We discuss potential mechanisms to explain this risk including greater frequency of co-morbidities known to be associated with heart failure. We also explore potential mechanistic links specific to the preterm-born population, including the impact of premature birth on myocardial and vascular development and the effects of perinatal haemodynamic changes and chronic lung disease on the developing heart. We highlight gaps in our knowledge and consider implications for patient management relevant to the adult physician.
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Affiliation(s)
- Charlotte Greer
- Cardiology Department, Christchurch Hospital, Christchurch, New Zealand
| | - Richard W Troughton
- Cardiology Department, Christchurch Hospital, Christchurch, New Zealand.,Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.,Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Sarah L Harris
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
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Williams MC, Massera D, Moss AJ, Bing R, Bularga A, Adamson PD, Hunter A, Alam S, Shah ASV, Pawade T, Roditi G, van Beek EJR, Nicol ED, Newby DE, Dweck MR. Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:262-270. [PMID: 33306104 PMCID: PMC7899264 DOI: 10.1093/ehjci/jeaa263] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. METHODS AND RESULTS In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60-5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47-8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease. CONCLUSION Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
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Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Daniele Massera
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Alastair J Moss
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Rong Bing
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anda Bularga
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Philip D Adamson
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch 8140, New Zealand
| | - Amanda Hunter
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Shirjel Alam
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anoop S V Shah
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Tania Pawade
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Giles Roditi
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow G514LB, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | | | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Marc R Dweck
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
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Fletcher A, Lembo M, Syed MBJ, Kwiencinski J, Tzolos E, Moss A, Adamson PD, Walker NL, Slomka PJ, Van Beek EJR, Newby DE, Dweck MR. Hybrid 18f-sodium fluoride PET/CT of the thoracic aorta identifies patients at increased risk of stroke. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Calcification of the thoracic aorta is associated with poor vessel wall health. Early detection of this disease process may highlight those at risk of future cardiovascular events.
Purpose
To investigate the potential of hybrid 18F-sodium fluoride (18F-NaF, a marker of vascular disease and microcalcification activity) positron emission tomography/computed tomography (PET/CT) to predict aortic disease progression and adverse cardiovascular events in patients with established risk factors.
Methods
Between 2015 and 2017, 197 patients underwent 18F-NaF PET/CT of the thoracic aorta as part of a randomised controlled trial. Baseline 18F-NaF aortic microcalcification activity (AMA) was calculated as the cumulative uptake in a standardised volume of interest of the arch and ascending aorta. Thirty-seven patients underwent follow up CT enabling aortic calcium score progression calculation. Fatal/non-fatal stroke (primary endpoint) and fatal/non-fatal myocardial infarction (MI, secondary endpoint) were recorded up to May 2020. The association between baseline AMA and both the progression of aortic calcium score and defined endpoints was analysed. AMA was stratified into tertiles (low, moderate or high). Data is presented as mean(SD) or median [IQR].
Results
18F-NaF AMA correlated with the progression of aortic calcium score (R = 0.42, P = 0.01). During 3.8 (0.9) years of follow up, 14 patients experienced the primary (stroke, n = 5) or secondary (MI, n = 9) endpoint. Patients who experienced stroke had higher AMA (171 [162-176] vs 150 [141 - 157], P = 0.0015). Increased cumulative incidence of stroke was seen in the highest AMA tertile (Figure, P = 0.019). There was no association between AMA and MI (P > 0.05).
Conclusion
Aortic microcalcification activity, as measured using 18F-NaF PET/CT, predicts the progression of aortic wall calcification and is associated with an increased risk of stroke but not MI. Consolidating these findings in further studies will improve stroke risk prediction using 18F-NaF PET/CT.
Table Baseline characteristics Overall n = 197 Low AMA (<144) n = 66 Moderate AMA (144-155) n = 66 High AMA (>155) n = 65 p-value (ANOVA / X2) Age (±sd) 65.17 (8.30) 64.02 (9.43) 65.47 (7.40) 66.03 (7.95) 0.364 Male Sex (%) 157 (80.5) 54 (83.1) 52 (78.8) 51 (79.7) 0.808 Ever Smoked (%) 101 (60.5) 37 (71.2) 32 (56.1) 32 (55.2) 0.164 Hypertension (%) 110 (56.4) 31 (47.7) 35 (53.0) 44 (68.8) 0.043 High Cholesterol (%) 188 (96.4) 60 (92.3) 65 (98.5) 63 (98.4) 0.093 Type II Diabetes (%) 37 (19.0) 16 (24.6) 9 (13.6) 12 (18.8) 0.277 AMA = aortic microcalcification activity, MI = myocardial infarction, sd = standard deviation, TIA = transient ischaemic attack, X2 = Chi squared Abstract Figure: AMA and Stroke
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Affiliation(s)
- A Fletcher
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Lembo
- Federico II University of Naples, Naples, Italy
| | - MBJ Syed
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Kwiencinski
- Institute of Cardiology, Department of Interventional Cardiology, Warsaw, Poland
| | - E Tzolos
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - A Moss
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - PD Adamson
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - NL Walker
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - PJ Slomka
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - EJR Van Beek
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - DE Newby
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - MR Dweck
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Coffey S, Adamson PD. Microvascular obstruction: time to bust the clot hypothesis? Heart 2021; 107:heartjnl-2020-318324. [PMID: 33452119 DOI: 10.1136/heartjnl-2020-318324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sean Coffey
- Department of Medicine - HeartOtago, University of Otago, Dunedin, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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Kwiecinski J, Tzolos E, Adamson PD, Cadet S, Moss AJ, Joshi N, Williams MC, van Beek EJR, Dey D, Berman DS, Newby DE, Slomka PJ, Dweck MR. Coronary 18F-Sodium Fluoride Uptake Predicts Outcomes in Patients With Coronary Artery Disease. J Am Coll Cardiol 2021; 75:3061-3074. [PMID: 32553260 DOI: 10.1016/j.jacc.2020.04.046] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking. Coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity. OBJECTIVES This study assessed whether 18F-NaF PET predicts myocardial infarction and provides additional prognostic information to current methods of risk stratification. METHODS Patients with known coronary artery disease underwent 18F-NaF PET computed tomography and were followed up for fatal or nonfatal myocardial infarction over 42 months (interquartile range: 31 to 49 months). Total coronary 18F-NaF uptake was determined by the coronary microcalcification activity (CMA). RESULTS In a post hoc analysis of data collected for prospective observational studies, the authors studied 293 study participants (age: 65 ± 9 years; 84% men), of whom 203 (69%) showed increased coronary 18F-NaF activity (CMA >0). Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary 18F-NaF activity (20 of 203 with a CMA >0 vs. 0 of 90 with a CMA of 0; p < 0.001). On receiver operator curve analysis, fatal or nonfatal myocardial infarction prediction was highest for 18F-NaF CMA, outperforming coronary calcium scoring, modified Duke coronary artery disease index and Reduction of Atherothrombosis for Continued Health (REACH) and Secondary Manifestations of Arterial Disease (SMART) risk scores (area under the curve: 0.76 vs. 0.54, 0.62, 0.52, and 0.54, respectively; p < 0.001 for all). Patients with CMA >1.56 had a >7-fold increase in fatal or nonfatal myocardial infarction (hazard ratio: 7.1; 95% confidence interval: 2.2 to 25.1; p = 0.003) independent of age, sex, risk factors, segment involvement and coronary calcium scores, presence of coronary stents, coronary stenosis, REACH and SMART scores, the Duke coronary artery disease index, and recent myocardial infarction. CONCLUSIONS In patients with established coronary artery disease, 18F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Evangelos Tzolos
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nikhil Joshi
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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McAlister CP, Yi M, Adamson PD, Troughton RW, Rhodes M, Blake JW, McClean DR, Elliott JM, Smyth DW, Puri A. Trends in the Detection, Management and 30-Day Outcomes of Spontaneous Coronary Artery Dissection: A Six-Year, New Zealand Centre Experience. Heart Lung Circ 2021; 30:78-85. [DOI: 10.1016/j.hlc.2020.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
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Newby DE, Adamson PD, Shaw LJ. Consistency and Generalizability of Trials for Coronary Computed Tomography Angiography. JAMA Cardiol 2020; 6:2773978. [PMID: 33355616 DOI: 10.1001/jamacardio.2020.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Doris MK, Meah MN, Moss AJ, Andrews JPM, Bing R, Gillen R, Weir N, Syed M, Daghem M, Shah A, Williams MC, van Beek EJR, Forsyth L, Dey D, Slomka PJ, Dweck MR, Newby DE, Adamson PD. Coronary 18F-Fluoride Uptake and Progression of Coronary Artery Calcification. Circ Cardiovasc Imaging 2020; 13:e011438. [PMID: 33297761 PMCID: PMC7771641 DOI: 10.1161/circimaging.120.011438] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Background Positron emission tomography (PET) using 18F-sodium fluoride (18F-fluoride) to detect microcalcification may provide insight into disease activity in coronary atherosclerosis. This study aimed to investigate the relationship between 18F-fluoride uptake and progression of coronary calcification in patients with clinically stable coronary artery disease. Methods Patients with established multivessel coronary atherosclerosis underwent 18F-fluoride PET-computed tomography angiography and computed tomography calcium scoring, with repeat computed tomography angiography and calcium scoring at one year. Coronary PET uptake was analyzed qualitatively and semiquantitatively in diseased vessels by measuring maximum tissue-to-background ratio. Coronary calcification was quantified by measuring calcium score, mass, and volume. Results In a total of 183 participants (median age 66 years, 80% male), 116 (63%) patients had increased 18F-fluoride uptake in at least one vessel. Individuals with increased 18F-fluoride uptake demonstrated more rapid progression of calcification compared with those without uptake (change in calcium score, 97 [39–166] versus 35 [7–93] AU; P<0.0001). Indeed, the calcium score only increased in coronary segments with 18F-fluoride uptake (from 95 [30–209] to 148 [61–289] AU; P<0.001) and remained unchanged in segments without 18F-fluoride uptake (from 46 [16–113] to 49 [20–115] AU; P=0.329). Baseline coronary 18F-fluoride maximum tissue-to-background ratio correlated with 1-year change in calcium score, calcium volume, and calcium mass (Spearman ρ=0.37, 0.38, and 0.46, respectively; P<0.0001 for all). At the segmental level, baseline 18F-fluoride activity was an independent predictor of calcium score at 12 months (P<0.001). However, at the patient level, this was not independent of age, sex, and baseline calcium score (P=0.50). Conclusions Coronary 18F-fluoride uptake identifies both patients and individual coronary segments with more rapid progression of coronary calcification, providing important insights into disease activity within the coronary circulation. At the individual patient level, total calcium score remains an important marker of disease burden and progression. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02110303.
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Affiliation(s)
- Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Jack P M Andrews
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rebecca Gillen
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Nick Weir
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Anoop Shah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit (L.F.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Piotr J Slomka
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Christchurch Heart Institute, University of Otago, Christchurch, NZ (P.D.A.)
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41
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Chan DZ, Stewart RA, Kerr AJ, Dicker B, Kyle CV, Adamson PD, Devlin G, Edmond J, El-Jack S, Elliott JM, Fisher N, Flynn C, Lee M, Liao YWB, Rhodes M, Scott T, Smith T, Stiles MK, Swain AH, Todd VF, Webster MW, Williams MJ, White HD, Somaratne JB. The impact of a national COVID-19 lockdown on acute coronary syndrome hospitalisations in New Zealand (ANZACS-QI 55). Lancet Reg Health West Pac 2020; 5:100056. [PMID: 34173604 PMCID: PMC7677076 DOI: 10.1016/j.lanwpc.2020.100056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Background Countries with a high incidence of coronavirus 2019 (COVID-19) reported reduced hospitalisations for acute coronary syndromes (ACS) during the pandemic. This study describes the impact of a nationwide lockdown on ACS hospitalisations in New Zealand (NZ), a country with a low incidence of COVID-19. Methods All patients admitted to a NZ Hospital with ACS who underwent coronary angiography in the All NZ ACS Quality Improvement registry during the lockdown (23 March – 26 April 2020) were compared with equivalent weeks in 2015–2019. Ambulance attendances and regional community troponin-I testing were compared for lockdown and non-lockdown (1 July 2019 to 16 February 2020) periods. Findings Hospitalisation for ACS was lower during the 5-week lockdown (105 vs. 146 per-week, rate ratio 0•72 [95% CI 0•61–0•83], p = 0.003). This was explained by fewer admissions for non-ST-segment elevation ACS (NSTE-ACS; p = 0•002) but not ST-segment elevation myocardial infarction (STEMI; p = 0•31). Patient characteristics and in-hospital mortality were similar. For STEMI, door-to-balloon times were similar (70 vs. 72 min, p = 0•52). For NSTE-ACS, there was an increase in percutaneous revascularisation (59% vs. 49%, p<0•001) and reduction in surgical revascularisation (9% vs. 15%, p = 0•005). There were fewer ambulance attendances for cardiac arrests (98 vs. 110 per-week, p = 0•04) but no difference for suspected ACS (408 vs. 420 per-week, p = 0•44). Community troponin testing was lower throughout the lockdown (182 vs. 394 per-week, p<0•001). Interpretation Despite the low incidence of COVID-19, there was a nationwide decrease in ACS hospitalisations during the lockdown. These findings have important implications for future pandemic planning. Funding The ANZACS-QI registry receives funding from the New Zealand Ministry of Health.
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Affiliation(s)
- Daniel Zl Chan
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.,Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Ralph Ah Stewart
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Campbell V Kyle
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand.,Department of Biochemistry, Labtests New Zealand, Auckland, New Zealand
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.,British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | | | - John Edmond
- Department of Cardiology, Southern District Health Board, Dunedin, New Zealand
| | - Seif El-Jack
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - John M Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Nick Fisher
- Department of Cardiology, Nelson Hospital, Nelson, New Zealand
| | - Charmaine Flynn
- The National Institute for Health Innovation, University of Auckland, Auckland New Zealand.,Tauranga Hospital, Tauranga, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Yi-Wen Becky Liao
- Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
| | - Maxine Rhodes
- The National Institute for Health Innovation, University of Auckland, Auckland New Zealand
| | - Tony Scott
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Tony Smith
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - Andrew H Swain
- Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand.,Wellington Free Ambulance, Wellington, New Zealand
| | - Verity F Todd
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Mark Wi Webster
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Michael Ja Williams
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Harvey D White
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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42
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Moss AJ, Sim AM, Adamson PD, Seidman MA, Andrews JPM, Doris MK, Shah ASV, BouHaidar R, Alcaide-Corral CJ, Williams MC, Leipsic JA, Dweck MR, MacRae VE, Newby DE, Tavares AAS, Sellers SL. Ex vivo 18F-fluoride uptake and hydroxyapatite deposition in human coronary atherosclerosis. Sci Rep 2020; 10:20172. [PMID: 33214599 PMCID: PMC7677392 DOI: 10.1038/s41598-020-77391-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/27/2020] [Indexed: 01/02/2023] Open
Abstract
Early microcalcification is a feature of coronary plaques with an increased propensity to rupture and to cause acute coronary syndromes. In this ex vivo imaging study of coronary artery specimens, the non-invasive imaging radiotracer, 18F-fluoride, was highly selective for hydroxyapatite deposition in atherosclerotic coronary plaque. Specifically, coronary 18F-fluoride uptake had a high signal to noise ratio compared with surrounding myocardium that makes it feasible to identify coronary mineralisation activity. Areas of 18F-fluoride uptake are associated with osteopontin, an inflammation-associated glycophosphoprotein that mediates tissue mineralisation, and Runt-related transcription factor 2, a nuclear protein involved in osteoblastic differentiation. These results suggest that 18F-fluoride is a non-invasive imaging biomarker of active coronary atherosclerotic mineralisation.
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Affiliation(s)
- Alastair J Moss
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. .,British Heart Foundation Cardiovascular Research Centre, University of Leicester, Leicester, UK.
| | - Alisia M Sim
- EaStCHEM School of Chemistry, University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.,Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Michael A Seidman
- Department of Pathology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Jack P M Andrews
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Mhairi K Doris
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Ralph BouHaidar
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Carlos J Alcaide-Corral
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Vicky E MacRae
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Stephanie L Sellers
- Department of Radiology and Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada
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Meah MN, Mills NL, Adamson PD, Newby DE. The 2020 European Society of Cardiology non-ST-segment elevation acute coronary syndromes guideline: the good, the bad and the ugly. Heart 2020; 107:heartjnl-2020-318195. [PMID: 33144391 DOI: 10.1136/heartjnl-2020-318195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Mohammed N Meah
- Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - Philip D Adamson
- Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - David E Newby
- Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
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45
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Bing R, Singh T, Dweck MR, Mills NL, Williams MC, Adamson PD, Newby DE. Validation of European Society of Cardiology pre-test probabilities for obstructive coronary artery disease in suspected stable angina. Eur Heart J Qual Care Clin Outcomes 2020; 6:293-300. [PMID: 31977010 PMCID: PMC7590886 DOI: 10.1093/ehjqcco/qcaa006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 01/25/2023]
Abstract
AIMS To assess contemporary pre-test probability estimates for obstructive coronary artery disease in patients with stable chest pain. METHODS AND RESULTS In this substudy of a multicentre randomized controlled trial, we compared 2019 European Society of Cardiology (ESC)-endorsed pre-test probabilities with observed prevalence of obstructive coronary artery disease on computed tomography coronary angiography (CTCA). We assessed associations between pre-test probability, 5-year coronary heart disease death or non-fatal myocardial infarction and study intervention (standard care vs. CTCA). The study population consisted of 3755 patients (30-75 years, 46% women) with a median pre-test probability of 11% of whom 1622 (43%) had a pre-test probability of >15%. In those who underwent CTCA (n = 1613), the prevalence of obstructive disease was 22%. When divided into deciles of pre-test probability, the observed disease prevalence was similar but higher than the corresponding median pre-test probability [median difference 2.3 (1.3-5.6)%]. There were more clinical events in patients with a pre-test probability >15% compared to those at 5-15% and <5% (4.1%, 1.5%, and 1.4%, respectively, P < 0.001). Across the total cohort, fewer clinical events occurred in patients who underwent CTCA, with the greatest difference in those with a pre-test probability >15% (2.8% vs. 5.3%, log rank P = 0.01), although this interaction was not statistically significant on multivariable modelling. CONCLUSION The updated 2019 ESC guideline pre-test probability recommendations tended to slightly underestimate disease prevalence in our cohort. Pre-test probability is a powerful predictor of future coronary events and helps select those who may derive the greatest absolute benefit from CTCA.
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Affiliation(s)
- Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Trisha Singh
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 9 Little France Road, Edinburgh EH16 4UX, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
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Abstract
Ticagrelor is a potent and orally active P2Y12 inhibitor. Ticagrelor has been extensively tested in Phase II and Phase III trials in patients with coronary artery disease. The pharmacokinetics and pharmacodynamics of ticagrelor result in more rapid and effective inhibition of platelet activation compared with other P2Y12 inhibitors. This has resulted in a reduction in recurrent major cardiovascular events in initial randomized controls trials comparing ticagrelor with clopidogrel. More recently, clinical trials have investigated the use of ticagrelor in patients with stable coronary artery disease and a high residual risk of coronary thrombotic events. In patients with stable coronary artery disease, the potent antiplatelet effect of ticagrelor is counterbalanced by an increased risk of major bleeding. Further research is ongoing to determine the optimal duration of ticagrelor therapy.
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Affiliation(s)
- Krithika Loganath
- Department of Cardiology, Dorset County Hospital, Dorchester, DT1 2JY, UK
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, UK.,Christchurch Heart Institute, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Alastair J Moss
- British Heart Foundation Cardiovascular Research Centre, University of Leicester, LE1 7RH, UK
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47
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Bularga A, Bing R, Shah AS, Adamson PD, Behan M, Newby DE, Flapan A, Uren N, Cruden N. Clinical outcomes following balloon aortic valvuloplasty. Open Heart 2020; 7:openhrt-2020-001330. [PMID: 32907920 PMCID: PMC7481086 DOI: 10.1136/openhrt-2020-001330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis. Methods We identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records. Results Patients undergoing BAV were elderly (median age 80, IQR 73–86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%–50%: HR 1.76, 95% CI 1.05 to 2.94; EF <30%: HR 1.90, 95% CI 1.12 to 3.20) was the only independent predictor at baseline of overall mortality. Median survival was 212 (IQR 54–490) days from the index procedure. Mortality at 1 year was lowest in patients who subsequently underwent TAVI or SAVR but high among those who had no further interventions or those who had a repeat BAV (14%, 19%, 60%, 89% respectively, log-rank p<0.001). Conclusion BAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.
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Affiliation(s)
- Anda Bularga
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anoop Sv Shah
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Miles Behan
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK.,Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew Flapan
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Neal Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick Cruden
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
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48
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Abstract
Non-invasive imaging of the coronary arteries is an enterprise in rapid development. From the research perspective, there is great demand for in vivo techniques that can reliably identify features of high-risk plaque that may offer insight into pathophysiological processes and act as surrogate indicators of response to therapeutic intervention. Meanwhile, there is clear clinical need for greater accuracy in diagnosis and prognostic stratification. Fortunately, ongoing technological improvements and emerging data from randomized clinical trials are helping make these elusive goals a reality. This review provides an update on the current status of non-invasive coronary imaging with computed tomography, magnetic resonance, and positron emission tomography with a focus on current clinical applications and future research directions.
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Affiliation(s)
- Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU 305, Chancellor's Building, 49 Little France Cres, Edinburgh, UK.,Christchurch Heart Institute, Department of Medicine, University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU 305, Chancellor's Building, 49 Little France Cres, Edinburgh, UK
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49
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Singh T, Bing R, Dweck MR, van Beek EJR, Mills NL, Williams MC, Villines TC, Newby DE, Adamson PD. Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris: A Post Hoc Analysis of the Randomized SCOT-HEART Trial. JAMA Cardiol 2020; 5:920-928. [PMID: 32492104 PMCID: PMC7271417 DOI: 10.1001/jamacardio.2020.1567] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
Importance Recent European guidance supports a diminished role for exercise electrocardiography (ECG) in the assessment of suspected stable angina. Objective To evaluate the utility of exercise ECG in contemporary practice and assess the value of combined functional and anatomical testing. Design, Setting, and Participants This is a post hoc analysis of the Scottish Computed Tomography of the Heart (SCOT-HEART) open-label randomized clinical trial, conducted in 12 cardiology chest pain clinics across Scotland for patients with suspected angina secondary to coronary heart disease. Between November 18, 2010, and September 24, 2014, 4146 patients aged 18 to 75 years with stable angina underwent clinical evaluation and 1417 of 1651 (86%) underwent exercise ECG prior to randomization. Statistical analysis was conducted from October 10 to November 5, 2019. Interventions Patients were randomized in a 1:1 ratio to receive standard care plus coronary computed tomography (CT) angiography or to receive standard care alone. The present analysis was limited to the 3283 patients who underwent exercise ECG alone or in combination with coronary CT angiography. Main Outcomes and Measures The primary clinical end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. Results Among the 3283 patients (1889 men; median age, 57.0 years [interquartile range, 50.0-64.0 years]), exercise ECG had a sensitivity of 39% and a specificity of 91% for detecting any obstructive coronary artery disease in those who underwent subsequent invasive angiography. Abnormal results of exercise ECG were associated with a 14.47-fold (95% CI, 10.00-20.41; P < .001) increase in coronary revascularization at 1 year and a 2.57-fold (95% CI, 1.38-4.63; P < .001) increase in mortality from coronary heart disease death at 5 years or in cases of nonfatal myocardial infarction at 5 years. Compared with exercise ECG alone, results of coronary CT angiography had a stronger association with 5-year coronary heart disease death or nonfatal myocardial infarction (hazard ratio, 10.63; 95% CI, 2.32-48.70; P = .002). The greatest numerical difference in outcome with CT angiography compared with exercise ECG alone was observed for those with inconclusive results of exercise ECG (5 of 285 [2%] vs 13 of 283 [5%]), although this was not statistically significant (log-rank P = .05). Conclusions and Relevance This study suggests that abnormal results of exercise ECG are associated with coronary revascularization and the future risk of adverse coronary events. However, coronary CT angiography more accurately detects coronary artery disease and is more strongly associated with future risk compared with exercise ECG. Trial Registration ClinicalTrials.gov Identifier: NCT01149590.
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Affiliation(s)
- Trisha Singh
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J. R. van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L. Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C. Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Todd C. Villines
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D. Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
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Moss AJ, Dweck MR, Doris MK, Andrews JPM, Bing R, Forsythe RO, Cartlidge TR, Pawade TA, Daghem M, Raftis JB, Williams MC, van Beek EJR, Forsyth L, Lewis SC, Lee RJ, Shah ASV, Mills NL, Newby DE, Adamson PD. Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque. JACC Cardiovasc Imaging 2020; 13:1549-1560. [PMID: 31422134 PMCID: PMC7342015 DOI: 10.1016/j.jcmg.2019.05.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The goal of this study was to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque. BACKGROUND High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy. METHODS In a randomized, double-blind, placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography/coronary computed tomography scanning and measurement of high-sensitivity cardiac troponin I. Patients were randomized (1:1) to receive ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake. RESULTS In total, 202 patients were randomized to treatment, and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (120 of 191), there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor vs. placebo: 1.11; 95% confidence interval: 0.90 to 1.36; p = 0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means: 0.86; 95% confidence interval: 0.63 to 1.17; p = 0.33). CONCLUSIONS Dual antiplatelet therapy with ticagrelor did not reduce plasma troponin concentrations in patients with high-risk coronary plaque, suggesting that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting. (Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND]; NCT02110303).
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Affiliation(s)
- Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jack P M Andrews
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy R Cartlidge
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tania A Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer B Raftis
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Steff C Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert J Lee
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
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